CHAPTER 51 Drug Administration © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-2 Learning Outcomes 51.1 Identify your responsibilities regarding drug administration 51.2 Execute dosage calculations accurately 51.3 Check the patient before administering any drug 51.4 Identify the rights of drug administration © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-3 Learning Outcomes (cont.) 51.5 Describe the various techniques of drug administration 51.6 Differentiate different types of needles and syringes 51.7 Demonstrate how to administer an intradermal, subcutaneous, or intramuscular injection © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-4 Learning Outcomes (cont.) 51.8 Outline information needed to teach a patient about drug use, interactions, and adverse effects 51.9 Describe special considerations related to drug administration 51.10 Describe nonpharmacologic ways to manage pain © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-5 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-6 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-7 Dosage Calculations • Measurement systems – Metric – Apothecaries – Household • TJC recommends using metric units © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-8 Dosage Calculations (cont.) • Basic units of volume and weight for: • Metric system • Household system – Liter (L) – volume – Drops, teaspoons, tablespoons, ounces, – Grams (g) – weight cups, pints, gallons, quarts – volume • Apothecaries’ system – Fluid ounces, fluid drams, pints, quarts – volume – Pounds – weight © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-9 Dosage Calculations (cont.) • Conversions between systems – Approximate equivalents – Charts – Calculations • Ratio method • Fraction method © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-10 Formula Method Desired dose Dose on hand × Quantity of dose on hand The physician orders aspirin, 10 grains On hand are 5-grain aspirins 10 grains grains × tablet = 10/5 or tablets © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-35 Special Considerations (cont.) • 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-36 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-37 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-38 Apply Your Knowledge What 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-39 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-40 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-41 Apply Your Knowledge 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 True or false: ANSWER: helps block pain perception S 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-42 In Summary 51.1 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 51.2 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-43 In Summary (cont.) 51.3 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 51.4 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-44 In Summary (cont.) 51.5 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 51.6 Needles vary in length from ½ to inches They vary in gauge (diameter) from 18 to 26; the smaller the number, the larger the diameter of the needle © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-45 In Summary (cont.) 51.7 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-46 In Summary (cont.) 51.8 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-47 In Summary (cont.) 51.9 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-48 In Summary (cont.) 51.10 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51-49 End of Chapter 51 Words are the most powerful drug used by mankind ~Rudyard Kipling © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed [...]... diameter) – Length – long enough to penetrate the appropriate layers of tissue • Syringes – – – – Barrel Plunger With or without needle Calibrated in milliliters or units © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 26 Techniques for Administering Drugs (cont.) • Parenteral drug packaging – Ampule – glass or plastic container that is sealed and sterile (open with care) – Cartridge –. .. name and date of birth on the patient record and ask the patient to state his/her name and date of birth © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 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 –. .. Pay close attention – Dose – Route – Form of medication • Medical assistant – Close attention to detail – Strong patient assessment skills – Expert technique © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 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 ©... McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 22 Apply Your Knowledge How do you properly identify... prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly Bravo! © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 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... small barrel prefilled with sterile drug – Vial – small bottle with rubber diaphragm that can be punctured by needle © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 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... 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 13... ed 51- 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 25 Techniques for Administering Drugs (cont.) • Needles – Available in different gauges – the... 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 28 Techniques for Administering Drugs (cont.) • Inhalation – administered through the mouth or nose • Topical – Direct application of a drug on the skin – Transdermal... -Hill Com panie s, Inc A ll rights reserv ed 51- 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 51- 32 Apply Your Knowledge What should you instruct