Notes:

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The Ten Rights of Medication Administration:

Includes the original five (patient, drug, dose, route, time), expanded to emphasize the critical thinking required by right documentation, right education, and patient’s right to refuse.

Independent double checks for high-alert drugs (insulin, opioids, anticoagulants, concentrated potassium chloride).

Critical point: Documentation must include the patient’s response, particularly within the hour for PRN medications.

Side Effects vs. Adverse Effects:

Side effects are predictable, like mild nausea or dry mouth.

Adverse effects are potentially harmful reactions.

Red Man Syndrome (vancomycin) vs. true allergy: Red Man Syndrome is not an allergy, but a histamine release due to rapid infusion. The solution is to slow the infusion over two hours, not stop the drug.

High-Risk Drug Interactions:

Warfarin and vitamin K-rich foods (like kale, spinach) neutralize the drug's effects.

Grapefruit juice can interfere with the metabolism of several medications, leading to toxicity.

Serotonin syndrome from combining SSRIs with MAOIs or Tramadol can lead to fever, confusion, and muscle rigidity.

Medication Math:

Key tip: Always use dimensional analysis and confirm that the units in the IV bag match the order.

Pediatric dosing error: forgetting to convert milligrams to micrograms can cause a 1,000-fold dosing error.

Subcutaneous Injections:

Insulin: Pinch the skin, inject at a 90° angle, and do not aspirate.

Enoxaparin (Lovenox): Inject into the abdomen 2 inches from the belly button, never massage (to prevent bruising/hematomas).

Heparin can be massaged (depending on hospital policy).

Intramuscular Injections (IM):

Ventrogluteal site is safest.

Deltoid: Only for small volumes (vaccines).

Vastus lateralis: Preferred in infants.

IV Push Medications:

Must know dilution requirements and the safe infusion rate to avoid critical errors.

Critical Medication Prototypes:

Insulin (NPH, rapid-acting): Hypoglycemia is most common in the first two hours after injection for rapid insulins.

Regular insulin is the only type that can be given IV in emergencies like DKA or hyperkalemia.

Digoxin: Toxicity risk is higher if potassium is low.

Pain Management:

Opioids cause sedation, respiratory depression, and constipation.

Naloxone (opioid reversal agent) must be administered slowly to avoid precipitating severe pain and withdrawal.

Meperidine (Demerol) is contraindicated in patients with kidney disease due to risk of seizures.

Central Venous Access Devices (CVADs):

Huber needle must be used for implanted ports to avoid damaging the port's septum.

Air embolism prevention requires Trendelenburg position and Valsalva maneuver.

Parenteral Therapies:

Hypertonic saline (3%) must be given via a central line to prevent vein damage.

Infiltration and extravasation require different management strategies; extravasation is an emergency.

TPN (Total Parenteral Nutrition) requires a central line and a micron filter to catch precipitates.

If TPN runs dry, D10W or D20W should be given at the same rate to prevent hypoglycemia.

Blood and Blood Products Administration:

Two-person verification of patient identity, blood type, and expiration date is required.

Platelets must be stored at room temperature with constant agitation to avoid clumping.

If a severe hemolytic reaction occurs, STOP the transfusion immediately and notify the physician.

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