Chapter 36 Calculation of Medication Dosage and Medication

Chapter 36 Calculation of Medication Dosage and Medication Administration © 2014 Cengage©Learning. 2014 Cengage All Rights Learning. Reserved. All Rights May not Reserved. be scanned, May not copied be scanned, copied or duplicated, or or posted duplicated, to a publicly or posted accessible to a publicly website, accessible in wholewebsite, or in part. in whole or in part.

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 (m. Eq) 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 (m. L) 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 cartridgeinjection – 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 library on the Instructor Resources CD to view video “Injections. ” © 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.