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ADMINISTRATION OF MEDICATION Part 1
CHAPTER 11 ADMINISTRATION OF MEDICATION Part 1
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Terms Pharmacology: The study of drugs
Includes: Preparation Use Action of drugs in the body Drug: A chemical that is used for the treatment, prevention, or diagnosis of disease Most drugs are produced synthetically but can also be obtained from animals, plants and minerals
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Introduction to Administration of Medication
In the office, medication may be: Administered: given to patient at office Prescribed: Physician provides patient with a handwritten or computer-generated prescription to be filled at a pharmacy Can also be telephoned or faxed to pharmacy Dispensed: Medication given at office for patient to take at home (e.g., drug samples) There are certain restrictions on faxed or telephone prescriptions.
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Legal Aspects Administer medication only under direction of physician
Unlawful to administer medication without physician's consent
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Routes of Administration
Oral Sublingual Inhalation Rectal Vaginal Topical Parenteral: IM, SC, ID, IV What are some medications the student is already familiar with in each category?
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Routes of Administration
Route depends on: Type of drug Dosage form Intended action Rapidity of response desired What is an example of a situation in which we would want a drug to work very quickly?
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Routes of Administration
Most common route of administration in office: Parenteral: Refers to sites located outside gastrointestinal (GI) tract Most commonly used to refer to administration of medication by injection Ask the students what medications they have had by this route and why they were given this medication.
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Classification of Drugs Based on Action
Drugs classified according to action they have on body For common drugs administered in office, MA should know: Category to which drug belongs Primary use Major therapeutic effects Why is it important to know the category? What are ways the MA can find out what category the drug is in?
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Guidelines for Preparation and Administration of Medication
Work in quiet, well-lit atmosphere free from distractions Always ask if you have a question about a medication order Know drug to be given Who would you ask if you have questions about the medication? What are some reference materials you can consult?
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Guidelines for Preparation and Administration of Medication, cont.
Select proper drug Check label three times When taking it from storage Before preparing medication After preparing medication Do not use if label is missing or difficult to read Why is it important to check the drug label three times?
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Guidelines for Preparation and Administration of Medication, cont.
Do not use drug if: Color has changed Precipitate has formed Unusual odor present 6. Check expiration date What is a precipitate?
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Guidelines for Preparation and Administration of Medication, cont.
Prepare proper dose Dose: the quantity of a drug to be administered at one time Dose too small: will not produce therapeutic effect Dose too large: could be harmful or fatal Identify patient: by full name and DOB Check for allergies to medication Check patient’s chart Question patient If air is drawn up with the medication, what will happen?
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Guidelines for Preparation and Administration of Medication, cont.
If giving injection: determine route and site Determined by the type of injection Examples: Allergy injection: administered subcutaneously (SC) Antibiotic: administered intramuscularly (IM) Site must be free from: Abrasions Lesions Bruises Edema Why is it important to administer into the right tissue?
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Guidelines for Preparation and Administration of Medication, cont.
Use proper technique Stay with patient after administration Document information in patient's chart: must be clear and legible Date and time Name of medication and lot number (if required) Why wouldn’t we want to administer an injection into the areas listed on the slide?
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Guidelines for Preparation and Administration of Medication, cont.
Dose given If dose contains a fraction of a unit: place a 0 before decimal point Example: 0.5 mg (not .5 mg) Never place a decimal point and a zero after a whole number Example: 20 mg (not 20.0 mg) So not misread as 200 mg If a decimal point is used, make sure it is clear and readable.
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Guidelines for Preparation and Administration of Medication, cont.
Route of administration Site of administration Any unusual observations or patient reactions Sign record with your name and credentials Why is all of this information that needs to be charted important? Answer all of the patient’s questions about the medication.
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Example
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Seven “rights” Always follow seven "rights" of preparing and administering medication Right drug Right dose Right time Right patient Right route Right technique Right documentation This protects the patient, the physician, and the MA.
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Oral Administration Most convenient and most common method to administer medication Drug is given by mouth (po) in solid or liquid form Absorption of most oral drugs: small intestine Why are most drugs developed absorbed in the small intestine and not the stomach?
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Oral Administration, cont.
Easier for many patients to swallow tablet/capsule with a glass of water Water should not be offered if patient has taken cough syrup Water dilutes beneficial effects What would you say to a patient who wants water after taking cough syrup? What would you do if a patient complains of solid medications getting stuck in his or her throat?
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Parenteral Administration
Advantages (SC, IM, IV): Absorbed more rapidly and completely than oral route May be only way drug can be given Unconscious patient Gastric disturbance Nausea Vomiting What is one medication that a patient gives himself or herself by this route?
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Parenteral Administration, cont.
MA usually responsible for administering SC, IM, ID Intravenous administration: when immediate effect is needed Usually administered by physician in emergency situation Can an MA start an IV?
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Parenteral Administration, cont.
Disadvantages Pain To minimize pain of an injection: Insert and withdraw needle quickly and smoothly Withdraw needle at same angle as that of insertion Possibility of infection at injection site What are signs of infection at the injection site?
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Parenteral Administration, cont.
Injections that are given repeatedly: must rotate sites (e.g., allergy injections): Prevents irritation and tissue damage Allows better absorption of drug Record administration of medication in patient's chart: Record site of administration Assists in proper rotation of sites for injections given repeatedly The MA should be knowledgeable of all sites that parenteral medication can be given.
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Parenteral Administration, cont.
Use medical asepsis when administering medications (Needle and inside syringe must remain sterile) Reduces danger of microorganisms entering patient's body Follow OSHA Bloodborne Pathogens Standard To Protect MA from bloodborne pathogens What PPE should the MA use?
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Parts of a Needle Needle a. Hub: fits onto top of syringe
b. Shaft: inserted into body tissue c. Lumen: opening in shaft of needle d. Point: located at end of needle shaft e. Bevel: slanted tip that makes a narrow, slitlike opening in skin Refer to slide 143 for diagram.
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Needle Gauge Gauge: Refers to diameter of lumen
Range: between 18 and 27 As size of gauge increases, diameter decreases Thick, oily medications: must be given with a large lumen Large lumen: makes a larger needle track in tissue Use smallest gauge needle possible: to reduce pain and tissue damage The MA must make sure the right gauge is used. Where would he or she find this information?
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Needle Length Length: refers to distance of shaft
Range: between ⅜ and 3 inches Based on type of injection given (IM, SC, ID) and size of the patient -Example: Giving an IM injection to an obese adult: requires a longer need to reach muscle tissue Why is it important to have the right length of needle?
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Parts of a Syringe Barrel: holds medication
Contains calibrated markings to measure proper amount (cc or ml) Flange: rim at end of barrel b. Helps in injecting medication and prevents syringe from rolling Plunger: moveable cylinder c. Used to draw medication into and out of syringe Refer to slide 151 for diagram.
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Hypodermic Syringe Calibrated in cc Available in 2, 2.5, 3, and 5 cc
Commonly used to administer IM injections
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Insulin Syringe Designed to administer insulin injections
Calibrated in units Most common: U-100
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Tuberculin Syringe To administer very small dose of medication (e.g., tuberculin test) Capacity of 1 cc Calibrations divided into tenths and hundredths of a cc
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Safety-Engineered Syringes
Safety-engineered syringes: built-in safety feature to reduce risk of needlestick injury OSHA requirements: Reduce needlesticks and other sharps injuries among health care workers Employers are required to evaluate and implement safer medical devices There are different types of safety-engineered syringes available.
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Safety Engineered Syringe
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Safety Engineered Syringe
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How Medication is Supplied
Vials Closed glass container with a rubber stopper Available in single-dose or multiple dose c. Vial may require mixing Examples: Reconstituting a powdered drug Roll medication between hands; Do not shake Some medications in vials may be stored at room temperature, while others need to be refrigerated. How would the MA know where to store the vial?
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Rolling Vial
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Removing Medication from Vial
Inject amount of air equal to amount of liquid to be removed Prevents formation of a partial vacuum: makes it difficult to remove medication How will the MA know how much air to inject into the vial?
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Removing Medication from Vial, cont.
Inject air above fluid level Prevents getting air bubbles into medication Why would we want air bubbles in the medication?
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Removing Medication from Vial, cont.
Remove medication by inserting needle opening below fluid level Prevents air bubbles from entering syringe Draw up correct amount of medication Notice the MA is careful not to let the needle touch her hand. What would you do if the needle touched your hand?
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Removing Medication from Vial, cont.
Remove air bubbles from syringe by tapping barrel with fingertips Air bubbles take up space medication should take up: prevents patient from receiving full dose of medication Make sure all bubbles are removed completely from the syringe once you have tapped them up to the top.
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How Medication is Supplied
Ampule Small, sealed glass container Holds a single dose of medication Constriction in the stem (neck): helps in opening it Make sure no medication in stem: tap it lightly What type of medication comes in an ampule? (Phenergen)
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Removing Medication from Ampule
Open by holding firmly with gauze and breaking off stem Remove medication from ampule Do not let needle touch outside of ampule Do not inject air into ampule Insert needle below fluid level Withdraw medication Why should we open the ampule using gauze?
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Hazard with Ampule Small glass particles can get into ampule: when stem broken off Prevent this by using filter needle to withdraw medication Where would you discard the filter needle after drawing up the medication?
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How Medication is Supplied
3. Prefilled syringes and cartridges Disposable Do not have to draw up medication The medication shown is Bicillin. In what category is this drug?
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Info. Printed on Prefilled Syringe/Cartridge
Name of drug Dose Expiration date Why is the expiration date important?
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Storage of Medications
Store properly following info in drug package insert Improper storage may alter effectiveness of medication If a medication is not stored properly or is expired, what would you do? Should there be a form to fill out if medication has to be disposed of? Why or why not?
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Subcutaneous Injections
Administered into subcutaneous tissue Consists of adipose (fat) tissue Located just under the skin SC tissue: located all over body Certain sites more commonly used Where bones and blood vessels are not near surface of skin Name a site where an SC injection is given.
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Subcutaneous Injections, cont.
SC sites commonly used: Upper lateral part of arms Anterior thigh Upper back Abdomen If a patient is giving his or her own insulin injections, what sites are easy for him or her to access?
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Subcutaneous Injection Sites
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Subcutaneous Injections, cont.
Angle of insertion: 45 or 90 degrees When would we give an SC injection at a 90-degree angle?
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Subcutaneous Injections, cont.
Medication is absorbed through capillaries Slower absorption rate than IM Do not give SC injection into tissue that is Grossly adipose Hardened Inflamed Edematous Why would we not want to give an SC injection in the sites that are not recommended on the slide?
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Subcutaneous Injections, cont.
Needle length range: ½ to ⅝ inch Use 45-degree angle of insertion with ⅝-inch needle Use 90-degree angle of insertion with ½-inch needle Needle gauge range: 23 to 25 Use proper length needle to make sure medication is administered into SC tissue Elderly and dehydrated patients: have less SC tissue Use shorter needle Obese patients: have more SC tissue Use longer needle Why wouldn’t we want to give an IM injection with a ½-inch needle?
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Subcutaneous Injections, cont.
SC tissue is sensitive to: Irritating solutions Large volumes of medication 10. Medications administered SC: Epinephrine Insulin Allergy injections
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Intramuscular Injections
Administered into muscular layer of the body Located below skin and SC layer Angle of insertion: 90 degrees to patient’s skin Why must we wear gloves when giving an injection?
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Angle of Insertion
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Intramuscular Injections, cont.
Amount that can be injected: Gluteal and vastus lateralis sites: Adults: Up to 3 cc Very thin adults and older patients: Up to 2 cc Deltoid site: no more than 1 cc Absorption more rapid than SC (more blood vessels in muscle tissue) Medication that is irritating to SC tissue: often given through IM route (fewer nerve endings in muscle tissue) If 2.5 cc of medication are to be given, where would you give it?
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Intramuscular Injections, cont.
5. Needle length range: 1 to 3 inches Average-sized adult: typically use 1-1½ inches Child or thin adult: 1 inch Obese patient: 2 inches or more depending on amount of SC tissue 6. Needle gauge range: 18 to 23 Depends upon viscosity of medication Intramuscular Injection Sites Located away from large nerves and blood vessels Should be fully exposed (Permits clear visualization of site) Why is it important to reach muscle tissue when giving an IM injection?
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Intramuscular Injection Sites
1. Dorsogluteal Site Gluteal muscles are well-developed: can absorb large amount of medication Used for: Adults Children older than 3 years of age Patient position: on abdomen with toes pointed inward (relaxes gluteal muscles) Show site on a student volunteer.
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Dorsogluteal Site Inject medication into upper outer quadrant of gluteal area Identify landmarks through palpation and visualization Be extremely careful to maintain proper boundary lines To avoid injection into sciatic nerve
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Deltoid Site Deltoid Site Make sure entire arm is exposed
Easily accessible Patient position: sitting or lying down Amount: no more than 1 cc should be administered Site is small because major nerves and blood vessels surround it Cannot administer large amount of medication Cannot administer repeated injections Make sure entire arm is exposed Completely pull up sleeve or remove arm from sleeve Tight sleeve constricts arm: causes bleeding from puncture site Show site on a student volunteer.
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Deltoid Site, cont. To locate site:
Palpate lower edge of acromion process Can also be located by placing four fingers horizontally across the deltoid muscle with top finger along acromion process; site located three finger widths below acromion process
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Vastus Lateralis Site Vastus Lateralis Site
Thick muscle away from major nerves and blood vessels Recommended for: infants and children younger than 3 years Gluteal muscles are not well developed yet Show site on a student volunteer.
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Vastus Lateralis Site, cont.
To locate site: Proximal boundary: hand's width below greater trochanter Distal boundary: hand's width above the knee Patient position: Easier to give lying down but patient can be sitting
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Z-Track Method Z-Track Method Used for administering medication that:
Irritate SC tissue or discolors skin b. To administer injection: Pull skin and SC tissue to the side Administer injection and remove needle Release skin: causes a zigzag path through tissue Seals off needle track and prevents medication from reaching SC layer or skin surface For what condition is iron dextran used?
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Z-Track Method
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