2. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-1 Math and Dosage Calculations for Health Care Third Edition Booth & Whaley Chapter 4: Equipment for Dosage Measurement

3. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-2 Learning Outcomes Identify equipment used to administer medication. Indicate the appropriate equipment for delivering various types of medicine. Measure medications using the calibrations on the equipment. Describe the method of administration appropriate for each piece of measuring equipment.

4. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-3 Introduction To prepare the correct dosage, it is important to be familiar with and use equipment properly. Accurately read the dosage markings Administration routes Oral Parenteral – bypassing the digestive tract Topical / transdermal Drops, sprays, and mists Vaginal and rectal

5. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-4 Oral Administration Measuring devices are calibrated or marked at varying intervals. Calibrations are used to Measure the amount of liquid in the container Compare to desired dose Match physician’s order units If container and order do not match, convert order to units of measurement to be used.

6. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-5 Oral Administration (cont.) Equipment Medicine cups Droppers Calibrated spoons Oral syringes

7. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-6 Oral Administration (cont.) Medicine cups Measurements from all three systems Metric Household Apothecary Meniscus Curve in the surface of the liquid Measure quantity at the bottom of the curve

8. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-7 Oral Administration (cont.) Rule 4 - 1 Do not use medicine cups for doses less than 5 mL, even if the cup has calibrations smaller than 5 mL. To ensure accuracy use a dropper a calibrated spoon an oral syringe

9. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-8 Droppers Uses Measure and administer small amounts of oral liquid medication Deliver medication to the eyes, ears, and nose Oral pediatric doses Units of measurement vary with dropper Packaged with product Do not interchange droppers

10. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-9 Calibrated Spoons Used with pediatric and elderly patients Administer medication directly into the mouth or into food or beverage

11. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-10 Oral Syringes Used for quantities less than 5 mL Safety features Eccentric tips Tinted Not sterile

12. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-11 Oral Syringes (cont.) Rule 4 – 2 1.Never attach a hypodermic needle to an oral syringe. 2.Never inject an oral dose. 3.In emergencies, you may use a hypodermic syringe without a needle to measure and administer liquid oral doses, but never while its needle is attached.

13. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-12 Oral Administration (cont.) When a patient cannot take medication orally, medications can be administered through a tube to the stomach. Types Nasogastric tube Nasal-small bowel tube PEG tube Jejunostomy tube

14. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-13 Error Alert! Utensil used must provide the calibration needed to accurately measure the dose. Example Which would you select to administer ½ tsp. of a liquid medication?

15. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-14 Practice Determine if the statements below are true. 1.You may use a hypodermic syringe with a needle to measure liquid for oral administration. 2.Oral and hypodermic syringes are identical in appearance. 3.Measuring spoons used for baking are acceptable for measuring liquid medications. False True

16. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-15 Practice 4.Oral medication comes in a bottle labeled 200 mg/5 cc. The dose to be administered is 600 mg. Which of the following is the correct dose? a) 1 tsp b) 2 tsp c) 1 tbsp d) 2 tbsp = 15 mL

17. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-16 Hypodermic Syringes Parenteral administration Administer medications by injection Intravenous (IV) Intramuscular (IM) Intradermal (ID) Subcutaneous (Sub-Q)

18. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-17 Standard Syringes Calibrated in milliliters (mL) Metric system is used most often May be marked in minims Allow for measurement of small doses 3-mL syringe most common

19. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-18 Standard Syringes (cont.) Zero calibration – edge of barrel near needle Leading ring - tip of plunger closest to needle Trailing ring – ring farthest from needle Click to view syringe

20. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-19 Trailing Ring Leading Ring Hypodermic Syringes (cont.) Plunger Leading Ring Trailing Ring Leading Ring Barrel Syringe hub Needle Trailing Ring Leading Ring Plunger

21. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-20 Safety Syringes Same components as standard syringe Safety shields protect needle Reduce the chance of needlestick injury 3 mL syringe with retractable needle

22. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-21 Prefilled Syringes A single, standard dose of medication Use once and discard Usually marked in tenths of a mL Measure the dose carefully Discard any excess medication prior to injection

23. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-22 Prefilled Syringes Rule 4 - 3 Rule 4 - 3 When using a prefilled syringe, always examine the markings to determine whether the syringe is calibrated in milliliters or milligrams and calculate the dose accordingly.

24. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-23 Insulin Syringes (cont.) Used only to measure and administer insulin Calibrated in units Insulin doses order in units U-100 insulin most common form 100 units of insulin per 1 mL Syringes available in 30, 50, and 100 Unit capacities

25. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-24 Insulin Syringes (cont.) 100 Unit Insulin Syringe 50 Unit Insulin Syringe

26. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-25 Insulin Syringes (cont.) Comparison of insulin syringes: 50 unit syringe 100 unit syringe

27. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-26 Insulin Syringes (cont.) Rule 4 - 4 Rule 4 - 4 Never use any type of syringe other than an insulin syringe to measure and administer insulin.

28. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-27 Tuberculin Syringes Used for doses less than 1 mL Calibrated in hundredths of a mL Requires careful measurement Examples: PPD skin test Vaccines Heparin Pediatric medicines Allergen extracts

29. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-28 Tuberculin Syringes (cont.) 1 mL Tuberculin Syringe 0.5 mL Tuberculin Syringe

30. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-29 Tuberculin Syringes (cont.) Comparison of tuberculin syringes: 0.5 mL syringe 1 mL syringe

31. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-30 Syringes for Established IV Lines Used to administer medication and fluids directly into a patient’s vein Uses the injection port of an IV line Advantages Eliminates repeated punctures for the patient Decreased risk of needlestick injuries Compatible drugs can be administered together Enables drug delivery on a periodic basis Enables dilution of the medication

32. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-31 Syringes for Established IV Lines (cont.) Plastic injection tip Injection port on IV line

33. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-32 Large-Capacity Syringes Not all medication can be delivered in doses of 3 mL or less. Syringes with 5 mL, 6 mL, 12 mL are available Volume is measured in milliliters but calibrations between may vary. Look carefully at the marks to measure an accurate amount of medication.

34. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-33 Large-Capacity Syringes (cont.) 10 mL syringe

35. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-34 Error Alert! Pay close attention to the calibration of any syringe you use. Check the marks carefully. Always align the leading ring with calibration.

36. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-35 Ampules, Vials, and Cartridges Cartridge Vial Ampule

37. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-36 Cartridges Prefilled container shaped like a syringe barrel One dose of medication Fits a reusable syringe Examples Tubex ® Carpuject ®

38. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-37 Ampule Sealed container holding one dose of medication Snaps open Use a standard syringe to withdraw the medication

39. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-38 Vials Container covered with a rubber stopper Contain one or more doses of medication Either liquid or powder form of medication that must be reconstituted

40. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-39 Preparing the Syringe Rule 4 - 5 Rule 4 - 5 In most circumstances, the person who prepares a syringe for injection should deliver the injection. Exceptions include: 1.Pharmacy technicians who prefill syringes for nurses, medical assistants, or patients 2.Nurses or medical assistants preparing a syringe for a physician 3.Health-care workers teaching a patient to administer his or her own medication

41. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-40 Needle Gauge and Length Choose appropriate needle for injection Gauge Interior diameter Smaller gauges correspond to larger diameters Use larger needles for more viscous drugs and deeper injections

42. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-41 Needle choice (cont.) Length The injection site determines length. Length must be long enough to reach the desired area of tissue. Length must not be so long that it penetrates beyond the desired area. Needle Gauge and Length (cont.)

43. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-42 Needle Gauge and Length (cont.) Type of InjectionNeedle Gauge Length (inches) for Adults Intradermal25 – 26 Subcutaneous23 – 27 Intramuscular18 – 231 – 2

44. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-43 Practice Identify the parts of this syringe: Barrel Syringe hub Needle Trailing Ring Leading Ring Plunger A. B. C. D. E. F.

45. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-44 Practice You have an order to administer 1.5 mL of a medication. It comes in a 3 mL prefilled syringe. What should you do? ANSWER Carefully check the calibration and discard the excess medication prior to giving the injection. In this case, you would discard 1.5 mL medication. You should NEVER attempt to inject the correct dose without removing the excess medication first.

46. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-45 Topical Medications Gels, creams, ointments, and pastes Apply directly to the skin Use a glove, tongue blade, or cotton-tipped applicator Avoid contact your own skin Wear non-sterile gloves to apply or remove

47. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-46 Transdermal Medications Form of topical medication absorbed through the skin. Use a self-adhesive patch. Place patch on clean, dry, hairless skin with no rash or irritation and with good circulation. Rotate placement sites. Remove older patches and dispose of them properly. Mark each new patch with your initials, the date, and the time.

48. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-47 Transdermal Medications (cont.) Maintain a consistent level of medication in the blood. Bypass GI system. Uses Cardiovascular drugs Hormones Allergy medications Pain medications

49. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-48 Drops, Sprays, and Mists Drops Instillations Nose, eyes, and ears Use the equipment that comes with the drug to administer the medication. Mists Inhaled by patient Vaporizers – water used to create mist Nebulizers and metered dose inhalers (MDIs) Sprays Nose and throat

50. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-49 Vaginal and Rectal Medications Rectal Suppositories Enemas for liquid forms of medication Creams and foams Vaginal Suppositories Tablets Douches for liquid forms of medication Creams and foams

51. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-50 Apply Your Knowledge Which type of delivery device is used to administer medication to the eyes and ears? ANSWER Dropper What instructions should you provide a patient who is starting a new medication delivered by a transdermal patch? ANSWER The patch should be put on clean, dry, hairless skin with no rash or irritation. Placement sites should be rotated. Older patches should be removed and disposes of properly.

52. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-51 Apply your Knowledge What kind of syringe is used to deliver vaccinations? ANSWER Tuberculin

53. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-52 Apply your Knowledge How many mL are indicated on this syringe? ANSWER 1.6 mL

54. © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 4-53 End of Chapter 4 Nothing will work unless you do. ~Maya Angelou