PowerPoint to accompany Second EditionRamutkowski Booth Pugh Thompson WhickerCopyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.Medical AssistingChapter 51

Objectives: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.51-5 Describe the various techniques of drug administration you may be asked to perform.Drug Administration

Objectives (cont.)51-6 Compare different types of needles and syringes.51-7 Explain how to administer an intradermal, subcutaneous, or intramuscular injection.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.Drug Administration

Introduction Drug administration is one of the most important and most dangerous duties.A patients condition can worsen or the patient could die when meds are given incorrectly.

To administer drugs safely and effectively, you must know and understand principles of pharmacology.

You should be familiar with the medications frequently prescribed in your practice.

Pharmacology PrinciplesRoute of medication administrationDosage calculationsTechniques involved with giving injectionsSeven Rights of Drug AdministrationPatient education

Drug Administration and Scope of PracticeStates have medical practice acts that define medical assistants exact dutiesAn act may specify which drugs you are allowed to give.You need to research the scope of practice for medical assistants in the state where you will work.You are responsible for knowing what you can and cannot do when giving medications.

Dosage CalculationsMeasurement Systems:MetricApothecariesHousehold Most doctors use metric system

Basic Calculations Formula MethodDesired dose X quantity of dose on hand Dose on hand

The physician orders aspirin, 10 grains. On hand are 5 grain aspirins

10 grains X 1 tablet = 10/5 or 2 tablets5 grains

Basic CalculationsWork these problems:The physician has ordered ampicillin 1000 mg, on hand 500 mg tablets.

2 tablets tabletYou have 500 mg scored tablets of a drug on hand and the doctor tells you to give 250 mg. How much would you give?

Basic Calculations Ratio MethodDoctor orders 500 mg of ampicillin. You have 250 mg on hand.

Answer = 2 tabletsSet up a ratio with the unknown number of tablets and the amount of drug ordered X:500 mg Set up a ratio with a single tablet and the amount of drug in single tablet 1 tab:250 mg

Create a proportion and multiply the outer and then the inner parts and solve for X. X:500 mg :: 1 tab:250 mg

Basic Calculations Fraction MethodSet the second fraction with the amount of drug in a capsule10 mg 1 cap

Then use both fractions in a proportion:30 mg 10 mg x = 1 cap

The doctor orders 30 mg of Adalat. Each capsule contains 10 mg.Set up the first fraction with the dose ordered and the unknown number of capsules30 mgxSolve for X = 3 capsules

Preparing to Administer a DrugDrug may be given: Local applied directly to skin, tissue, or mucous membranesSystemic routes that allow the drug to be absorbed or distributed into the bloodstreamPay close attention to the dose, route, and form of the medication. To administer medications you require close attention to detail, strong patient assessment skills, and expert technique.

Apply Your KnowledgeWhich measuring system is used the most in pharmacology?

Apply Your Knowledge -Answer Most doctors use the metric system when utilizing pharmacology principles.Which measuring system is used the most in pharmacology?

Apply Your Knowledge #2Convert 25 grams to milligrams.

Apply Your Knowledge #2 - AnswerConvert 25 grams to milligrams.Answer:Add a decimal point to the measurement: 25. gAdd 3 zeroes so you can move the decimal point three places to the right: 25.000 gMove the decimal point to the right three places: 25,000Change the unit: 25,000 mg

Apply Your Knowledge #3 Calculate the dose to give for 500 mg Augmentin.

Apply Your Knowledge #3 - AnswerCalculate the dose to give for 500 mg Augmentin.Answer: 20 mL

Assessment of PatientAs you interview the patient, you must be alert to any changes in the patients condition that could affect drug therapy.

General Rules Give only the drugs the doctor orders.If you are unfamiliar with any aspect of the order, consult a drug reference book.Wash your hands.Prepare in a well-lit area.Focus on the task at hand.Calculate the dose carefully.Avoid leaving a prepared drug unattended. Never give a drug that someone else has prepared.

General Rules Ask the patient to state his name to ensure correct identificationAsk the patient if they have an allergiesBe sure the physician is in the office when you give the drug.If the patient refuses to take the drug, flush it down the toilet.Do not return it to the original container.If you make an error, tell the doctor at once.

Seven RightsRight patientRight drugRight doseRight timeRight routeRight techniqueRight documentation

Techniques of Administering DrugsOral tablets, capsules, lozenges, and liquidsBuccal or sublingual placed under the tongue or between the cheek and gumParenteral administration of substance into a muscle, vein, or GI tractIntradermal (ID)Subcutaneous (SC)Intramuscular (IM)Intravenous (IV)

Needles and SyringesNeedlesAvailable in different gauges smaller the number the larger the gaugeLength long enough to penetrate the appropriate layers of tissueSyringesBarrelPlungerSizes 3 mL, 1 mL (tuberculin or insulin)

Parenteral Drugs PackagingAmpule glass or plastic container that is sealed and sterile (open with care)Cartridge small barrel prefilled with sterile drugVial small bottle with rubber diaphragm that can be punctured by needle.

Other Drug AdministrationInhalation -administered through the mouth or nose.Topical applied direct application of a drug on the skin.Transdermal use of a medication patch that will release medication slowly and evenlyUrethral instill liquid drugs directly into the bladder.Vaginal and rectal

Educating the PatientReading the drug package labelInteractionsDrug drug interactionsDrug food interactionAdverse effectsEffects of medication take the drug at the right time, in the right amount, and under the right circumstances.

Special ConsiderationsPediatric patients physiology and immature body systems may make the drug effects less predictablePlan to observe a pediatric patients closely for adverse effects and interactions.

Pregnant PatientsRemember that you are caring for two patients at onceWhen you give the mother a drug, you are also giving it to the babySome drugs can cause physical defects in the fetus if taken in the first three months of pregnancy

Patients Who Are Breast FeedingSome drugs are excreted in breast milkIngestion can be dangerous because baby cant metabolize or excrete drugsCheck drug reference work to see if contraindicated during lactation

Elderly PatientsMay have increased risk of:Drug toxicityAdverse effects Lack of therapeutic effects

Age related changes in the body

Patients From Different CulturesCan affect a patients understanding of drug therapy and compliance with itObtain drug information sheets in the languages that are commonly spoken by patients in your office

Nonpharmacologic Pain ManagementBiofeedback equipment measures physical indicator of stress and relaxationGuided imagery- envisioning calm, nurturing placeRelaxation exercises

Apply Your Knowledge The physician orders you to give an IM medication to a 2-year-old child. What site will you use?

Apply Your Knowledge -Answer The vastus lateralis or the ventrogluteal. The physician orders you to give an IM medication to a 2-year-old child. What site will you use?

Summary Medical Assistant You must be prepared to administer drugs safely and effectively. You must follow the Seven Rights of Medication Administration.

End of Chapter