Download Learning Outcomes Chapter Outline Lesson Plan

5. right time
CHAPTER 5
DRUG ORDERS
6. right reason
7. right to know
8. right to refuse
Learning Outcomes
5-1 Summarize the Rights of Medication
Administration.
5-2 Interpret a written drug order.
5-3 Identify on physicians’ orders and prescriptions the information needed to dispense
medication.
5-4 Locate on medication administration records
or electronic medication records the information needed to administer medication.
5-5 Recognize drug orders that do not contain
all the necessary information to carry out the
orders safely.
5-6 Select appropriate action for confusing, incomplete, or illegible drug orders.
Chapter Outline
5-1 The Rights of Medication Administration
5-2 Roman Numerals
9. right technique
10. right documentation
On the back of each card, have them write the procedure that ensures the step (or “right”) has been
accomplished correctly. Have one partner in each
pair shuffle her “ten rights” cards and place each
one—with the “right” side (not the procedure side)
up—to the left of the correct numbered card. This
student should then ask his partner to explain the
procedure for ensuring each “right.” After each
explanation, the student should check his partner’s
explanation. If the explanation is correct and
complete, the student should allow his partner to
remove her “right” card. His partner should study
the procedures for any “rights” cards that remain
on the desk. Finally, the two partners should
change roles and repeat the activity until each partner can correctly sequence and explain the procedures to accomplish each of the “ten rights.”
Teaching Strategies
• Assign and collect the homework for Chapter 5.
Check the student’s answers to discover the
topics within the chapter that require the most
focused attention during class time.
5-5 Medication Reference Materials
• Have a health care professional visit the class
and discuss their role in dosage calculations as
well as the importance of math accuracy and
preventing medication errors in the health care
profession.
Lesson Plan
• Have students review the key terms for Chapter 5 using the Audio glossary and Key Term
Concentration game on the student CD.
5-3 Physicians’ Orders and Prescriptions
5-4 Medication Administration Systems
Anticipatory Set
Introduce the rights of medication administration.
Differentiate between the basic five rights and the
additional rights. Distribute ten index cards to each
student. On each card, have students write one of
the “ten rights” as found on Table 5-1, page 140 in
the text/workbook and listed here. (1 to 5 are basic
6 to 10 are additional rights)
1. right patient
2. right drug
3. right dose
4. right route
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• Have students in groups of three; review their
basic math skills using the “Math Challenge”
game on the student CD.
• Encourage students to complete each review
and practice section in the text/workbook and
check their answers. You can also remove the
answers from the back of the book and use
the review and practice questions as a graded
assignment.
• Use the Critical Thinking on the Job Activities
from Chapter 5 as Think-Pair-Share assignments in class. Have student groups discuss their
answers and present to the rest of the class.
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• Use the PowerPoint® presentation for Chapter 5,
found on the student and instructor resource CDROM, for a class lecture and/or review. Use the
“Test Your Knowledge” questions for discussion.
• The online learning center at www.mhhe.com/
MathDosage3e contains additional activities for each chapter. Links for the Internet
activities from at the end of this chapter are
provided on this site. Have students navigate
to this site to complete the Internet activities.
• Play the Spin the Wheel on the student CD with
individual, small groups or within the classroom
in preparation for the final evaluation.
2. A blood thinner most likely should not be given
to a patient with a bleeding disorder. H. Right
reason
3. James F. Jones received James E. Jones medication. A. Right patient
4. The nurse charted a medication on the medication record before the patient had taken the
medication. G. Right documentation
5. When a patient asks why they are getting a
medication they should be told. I. Right to
know
6. The dose to be administered was 1/2 teaspoon
and the patient received 5mL. C. Right dose
Assess
• Use the Additional Exercises for Chapter 5
found at the end of this document for reinforcement of chapter concepts. These exercises
can also be used as chapter quizzes.
• Students should complete each student CD
activity when directed within the text. Have
students save, print, or email their completed
“Progress Report” from the student CD for
Chapter 5.
• The chapter review should be completed and
checked in preparation for the final chapter
evaluation.
• Using the EZTest test bank for Chapter 5, create a written test in two versions for a final
evaluation of student’s proficiency.
• Access the Instructor’s Manual documents in
electronic format and modify to match your
curriculum needs.
• Use the chapter images and labels to create
your own worksheets, tests, or PowerPoint®
presentations.
7. The medication was ordered at bedtime and
the patient took it at 9 A.M. E. Right time
8. The physician ordered Uracel and the patient
received uracil. B. Right drug
9. The medication was to be given under the
tongue and the patient was told to swallow it.
F. Right technique
Critical Thinking on the Job: Understanding
the Order of Roman Numerals: The numeral
with the smaller value comes immediately
before the one with the larger value. Instead
of adding i and x, the health care professional
should subtract i from x to calculate the correct
dose of 9 gr.
REVIEW AND PRACTICE:
5-2 Roman Numerals
1. 6
CHAPTER 5
2. 12
Solutions
3. 9
4. 14
REVIEW AND PRACTICE:
5. 24
5-1 The Rights of Medication
Administration
1. The medication bottle said for optic use and
the medication was instilled into the patient’s
ears. D. Right route
6. 18
7. 5 1/2
8. 9 1/2
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9. 11 1/2
2. 90. The section Quan tells the quantity to
dispense.
10. 25
3. Three times a day. The frequency tid is in the
section labeled Sig.
11. 19
1
12. 8__
2
4. 50 mg. This information appears after the drug
name.
13. 21
4 ⫹ 17 ⫽ 21
14. 26
12 ⫹ 14 ⫽ 26
15. 11
8 ⫹ 3 ⫽ 11
16. 10
5 ⫹ 5 ⫽ 10
17. 16
23 ⫺ 7 ⫽ 16
18. 7
16 ⫺ 9 ⫽ 7
19. 18
21 ⫺ 3 ⫽ 18
20. 25
30 ⫺ 5 ⫽ 25
Critical Thinking on the Job: The Importance
of the Right Dose: The pediatrician made the
initial error by not specifying the dose. This error
does not relieve the health care professional of her
responsibilities. They are/should have recognized
that one of the rights of medication administration—
the right dose—was missed in this order. They
should have called the physician to clarify the
desired dose.
5. 180 days or approximately 6 months. The
patient takes one tablet three times a day, or
3 tablets per day. The 90 tablets in the original prescription will last 30 days. Each refill
will last another 30 days. Five refills will
last 150 days. Thus, the original order and
the refills will last 180 days, approximately
6 months.
6. Prescription B does not include adequate
information to determine the dose. Amoxil
oral suspension comes in strengths of 50
mg/mL, 125 mg/mL, and 250 mg/mL. A
teaspoon of each yields a different dose.
The physician must specify the solution
strength.
7. 100 mL; however, the pharmacy technician still
needs to know the solution strength.
8. One teaspoon (1 tsp)
9. It cannot be refilled. Refills is marked 0.
10. Every 8 hours (q8h)
Critical Thinking on the Job: The Importance
of the Right Drug: The health care professional
should have read the label 3 times to be certain
that he had the correct drug. If the label was
shown to the physician, the error could have
been avoided.
REVIEW AND PRACTICE:
5-3 Physicians’ Orders
and Prescriptions
1. Prescription A includes all required elements.
The patient’s name is Ann Pechin, the drug is
Lopressor, the dose is 50 mg given in 1 tablet
(tab i), the route is oral (po), the frequency
is three times a day (tid), 90 tablets are to be
dispensed at one time, and the prescription
may be refilled five times. The card includes
the physician’s name, signature, and prescriber
number.
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11. Prescription C does not include the
following:
• Dose since Norvasc comes in 2.5, 5, and
10 mg tablets it is unknown which to use
• Complete first name of the patient
• Frequency of the dosing
• Form of the medication
12. 30; however, the pharmacy technician still
needs to know the strength of the tablets.
13. One; 1 po, but the frequency of dosing needs to
be clarified.
14. 2 refills are indicated.
15. Without knowing how frequently the patient
is to take the medication, it is not possible to
determine how long 30 tablets will last.
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16. Three times a day (TID) before meals (AC). If
no time is specified, AC medications are usually
given 30 minutes before meals.
17. Instilled into the left eye (OS)
5. The Maalox order includes the instruction
2 H PC and HS, which means 2 hours after
meals and at bedtime. The times 1000 – 1400 –
1900 would be 2 hours after this facility’s mealtimes of 0800, 1200, and 1700. The time 2200,
or 10:00 P.M., represents the patient’s bedtime.
18. Once a day (qd)
6. Each dose for this patient is 30 mL.
19. 0.4 mg
7. 45 units (45 U)/mL
20. Orally (po)
8. No times are indicated because the Dulcolax
is to be given prn, or only if the patient has a
need for it.
21. Twice a day (BID)
22. 0.25 mg
9. Normodyne, Atrovent, Buspar
23. Once a day (QD) at bedtime (HS)
10. C. Dulcolax and B. Humulin
24. Sublingually (SL)
25. Seven. Risperdal is administered once a day. The
patient would need seven pills for the week.
Critical Thinking on the Job: When in Doubt,
Check: By using her critical thinking skills, the
health care professional has prevented a serious error.
The Lasix order appears to be 600 mg. However, she
realizes that the second zero of 600 is actually the
loop of the q from the Digoxin order. The intended
dose of Lasix is 60 mg. If she had not checked the
physician’s orders, she might have given 10 times
more than the physician intended. When in doubt,
always verify the order written on the chart. In this
case if daily was used instead of qd, the error would
not have occurred.
11. C. The order indicates that the medication is
to be administered prn, but does not indicate
why the patient would need it or the dose
that should be given. B. The order does not
include the route the medication should be
administered.
12. Oral (po)
13. 2 puffs 4 times a day via a multi-dose inhaler
(MDI)
14. The Furosemide should be given as soon as
possible. Stat means immediately.
15. Viroptic should be instilled into both eyes. OU
means both eyes.
REVIEW AND PRACTICE:
16. Ancef should be administered by IVPB, or
intravenous piggyback.
5-4 Medication Administration
Systems
17. Dilantin, Ancef, Viroptic
1. The special instructions (hold for systolic
BP < 110) indicate that the Accupril is not to
be given if systolic blood pressure is below
110. You must first check the patient’s blood
pressure.
18. 3 doses of Adalat, Ancef, and Dilantin
6 doses of Viroptic
1 dose of Furosemide would be given on the
day of the order.
19. The patient will receive Viroptic 6 times a day.
2. 5 mg
20. Furosemide and Ancef
3. The time 0630 is listed. The patient should
receive her insulin at 6:30 A.M.
4. The route is Sub-Q, or subcutaneous injection.
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5. Take one teaspoonful by mouth every 8 hours
until gone
REVIEW AND PRACTICE:
5-5 Medication Reference Materials
Mark DeSantis
123 Baker Drive
Owosso, MI 48867
989-555-1234
1. B
2. C
Name
3. D
Jeannies Kucharek
Date
1/23/2012
Address
4. A
Rx:
CHAPTER 5
HOMEWORK
SOLUTIONS
Amoxil 250 mg/5ml
1 tsp. p.o. q8h until gone
SIG:
Refills:
MD1234567
Mark Desantis, MD
Referring to Prescription 1
1. Take 1 tablet three times a day by mouth
Prescription 2
2. oral
3. refills are not specified, so no refills can be given
6. The order is for ear drops, but the instructions
are for the drops to be used in the left eye. The
physician must be contacted to determine if
this order is for the ear or for the eye.
Mark DeSantis
123 Baker Drive
Owosso, MI 48867
989-555-1234
Name
Jeannies Kucharek
Date
Referring to Prescription 3
1/23/2012
Mark DeSantis
123 Baker Drive
Owosso, MI 48867
989-555-1234
Address
Rx:
Synthroid 0.1 mg
QUANTITY:
SIG:
#30
tab i po tid
Name
Jeannies Kucharek
1/23/2012
Address
Rx:
Cortisporin Otic Drops
QUANTITY:
MD1234567
Date
5 ml
gtts. ii os quid
SIG:
Refills:
0
Prescription 1
MD1234567
Mark Desantis, MD
Referring to Prescription 2
4. Before filling, you must know the quantity to
dispense. Contact the physician to learn this
quantity or to find the number of days the
patient is to be on the medication
Prescription 3
Referring to MAR1
7. subcutaneously
8. 4 times
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9. 5/23/12 – the first odd day after the order
10. 3
11. 12 midnight
16. three times a day (TID)
TCP Hospital Medication Administration Record
Order Medication, dose,
date duration frequency
Init. route
5/21/12 heparin 5,000 units
sub-q q12h
5/22/12 Procan SR 500 mg
tab-SR po q6h
D/C
date
init.
15. 8:00 P.M. is 2000. Trental and Rocephin are
administered at 2000.
Dates Administered
Times
22 Feb
23 Feb
24 Feb
25 Feb
26 Feb
27 Feb
28 Feb
0900
2100
05 Feb
12 0600 1200
5/22/12 digoxin [Lanoxin]
125 mg tab po
daily odd days
1800 2400
5/22/12 furosemide [Lasix]
40 mg tab po daily
0900
17. He should be served breakfast at 8:00 A.M.
Mr. Simons is scheduled to be given Propulsid
at 7:30 A.M. This medication should be given
30 minutes before breakfast. In addition, he is
scheduled to be given Trental at 8:00 A.M. Trental should be given with food.
0900
CHAPTER 5 REVIEW
Check Up
18. Order B for Tobramycin violates the Right
Time Rule. The order is for tobramycin every
8 hours, but the times given are every 6 hours.
Order C for Rocephin does not list a specified
route. Order D for Propulsid does not list a
specific frequency. The abbreviation AC means
before a meal. It cannot be assumed that this
means it should be given before every meal. A
frequency is still required.
19. OD, instilled into the right eye
1. Administer one 2-mg tablet of Dilaudid orally
when necessary for pain, as often as every four
hours.
20. 1.25 mg
21. 0800, 1400, and 2000 (8 a.m., 2 p.m., 8 p.m.)
2. Administer one 30-mg tablet of Codeine orally
four times a day.
3. Instill 2 drops in the right eye 4 times a day
(gtts ii od QID).
4. twice (Refills: 2)
22. A. Heparin and D. Proventil
23. 4 hours later, or 0600; The medication card
indicates that Benadryl should be administered
whenever necessary (PRN) every four hours
(q4h). If Margaret Bell has a dose at 0200, the
next dose will be at 0600.
5. instilled into the right eye (od)
24. q8h, every 8 hours
6. The label should include “for ophthalmic use.”
7. every 8 hours (q8h)
8. by inhalation, using a metered dose inhaler
(MDI)
26. B. Bleph-10 does not give the dose. (Do not
interpret the 10 in Bleph-10 as the dose.)
C. Premarin does not give the route.
9. 1000 (Q6H, 6 hours later)
10. 8 tablets. Each dose is 2 tablets. The patient
may have one dose every 6 hours, so she can
receive 4 doses per day.
11. 200 mg
12. twice a day (BID)
13. Intravenous (IV)
25. He would receive 3 doses per day, and they
would be spaced throughout the day. For
instance, at 0800, 1400, and 2000. (8 a.m.,
2 p.m., 8 p.m.)
27. Determine if the patients ate at lunchtime.
Determine if any medications have to be taken
on an empty stomach. Double-check your
calculations to ensure that they are correct
and that your answers make sense. Make sure
you use the appropriate measuring device to
administer medications. Finally, ensure that
there are no time considerations for administering these medications after a meal.
14. 10 mg
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28. Ask patients their names before administering
medication. Verify their names with patient
identification bracelets. Do not administer
drugs that are typically prescribed for the
elderly to children or vice versa.
Critical Thinking
The order includes the abbreviation stat, which
means immediately. You must carry out the order
as quickly as possible. However, the order does not
include all necessary information. Lasix is available
in several strengths, including 10-mg, 20-mg, and
40-mg tablets. Before carrying out this order, contact the prescribing physician and determine which
strength was intended. Have the physician rewrite
the order or countersign it after you have rewritten
it so that it lists the correct dose. Promptly obtain
a tablet of the correct strength and administer it to
the patient by mouth.
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Case Study
1. Tell Mr. Burke to take one Xanax tablet with
breakfast, lunch, and dinner. One tablet three
times a day with meals.
2. Give Mr. Burke 120 tablets at one time (Quan:
120). You may refill the prescription once
(Refills: 1).
Internet Activity
According to the article on cephalexin, the usual
adult dose of cephalexin is 1 to 4 g daily, in
divided doses. If the patient receives 500 mg q6h,
the patient will receive 500 mg every 6 hours or
4 times a day. Four doses of 500 mg is a total of
2000 mg, or 2 g per day. This amount is within
the acceptable range. You may want to check for
more information by using “cephalexin” as your
search word.
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