Download Chapter 36

Chapter 36
Calculation of Medication Dosage
and Medication Administration
© 2014 Cengage©Learning.
2014 Cengage
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Legal and Ethical Implications of
Medication Administration
• Laws vary from state to state
• Knowledgeable about drugs
administered and effects drug(s) may or
will have
• Ethical considerations
– Using drugs for personal benefit (illegal)
– Proper authorization
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Legal and Ethical Implications of
Medication Administration
• The medication order
– Given by provider
• The prescription
– Written legal document that gives directions for
compounding, dispensing, administering
medication to patient
– Nine parts
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Legal and Ethical Implications of
Medication Administration
• The prescription
– Purpose: control sale and use of drugs
– Two types of medicines
• Prescription (legend)
• Over-the-counter (OTC)
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Legal and Ethical Implications of
Medication Administration
• The prescription
– E-prescribing: electronically accessing patient’s
medical history, prescribing medication, selecting
pharmacy
– HIPAA e-prescribing standards
– Prescriptions for controlled substances
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Legal and Ethical Implications of
Medication Administration
• The prescription
– Prescription abbreviations and symbols
– Medical shorthand is international language
– The Joint Commission’s “Do Not Use” list
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Drug Dosage
• Amount of medicine prescribed
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Age
Weight
Sex
Other factors
Pediatric considerations
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medication Label
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Trade or brand name for medication
Generic name
National Drug Code (NDC) numbers
Dosage strength
Usual dosage; frequency of administration
Route of administration
Precautions and warnings
Expiration date
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculation of Drug Dosages
• Incorrectly calculated or measured
dosages leading cause of error in
administration of medications
• Drug error violation of a patient’s rights
• E-prescribing reduces number of errors
• Bar codes results in far fewer errors
• Simplify look-alike labels and packaging
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculation of Drug Dosages
• Understanding ratio
– Ratio expressed as a quotient
– Ratio expressed as a fraction
– Ratio expressed as a decimal
• Understanding proportion
– Expresses relationship between two ratios
– Means and extremes
– Solving for X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculation of Drug Dosages
• Weights and measures
– Metric system guidelines
– The seven common metric prefixes
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MicroMilliCentiDeciDekaHectoKilo-
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculation of Drug Dosages
• Weights and measures
– Fundamental units of metric system
– Household measurements
– Metric system conversion
• Moving the decimal in correct direction
• Proportional method for converting metric equivalents
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medications Measured in Units
• How to calculate unit dosages
– Proportional method
– Formula method
• Insulin
– Hormone secreted by pancreas
– Necessary for proper metabolism of blood glucose
and maintenance of blood sugar level
– Individualized needs and treatment
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medications Measured in Units
• Diabetes
– Type 1: insulin-dependent diabetes mellitus
(IDDM)
– Type 2: noninsulin-dependent diabetes mellitus
(NIDDM)
– Type 3: gestational diabetes
– Type 4: other types of diabetes
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medications Measured in Units
• Diabetes
– Importance of exact dosage of insulin
– Precautions to observe when administering insulin
– Oral hypoglycemic medication
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculating Adult Dosages
• Weight
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Milliequivalent (mEq)
Microgram (mcg)
Milligram (mg)
Gram (Gm, g)
Unit
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculating Adult Dosages
• Volume
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Milliliter (mL)
Minim (m)
Dram (dr)
Ounce (oz)
Variety of household measures
• Proportional method
• Formula method
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Calculating Children’s Dosages
• Young’s, Clark’s, Fried’s rules
replaced by more exact methods
• Kilogram of body weight
• BSA
– Most accurate method of calculating medication
dosages for infants and children up to 12 years of
age
– Nomogram estimates BSA according to
height/weight
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Medications
• Follow basic guidelines
• “Six rights” of proper drug
administration
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Right drug
Right dose
Right route
Right time
Right patient
Right documentation
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Medications
• Please refer to the video library on the
Instructor Resources CD to view video
“Medication Errors, Documentation and
Administration.”
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Medications
• Medication errors
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Recognize error has been made
Stay calm
Report error immediately to provider
Follow provider’s order for correcting error
Document error
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Medications
• Patient assessment
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Age
Physical conditions
Body size
Sex
• Build
• Skin texture
– Injection site
• Sites to be avoided
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Oral Medications
• Equipment and supplies for oral
medications
– Medicine cup, water cup, medicine dropper
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of
Parenteral Medications
• Parenteral routes
– Subcutaneous
– Intramuscular
– Intradermal
• Unit dose forms
– Ampule
– Cartridge-needle unit
– Vial
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of
Parenteral Medications
• Hazards associated with parenteral
medications
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Sterile technique must be used
Allergic reaction swift
Injury to bone, nerve, blood vessel
Breaking of needle in tissue (rare)
Injecting into blood vessel instead of tissue
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of
Parenteral Medications
• Reasons for parenteral route selection
– Inability to administer orally; medication destroyed
by gastric juices or patient incapable of taking
medication orally
– Liquid or powder form
– Expressed in terms of volume
– Ordered by weight and volume
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Parenteral Equipment and Supplies
• Syringes
– Disposable
– Non-disposable
– Combination disposable/nondisposable cartridgeinjection
– Classified according to intended use
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Parenteral Equipment and Supplies
• Please refer to the video library on the
Instructor Resources CD to view video
“Cartridge Injection System.”
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Parenteral Equipment and Supplies
• Parts of a syringe
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Barrel
Plunger
Flange
Tip
Safety shield
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Parenteral Equipment and Supplies
• Parts of a needle
– Disposable and
nondisposable
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Point
Bevel
Lumen
Shaft
Hub
Hilt
Sheath
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Parenteral Equipment and Supplies
• Safe disposal of needles and syringes
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Rigid, puncture-proof container
Never recap needle after giving injection
Engage safety feature
Most needlesticks occur while recapping
Sharps collector systems
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Parenteral Equipment and Supplies
• Please refer to the video library on the
Instructor Resources CD to view video
“Needle Sticks & Safety.”
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Principles of Intravenous Therapy
• Patient needs,
conditions, diseases
• Patient safety
• Complications
• Types of solutions
• Legal considerations
Basic IV Administration Set
>>
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Site Selection and Injection Angle
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Site Selection and Injection Angle
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Basic Guidelines for
Administration of Injections
• Please refer to the video “Injections”
through the instructor companion site.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Z-Track Method of
Intramuscular Injection
• Similar to intramuscular injection,
except skin pulled to side before needle
insertion
• Given to avoid irritation to subcutaneous
tissues
– Imferon example of medication given by this route
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Z-Track Method of
Intramuscular Injection
• Please refer to the video library on the
Instructor Resources CD to view video
“Z Track Method.”
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Allergenic Extracts
• MAs may administer allergenic extracts
– Always follow guidelines
– Have emergency equipment and supplies
available
– Allergic reactions: observe patient for 20-30
minutes after administration
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Inhaled Medications
• Inhalation therapy
– Administration of medicines; water vapor; gases
as oxygen, carbon dioxide, helium
– Inhaler may be used to deliver medication to lungs
• Implications for patient care
– Instructed to follow prescribed medication regimen
– Contraindications
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Administration of Inhaled Medications
• Administration of
oxygen
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Hypoxemia
Oxygen tanks
Dosage
Methods of oxygen
delivery
– Oxygen safety
precautions
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medication Calculation Practice
• Ordered: 250mg tablet
• On hand: 500mg tablets
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medication Calculation Practice
• Ordered: 4mg to be given IM
• On hand: Injectable medication is
available in 2mg per mL
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medication Calculation Practice
• Ordered: 800mg tablet
• On hand: 200mg tablets
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medication Calculation Practice
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Ordered: 40mg/kg/day
On hand: 400mg/5mL
Child weight: 22lbs
Now try with the following:
– Ordered: 40mg/kg/day BID
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Medication Calculation Practice
• Ordered: 100mg/kg/day
• On hand: 200mg/5mL
• Child weight: 10kg
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.