Background: Oral Medications (p. 254) Most economical Easiest to administer Most common type of medication given Available as solids and liquids To calculate dosages appropriately, the nurse must understand the principles applying to administration of oral medication. NURSING APPLICATION: Considering that Ms. Jackson is confused, would it be appropriate to give her medications orally? Why or why not? Copyright © 2011 by Elsevier Inc. All rights reserved.

Copyright © 2011 by Elsevier Inc. All rights reserved. Points to Remember (p. 256) Converting dosages from apothecary to metric systems can result in discrepancies ASA (CF: gr i = 60 to 65 mg) 10% rule: no more than 10% variance should exist between dose ordered and dose administered Capsules are administered whole Tablets are available in different strengths Only scored tablets should be cut with a pill cutter. Breaking an unscored tablet is dangerous and can result in an unintended dose. NURSING APPLICATION: How would Ms. Jackson take one-half of a tablet? Could she break it into pieces? Copyright © 2011 by Elsevier Inc. All rights reserved.

Points to Remember (cont’d) (p. 258) It is safer to give whole tablets equal to the dose than to cut tablets Maximum number of tablets or capsules used to deliver a dose is usually three (3) Exceptions exist, such as some HIV meds; always double-check dosage Some measures and units such as mEq do not convert between metric and apothecary The rule of 10% variation is often applied with adults, but not necessarily in the pediatric setting. NURSING APPLICATION: Why is it safer to give whole tablets? Wouldn't it be cheaper to get the greater strength and then cut the tablets in half? Copyright line.

Ratio and Proportion Method (p. 260) Review the ratio and proportion method of calculating dosages. NURSING APPLICATION: When would the nurse use this method of calculation over another method? Copyright © 2011 by Elsevier Inc. All rights reserved.

Copyright © 2011 by Elsevier Inc. All rights reserved. Formula Method (p. 260) Review the use of the formula method of calculation. NURSING APPLICATION: Is this an easier way to determine the correct amount of medication for Ms. Jackson? Why or why not? Copyright © 2011 by Elsevier Inc. All rights reserved.

Dimensional Analysis Method (p. 260) Review the use of the dimensional analysis method of calculation. NURSING APPLICATION: Which of the three methods of dosage calculation is the best for calculating medication dosages? Why? Copyright © 2011 by Elsevier Inc. All rights reserved.

Measuring Oral Liquids (p. 278) Standard calibrated measuring cup Metric, apothecary, or household measure Place on flat surface and view at eye level Pour with label facing you so it can be read Calibrated droppers Use only dropper supplied with medication Calibrated oral syringes (tsp/mL marks) Used for accuracy of liquid doses (e.g., 6.4 mL) Pour medication in cup and draw up into syringe NEVER use oral syringes for parenteral meds Do not confuse dosage strength with total volume in container. Calculations are performed in the same manner as for solid forms of medicines. NURSING APPLICATION: What is the best way to administer Ms. Jackson's medication? Copyright line.

Packaging of Parenteral Medications (p. 310) Ampules Sealed glass container designed to hold single dose Designed to snap open at neck Use SEALED alcohol wipe (not wet wipe) or gauze to hold while snapping Withdraw meds with filter needle to prevent aspiration of tiny glass shards, if indicated by institutional policy Insert needle to base of ampule and withdraw medication; avoid touching rim with needle Vials are a closed system, ampules are not. NURSING APPLICATION: How should the nurse maintain safety for her/himself while giving medications from a glass ampule? Copyright © 2011 by Elsevier Inc. All rights reserved.

Packaging of Parenteral Medications (cont’d) (p. 310) Vial Plastic or glass with rubber stopper affixed with a capped aluminum band Sterility of rubber stopper not guaranteed; wipe first with alcohol Single dose or multi-dose May require reconstitution Injection of air equal to amount to be withdrawn facilitates removal of solution—DO NOT OVERFILL Draw up only amount of solution needed for dose Avoid finger sticking; never re-cap a used needle. It is important to note that for both single-dose vials and ampules, a little extra medication is present; it is most important to measure the amount of medication carefully. NURSING APPLICATION: Ms. Jackson's family member saw the nurse putting air into a vial before withdrawing medication for the vial. Explain how that air will not reach Ms. Jackson. Copyright © 2011 by Elsevier Inc. All rights reserved.

Calculating Parenteral Doses (p. 330) Use same rules and methods as for oral calculations Convert if necessary 3-mL syringe: calculate to hundredths, round to nearest tenth 1-mL syringe: calculate to thousandths, round to nearest hundredth NEVER round to the whole number Insulin is given in UNITS. When the dosage for parenteral administration exceeds recommended guidelines for amount of medication to be injected in one area, the dosage should be questioned, and the calculation should be double-checked (p. 331). NURSING APPLICATION: What volume of medication, if given parenterally, would be recommended for Ms. Jackson? Why? Copyright © 2011 by Elsevier Inc. All rights reserved.