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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Drug AdministrationDrug AdministrationPowerPoint® presentation to accompany:
Medical AssistingThird Edition
Booth, Whicker, Wyman, Pugh, Thompson
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-2
Learning Outcomes
51.1 Discuss your responsibilities regarding drug administration.
51.2 Perform dosage calculations accurately.
51.3 Describe how to assess the patient before administering any drug.
51.4 Identify the seven rights of drug administration.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-3
Learning Outcomes (cont.)
51.5 Describe the various techniques of drug administration.
51.6 Compare different types of needles and syringes.
51.7 Explain how to administer an intradermal, subcutaneous, or intramuscular injection.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-4
Learning Outcomes (cont.)
51.8 Explain what information you need to teach the 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.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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 Seven rights Patient education
You should be familiar with the medications frequently prescribed in your practice.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-7
Dosage Calculations Measurement systems
Metric Apothecaries Household
Most doctors use the metric system
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-8
Dosage Calculations (cont.)
Basic units of volume and weight Metric system
Liter (L) – volume Grams (g) – weight
Apothecaries’ system Fluidounces, fluidram, pints, quarts – volume Pounds – weight
Household system Drops, teaspoons,
tablespoons, ounces, cups, pints, gallons, quarts – volume
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-9
Dosage Calculations (cont.)
Conversions between systems Approximate equivalents
Charts
Calculations Ratio method Fraction method
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51-10
Dosage Calculations: Formula Method
Desired doseDose on hand
The physician orders aspirin, 10 grains
On hand are 5-grain aspirins
10 grains 5 grains
× Quantity of dose on hand
× 1 tablet = 10/5 or 2 tablets
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-11
Work these problems:1. The physician has ordered ampicillin 500
mg, on hand 250 mg capsules. How much would you give?
2. You have 50 mg metropolol as a scored tablet on hand and the doctor tells you to give 25 mg. How much would you give?
2 capsules
½ tablet
Dosage Calculations: Formula Method (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-12
1. Doctor orders 500 mg of ampicillin. You have 250 mg 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 capsules 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
Dosage Calculations: Ratio Method
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-13
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
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 mgx
Solve for X = 3 capsules
Dosage Calculations: Fraction Method
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-14
Metabolism and absorption altered
Require precise calculations BSA – body surface area Weight
Dosage Calculations: Pediatric and Geriatric
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-15
Apply Your Knowledge1. 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. g2. Add 3 zeros so you can move the decimal point three
places to the right: 25.000 g3. Move the decimal point to the right three places: 25,0004. Change the unit: 25,000 mg
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-16
Apply Your Knowledge3. Calculate the dose to give
for 500 mg Augmentin®.ANSWER:
20 mL
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-17
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-19
Rules for 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
Preparing to Administer a Drug (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-20
Rules for administration 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
Preparing to Administer a Drug (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-21
Seven Rights of Drug Administration
1. Right patient
2. Right drug
3. Right dose
4. Right time
5. Right route
6. Right technique
7. Right documentation
Preparing to Administer a Drug (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-22
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.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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 Faster absorption; bypasses GI tract
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-24
Parenteral Administration of substance into a muscle or vein Fast absorption; bypasses GI tract Safety risks
Rapid administration; rapid action Exposure to bloodborne pathogens
Methods of injection Intradermal (ID) Subcutaneous (SC) Intramuscular (IM) Intravenous (IV)
Techniques for Administering Drugs (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-25
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
Techniques for Administering Drugs (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-26
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
Techniques for Administering Drugs (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-27
Methods of injection Intradermal
Into upper layer of skin Used for skin tests
Subcutaneous Provides slow,
sustained release and longer duration of action
Rotate sites
Intramuscular More rapid absorption Less irritation of tissue Larger amount of drug Z-track method
Intravenous Not usually given by
medical assistants
Techniques for Administering Drugs (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-28
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
Techniques for Administering Drugs (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-29
Apply Your KnowledgeMatching:
___ Absorption through GI tract A. Topical drug
___ Under the tongue B. Oral drug
___ Small bottle with rubber diaphragm C. Intramuscular drug
___ Less irritation of tissue D. Subcutaneous drug
___ Direct application to skin E. Sublingual drug
___ Need to rotate sites F. Vial
ANSWER:
F
E
D
C
B
A
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-30
Educating the Patient About Drug Administration How to read the prescription drug label
Interactions Drug-drug interactions Drug-food interactions
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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
Educating the Patient About Drug Administration (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-32
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!
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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 closely for adverse effects and interactions
Administration sites and techniques may differ
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-34
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
Special Considerations (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-35
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
Special Considerations (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-36
Elderly patients Age-related changes
affect Absorption Metabolism Distribution Excretion
May have increased risk of Drug toxicity Adverse effects Lack of therapeutic effects
Special Considerations (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-37
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
Special Considerations (cont.)
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-38
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!
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-40
Nonpharmacologic PainManagement Biofeedback – evokes relaxation;
helps block pain perception
Guided imagery – patient envisions being in a calm, nurturing place; promotes relaxation
Relaxation exercises – breathing techniques
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-41
Apply Your Knowledge1. 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.
2. True or false:
___ Biofeedback involves special breathing techniques .
___ Audiotapes can be used with guided imagery.
___ Relaxation exercises are used to relax different muscle groups.
F
T
T
helps block pain perceptionANSWER:
I
M
P
R
E
S
S
I
V
E
!
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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In Summary Medical assistant
Administer drugs safely and effectively Conversions and calculations Patient assessment Observe general rules Follow seven rights of drug administration
Be aware of patients needing special considerations
Be aware of nonpharmacologic methods for managing pain control
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
51-43
End of Chapter
Words are the most powerful drug used by mankind.
~Rudyard Kipling