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
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
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)
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
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
Drug Dosage • Amount of medicine prescribed • Age • Weight • Sex • Other factors • Pediatric considerations
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
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
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
Calculation of Drug Dosages • Weights and measures • Metric system guidelines • The seven common metric prefixes • Micro- • Milli- • Centi- • Deci- • Deka- • Hecto- • Kilo-
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
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
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
Medications Measured in Units • Diabetes • Importance of exact dosage of insulin • Precautions to observe when administering insulin • Oral hypoglycemic medication
Calculating Adult Dosages • Weight • Milliequivalent (mEq) • Microgram (mcg) • Milligram (mg) • Gram (Gm, g) • Unit
Calculating Adult Dosages • Volume • Milliliter (mL) • Minim (m) • Dram (dr) • Ounce (oz) • Variety of household measures • Proportional method • Formula method
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
Administration of Medications • Follow basic guidelines • “Six rights” of proper drug administration • Right drug • Right dose • Right route • Right time • Right patient • Right documentation
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
Administration of Medications • Patient assessment • Age • Physical conditions • Body size • Sex • Build • Skin texture • Injection site • Sites to be avoided
Administration of Oral Medications • Equipment and supplies for oral medications • Medicine cup, water cup, medicine dropper
Administration of Parenteral Medications • Parenteral routes • Subcutaneous • Intramuscular • Intradermal • Unit dose forms • Ampule • Cartridge-needle unit • Vial
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
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
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
Parenteral Equipment and Supplies • Syringes • Disposable • Non-disposable • Combination disposable/nondisposable cartridge-injection • Classified according to intended use
Parenteral Equipment and Supplies • Parts of a syringe • Barrel • Plunger • Flange • Tip • Safety shield
Parenteral Equipment and Supplies • Parts of a needle • Disposable and nondisposable • Point • Bevel • Lumen • Shaft • Hub • Hilt • Sheath
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
Principles of Intravenous Therapy • Patient needs, conditions, diseases • Patient safety • Complications • Types of solutions • Legal considerations Basic IV Administration Set >>
Site Selection and Injection Angle
Site Selection and Injection Angle
Site Selection and Injection Angle • Marking the correct site for intramuscular injection • Dorsogluteal site • Ventrogluteal site • Deltoid muscle • Vastus lateralis site
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
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
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
Administration of Inhaled Medications • Administration of oxygen • Hypoxemia • Oxygen tanks • Dosage • Methods of oxygen delivery • Oxygen safety precautions
