CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 20 Drug Administration

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

20Drug Administration


20-2

Learning Outcomes

20.1 Identify your responsibilities regarding drug administration.

20.2 Execute dosage calculations accurately.

20.3 Check the patient before administering any drug.

20.4 Identify the rights of drug administration.


20-3

Learning Outcomes (cont.)

20.5 Describe the various techniques of drug administration.

20.6 Differentiate different types of needles and syringes.

20.7 Demonstrate how to administer an intradermal, subcutaneous, or intramuscular injection.


20-4

Learning Outcomes (cont.)

20.8 Outline information needed to teach a patient about drug use, interactions, and adverse effects.

20.9 Describe special considerations related to drug administration.

20.10 Describe nonpharmacologic ways to manage pain.


20-5

Introduction

• Drug administration is very important and can be a dangerous duty

– Given correctly – restore patient to health

– Given incorrectly – patient’s condition can worsen

• Medical assistant must– Understand principles of

pharmacology– Understand fundamentals

of drug administration• Routes• Dosage calculations• Techniques for injection• Rights of medication

administration• Patient education

You should be familiar with the medications frequently prescribed in your practice.


20-6

Drug Administration and Scope of Practice

• States’ medical practice acts define medical assistants’ exact duties

• Know your scope of practice in the state where you will work


20-7

Dosage Calculations

• Measurement systems– Metric– Apothecaries– Household

• TJC recommends usingmetric units


20-8

Dosage Calculations (cont.)

• Basic units of volume and weight for: • Metric system

– Liter (L) – volume – Grams (g) – weight

• Apothecaries’ system– Fluid ounces, fluid drams, pints, quarts –

volume– Pounds – weight

• Household system – Drops, teaspoons,

tablespoons, ounces, cups, pints, gallons, quarts – volume


20-9

Dosage Calculations (cont.)

• Conversions between systems– Approximate equivalents

– Charts

– Calculations • Ratio method• Fraction method


20-10

Formula Method

Desired doseDose on hand

The physician orders aspirin, 10 grains

On hand are 5-grain aspirins

10 grains 5 grains

× Quantity of dose on hand

× 1 tablet = 10/5 or 2 tablets


20-11

Formula Method (cont.)

Work these problems:1. The physician has ordered ampicillin 500

mg, on hand 250 mg capsules. How much would you give?

2. You have 50 mg metoprolol as a scored tablet on hand and the doctor tells you to give 25 mg. How much would you give?

2 capsules

½ tablet


20-12

Ratio Method

1. Doctor orders 500 mg of ampicillin. You have 250 mg capsules on hand.

2. Set up a ratio with the unknown number of capsules needed and the amount of drug ordered X:500 mg

3. Set up a ratio with a single capsule and the amount of drug in a single capsule 1 tab:250 mg

4. Create a proportion, multiply the outer and then the inner parts, and solve for X.

X:500 mg :: 1cap:250 mgAnswer = 2 capsules


20-13

3. Set the second fraction with the amount of drug in a capsule

10 mg 1 cap

4. Then use both fractions in a proportion:30 mg 10 mg

x = 1 cap

1. The doctor orders 30 mg of Adalat. Each capsule contains 10 mg.

2. Set up the first fraction with the dose ordered and the unknown number of capsules

30 mgx

Solve for X = 3 capsules

Fraction Method


20-14

Pediatric and Geriatric Considerations

• Metabolism and absorption altered

• Require precise calculations– BSA – body surface area– Weight


20-15

Apply Your Knowledge

1. Which measuring system is used by most physicians?

ANSWER: Most doctors use the metric system when working with pharmacology principles.

2. Convert 25 grams to milligrams.

ANSWER:1. Add a decimal point to the measurement: 25. g2. Add 3 zeros so you can move the decimal point three places

to the right: 25.000 g3. Move the decimal point to the right three places: 25,0004. Change the unit: 25,000 mg


20-16


3. Calculate the dose to give for 500 mg Augmentin®. ANSWER:

20 mL


20-17

Preparing to Administer a Drug• Drugs

– Local effect – applied directly to skin, tissue, or mucous membranes

– Systemic effect – given by routes that allow the drug to be absorbed or distributed into the bloodstream

• Pay close attention– Dose– Route – Form of medication

• Medical assistant– Close attention to

detail– Strong patient

assessment skills– Expert technique


20-18

Preparing to Administer a Drug (cont.)

• Assessment – Injection site

– Drug allergies

– Patient condition – be alert to changes that can affect drug therapy

– Consent forms


20-19

Rules for Drug Administration• Give only drugs the doctor orders – use

drug reference, if necessary

• Wash your hands– Prepare in a well-lit area– Focus on task; avoid distractions

• Calculate the dose carefully

• Do not leave a prepared drug unattended – never give a drug that someone else has prepared


20-20

Rules for Drug Administration (cont.)

• Identify patient properly

• Physician should be in the office

• Observe patient following administration

• Discard any ungiven medications properly

• Report error to physician immediately

• Document properly


20-21

Rights of Drug Administration

• Basic rights– Right patient

– Right drug

– Right dose

– Right time

– Right route

• Additional rights– Right technique

– Right documentation

– Right to know

– Right to refuse

– Right reason


20-22


How do you properly identify the patient before administering a drug?

ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth.


20-23

Techniques for Administering Drugs

• Oral– Tablets, capsules, lozenges, and

liquids– Slower absorption through GI tract

• Buccal or sublingual – Buccal – placed between the cheek and gum– Sublingual – placed under the tongue – Faster absorption; bypasses GI tract


20-24

Techniques for Administering Drugs (cont.)

• Parenteral – Administration of substance into a muscle or

vein

– Fast absorption; bypasses GI tract

– Safety risks• Rapid administration• Rapid action• Exposure to blood-borne

pathogens


20-25


• Needles– Available in different gauges – the smaller the

number, the larger the gauge (inside diameter)– Length – long enough to penetrate the appropriate

layers of tissue

• Syringes– Barrel– Plunger– With or without needle– Calibrated in milliliters or units


20-26


• Parenteral drug packaging– Ampule – glass or plastic container that is

sealed and sterile (open with care)

– Cartridge – small barrel prefilled with sterile drug

– Vial – small bottle with rubber diaphragm that can be punctured by needle


20-27


• Methods of injection– Intradermal (ID)

• Into upper layer of skin• Used for skin tests

– Subcutaneous (sub-q)• Provides slow, sustained

release and longer duration of action

• Rotate sites

– Intramuscular (IM)• More rapid absorption• Less irritation of tissue• Larger amount of drug• Z-track method

– Intravenous (IV)• Not usually given by

medical assistants


20-28


• Inhalation – administered through the mouth or nose

• Topical – Direct application of a drug on the skin

– Transdermal – use of a medication patch that will release medication slowly and evenly

• Urethral – instill liquid drugs directly into the bladder

• Vaginal and rectal

• Eye or ear – creams, ointments, drops, or irrigations


20-29


Matching:

___ Absorption through GI tract A. Topical drug

___ Under the tongue B. Oral drug

___ Small bottle with rubber diaphragm C. Intramuscular drug

___ Less irritation of tissue D. Subcutaneous drug

___ Direct application to skin E. Sublingual drug

___ Need to rotate sites F. Vial

ANSWER:

F

E

D

C

B

A


20-30

Educating the Patient about Drug Administration

• How to read the prescription drug label

• Interactions– Drug-drug interactions– Drug-food interactions


20-31

Educating the Patient about Drug Administration (cont.)

• Adverse effects– Report changes – Recognize significant

adverse effects

• Instructions on taking the drug – At the right time– In the right amount– Under the right

circumstances


20-32


What should you instruct the patient about regarding drug administration?

ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly.

Bravo!


20-33

Special Considerations

• Pediatric patients – Physiology and immature body systems may

make the drug effects less predictable– Require dosage adjustments and careful

measurements of doses– Observe pediatric patients closely for adverse

effects and interactions– Administration sites and techniques may differ


20-34

Special Considerations (cont.)

• Pregnant patients – Remember that you are caring

for two patients

– Giving the mother a drug also gives it to the baby

– Check drug information sources for pregnancy drug risk categories


20-35


• Patients who are breast-feeding– Some drugs are excreted in

breast milk

– Ingestion can be dangerous because baby can’t metabolize or excrete drugs

– Check drug information sources for contraindication during lactation


20-36


• Elderly patients– Age-related changes

affect • Absorption• Metabolism• Distribution• Excretion

– May have increased risk of

• Drug toxicity• Adverse effects • Lack of therapeutic effects


20-37


• Patients from different cultures– Can affect a patient’s understanding of drug

therapy and compliance with it

– Obtain drug information sheets in the languages that are commonly spoken by patients in your office


20-38


What do children and the elderly have in common in relation to drug administration?

ANSWER: Both have alterations in metabolism and absorption of drugs requiring adjustments in dosages.

Fantastic!


20-39

Charting Medications

• Progress notes– Administration – Special problems

• New symptoms• Patient’s statements• Patient tolerance

• Be sure to have the right chart

• Be specific and accurate


20-40

Nonpharmacologic Pain Management

• Biofeedback – evokes relaxation; helps block pain perception

• Guided imagery – patient envisions being in a calm, nurturing place; promotes relaxation

• Relaxation exercises – breathing techniques


20-41


1. You administer a medication to Mr. Max. What and where should you chart?

ANSWER: You should chart in the progress notes the date, time, dosage, route, and name of the medication, as well as how well the patient tolerated it.

2. True or false:

___ Biofeedback involves special breathing techniques.

___ Audiotapes can be used with guided imagery.

___ Relaxation exercises are used to relax different muscle groups.

F

T

T

helps block pain perceptionANSWER:

I

M

P

R

E

S

S

I

V

E

!


20-42

In Summary

20.1As a medical assistant, you must be able administer or assist with administering medications by various routes, perform drug dosage calculations accurately, and provide patient education as necessary.

20.2Dosage calculations must be done accurately using the formula, ratio, or fraction method. If you are unsure of your calculation results, you should double-check yourself, check with a coworker, or ask the physician.


20-43

In Summary (cont.)

20.3Before administering a medication, assess the patient for allergies; evaluate any drug-drug interactions; and check all injection sites for abnormalities. Additionally, you should be aware of the patient’s condition and have the patient sign a consent form if necessary.

20.4The rights of drug administration include the right patient, right drug, right dose, right time, right route, right technique, right documentation, right to know, and right to refuse.


20-44

In Summary (cont.)

20.5You may be asked to assist or administer medications by any of the following routes: oral, buccal, sublingual, intradermal, intramuscular, intravenous, inhalation, eye, ear, rectal, subcutaneous, sublingual, topical, transdermal, urethral, and vaginal. Your responsibilities will vary based upon the facility where you practice. You should be familiar with the routes and medications used at your facility.

20.6Needles vary in length from ½ to 3 inches. They vary in gauge (diameter) from 18 to 26; the smaller the number, the larger the diameter of the needle.


20-45

In Summary (cont.)

20.7 The three most common injection routes are intradermal, subcutaneous, and intramuscular. All injections are given using aseptic technique.

Intradermal (ID) injections are administered between the upper layers of skin and create a wheal.

Subcutaneous (sub-Q) injections are administered just under the skin.

Intramuscular (IM) injections are administered into a muscle.


20-46

In Summary (cont.)

20.8 Patients should be aware of possible interactions and taught to report all medications including OTC, supplements, and herbal remedies. They should know how to read the prescription label and in some cases the package insert. Patients should be aware of the possible adverse effects of medications and what and when to report them to the health-care facility.


20-47

In Summary (cont.)

20.9Pediatric and geriatric patients require extreme care when calculating doses due to the differences in how their bodies absorb, metabolize, eliminate, and distribute the medications. Treat pediatric patients with special care and communication to make the experience as positive as possible. Restraining may be necessary.

Checking medications given to pregnant and breastfeeding patients for possible adverse effects is essential. Being considerate to patient’s cultural differences is also part of a medical assistant’s role.


20-48

In Summary (cont.)

20.10 To avoid the overuse or abuse of pain medications, other types of pain therapy have gained popularity. Some examples include biofeedback, guided imagery, and relaxation exercises.


20-49

End of Chapter 20

Words are the most powerful drug used by mankind.

~Rudyard Kipling

Documents

CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 20 Drug Administration