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Chapter 21

Mathematics Review and Medication Administration

All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Mathematics and Dosage Calculation Review

The metric system Volume—liters Weight—grams Length—meters

All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

Mathematics and Dosage Calculation Review cont’d

The apothecary system Volume—fluid ounce, pint, quart Weight—grains, ounce, pound


Big to Small Rule

1. Write down BIG SMALL 2. Place the large unit under the word big and

the small unit under the word small 3. Move the decimal point three places in the

direction of the arrow; add zeros


Fractions

Proper fractions—the numerator is less than the denominator

Improper fractions—the numerator is larger than the denominator

Mixed fractions—consist of a whole number plus a fraction


Fractions cont’d

Functions Changing an improper fraction to a whole or mixed

number Changing a mixed number to an improper fraction Reducing fractions to the lowest term Determining which fraction is larger Adding, subtracting, multiplying, and dividing

fractions


Decimal Fractions

A decimal point found to the left of a whole number means that the number is a fraction of a whole number

A decimal point found after (to the right of) a number means that it is a whole number.

A number without a decimal point is understood to have an “invisible” decimal point following it


Percents

A fraction of 100 (The denominator is understood to be 100.)


Ratios and Proportions

Ratios show the relationship of one number or quantity to another number or quantity

Proportions show that the relationship between two ratios has equal value


Calculating Medications Using the mg/kg Method

Calculated based on the patient’s weight


Pediatric Dosage Considerations

Young’s rule Clark’s rule Fried’s rule Body surface area


Question 1

100 meters is how many kilometers?

1. 1 2. 10 3. 100 4. 1000


Question 2

60 grams is equivalent to how many ounces?

1. 1 2. 2 3. 3 4. 4


Pharmacology

The study of drugs and their action on the living body

Phases of drug action Pharmaceutical phase Pharmacokinetic phase Pharmacodynamic phase


Pharmacology cont’d

Liver—metabolizes drugs Kidneys—eliminate metabolites of drugs from

the body



Drug actions and interactions Actions

• Local versus systemic



Drug actions and interactions Interactions

• Potentiation or synergism • Compatibility • Incompatibility



Agonist vs. antagonist Idiosyncratic reactions Toxicity Adverse drug reactions



Factors that may affect how patients respond to medication Age Weight Physical condition Environmental temperature Gender Amount of food in the stomach Ethnicity Route of administration


Medication Orders

The nurse is legally and ethically responsible for ensuring that the patient receives the correct medication that has been ordered by the health care provider


Drug Distribution Systems

Unit dose system Computer-controlled dispensing systems


Types of Orders

Standing orders Verbal or telephone orders


“Six Rights” of Medication Administration

Right medication Right dose Right time Right route Right patient Right documentation


Routes of Administration

Enteral administration Percutaneous administration Parenteral administration


Question 3

What is the term for when combining two drugs produces an entirely unpredicted effect?

1. Interaction 2. Antagonist 3. Synergism 4. Incompatibility


Question 4

What is the term for a drug that will block the action of another drug?

1. Interaction 2. Antagonist 3. Synergism 4. Incompatibility


Enteral Administration

Powders Pills Tablets Liquids and suspensions Suppositories


Percutaneous Administration

Ointments Creams Lotions Transdermal

patches Eyedrops/ointments

Eardrops Nose drops Nasal sprays Inhalants Sublingual Buccal


Parenteral Administration

IM: intramuscular (within the muscle) ID: intradermal (within the dermis) Sub-Q or subQ: subcutaneous (under the

dermis; fatty tissue) IV: intravenous (within the vein)


Parenteral Administration cont’d

Intramuscular injections Ensure site is free of pain, infection, necrosis,

ecchymosis, and abrasions Consider the location of underlying bones, nerves,

and major blood vessels, and amount of solution to be injected

Ventrogluteal site is preferred, but vastus lateralis and deltoid muscle can be used



Intradermal injections Best route for allergy sensitivity tests, tuberculin

screening, desensitization injections, local anesthetics, and vaccinations

Use the upper chest, the inner aspect of the lower arm, or the scapular area for ID injections



Subcutaneous injections Inject into the loose connective tissue between the

dermis and the muscle layer



Intravenous therapy IV push Intermittent venous access device Intermittent infusion (or piggyback) Continuous infusions Electronic IV pumps Patient-controlled analgesia Volumetric chambers


Question 5

The health care provider has requested an allergy screening on a patient. Which type of injection should the nurse expect this patient to receive?

1. Intramuscular 2. Intradermal 3. Subcutaneous 4. Percutaneous


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