Download Drug Administration

CHAPTER
20
Drug Administration
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-7
Dosage Calculations
• Measurement systems
– Metric
– Apothecaries
– Household
• TJC recommends using
metric units
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20-8
Dosage Calculations (cont.)
• Basic units of volume and weight for:
• Household system
• Metric system
– Liter (L) – volume
– Grams (g) – weight
– Drops, teaspoons,
tablespoons, ounces,
cups, pints, gallons,
quarts – volume
• Apothecaries’ system
– Fluid ounces, fluid drams, pints, quarts –
volume
– Pounds – weight
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-9
Dosage Calculations (cont.)
• Conversions between systems
– Approximate equivalents
– Charts
– Calculations
• Ratio method
• Fraction method
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-10
Formula Method
Desired dose × Quantity of dose on hand
Dose on hand
The physician orders aspirin, 10 grains
On hand are 5-grain aspirins
10 grains × 1 tablet = 10/5 or 2 tablets
5 grains
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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 capsules
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?
½ tablet
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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 mg
Answer = 2 capsules
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-13
Fraction Method
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 mg
x
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
Solve for X = 3 capsules
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-14
Pediatric and Geriatric Considerations
• Metabolism and absorption altered
• Require precise calculations
– BSA – body surface area
– Weight
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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. g
2. Add 3 zeros so you can move the decimal point three places
to the right: 25.000 g
3. Move the decimal point to the right three places: 25,000
4. Change the unit: 25,000 mg
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-16
Apply Your Knowledge
3. Calculate the dose to give for 500 mg
Augmentin®.
ANSWER:
20 mL
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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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-22
Apply Your Knowledge
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
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20-25
Techniques for Administering Drugs (cont.)
• 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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-26
Techniques for Administering Drugs (cont.)
• 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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-27
Techniques for Administering Drugs (cont.)
• 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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-28
Techniques for Administering Drugs (cont.)
• 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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-29
Apply Your Knowledge
Matching:
ANSWER:
B Absorption through GI tract
___
A. Topical drug
___
E Under the tongue
B. Oral drug
___
F Small bottle with rubber diaphragm
C. Intramuscular drug
___
C Less irritation of tissue
D. Subcutaneous drug
___
A Direct application to skin
E. Sublingual drug
D Need to rotate sites
___
F. Vial
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-30
Educating the Patient about Drug
Administration
• How to read the prescription drug label
• Interactions
– Drug-drug interactions
– Drug-food interactions
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-32
Apply Your Knowledge
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-35
Special Considerations (cont.)
• Patients who are breastfeeding
– 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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-36
Special Considerations (cont.)
• Elderly patients
– Age-related changes
affect
• Absorption
• Metabolism
• Distribution
• Excretion
– May have increased risk
of
• Drug toxicity
• Adverse effects
• Lack of therapeutic effects
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-37
Special Considerations (cont.)
• 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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-38
Apply Your Knowledge
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-41
Apply Your Knowledge
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.
I
M
P
R
E
2.
True or false:
ANSWER:
S
helps block pain perception
F Biofeedback involves special breathing techniques.
___
S
T Audiotapes can be used with guided imagery.
___
I
T Relaxation exercises are used to relax different muscle
___
groups.
V
E
!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-42
In Summary
20.1 As 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.
20.2 Dosage 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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-43
In Summary (cont.)
20.3 Before 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.
20.4 The 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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-44
In Summary (cont.)
20.5 You 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.
20.6 Needles 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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-47
In Summary (cont.)
20.9 Pediatric 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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
20-49
End of Chapter 20
Words are the most
powerful drug used by
mankind.
~Rudyard Kipling
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.