HESI Final Study Guide: Fundamentals

Medication Calculations

(IM, mg and mL,

IV-gtt/min)

Review: All oral and

Injectable calculations;

conversion methods for

weights and temperatures

 I ntramuscular Injection (IM): Injection into a muscle

Intradermal (ID): Injection into the dermis just under the epidermis

Subcutaneous: Injection into tissue just below the dermis of the skin

Intravenous (IV): Injection into a vein

PRN: As needed. When administering medications, document the assessment findings

that show why the patient needs the medication and the time of administration.

Single-One Time Orders: Prescriber orders a medication to be given only once at a

specified time.

STAT Orders: Signifies that a single dose of medication is to be given immediately and

only once. STAT orders are written for emergencies when a patient’s condition changes

suddenly.

Now Orders: More specific than a one-time order and is used when a patient needs

medication quickly but not right away, as in a STAT order.

 Five rights 1. Right Medication

2. Right Dose

3. Right Patient

4. Right Route

5. Right Time

6. Right Documentation

Safe administration, side

effects

1. Check information on the patient’s MAR: use it to prepare and administer

medications.

2. When preparing the medications from bottles or containers, compare the label of

the medication container with the MAR three times.

3. Check the label with the MAR when taking medications out of the medication

dispensing system.

4. Verify all medications at the patient’s bedside with the patient’s MAR and use at

least two identifiers before giving the patient any medications.

5. Unit-dose system is designed to minimize errors.

6. Pharmacists split medications, label and package them.

7. Check patient ID band; wireless bar-code scanner to help identify the right

patient.

8. Check for allergies and ensure all patient reactions

Side Effects:

1. Predictable and often unavoidable secondary effects produced at a usual

therapeutic dose.

Adverse Effects:

1. Unintended, undesirable, and often unpredictable severe responses to

medication.

2. Immediate, whereas other take weeks or months to develop.

3. Early recognition is important

Toxic Effects:

1. Develop after prolonged intake of a medication or when a medication

accumulates in the blood because of impaired metabolism or excretion.

INFO ON: Syringe Sizes: It is unusual to use a syringe size larger than 5 mL for injection. Syringes

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often come prepackaged.

1. A 1-3 mL syringe is usually adequate for subcutaneous or IM injections.

2. A TB syringe has the 1 mL capacity

3. Insulin syringes have the capacity of 0.3 to 1 mL

19 gauge,1 ½ -inch length;

20 gauge, 1-inch length;

21 gauge, 1-inch length;

23 gauge, 1-inch length;

and 25 gauge,⅝ -inch length.

Ampules: Ampules contain single doses of medication in a liquid. Ampules are available

in several sizes, from 1 mL to 10 mL or more. An ampule is made of glass with a

constricted neck that must be snapped off to allow access to the medication. A colored

ring around the neck indicates where the ampule is pre-scored so you can break it easily.

Carefully aspirate the medication into a syringe *CLOSED SYSTEM*

Vial: a single-dose or multidose container with a rubber seal at the top. Vials contain

liquid or dry forms of medications. Medications that are unstable in solution are

packaged dry. The vial label specifies the solvent or diluent used to dissolve the

medication and the amount of diluent needed to prepare a desired medication

concentration. *CLOSED SYSTEM*

IM: *90 DEGREE* Intramuscular injections, syringes are up to 5 mL. The IM route

provides faster medication absorption than the subcutaneous route because of the

greater vascularity of the muscle. However, IM injections are associated with many risks.

Ventrogluteal and Vastus Lateralis are common sites for IM injections.

SQ: *45 TO 90 DEGREE* Subcutaneous injections involve placing medications into the

loose connective tissue under the dermis. Because subcutaneous tissue is not as richly

supplied with blood as the muscles, medication absorption is somewhat slower than with

IM injections. Deltoid is a common site for injection.

Eyedrops:

1. Avoid instilling any form of eye medications directly onto the cornea. The cornea

of the eye has many pain fibers and thus is very sensitive to anything applied to

it.

2. Avoid touching the eyelids or other eye structures with eyedroppers or ointment

tubes. The risk of transmitting infection from one eye to the other is high.

3. Use eye medication only for the patient's affected eye.

4. Never allow a patient to use another patient's eye medications

G-Tube:

1. Connect syringe with medication to nasogastric tube, G-tube, J-tube, or smallbore feeding tube. Do not use pigtail vent

Basic Skills Vital Signs:

1. Adult Normal Temp Range: 98.6 to 100.4 degrees F

2. Adult Normal Respirations: 12 to 20 Breaths/PM

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3. Adult Normal BP: 120/80

4. Adult Normal Pulse: 60 to 100 BPM

Pulse Ox: Measures the oxygen saturation of blood. Usually between 95% to 100%.

1. Outside light sources interfere with ability of oximeter to process reflected

light.

2. Carbon monoxide (caused by smoke inhalation or poisoning) artificially

elevates SpO2 by absorbing light similar to oxygen.

3. Patient motion interferes with ability of oximeter to process reflected light.

4. Jaundice interferes with ability of oximeter to process reflected light.

5. Intravascular dyes (methylene blue) absorb light similar to deoxyhemoglobin

and artificially lower saturation.

6. Nail polish, artificial nails, or metal studs in nails can interfere with light

absorption and the ability of the oximeter to process reflected light

7. Dark skin pigment sometimes results in signal loss or overestimation of

saturation.

Gloving (Sterile):

1. Hands remain clean. Sterile gown cuff touches sterile glove surface

2. With dominant hand inside gown cuff, pick up glove for nondominant hand by

grasping folded cuff.

3. Extend nondominant forearm with palm up and place palm of glove against palm

of nondominant hand. Glove fingers point toward elbow.

4. Grasp back of glove cuff with covered dominant hand and turn glove cuff over

end of nondominant hand and gown cuff.

5. Grasp top of glove and underlying gown sleeve with covered dominant hand.

Carefully extend fingers into glove, being sure that glove cuff covers gown cuff.

6. Glove dominant hand in same manner, reversing hands. Use gloved nondominant

hand to pull on glove. Keep hand inside sleeve.

* Standard Precautions

* Isolation Precautions (i.e.

MRSA, droplet)

* Infection control

> biohazard

* Gloving sterile

You will learn to follow certain principles and procedures, including standard

precautions, to prevent and control infection and its spread. Standard precautions apply

to contact with blood, body fluid, nonintact skin, and mucous membranes from all

patients. These precautions protect the patient and provide protection for the health

care worker.

Isolation Precautions:

1. Airborne Precautions: Private room, negative-pressure airflow of at least 6 to 12

exchanges per hour via high-efficiency particulate air (HEPA) filtration; mask or

respiratory protection device, N95 respirator (depending on condition)

2. Droplet Precautions: Private room or cohort patients; mask or respirator

required (depending on condition) (refer to agency policy)

3. Contact Precautions: Private room or cohort patients (see agency policy), gloves,

gowns

4. Protective Environment: Private room; positive airflow with 12 or more air

exchanges per hour; HEPA filtration for incoming air; mask to be worn by patient

when out of room during times of construction in area

Infection Control:

1. Bathing: use soap and water to remove drainage, dried secretions, or excess

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