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Chapter 36
Calculation of Medication Dosage
and Medication Administration
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Legal and Ethical Implications of
Medication Administration
• Laws vary from state to state
• Thorough knowledge of medications
administered to patient
• Ethical considerations
– Using drugs for personal benefit
– Proper authorization
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Legal and Ethical Implications of
Medication Administration
• The medication order
– Given by provider
• The prescription
– Written legal document that gives directions for
compounding, dispensing, and administering
medication to patient
– Eight parts
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Legal and Ethical Implications of
Medication Administration
• The prescription
– Two types of medicines
• Prescription
• Over-the-counter (OTC)
– Prescriptions for controlled substances
– Approved prescription abbreviations and symbols
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Calculation of Drug Dosages
• Understanding ratio
– Ratio expressed as a quotient
– Ratio expressed as a fraction
– Ratio expressed as a decimal
• Understanding proportion
– Means and extremes
– Solving for X
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Calculation of Drug Dosages
• Weights and measures
– Metric system guidelines
– The seven common metric prefixes
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MicroMilliCentiDeciDekaHectoKilo-
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Calculation of Drug Dosages
• Weights and measures
– Fundamental units
– Household measurements
– Metric system conversion
• Proportional method for converting metric equivalents
• Moving the decimal in the correct direction
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medications Measured in Units
• How to calculate unit dosages
– Proportional method
– Formula method
• Insulin
– Individualized needs and treatment
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medications Measured in Units
• Types of diabetes
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Type I insulin-dependent diabetes mellitus
Type II noninsulin-dependent diabetes mellitus
Type III gestational diabetes
Type IV other types of diabetes
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medications Measured in Units
• Importance of exact dosage
• Precautions to observe when administering
insulin
• Expressing the weight of medication
• Expressing the volume of medication
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Calculating Adult Dosages
• The proportional method
• The formula method
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Calculating Children’s Dosages
• Young’s, Clark’s, and Fried’s rules replaced
by more exact methods
• By body surface area (BSA)
– Nomogram
– Used for infants and children up to 12 years of age
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Calculating Children’s Dosages
• By kilogram of body weight
– Mathematical process
– Proportional method
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of Medications
• The “Six Rights” of proper drug
administration
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of Medications
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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of Medications
• Medication errors
– When a medication error occurs
– Standard procedure for reporting errors
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of Medications
• Patient assessment
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Age
Physical condition
Body size
Gender
• Muscular build
• Skin texture
• Injection sites to avoid
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of Oral Medications
• Equipment and supplies for oral medications
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of
Parenteral Medications
• Parenteral routes
– Subcutaneous
– Intramuscular
– Intradermal
• Multiple dose form
• Unit dose forms
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of
Parenteral Medications
• Hazards associated with parenteral
medications
• Reasons for parenteral route selection
– Rapid response time to medication
– Accuracy of dosage
– Need to concentrate medication in specific body part or
area
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of
Parenteral Medications
• Reasons for parenteral route selection
– Inability to administer orally because medication is
destroyed by gastric juices or patient is incapable of
taking medication orally
– Liquid or powder form
– Expressed in terms of volume
– Ordered in terms of weight and volume
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Parenteral Equipment and Supplies
• Syringes
– Disposable syringes
– Non-disposable syringes
– Combination disposable and non-disposable cartridgeinjection syringes
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Parenteral Equipment and Supplies
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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Parts of a Syringe
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Parts of a Needle
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Parenteral Equipment and Supplies
• Safe disposal of needles and syringes
– Sharps containers
– Needlesticks
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Parenteral Equipment and Supplies
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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Principles of Intravenous Therapy
• Patient needs and
conditions
• Patient safety
• Types of solutions
• Legal aspects
Basic IV
Administration
Set >>
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Site Selection for Injections
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Injection Angles
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Site Selection and Injection Angle
• Marking the correct site for intramuscular
injection
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Dorsogluteal site
Ventrogluteal site
Deltoid muscle
Vastus lateralis site
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Basic Guidelines for
Administration of Injections
• Withdrawing medication
– Withdrawing medication from a vial
– Withdrawing medication from an ampule
• Reconstituting a powder medication
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Basic Guidelines for
Administration of Injections
• Administering subcutaneous, intramuscular,
and intradermal injections
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Basic Guidelines for
Administration of Injections
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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Z-track Method of
Intramuscular Injection
• Given to avoid irritation to subcutaneous
tissues
– Imferon is an example of a medication given by this
route
• Pull skin to side before inserting needle
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Z-track Method of
Intramuscular Injection
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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of Allergenic Extracts
• MAs may administer allergenic extracts
– Always follow guidelines
– Have emergency supplies on hand
• Allergic reactions
– Observe the patient for 20-30 minutes after
administration
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of
Inhaled Medications
• Inhalation therapy
– Inhaler may be used to administer medication to the
lungs
• Implications for patient care
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Administration of
Inhaled Medications
• Administration of
oxygen
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Hypoxemia
Oxygen tanks
Dosage
Methods of oxygen delivery
• Oxygen safety
precautions
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.