1 PowerPoint ® to accompany Second Edition Ramutkowski  Booth  Pugh  Thompson  Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 51

2 Objectives: 51-1 Discuss your responsibilities regarding drug administration Perform dosage calculations accurately Describe how to assess the patient before administering any drug Identify the “seven rights” of drug administration Describe the various techniques of drug administration you may be asked to perform. Drug Administration

3 Objectives (cont.) 51-6 Compare different types of needles and syringes Explain how to administer an intradermal, subcutaneous, or intramuscular injection Explain what information you need to teach the patient about drug use, interactions, and adverse effects Describe special considerations related to drug administration Describe nonpharmacologic ways to manage pain. Drug Administration

4 Introduction Drug administration is one of the most important and most dangerous duties. A patient’s 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.

5 Pharmacology Principles  Route of medication administration  Dosage calculations  Techniques involved with giving injections  Seven Rights of Drug Administration  Patient education

6 Drug Administration and Scope of Practice  States have medical practice acts that define medical assistants’ exact duties  An 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.

7 Dosage Calculations  Measurement Systems: Metric Apothecaries Household  Most doctors use metric system

8 Basic Calculations – Formula Method Desired 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 tablets 5 grains

9 Basic Calculations Work these problems:  The physician has ordered ampicillin 1000 mg, on hand 500 mg tablets. 2 tablets ½ tablet  You have 500 mg scored tablets of a drug on hand and the doctor tells you to give 250 mg. How much would you give?

10 Basic Calculations –Ratio Method Doctor orders 500 mg of ampicillin. You have 250 mg on hand. Answer = 2 tablets Set 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

11 Basic Calculations Fraction Method Set the second fraction with the amount of drug in a capsule 10 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 capsules 30 mg x Solve for X = 3 capsules

12 Preparing to Administer a Drug Drug may be given:  Local – applied directly to skin, tissue, or mucous membranes  Systemic – routes that allow the drug to be absorbed or distributed into the bloodstream  Pay 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.

13 Apply Your Knowledge Which measuring system is used the most in pharmacology?

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

15 Apply Your Knowledge #2 Convert 25 grams to milligrams.

16 - Answer Apply Your Knowledge #2 - Answer Convert 25 grams to milligrams. Answer: 1.Add a decimal point to the measurement: 25. g 2.Add 3 zeroes so you can move the decimal point three places to the right: g 3.Move the decimal point to the right three places: 25,000 4.Change the unit: 25,000 mg

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

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

19 Assessment of Patient As you interview the patient, you must be alert to any changes in the patient’s condition that could affect drug therapy.

20 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.

21 General Rules  Ask the patient to state his name to ensure correct identification  Ask the patient if they have an allergies  Be 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.

22 “Seven Rights” 1.Right patient 2.Right drug 3.Right dose 4.Right time 5.Right route 6.Right technique 7.Right documentation

23 Techniques of Administering Drugs  Oral – tablets, capsules, lozenges, and liquids  Buccal or sublingual – placed under the tongue or between the cheek and gum  Parenteral – administration of substance into a muscle, vein, or GI tract Intradermal (ID) Subcutaneous (SC) Intramuscular (IM) Intravenous (IV)

24 Needles and Syringes  Needles Available in different gauges – smaller the number the larger the gauge Length – long enough to penetrate the appropriate layers of tissue  Syringes Barrel Plunger Sizes 3 mL, 1 mL (tuberculin or insulin)

25 Parenteral Drugs Packaging  Ampule – glass or plastic container that is sealed and sterile (open with care)  Cartridge – small barrel prefilled with sterile drug  Vial – small bottle with rubber diaphragm that can be punctured by needle.

26 Other Drug Administration  Inhalation -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 evenly  Urethral – instill liquid drugs directly into the bladder.  Vaginal and rectal

27 Educating the Patient  Reading the drug package label  Interactions Drug – drug interactions Drug – food interaction  Adverse effects  Effects of medication – take the drug at the right time, in the right amount, and under the right circumstances.

28 Special Considerations  Pediatric patients – physiology and immature body systems may make the drug effects less predictable  Plan to observe a pediatric patients closely for adverse effects and interactions.

29 Pregnant Patients  Remember that you are caring for two patients at once  When you give the mother a drug, you are also giving it to the baby  Some drugs can cause physical defects in the fetus if taken in the first three months of pregnancy

30 Patients Who Are Breast Feeding  Some drugs are excreted in breast milk  Ingestion can be dangerous because baby can’t metabolize or excrete drugs  Check drug reference work to see if contraindicated during lactation

31 Elderly Patients May have increased risk of:  Drug toxicity  Adverse effects  Lack of therapeutic effects Age related changes in the body

32 Patients From Different Cultures  Can affect a patient’s understanding of drug therapy and compliance with it  Obtain drug information sheets in the languages that are commonly spoken by patients in your office

33 Nonpharmacologic Pain Management  Biofeedback – equipment measures physical indicator of stress and relaxation  Guided imagery- envisioning calm, nurturing place  Relaxation exercises

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

35 Answer 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?

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

37 End of Chapter