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 – Using drugs for personal benefit (illegal) – Proper authorization © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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) © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Drug Dosage

• Amount of medicine prescribed – Age – Weight – Sex – Other factors – Pediatric considerations © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Calculation of Drug Dosages

• Weights and measures – Metric system guidelines – The seven common metric prefixes • Micro • Milli • Centi • Deci • Deka • Hecto • Kilo © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medications Measured in Units

• Diabetes – Importance of exact dosage of insulin – Precautions to observe when administering insulin – Oral hypoglycemic medication © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Calculating Adult Dosages

• Weight – Milliequivalent (mEq) – Microgram (mcg) – Milligram (mg) – Gram (Gm, g) – Unit © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Calculating Adult Dosages

• Volume – Milliliter (mL) – Minim (m) – Dram (dr) – Ounce (oz) – Variety of household measures • Proportional method • Formula method © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Medications

• • Follow basic guidelines “ Six rights ” of proper drug administration – Right drug – Right dose – Right route – Right time – Right patient – Right documentation © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Medications

• Please refer to the video library on the Instructor Resources CD to view video “Medication Errors, Documentation and Administration.” © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Medications

• Patient assessment – Age – Physical conditions – Body size – Sex • Build • Skin texture – Injection site • Sites to be avoided © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Oral Medications

• Equipment and supplies for oral medications – Medicine cup, water cup, medicine dropper © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Parenteral Medications

• Parenteral routes – Subcutaneous – Intramuscular – Intradermal • Unit dose forms – Ampule – Cartridge-needle unit – Vial © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Parenteral 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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Parenteral Medications

• Reasons for parenteral route selection – Rapid response time to medication – Accuracy of dosage – Need to concentrate medication in specific body part or area © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Parenteral 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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Parenteral Equipment and Supplies • Syringes – Disposable – Non-disposable – Combination disposable/nondisposable cartridge injection – Classified according to intended use © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Parenteral Equipment and Supplies • Please refer to the video library on the Instructor Resources CD to view video “Cartridge Injection System.” © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Parenteral Equipment and Supplies • Parts of a syringe – Barrel – Plunger – Flange – Tip – Safety shield © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Parenteral Equipment and Supplies • Parts of a needle – Disposable and nondisposable • Point • Bevel • Lumen • Shaft • Hub • Hilt • Sheath © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Parenteral Equipment and Supplies • Please refer to the video library on the Instructor Resources CD to view video “Needle Sticks & Safety.” © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Principles of Intravenous Therapy

• Patient needs, conditions, diseases • Patient safety • Complications • Types of solutions • Legal considerations Basic IV Administration Set >> © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Site Selection and Injection Angle

© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Site Selection and Injection Angle

© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Site Selection and Injection Angle

• Marking the correct site for intramuscular injection – Dorsogluteal site – Ventrogluteal site – Deltoid muscle – Vastus lateralis site © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Basic Guidelines for Administration of Injections

• Please refer to the video “Injections” through the instructor companion site.

© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Z-Track Method of Intramuscular 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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Z-Track Method of Intramuscular Injection

• Please refer to the video library on the Instructor Resources CD to view video “Z Track Method.” © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Administration of Inhaled Medications • Administration of oxygen – Hypoxemia – Oxygen tanks – Dosage – Methods of oxygen delivery – Oxygen safety precautions © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medication Calculation Practice

• Ordered: 250mg tablet • On hand: 500mg tablets © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medication Calculation Practice

• Ordered: 4mg to be given IM • On hand: Injectable medication is available in 2mg per mL © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medication Calculation Practice

• Ordered: 800mg tablet • On hand: 200mg tablets © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medication Calculation Practice

• Ordered: 40mg/kg/day • On hand: 400mg/5mL • Child weight: 22lbs • Now try with the following: – Ordered: 40mg/kg/day BID © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Medication Calculation Practice

• Ordered: 100mg/kg/day • On hand: 200mg/5mL • Child weight: 10kg © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.