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Chapter 51 Drug Administration Medical Assisting
PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson
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Learning Outcomes 51.1 Discuss your responsibilities regarding drug administration. 51.2 Perform dosage calculations accurately. 51.3 Describe how to assess the patient before administering any drug. 51.4 Identify the seven rights of drug administration.
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Learning Outcomes (cont.)
51.5 Describe the various techniques of drug administration. 51.6 Compare different types of needles and syringes. 51.7 Explain how to administer an intradermal, subcutaneous, or intramuscular injection.
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Learning Outcomes (cont.)
51.8 Explain what information you need to teach the patient about drug use, interactions, and adverse effects. 51.9 Describe special considerations related to drug administration. 51.10 Describe nonpharmacologic ways to manage pain.
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Introduction Drug administration is very important and can be a dangerous duty Given correctly – restore patient to health Given incorrectly – patient’s condition can worsen Medical assistant must Understand principles of pharmacology Understand fundamentals of drug administration Routes Dosage calculations Techniques for injection Seven rights Patient education You should be familiar with the medications frequently prescribed in your practice.
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Drug Administration and Scope of Practice
States’ medical practice acts define medical assistants’ exact duties Know your scope of practice in the state where you will work
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Dosage Calculations Measurement systems
Metric Apothecaries Household Most doctors use the metric system
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Dosage Calculations (cont.)
Basic units of volume and weight Metric system Liter (L) – volume Grams (g) – weight Apothecaries’ system Fluidounces, fluidram, pints, quarts – volume Pounds – weight Household system Drops, teaspoons, tablespoons, ounces, cups, pints, gallons, quarts – volume
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Dosage Calculations (cont.)
Conversions between systems Approximate equivalents Charts Calculations Ratio method Fraction method
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Dosage Calculations: Formula Method
Desired dose Dose on hand The physician orders aspirin, 10 grains On hand are 5-grain aspirins 10 grains 5 grains × Quantity of dose on hand × 1 tablet = 10/5 or 2 tablets
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Dosage Calculations: Formula Method (cont.)
Work these problems: The physician has ordered ampicillin 500 mg, on hand 250 mg capsules. How much would you give? You have 50 mg metropolol as a scored tablet on hand and the doctor tells you to give 25 mg. How much would you give? 2 capsules ½ tablet
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Dosage Calculations: Ratio Method
Doctor orders 500 mg of ampicillin. You have 250 mg on hand. Set up a ratio with the unknown number of capsules needed and the amount of drug ordered X:500 mg Set up a ratio with a single capsules and the amount of drug in a single capsule 1 tab:250 mg Create a proportion, multiply the outer and then the inner parts, and solve for X X:500 mg :: 1cap:250 mg Answer = 2 capsules
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Dosage Calculations: Fraction Method
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 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 mg x = cap Solve for X = 3 capsules
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Dosage Calculations: Pediatric and Geriatric
Metabolism and absorption altered Require precise calculations BSA – body surface area Weight
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Apply Your Knowledge Which measuring system is used by most physicians? ANSWER: Most doctors use the metric system when working with pharmacology principles. Convert 25 grams to milligrams. ANSWER: Add a decimal point to the measurement: 25. g Add 3 zeros so you can move the decimal point three places to the right: g Move the decimal point to the right three places: 25,000 Change the unit: 25,000 mg
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Apply Your Knowledge 3 for 3! Very Good!
Calculate the dose to give for 500 mg Augmentin®. ANSWER: 20 mL 3 for 3! Very Good!
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Preparing to Administer a Drug
Drugs Local effect – applied directly to skin, tissue, or mucous membranes Systemic effect – given by routes that allow the drug to be absorbed or distributed into the bloodstream Pay close attention Dose Route Form of medication Medical assistant Close attention to detail Strong patient assessment skills Expert technique
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Preparing to Administer a Drug (cont.)
Assessment Injection site Drug allergies Patient condition – be alert to changes that can affect drug therapy Consent forms
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Preparing to Administer a Drug (cont.)
Rules for administration Give only drugs the doctor orders – use drug reference, if necessary Wash your hands Prepare in a well-lit area Focus on task; avoid distractions Calculate the dose carefully Do not leave a prepared drug unattended – never give a drug that someone else has prepared
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Preparing to Administer a Drug (cont.)
Rules for administration Identify patient properly Physician should be in the office Observe patient following administration Discard any ungiven medications properly Report error to physician immediately Document properly
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Preparing to Administer a Drug (cont.)
Seven Rights of Drug Administration Right patient Right drug Right dose Right time Right route Right technique Right documentation
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Apply Your Knowledge Right!
How do you properly identify the patient before administering a drug? ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth. Right!
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Techniques for Administering Drugs
Oral Tablets, capsules, lozenges, and liquids Slower absorption through GI tract Buccal or sublingual Buccal – placed between the cheek and gum Sublingual – placed under the tongue Faster absorption; bypasses GI tract
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Techniques for Administering Drugs (cont.)
Parenteral Administration of substance into a muscle or vein Fast absorption; bypasses GI tract Safety risks Rapid administration; rapid action Exposure to bloodborne pathogens Methods of injection Intradermal (ID) Subcutaneous (SC) Intramuscular (IM) Intravenous (IV)
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Techniques for Administering Drugs (cont.)
Needles Available in different gauges – the smaller the number, the larger the gauge (inside diameter) Length – long enough to penetrate the appropriate layers of tissue Syringes Barrel Plunger With or without needle Calibrated in milliliters or units
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Techniques for Administering Drugs (cont.)
Parenteral drug 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
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Techniques for Administering Drugs (cont.)
Methods of injection Intradermal Into upper layer of skin Used for skin tests Subcutaneous Provides slow, sustained release and longer duration of action Rotate sites Intramuscular More rapid absorption Less irritation of tissue Larger amount of drug Z-track method Intravenous Not usually given by medical assistants
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Techniques for Administering Drugs (cont.)
Inhalation – administered through the mouth or nose Topical 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 Eye or ear – creams, ointments, drops, or irrigations
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Apply Your Knowledge Super! Matching:
___ Absorption through GI tract A. Topical drug ___ Under the tongue B. Oral drug ___ Small bottle with rubber diaphragm C. Intramuscular drug ___ Less irritation of tissue D. Subcutaneous drug ___ Direct application to skin E. Sublingual drug ___ Need to rotate sites F. Vial ANSWER: B E F C A D Super!
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Educating the Patient About Drug Administration
How to read the prescription drug label Interactions Drug-drug interactions Drug-food interactions
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Educating the Patient About Drug Administration (cont.)
Adverse effects Report changes Recognize significant adverse effects Instructions on taking the drug At the right time In the right amount Under the right circumstances
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Bravo! Apply Your Knowledge
What should you instruct the patient about regarding drug administration? ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly. Bravo!
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Special Considerations
Pediatric patients Physiology and immature body systems may make the drug effects less predictable Require dosage adjustments and careful measurements of doses Observe pediatric patients closely for adverse effects and interactions Administration sites and techniques may differ
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Special Considerations (cont.)
Pregnant patients Remember that you are caring for two patients Giving the mother a drug also gives it to the baby Check drug information sources for pregnancy drug risk categories
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Special Considerations (cont.)
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 information sources for contraindication during lactation
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Special Considerations (cont.)
Elderly patients Age-related changes affect Absorption Metabolism Distribution Excretion May have increased risk of Drug toxicity Adverse effects Lack of therapeutic effects
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Special Considerations (cont.)
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
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Fantastic! Apply Your Knowledge
What do children and the elderly have in common in relation to drug administration? ANSWER: Both have alterations in metabolism and absorption of drugs requiring adjustments in dosages. Fantastic!
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Charting Medications Progress notes Be sure to have the right chart
Administration Special problems New symptoms Patient’s statements Patient tolerance Be sure to have the right chart Be specific and accurate
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Nonpharmacologic Pain Management
Biofeedback – evokes relaxation; helps block pain perception Guided imagery – patient envisions being in a calm, nurturing place; promotes relaxation Relaxation exercises – breathing techniques
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helps block pain perception
Apply Your Knowledge I M P R E S V ! You administer a medication to Mr. Max. What and where should you chart? ANSWER: You should chart in the progress notes the date, time, dosage, route, and name of the medication, as well as how well the patient tolerated it. True or false: ___ Biofeedback involves special breathing techniques . ___ Audiotapes can be used with guided imagery. ___ Relaxation exercises are used to relax different muscle groups. ANSWER: helps block pain perception F T T
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In Summary Medical assistant Administer drugs safely and effectively
Conversions and calculations Patient assessment Observe general rules Follow seven rights of drug administration Be aware of patients needing special considerations Be aware of nonpharmacologic methods for managing pain control
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End of Chapter 51 Words are the most powerful drug used by mankind.
~Rudyard Kipling
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