Lecture Medical assisting: Administrative and clinical procedures with anatomy and physiology (4e) – Chapter 51

Learning Outcomes cont.51.8 Outline information needed to teach a patient about drug use, interactions, and adverse effects.. Rules for Drug Administration• Give only drugs the doctor o

Drug Administration

Learning Outcomes

51.1 Identify your responsibilities regarding drug

administration.

51.2 Execute dosage calculations accurately.

51.3 Check the patient before administering any

drug

51.4 Identify the rights of drug administration.

Learning Outcomes (cont.)

51.5 Describe the various techniques of drug

administration.

51.6 Differentiate different types of needles and

syringes.

51.7 Demonstrate how to administer an

intradermal, subcutaneous, or intramuscular injection.

Learning Outcomes (cont.)

51.8 Outline information needed to teach a

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

• Patient education

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

Dosage Calculations (cont.)

• Basic units of volume and weight for:

• Household system

– Drops, teaspoons, tablespoons, ounces, cups, pints, gallons, quarts – volume

Dosage Calculations (cont.)

• Conversions between systems

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

Formula Method (cont.)

Work these problems:

1 The physician has ordered ampicillin 500 mg, on hand

250 mg capsules How much would you give?

2 You have 50 mg metoprolol as a scored tablet on hand

and the doctor tells you to give 25 mg How much would you give? 2 capsules

½ tablet

Ratio Method

1 Doctor orders 500 mg of ampicillin You have

250 mg capsules on hand

2 Set up a ratio with the unknown number of

capsules needed and the amount of drug ordered X:500 mg

3 Set up a ratio with a single capsule and the

amount of drug in a single capsule 1 tab:250 mg

4 Create a proportion, multiply the outer and

then the inner parts, and solve for X

X:500 mg :: 1cap:250 mg

Answer = 2 capsules

3. Set the second fraction

with the amount of drug

1. The doctor orders 30 mg

of Adalat Each capsule

contains 10 mg

2. Set up the first fraction

with the dose ordered

and the unknown number

of capsules

30 mgx

Solve for X = 3 capsules

Fraction Method

Pediatric and Geriatric Considerations

• Metabolism and absorption altered

• Require precise calculations

– BSA – body surface area

– Weight

Apply Your Knowledge

1. Which measuring system is used by most

physicians?

ANSWER: Most doctors use the metric system when working

with pharmacology principles.

2. Convert 25 grams to milligrams.

ANSWER:

1 Add a decimal point to the measurement: 25 g

2 Add 3 zeros so you can move the decimal point three places

to the right: 25.000 g

3 Move the decimal point to the right three places: 25,000

4 Change the unit: 25,000 mg

Apply Your Knowledge

3 Calculate the dose to give for 500 mg

Augmentin®. ANSWER:

20 mL

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

Preparing to Administer a Drug (cont.)

– Consent forms

Rules for Drug 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

Rules for Drug Administration (cont.)

• 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

Rights of Drug Administration

– Right to refuse – Right reason

Apply Your Knowledge

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.

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

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 blood-borne pathogens

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

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

Techniques for Administering Drugs (cont.)

• Methods of injection

– Intradermal (ID)

• Into upper layer of skin

• Used for skin tests

• More rapid absorption

• Less irritation of tissue

• Larger amount of drug

• Z-track method

– Intravenous (IV)

• Not usually given by medical assistants

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

Apply Your Knowledge

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

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

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!

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

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

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

Special Considerations (cont.)

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

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!

• Be sure to have the right chart

• Be specific and accurate

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

Apply Your Knowledge

1 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

2 True or false:

_ Biofeedback involves special breathing techniques.

_ Audiotapes can be used with guided imagery.

_ Relaxation exercises are used to relax different muscle

In Summary

51.1As a medical assistant, you must be able administer or

assist with administering medications by various routes, perform drug dosage calculations accurately, and provide patient education as necessary

51.2Dosage calculations must be done accurately using

the formula, ratio, or fraction method If you are unsure

of your calculation results, you should double-check yourself, check with a coworker, or ask the physician

In Summary (cont.)

51.3Before administering a medication, assess the patient

for allergies; evaluate any drug-drug interactions; and check all injection sites for abnormalities Additionally, you should be aware of the patient’s condition and

have the patient sign a consent form if necessary

51.4The rights of drug administration include the right

patient, right drug, right dose, right time, right route, right technique, right documentation, right to know, and right to refuse

In Summary (cont.)

51.5You may be asked to assist or administer medications

by any of the following routes: oral, buccal, sublingual, intradermal, intramuscular, intravenous, inhalation,

eye, ear, rectal, subcutaneous, sublingual, topical, transdermal, urethral, and vaginal Your responsibilities will vary based upon the facility where you practice

You should be familiar with the routes and medications used at your facility

51.6Needles vary in length from ½ to 3 inches They vary

in gauge (diameter) from 18 to 26; the smaller the number, the larger the diameter of the needle

In Summary (cont.)

51.7 The three most common injection routes are

intradermal, subcutaneous, and intramuscular All injections are given using aseptic technique

Intradermal (ID) injections are administered between the upper layers of skin and create a wheal

Subcutaneous (sub-Q) injections are administered just under the skin

Intramuscular (IM) injections are administered into a muscle

In Summary (cont.)

51.8 Patients should be aware of possible interactions and

taught to report all medications including OTC, supplements, and herbal remedies They should know how to read the prescription label and in some cases the package insert Patients should be aware of the possible adverse effects of medications and what and when to report them to the health-care facility

In Summary (cont.)

51.9Pediatric and geriatric patients require extreme care

when calculating doses due to the differences in how their bodies absorb, metabolize, eliminate, and

distribute the medications Treat pediatric patients with special care and communication to make the

experience as positive as possible Restraining may

be necessary

Checking medications given to pregnant and breastfeeding patients for possible adverse effects is essential Being considerate to patient’s cultural

differences is also part of a medical assistant’s role

In Summary (cont.)

51.10 To avoid the overuse or abuse of pain medications,

other types of pain therapy have gained popularity

Some examples include biofeedback, guided imagery, and relaxation exercises

End of Chapter 51

Words are the most powerful drug used by mankind.

~Rudyard Kipling