Bài giảng Clinical procedures - Chapter 20: Drug Administration

20Drug Administration20-*Learning Outcomes20.1 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.20-*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.20-*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. 20-*Introduction Drug administration is very important and can be a dangerous duty Given correctly – restore patient to healthGiven incorrectly – patient’s condition can worsenMedical assistant mustUnderstand principles of pharmacologyUnderstand fundamentals of drug administrationRoutesDosage calculationsTechniques for injectionRights of medication administrationPatient education You should be familiar with the medications frequently prescribed in your practice.20-*Drug Administration and Scope of PracticeStates’ medical practice acts define medical assistants’ exact dutiesKnow your scope of practice in the state where you will work20-*Dosage CalculationsMeasurement systemsMetricApothecariesHousehold TJC recommends usingmetric units20-*Dosage Calculations (cont.)Basic units of volume and weight for: Metric systemLiter (L) – volume Grams (g) – weight Apothecaries’ systemFluid ounces, fluid drams, pints, quarts – volumePounds – weight Household system Drops, teaspoons, tablespoons, ounces, cups, pints, gallons, quarts – volume 20-*Dosage Calculations (cont.)Conversions between systemsApproximate equivalentsCharts Calculations Ratio methodFraction method20-*Formula Method Desired doseDose on handThe physician orders aspirin, 10 grains On hand are 5-grain aspirins10 grains 5 grains× Quantity of dose on hand× 1 tablet = 10/5 or 2 tablets20-*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 metoprolol as a scored tablet on hand and the doctor tells you to give 25 mg. How much would you give?2 capsules½ tablet20-*Ratio MethodDoctor orders 500 mg of ampicillin. You have 250 mg capsules 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 capsule and the amount of drug in a single capsule 1 tab:250 mgCreate a proportion, multiply the outer and then the inner parts, and solve for X.  X:500 mg :: 1cap:250 mgAnswer = 2 capsules20-*Set the second fraction with the amount of drug in a capsule10 mg 1 capThen use both fractions in a proportion: 30 mg 10 mg x = 1 capThe 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 capsules30 mgxSolve for X = 3 capsulesFraction Method20-*Pediatric and Geriatric ConsiderationsMetabolism and absorption alteredRequire precise calculationsBSA – body surface areaWeight20-*Apply Your KnowledgeWhich 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. gAdd 3 zeros so you can move the decimal point three places to the right: 25.000 gMove the decimal point to the right three places: 25,000Change the unit: 25,000 mg20-*Apply Your KnowledgeCalculate the dose to give for 500 mg Augmentin®.ANSWER: 20 mL3 for 3!Very Good!20-*Preparing to Administer a DrugDrugs Local effect – applied directly to skin, tissue, or mucous membranesSystemic effect – given by routes that allow the drug to be absorbed or distributed into the bloodstreamPay close attentionDoseRoute Form of medication Medical assistantClose attention to detailStrong patient assessment skillsExpert technique20-*Preparing to Administer a Drug (cont.)Assessment Injection siteDrug allergiesPatient condition – be alert to changes that can affect drug therapyConsent forms20-*Rules for Drug AdministrationGive only drugs the doctor orders – use drug reference, if necessaryWash your handsPrepare in a well-lit areaFocus on task; avoid distractionsCalculate the dose carefullyDo not leave a prepared drug unattended – never give a drug that someone else has prepared20-*Rules for Drug Administration (cont.)Identify patient properlyPhysician should be in the officeObserve patient following administrationDiscard any ungiven medications properlyReport error to physician immediatelyDocument properly20-*Rights of Drug AdministrationBasic rightsRight patientRight drugRight doseRight timeRight routeAdditional rightsRight techniqueRight documentationRight to knowRight to refuseRight reason20-*Apply Your KnowledgeHow 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!20-*Techniques for Administering DrugsOralTablets, capsules, lozenges, and liquidsSlower absorption through GI tractBuccal or sublingual Buccal – placed between the cheek and gumSublingual – placed under the tongue Faster absorption; bypasses GI tract 20-*Techniques for Administering Drugs (cont.)Parenteral Administration of substance into a muscle or vein Fast absorption; bypasses GI tractSafety risksRapid administrationRapid actionExposure to blood-borne pathogens20-*Techniques for Administering Drugs (cont.)NeedlesAvailable in different gauges – the smaller the number, the larger the gauge (inside diameter)Length – long enough to penetrate the appropriate layers of tissueSyringesBarrelPlungerWith or without needleCalibrated in milliliters or units20-*Techniques for Administering Drugs (cont.)Parenteral drug packagingAmpule – glass or plastic container that is sealed and sterile (open with care)Cartridge – small barrel prefilled with sterile drugVial – small bottle with rubber diaphragm that can be punctured by needle20-*Techniques for Administering Drugs (cont.)Methods of injectionIntradermal (ID)Into upper layer of skinUsed for skin testsSubcutaneous (sub-q)Provides slow, sustained release and longer duration of actionRotate sites Intramuscular (IM)More rapid absorptionLess irritation of tissueLarger amount of drugZ-track methodIntravenous (IV)Not usually given by medical assistants20-*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 evenlyUrethral – instill liquid drugs directly into the bladderVaginal and rectal Eye or ear – creams, ointments, drops, or irrigations20-*Apply Your KnowledgeMatching:___ 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. VialANSWER:FEDCBASuper!20-*Educating the Patient about Drug AdministrationHow to read the prescription drug label InteractionsDrug-drug interactionsDrug-food interactions20-*Educating the Patient about Drug Administration (cont.)Adverse effectsReport changes Recognize significant adverse effectsInstructions on taking the drug At the right timeIn the right amountUnder the right circumstances20-*Apply Your KnowledgeWhat 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!20-*Special ConsiderationsPediatric patients Physiology and immature body systems may make the drug effects less predictableRequire dosage adjustments and careful measurements of dosesObserve pediatric patients closely for adverse effects and interactionsAdministration sites and techniques may differ20-*Special Considerations (cont.)Pregnant patients Remember that you are caring for two patients Giving the mother a drug also gives it to the babyCheck drug information sources for pregnancy drug risk categories20-*Special Considerations (cont.)Patients who are breast-feedingSome drugs are excreted in breast milkIngestion can be dangerous because baby can’t metabolize or excrete drugsCheck drug information sources for contraindication during lactation20-*Special Considerations (cont.)Elderly patientsAge-related changes affect AbsorptionMetabolismDistributionExcretionMay have increased risk ofDrug toxicityAdverse effects Lack of therapeutic effects20-*Special Considerations (cont.)Patients from different culturesCan affect a patient’s understanding of drug therapy and compliance with itObtain drug information sheets in the languages that are commonly spoken by patients in your office20-*Apply Your KnowledgeWhat 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! 20-*Charting MedicationsProgress notesAdministration Special problemsNew symptomsPatient’s statementsPatient toleranceBe sure to have the right chartBe specific and accurate20-*Nonpharmacologic Pain ManagementBiofeedback – evokes relaxation; helps block pain perception Guided imagery – patient envisions being in a calm, nurturing place; promotes relaxationRelaxation exercises – breathing techniques20-*Apply Your KnowledgeYou 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.FTThelps block pain perceptionANSWER:IMPRESSIVE!20-*In Summary20.1 As 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.20.2 Dosage 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. 20-*In Summary (cont.)20.3 Before 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.20.4 The 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.20-*In Summary (cont.)20.5 You 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.20.6 Needles 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. 20-*In Summary (cont.)20.7 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. 20-*In Summary (cont.)20.8 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. 20-*In Summary (cont.)20.9 Pediatric 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.20-*In Summary (cont.)20.10 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.20-*End of Chapter 20Words are the most powerful drug used by mankind.~Rudyard Kipling