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Chapter 36

Chapter 36 . Calculation of Medication Dosage and Medication Administration. 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

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Chapter 36

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  1. Chapter 36 Calculation of Medication Dosage and Medication Administration

  2. 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

  3. 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

  4. 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)

  5. 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

  6. 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

  7. Drug Dosage • Amount of medicine prescribed • Age • Weight • Sex • Other factors • Pediatric considerations

  8. Medication Label • 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

  9. 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

  10. 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

  11. Calculation of Drug Dosages • Weights and measures • Metric system guidelines • The seven common metric prefixes • Micro- • Milli- • Centi- • Deci- • Deka- • Hecto- • Kilo-

  12. 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

  13. 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

  14. 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

  15. Medications Measured in Units • Diabetes • Importance of exact dosage of insulin • Precautions to observe when administering insulin • Oral hypoglycemic medication

  16. Calculating Adult Dosages • Weight • Milliequivalent (mEq) • Microgram (mcg) • Milligram (mg) • Gram (Gm, g) • Unit

  17. Calculating Adult Dosages • Volume • Milliliter (mL) • Minim (m) • Dram (dr) • Ounce (oz) • Variety of household measures • Proportional method • Formula method

  18. 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

  19. Administration of Medications • Follow basic guidelines • “Six rights” of proper drug administration • Right drug • Right dose • Right route • Right time • Right patient • Right documentation

  20. Administration of Medications • Please refer to the video library on the Instructor Resources CD to view video “Medication Errors, Documentation and Administration.”

  21. Administration of Medications • Medication errors • Recognize error has been made • Stay calm • Report error immediately to provider • Follow provider’s order for correcting error • Document error

  22. Administration of Medications • Patient assessment • Age • Physical conditions • Body size • Sex • Build • Skin texture • Injection site • Sites to be avoided

  23. Administration of Oral Medications • Equipment and supplies for oral medications • Medicine cup, water cup, medicine dropper

  24. Administration of Parenteral Medications • Parenteral routes • Subcutaneous • Intramuscular • Intradermal • Unit dose forms • Ampule • Cartridge-needle unit • Vial

  25. Administration ofParenteral Medications • Hazards associated with parenteral medications • 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

  26. Administration ofParenteral Medications • Reasons for parenteral route selection • Rapid response time to medication • Accuracy of dosage • Need to concentrate medication in specific body part or area

  27. Administration ofParenteral 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

  28. Parenteral Equipment and Supplies • Syringes • Disposable • Non-disposable • Combination disposable/nondisposable cartridge-injection • Classified according to intended use

  29. Parenteral Equipment and Supplies • Please refer to the video library on the Instructor Resources CD to view video “Cartridge Injection System.”

  30. Parenteral Equipment and Supplies • Parts of a syringe • Barrel • Plunger • Flange • Tip • Safety shield

  31. Parenteral Equipment and Supplies • Parts of a needle • Disposable and nondisposable • Point • Bevel • Lumen • Shaft • Hub • Hilt • Sheath

  32. Parenteral Equipment and Supplies • Safe disposal of needles and syringes • Rigid, puncture-proof container • Never recap needle after giving injection • Engage safety feature • Most needlesticks occur while recapping • Sharps collector systems

  33. Parenteral Equipment and Supplies • Please refer to the video library on the Instructor Resources CD to view video “Needle Sticks & Safety.”

  34. Principles of Intravenous Therapy • Patient needs, conditions, diseases • Patient safety • Complications • Types of solutions • Legal considerations Basic IV Administration Set >>

  35. Site Selection and Injection Angle

  36. Site Selection and Injection Angle

  37. Site Selection and Injection Angle • Marking the correct site for intramuscular injection • Dorsogluteal site • Ventrogluteal site • Deltoid muscle • Vastus lateralis site

  38. Basic Guidelines forAdministration of Injections • Please refer to the video library on the Instructor Resources CD to view video “Injections.”

  39. Z-Track Method ofIntramuscular 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

  40. Z-Track Method ofIntramuscular Injection • Please refer to the video library on the Instructor Resources CD to view video “Z Track Method.”

  41. 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

  42. 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

  43. Administration of Inhaled Medications • Administration of oxygen • Hypoxemia • Oxygen tanks • Dosage • Methods of oxygen delivery • Oxygen safety precautions

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