1. © 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. Chapter 36 Calculation of Medication Dosage and Medication Administration

2. © 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 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

3. © 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

4. © 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)

5. © 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

6. © 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

7. © 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

8. © 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

9. © 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

10. © 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

11. © 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-

12. © 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

13. © 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

14. © 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

15. © 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

16. © 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

17. © 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

18. © 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

19. © 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

20. © 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.”

21. © 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

22. © 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

23. © 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

24. © 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

25. © 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

26. © 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

27. © 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

28. © 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

29. © 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.”

30. © 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

31. © 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

32. © 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

33. © 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.”

34. © 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 >>

35. © 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

36. © 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

37. © 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

38. © 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.

39. © 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

40. © 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.”

41. © 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

42. © 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

43. © 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

44. © 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

45. © 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

46. © 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

47. © 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

48. © 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