Lecture Clinical procedures for medical assisting (4/e): Chapter 20 – Booth, Whicker, Wyman

CHAPTER

20
Drug Administration

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20­2

Learning Outcomes
20.1 Identify your responsibilities regarding drug
administration.
20.2 Execute dosage calculations accurately.
20.3 Check the patient before administering any
drug.
20.4 Identify the rights of drug administration.

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20­3

Learning Outcomes (cont.)
20.5 Describe the various techniques of drug
administration.
20.6 Differentiate different types of needles and
syringes.
20.7 Demonstrate how to administer an
intradermal, subcutaneous, or intramuscular
injection.

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20­4

Learning Outcomes (cont.)
20.8 Outline information needed to teach a
patient about drug use, interactions, and
adverse effects.
20.9 Describe special considerations related to
drug administration.
20.10 Describe nonpharmacologic ways to
manage pain.

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20­5

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
• Rights of medication
administration
• Patient education

You should be familiar with the medications frequently prescribed
in your practice.
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20­6

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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20­7

Dosage Calculations
• Measurement systems
– Metric
– Apothecaries
– Household

• TJC recommends using
metric units

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20­8

Dosage Calculations (cont.)
• Basic units of volume and weight for:
• Household system
• Metric system
– Liter (L) – volume
– Grams (g) – weight

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

• Apothecaries’ system
– Fluid ounces, fluid drams, pints, quarts –

volume
– Pounds – weight
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20­9

Dosage Calculations (cont.)
• Conversions between systems
– Approximate equivalents
– Charts
– Calculations
• Ratio method
• Fraction method

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20­10

Formula Method
Desired dose × Quantity of dose on hand
Dose on hand
The physician orders aspirin, 10 grains
On hand are 5-grain aspirins
10 grains × 1 tablet = 10/5 or 2 tablets
5 grains

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20­11

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 capsules

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?
½ tablet
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20­12

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
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20­13

Fraction Method
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 mg
x

3.

Set the second fraction
with the amount of drug
in a capsule
10 mg
1 cap

4.

Then use both fractions
in a proportion:
30 mg
10 mg
x
= 1 cap

Solve for X = 3 capsules

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20­14

Pediatric and Geriatric Considerations
• Metabolism and absorption altered
• Require precise calculations
– BSA – body surface area
– Weight

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20­15

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

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20­16

Apply Your Knowledge
3. Calculate the dose to give for 500 mg
Augmentin®.
ANSWER:
20 mL

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20­17

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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20­18

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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20­19

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

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20­20

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

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20­21

Rights of Drug Administration
• Basic rights
– Right patient
– Right drug
– Right dose
– Right time
– Right route

• Additional rights
– Right technique
– Right documentation
– Right to know
– Right to refuse
– Right reason

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


20­22

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.

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20­23

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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20­24

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

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20­25

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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