Chapter 36

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Chapter 36

Calculation of Medication Dosage and Medication Administration


Legal and Ethical Implications of Medication Administration

• Laws vary from state to state

• Knowledgeable about drugs administered and effects drug(s) may or will have

• Ethical considerations– Using drugs for personal benefit (illegal)– Proper authorization



• The medication order– Given by provider

• The prescription– Written legal document that gives directions for

compounding, dispensing, administering medication to patient

– Nine parts



• The prescription– Purpose: control sale and use of drugs – Two types of medicines

• Prescription (legend)• Over-the-counter (OTC)



• The prescription– E-prescribing: electronically accessing patient’s

medical history, prescribing medication, selecting pharmacy

– HIPAA e-prescribing standards– Prescriptions for controlled substances



• The prescription– Prescription abbreviations and symbols– Medical shorthand is international language – The Joint Commission’s “Do Not Use” list


Drug Dosage

• Amount of medicine prescribed– Age– Weight– Sex– Other factors– Pediatric considerations


Medication Label

• Trade or brand name for medication

• Generic name

• National Drug Code (NDC) numbers

• Dosage strength

• Usual dosage; frequency of administration

• Route of administration

• Precautions and warnings

• Expiration date


Calculation of Drug Dosages

• Incorrectly calculated or measured dosages leading cause of error in administration of medications

• Drug error violation of a patient’s rights

• E-prescribing reduces number of errors

• Bar codes results in far fewer errors

• Simplify look-alike labels and packaging



• Understanding ratio– Ratio expressed as a quotient– Ratio expressed as a fraction– Ratio expressed as a decimal

• Understanding proportion– Expresses relationship between two ratios– Means and extremes– Solving for X



• Weights and measures– Metric system guidelines– The seven common metric prefixes

• Micro-• Milli-• Centi-• Deci-• Deka-• Hecto-• Kilo-



• Weights and measures– Fundamental units of metric system– Household measurements– Metric system conversion

• Moving the decimal in correct direction• Proportional method for converting metric equivalents


Medications Measured in Units

• How to calculate unit dosages– Proportional method– Formula method

• Insulin– Hormone secreted by pancreas– Necessary for proper metabolism of blood glucose

and maintenance of blood sugar level – Individualized needs and treatment



• Diabetes– Type 1: insulin-dependent diabetes mellitus

(IDDM)– Type 2: noninsulin-dependent diabetes mellitus

(NIDDM)– Type 3: gestational diabetes– Type 4: other types of diabetes



• Diabetes– Importance of exact dosage of insulin– Precautions to observe when administering insulin– Oral hypoglycemic medication


Calculating Adult Dosages

• Weight– Milliequivalent (mEq)– Microgram (mcg)– Milligram (mg)– Gram (Gm, g)– Unit


Calculating Adult Dosages

• Volume– Milliliter (mL)– Minim (m)– Dram (dr)– Ounce (oz)– Variety of household measures

• Proportional method

• Formula method


Calculating Children’s Dosages

• Young’s, Clark’s, Fried’s rules replaced by more exact methods

• Kilogram of body weight

• BSA– Most accurate method of calculating medication

dosages for infants and children up to 12 years of age

– Nomogram estimates BSA according to height/weight


Administration of Medications

• Follow basic guidelines

• “Six rights” of proper drug administration– Right drug– Right dose– Right route– Right time– Right patient– Right documentation



• Please refer to the video library on the Instructor Resources CD to view video “Medication Errors, Documentation and Administration.”



• Medication errors– Recognize error has been made– Stay calm– Report error immediately to provider– Follow provider’s order for correcting error– Document error



• Patient assessment– Age– Physical conditions– Body size– Sex

• Build• Skin texture

– Injection site• Sites to be avoided


Administration of Oral Medications

• Equipment and supplies for oral medications– Medicine cup, water cup, medicine dropper


Administration of Parenteral Medications

• Parenteral routes– Subcutaneous– Intramuscular– Intradermal

• Unit dose forms– Ampule– Cartridge-needle unit– Vial


Administration ofParenteral Medications

• Hazards associated with parenteral medications– Sterile technique must be used– Allergic reaction swift– Injury to bone, nerve, blood vessel– Breaking of needle in tissue (rare)– Injecting into blood vessel instead of tissue



• Reasons for parenteral route selection– Rapid response time to medication– Accuracy of dosage– Need to concentrate medication in specific body

part or area



• Reasons for parenteral route selection– Inability to administer orally; medication destroyed

by gastric juices or patient incapable of taking medication orally

– Liquid or powder form– Expressed in terms of volume– Ordered by weight and volume


Parenteral Equipment and Supplies

• Syringes– Disposable– Non-disposable– Combination disposable/nondisposable cartridge-

injection– Classified according to intended use



• Please refer to the video library on the Instructor Resources CD to view video “Cartridge Injection System.”



• Parts of a syringe– Barrel– Plunger– Flange– Tip– Safety shield



• Parts of a needle– Disposable and

nondisposable• Point • Bevel• Lumen• Shaft• Hub• Hilt• Sheath



• Safe disposal of needles and syringes– Rigid, puncture-proof container – Never recap needle after giving injection– Engage safety feature– Most needlesticks occur while recapping– Sharps collector systems



• Please refer to the video library on the Instructor Resources CD to view video “Needle Sticks & Safety.”


Principles of Intravenous Therapy

• Patient needs, conditions, diseases

• Patient safety• Complications• Types of solutions• Legal considerations

Basic IV Administration Set >>


Site Selection and Injection Angle





• Marking the correct site for intramuscular injection– Dorsogluteal site– Ventrogluteal site– Deltoid muscle– Vastus lateralis site


Basic Guidelines forAdministration of Injections

• Please refer to the video library on the Instructor Resources CD to view video “Injections.”


Z-Track Method ofIntramuscular Injection

• Similar to intramuscular injection, except skin pulled to side before needle insertion

• Given to avoid irritation to subcutaneous tissues– Imferon example of medication given by this route


Z-Track Method ofIntramuscular Injection

• Please refer to the video library on the Instructor Resources CD to view video “Z Track Method.”


Administration of Allergenic Extracts

• MAs may administer allergenic extracts– Always follow guidelines– Have emergency equipment and supplies

available– Allergic reactions: observe patient for 20-30

minutes after administration


Administration of Inhaled Medications

• Inhalation therapy– Administration of medicines; water vapor; gases

as oxygen, carbon dioxide, helium– Inhaler may be used to deliver medication to lungs

• Implications for patient care– Instructed to follow prescribed medication regimen– Contraindications


Administration of Inhaled Medications

• Administration of oxygen– Hypoxemia– Oxygen tanks– Dosage– Methods of oxygen

delivery– Oxygen safety

precautions

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Chapter 36

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