1. Medical Assisting Review Passing the CMA, RMA, and NHA Exams Fourth Edition © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 19 Administration of Medication

2. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-2 Drug Classifications Based on form –Liquid Aerosol Elixir Emulsion Liniment Lotion Spirit Spray Syrup Tincture

3. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-3 Drug Classifications –Solid Capsule Cream Ointment Suppository Tablet

4. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-4 Measuring Medication Systems of Measurement –Metric Most commonly used Most accurate Easiest –Apothecaries’ system Older Less accurate Only units used in administration of medication are based on volume

5. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-5 Conversions Between Systems of Measurement Conversion chart – gives approximate equivalents. Use great care when using a conversion chart.

6. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-6 Conversions Between Systems of Measurement Ratio method: to convert aspirin grains x to metric measurement, follow these steps: –Set up the first ratio: unknown quantity : known quantity x : 10 grains –Set up the second ratio to show the standard equivalence between the desired unit of measurement (mg) and the given unit of measurement (grains); there are 60 mg in 1 grain, so the second ratio is 60 mg : 1 grain

7. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-7 Conversions Between Systems of Measurement Fraction method: To convert 300 mg of aspirin to an apothecaries’ measure, follow these steps: –Set up a fraction with the known dose as the numerator (on top) and the unknown amount, representing grains, as the denominator (on the bottom): 300 mg x

8. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-8 Conversions Between Systems of Measurement –Set up a fraction with the standard equivalent, making sure that the units of measurement are in the same positions as in the first fraction: 60 mg 1 gr

9. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-9 Conversions Between Systems of Measurement –Set up a proportion with both fractions; in other words, set the two fractions equal to each other: 300 mg= 60 mg x 1 gr –Cross multiply: x × 60 mg = 300 mg × 1 gr –Divide both sides of the equation by 60 mg, and then do the arithmetic x = 5 gr

10. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-10 Calculating Drug Doses Ratio method – amount ordered = 500 mg Amount on hand = 250 mg tablets –Set up a ratio of the unknown quantity to the known quantity x : 500 mg –Set up a ratio of the known conversion equivalence 1 tab : 250 mg

11. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-11 Calculating Drug Doses –Put the ratios into a proportion: x : 500 mg :: 1 tab : 250 gr –Multiply the outer and then the inner parts of the proportion: x × 250 mg = 500 mg × 1 tab –To solve for x, divide both sides of the equation by 250 mg, and then do the arithmetic: x = 2 tabs

12. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-12 Calculating Drug Doses Fraction method – amount ordered = 30 mg of a drug that comes in 10 mg capsules –Set up a fraction with the dose ordered and the unknown number of capsules 30 mg x

13. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-13 Calculating Drug Doses –Set up a fraction with the known conversion equivalence. Make sure that the units of measurement are in the same position as in the first fraction: 10 mg 1 cap –Set the two fractions equal to each other: 30 mg = 10 mg x 1 cap

14. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-14 Calculating Drug Doses –Cross multiply: x × 10 mg = 30 mg × 1 cap –To solve for x, divide both sides by 10 mg, and then do the arithmetic x = 3 caps

15. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-15 Pediatric Dosage Calculations Clark's Rule weight of child × adult dose = child’s dose 150 lbs Fried’s Rule age of child in months × average adult dose = child’s dose 150 lbs

16. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-16 Methods of Administering Medications “Seven rights” of drug administration –Right patient –Right drug –Right dose –Right time –Right route –Right technique –Right documentation

17. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-17 Methods of Administering Medications Route of administration –Oral –Sublingual –Buccal –Inhalation –Topical –Transdermal –Rectal

18. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-18 Methods of Administering Medications –Urethral –Vaginal –Parenteral –Intradermal injection –Subcutaneous injection –Intramuscular injection –Intravenous –Ophthalmic –Optic

19. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. An Intradermal Injection 19-19

20. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-20 Needles and Syringes

21. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-21 Needles and Syringes Needle gauge – the inside diameter of the needle; a larger gauge indicates a smaller diameter Needle length – ranges between 3/8 inch and 3 inches

22. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-22 Needles and Syringes

23. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-23 Needles and Syringes Syringe –Available in 2, 2.5, 3, and 5 cc sizes –Insulin syringe –Tuberculin syringe –Prefilled syringe

24. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-24 Choosing a Needle

25. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-25 Medication Orders Directive issued by a physician telling a healthcare worker which drug to administer Prescription pads – used to write medication orders for outpatients

26. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-26 Medication Orders Components of a medication order –Patient’s name, date of order, name of drug, dosage, route of administration, time and frequency, physician’s signature, number of refills, quantity, physician’s DEA number

27. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-27 Types of Drug Orders Routine order – administer until discontinuation order is written or until specified termination date is reached Standing order – specifies condition for which the drug is to be administered PRN order – drug is given as needed Stat order – single order that is administered immediately

28. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-28 Setting Up Medications Always follow the “seven rights” Wash hands and avoid touching drugs if possible Tablets –Use a knife or pill cutter to divide –Do not open packet until time of administration –Pour into a medicine cup –Some tablets may be crushed; check first

29. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-29 Setting Up Medications Liquid medications –Remove cap and place upside down –Palm label when pouring –Place medication cup on flat surface

30. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-30 Recording Medication Administration Kardex file – card file system for quick reference of patient needs Medicine card – one medicine card for each type of drug the patient is to receive; includes patient’s name, bed number, room number, name of drug, dose, route, and time of administration

31. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-31 Recording Medication Administration Medication administration record (MAR) – complete record, including schedule for all medications a patient needs Patient chart (medical record) – all events related to the treatment of a patient are recorded here; this is a permanent record

32. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-32 Vaccinations Immunization – the process of rendering a patient immune to disease Artificial immunity – produced by the administration of vaccines or other forms of immunization Vaccines –Made from dead or harmless infectious agents

33. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-33 Vaccinations –Trigger the immune response to make antibodies against a particular disease- causing agent

34. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-34 Vaccinations

35. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-35 Vaccinations

36. McGraw-Hill © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19-36 Vaccinations Optional vaccines for special circumstances –Rabies –Hepatitis A –Meningitis –Pneumonia –Typhoid fever –Cholera –Tuberculosis