Injection Medication Administration Review CHRMC

1. Injection & Medication Administration Review CHRMC Michaelann M. Allen, MA.Ed, CMA

2. Learning Objectives Discuss the legal and ethical implications of administering medications. Describe the medication order and the prescription. List the information contained in the medication label. Determine accurate dosages using the ratio and proportion method. Explain various units of medication dosages. Calculate accurate adult and pediatric dosages. Recall and explain guidelines to follow when preparing and administering drugs. Properly dispose of syringes, needles and supplies following practice of injections. Describe the site selection factors for injections. Apply aseptic technique and follow applicable safety rules in the practice of injections.

3. Learning Objectives Continued� Discuss medical uses for various drugs. Read drug names and recall examples in all three drug names (generic, brand and chemical). Compare and contrast administering, prescribing and dispensing drugs. Locate drug information using the PDR and other drug reference sources and explain the various sections and categories of information available. Explain the actions of drugs and give examples. Recall and describe routes of drug administration and the forms drugs may be supplied in. Discuss the handling and storage of medications. Describe emergency medications and supplies.

4. *Injection Protocol and Criteria for Medical Assistants: Injection techniques Critical elements of patient assessment, site placement and needle choice Adverse reaction protocol �Six Rights�, checking the label x 3 Medication errors and proper documentation Math calculations Documentation Procedures covered: Intradermal, Subcutaneous, Intramuscular, Deltoid, Vastus, Gluteus and Z-track, Oral medication administration, reconstituting powdered medication and withdrawing medication from an ampule.

5. Legal and Ethical Implications CHRMC � You must be a CMA Washington State Law � You must have your HCA license levels A, C & E Delegation: You can only be delegated to give injections by an MD, ARNP or PA Documentation and Consent: The patient and/or parent must give consent/sign and you must have a Medication Order to administer medications

6. Parts of a Prescription

7. Medication Label Medication Name Medication Strength Medication Use Expiration Date Manufacturer Medication Information

8. Dosage Calculations Ratios: 3:4 = 1:2 multiply the means and the extremes (4) (1) means (3) (2) extremes Solve for X 30mg : 1cc = 60mg : x 1cc x 60mg = 30mg x x 60 = 30x 60/30 = x 2 = x give 2cc or 2mL Formula Method: Dose ordered X Quantity = Amount to give Dose on hand Ordered: 40mg Demerol / On hand: 80mg X Quantity: per 1mL 40/80 x 1mL = 0.5mL(cc) Children�s Dosages by BSA (Body Surface Area): BSA of Child x Adult Dose = Child�s Dose 1.7 0.7 (40 inches tall, weight 38 pounds) x 50mg Demerol(adult dose) = child dose 1.7 0.41 x 50 = 20.6mg Demerol for the child * Then go to formula method to determine what is on hand to determine cc�s to give�

9. Medication Preparation & Administration Guidelines Aseptic Technique/PPE � ALWAYS WASH YOUR HANDS BEFORE PREPARATION AND IN BETWEEN PATIENTS!!! Wear gloves. Disposal: Always use a Sharps Container; dispose of used needles right away, and use Safety Needles if possible � Never Recap! (1 exception) Always label your syringe! (Especially for multiple injections/Pediatric Immunizations) Site Selection � Choose your site carefully, don�t guess, evaluate your patient, follow office protocol � select the correct route according to the medication you are giving; wrong route, medication doesn�t work Avoid: scars, rashes, sores/lesions, excessive hair, moles, burns, edematous areas, paralyzed areas, cyanotic areas, previous injection sites, etc�

10. Medical Uses for Drugs Medical uses for drugs: Therapeutic: used in treatment such as antihistamine for allergies Diagnostic: used in radiology such as barium for x-rays Curative: used to kill the causative agent in a disease such as antibiotics Replacement: used to replace substances normally found in the body such as hormones Preventative or Prophylactic: used to lessen severity or ward off disease such as immunizations Ways to handle drugs: Prescribe: licensed practitioner gives a written prescription to be filled later Dispense: to give medication ordered by the practitioner to be taken at another time Administer: to give medication by mouth, injection, etc� right then as ordered by the practitioner

11. Drug Names Chemical Name: describes the drug�s molecular structure � i.e. 2-(N,N-dimethylcarbamimidoyl)guanidine Generic Name: is the drug�s official name (lower case, can be made by more than one pharmaceutical company) i.e. metformin Trade or Brand Name: registered by patent and protected for 17 years � i.e. Glucophage

12. Drug Actions In general drugs may be grouped as follows: those that act directly on one or more tissues of the body; those that act on microorganisms; and those that replace body chemicals. Certain drugs have selective action: such as stimulants which increase cell activity and depressants, which decrease cell activity. Other drugs may have what is known as: Local Action � the drug acts on the area to which it is administered, i.e. ointment for a rash Remote Action � a drug affects a part of the body that is distant from the site of administration, i.e. chemotherapy Systemic Action � the drug is carried via the bloodstream throughout the body, i.e. antibiotics Synergistic Action � one drug increases or counteracts the action of another, i.e. HIV meds

13. FACTORS THAT AFFECT DRUG ACTION The four principal factors that affect drug action are: absorption, distribution, biotransformation, and elimination. These factors depend on the individual patient, the form and chemical composition of the drug and the method of administration. Absorption is the process whereby the drug passes into the body fluids and tissues. Distribution is the process whereby the drug is transported from the blood to the intended site of action, site of biotransformation, site of storage and site of elimination. Biotransformation is the chemical alteration that a drug undergoes in the body. Elimination is the process whereby the drug is excreted from the body. Elimination occurs via the gastrointestinal tract, respiratory tract, skin, mucous membranes and mammary glands.

14. Undesirable Actions of Drugs Side Effect: undesirable action that may limit usefulness Drug Interaction: one drug potentially increases or diminishes the action of another, (drugs may also interact with food, alcohol, etc�) Adverse Reaction: unfavorable or harmful unintended action such as allergic reaction

15. Routes and Administration Direct Application: lotions, creams, transdermal Sublingual: under the tongue, tablets, liquid, drops Buccal: in the cheek, tablets Rectal: suppositories, ointments Vaginal: suppositories, creams, etc� Inhalation: inhalers, oxygen, sprays Instillation: liquid, drops (eyes and ears) Parenteral: injections

16. Storage and Handling Store in original containers Keep in locked cabinet Follow special handling i.e. refrigeration, freezing, keep in dark place, etc.. Drug labels indicate proper handling, always read! Always label drawn up medication! Keep medications for internal use separate from those for external use Always check expiration dates! Read the label 3 times!

17. Emergency Medications and Supplies � Medication Errors Some examples of emergency drugs and their use: Adrenalin: anaphylactic shock (vasoconstrictor) Albuterol: asthma (bronchodilator) Benadryl: allergic reaction (antihistamine) Compazine: relieves nausea and vomiting (antiemetic) Dextrose: hypoglycemia Hydrocortisone: suppresses swelling and shock (antiinflammatory) Insulin: diabetic coma Narcan: drug overdose (antidote) Nitroglycerin: angina (vasodilator) Oxygen: respiratory difficulties When an error occurs: Recognize Stay calm Report Follow orders Document

18. Patient Assessment & Needle Choice Patient Assessment: Age: child or adult? Physical Condition: pregnant, disabled, etc� Body Size: don�t guess! Palpate site! Is the amount of medication correct for size? Sex: muscular build, skin texture, obesity Site: watch for places to avoid, route, type of medication, etc� Needle Choice: Type of medication: thicker medication, larger gauge needle (remember: the larger the number, the smaller the gauge of the needle) Route: choose correct needle length for route

20. �6 Rights� � Check the Label x 3! Right Drug Check the label 3 times!! 1) when removing from storage area 2) when removing from container 3) when returning to storage or before discarding empty container Right Dose Right Route Right Time Right Patient Right Documentation

21. Procedures Deltoid � Intramuscular Vaccines, narcotics, sedatives, vitamins 90 degree angle 1� needle (depends on patient size) Volume: usual 0.5mL maximum 2.0mL

22. Procedures Subcutaneous Vaccines, Insulin, allergy shots 45 degree angle (except Insulin is 90 degrees) 25g 5/8� needle, insulin syringe/needle Volume: 0.5mL or less

23. Procedures Intradermal PPD, allergy testing 5 � 10 degree angle 25g 5/8� needle to 27g �� needle Volume: 0.1mL or less

24. Procedures Dorsogluteal � Intramuscular � (deep IM) Hormones, antibiotics, narcotics, etc� 90 degree angle 22g 1 �� to 19g 1 �� needle (depends on patient size) and thickness of medication Volume: usual 1-2mL maximum 3mL

25. Procedures Z � Track Dorsogluteal � Intramuscular � (deep IM) Caustic medications mainly, or hormones, antibiotics, narcotics, etc� 90 degree angle 22g 1 �� to 19g 1 �� needle (depends on patient size) and thickness of medication Volume: usual 1-2mL maximum 3mL Be sure to displace skin and wait 10 seconds prior to removing needle!

26. Procedures Vastus Lateralis � Intramuscular Preferred site for infants and children for vaccines and other IM meds 90 degree angle 21g 1� to 23 1� needle Volume: usual 0.5 mL maximum 2.0mL (children)

27. Patient Education Take medication exactly as directed for the prescribed duration; do not stop unless you ask provider Inform the Provider of any unusual or adverse reactions Do not take other meds unless you ask the provider; never take another person�s medication Store away from children Discard properly; always check expiration date Heed warning labels; always check label of prescribed meds at pharmacy to be sure it is correct Be sure you understand what you are taking; ask for explanation if needed Enroll in education classes if you are taking lifelong drug therapy

28. References http://www.drugs.com/top200.html http://www.rxlist.com/script/main/art.asp?articlekey=79509 http://home.sc.rr.com/nurdosagecal/ http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Parenteral%20Medications http://nursesaregreat.com/articles/drugcal.htm http://www.cdc.gov/Nip/recs/child-schedule.htm