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Administering Medications
aqueous - A waterlike substance; a medication prepared with water asymptomatic - Without symptoms of a disease process bevel - The angled tip of a needle. bronchoconstriction - Narrowing of the bronchiole tubes. edema - An abnormal accumulation of fluid in the interstitial spaces of tissues immunosuppressant - A substance that suppresses or prevents an immune system response immunotherapy - Administration of repeated injections of diluted extracts of a substance that causes an allergy; also called desensitization. induration - An abnormally hard, inflamed area. loading dose - A large dose administered as the first dose of a medication; it usually is used in antibiotic therapy to quickly achieve therapeutic blood levels of the drug
meniscus - The curved surface of liquids in a container polyuria - Excretion of an unusually large amount of urine scored - A term referring to a tablet manufactured with an indentation for division through the center vasodilation - An increase in the diameter of a blood vessel viscosity - The quality of being thick and of lacking the capability of easy movement. wheal - A localized area of edema or a raised lesion To ensure patient safety in drug administration: - the medical assistant must perform certain procedures every time a medication is ordered. First, it is essential that the medical assistant understand the provider's order. Safety starts with a clearly written order that can be easily read and understood. Many times in the clinical setting the provider gives a verbal order for a medication. Patient safety requires that you write down a verbal order and repeat it back to the provider to make sure there are no errors. Ask the provider for clarification if you have any questions about the medication, dose, strength, or route of administration.
- The right patient - The patient should be identified in two ways: by his or her full name and date of birth (DOB). A patient identification number can also be used, but most patients will not know their medical record number
A medical assistant must be familiar with the proper techniques for all routes of administration such as the correct method for giving injections. If you have any doubts about your ability to administer a particular drug, always ask for help.
- The right documentation - Immediately after administering the drug, document the date and time of administration; the drug's name, strength, dose, and route of administration; any reactions the patient has to the medication; and the details of patient education about the drug. Some medications, such as vaccines, also require documentation of the lot number, expiration date, and manufacturer. For parenteral medications, inspect the site of injection before administration for scarring, altered pigmentation, or any other indication of a possible problem with medication absorption. The exact site of administration must be documented. If the patient calls in for a prescription refill, document all pertinent information in the patient's record Additional Safety Steps for Medication Administration -
- Prepare medications in a quiet, well-lit area.
- Pay close attention to all the steps involved in dispensing drugs.
- Never substitute a drug or drug strength. Consult the provider about any discrepancy between the medication ordered and the medication available.
- Store medications as ordered on the package, and return containers to the proper storage area immediately after dispensing the dose.
- The person who administers the medication is responsible for any drug errors. Never administer a medication that you have not personally prepared.
- If ordered to prepare a medication for the provider to administer, place the container with the dispensed drug so that the provider can verify the seven rights.
- The provider should document every medication order in the patient's electronic health record (EHR) before the medication is administered.
- Routinely check expiration dates when verifying the Seven Rights. Properly discard expired drugs.
- Discard medications with damaged labels to avoid errors caused by inaccurate reading of label information.
- If a medication is not administered after it is dispensed, discard it rather than returning it to the container.
- Before administering any medication, ask the patient about drug allergies; these can change over time.
- Patients should be observed for side effects or adverse reactions for up to 30 minutes after administration of a medication. Any reactions must be reported to the provider and documented in the patient's health record.
- Always provide and document patient education about the medication, time of administration, side effects, and so on, when administering a drug. Patients receiving penicillin (a drug with a high incidence of allergic response) or immunotherapy must remain in the office for _____________ minutes after administration in case of an acute anaphylactic reaction - 20 to 30 minutes The provider may order an antihistamine, such as diphenhydramine (Benadryl), if these reactions occur: - Lesser allergic reactions that may occur include hives, swelling, and itching True/False? Patient factors such as age, weight, and height may be used to determine the correct therapeutic dose - True Suggestions for Medication Administration for Children -
- Explain why the medication is needed and how it will make the child feel.
- Attempt to gain cooperation by getting down on the child's level and using a soft but firm voice.
- When possible, offer choices of care, such as "Would you like your medicine in your right leg or your left leg?"
- Divert the child to relieve stressful moments.
- If the child refuses to cooperate, get help as needed to restrain the child so the medication can be given safely.
- Encourage parents to participate as much as possible, and make sure that both parents and the child (if of an appropriate age) understand the prescribed drug therapy.
- Offer a "treat," such as a sticker, at the end of the visit. Guidelines Administration to Geriatric Patients -
- Educate the patient and family about the purpose of the drug; the time, dose, and route of administration; and common side effects. Instructions should be written clearly for home
Ask this question to gather a history of medication use and perhaps to discover health problems that have not been recorded previously.
- Do you regularly use any alternative or herbal products? What are they? How much do you use and how frequently are they used? For what purpose are they used? Herbal products or alternative methods of treatment may interfere with prescribed medications.
- It is important that patients take their medications as prescribed, so focus a few questions on how currently prescribed drugs are taken.
- What time of day do you take your medicine?
- How do you remember to take it?
- Are you having any problems or do you notice side effects from the medication?
- Can you afford to take the medication as prescribed?
- Are you having the desired response to the medication (e.g., pain relief, breathing better, lowered blood pressure)?
- Where do you store your medications at home? Review any special storage precautions for prescribed drugs. Most medications should be stored away from any heat source and sunlight, and some must be refrigerated.
- Have you checked the expiration dates on your containers? Patients often neglect to dispose of unused medication and may take it after the expiration date if not informed of this precaution.
- Can you tell me why you a The basic forms for solid oral dosage: - tablets, capsules, and lozenges (troches) Capsules - gelatin coated and dissolve in the stomach, or they may be enteric coated to protect them from stomach acids. Caplets - tablets without a coating; they are solid and oblong, similar in shape to capsules. lozenge (or troche) -
a flattened disk that is dissolved in the mouth to coat the throat, such as a lozenge for a sore throat tablet - placed on the tongue, where it quickly dissolves, rather than being swallowed. This allows for rapid absorption of the medication. solution - a mixture of a liquid, such as normal saline Syrups: - A syrup is a solution of sugar and water, usually containing flavoring and medicinal substances. Cough syrups, such as Robitussin, are the most common. Suspensions: - Suspensions are insoluble drug substances contained in a liquid (e.g., amoxicillin solutions for pediatric patients). A solution separates if left standing, so you must shake the container before administering the medication. Emulsions: - An emulsion is a mixture of oil and water that improves the taste of otherwise distasteful products (e.g., cod liver oil). Gels and magmas: - Gels and magmas consist of minerals suspended in water. Minerals settle; therefore, products containing minerals must be shaken before use. Milk of magnesia is an example. Fluid extracts: - Fluid extracts are combinations of alcohol and vegetable products that are more potent than tinctures. For example, belladonna fluid extract has a higher percentage of the powdered belladonna leaf than tincture of belladonna. Tinctures: -
completed with an applicator and most effective if the patient remains lying down after administration to prevent leakage; many preparations, therefore, are intended to be used at bedtime. The patient may need to wear a pad to absorb drainage. Administration of Medications by Mouth - If the drug is not intended to coat the oral cavity or throat, oral medications should be taken with enough water to transport the drug to the stomach. Make sure the patient is able to swallow the medication. It may be helpful to place the medication on the back part of the tongue. Liquid medications are ideal for children. Solid drugs should not be administered to children until they reach the age at which they can safely swallow a solid drug form without the danger that they will aspirate the drug. Oral syringes are the best way to give liquid medications to children because there is less likelihood the medication will be spilled. Liquid medications, especially those that stain the teeth, can be taken through a straw. If the patient has been vomiting or is nauseated, an alternative route of administration may be necessary. Always remain with the patient until all of the medication has been swallowed. Nasal Administration - Nose drops and nasal sprays may be used for localized effect; however, like the inhalation drugs, they can spill over into the bloodstream. Some nasal preparations, such as decongestants, can cause an increased heart rate, elevated blood pressure, or central nervous system stimulation. Nasal medications are commonly used for blocked nasal passages (decongestants) and nosebleeds (hemostatics). Nasal decongestant sprays are often misused by patients. Be sure to teach the patient not to exceed the amount or frequency ordered by the provider. If too much is used, these drugs can dry the mucosa and make congestion worse. Nasal inhalants can also be used for their systemic effect, such as the corticosteroid Flonase, which may be prescribed as part of asthmatic treatment. Topical Forms - Topical drugs are prescribed for both local and systemic effects. Skin medication forms include lotions, liniments, ointments, and transdermal patches. The medical assistant should wear gloves when applying any topical treatment to prevent self-administration of the drug Lotions - Often used to control itching, lotions are applied by dabbing with a soft cloth, a cotton ball, or a tongue blade. To prevent contamination, only a sterile item, such as a sterile tongue
blade, should be inserted into the lotion container. Calamine is an example. Some lotions are used to relieve inflammation and pain in muscles and joints. After the lotion has been applied, the area may be covered with a thick cloth to retain heat. However, the therapeutic value of these preparations is controversial. The effects of musculoskeletal lotions are limited to the skin surface where the medication is applied. Liniments - Liniments (emulsions) have a higher portion of oil than lotions, and volatile active ingredients may be added. Liniments are often used to protect dried, cracked, or fissured skin Ointments - Ointments, such as bacitracin, are semisolid medications containing bases such as petrolatum and lanolin. An ointment should be removed from a jar or tube with a tongue blade to prevent contamination of the remaining medication. Transdermal Patches - Certain medications can be absorbed slowly through the skin to create a constant, timed- release systemic effect. The nitroglycerin patch is particularly useful for patients with frequent attacks of angina. Estrogen and testosterone patches allow the hormones to be absorbed slowly through the skin. With dermal patches, drugs can be administered in a time-released manner for as long as 7 days. The date and time the patch was applied should be written on the patch and documented in the patient's record. Patient Teaching for Transdermal Patches -
- Wash your hands.
- Hold the patch so that the plastic backing is facing you.
- Peel off one side of the plastic backing.
- Use the other side of the patch as a handle, and apply the sticky half to your skin in the spot you have chosen.
- Press the sticky side of the patch against the skin and smooth it down.
- Fold back the other side of the patch. Hold onto the remaining piece of plastic backing and use it to pull the patch across the skin.
- Wash your hands again.
- When you are ready to remove the patch, press down on its center to lift the edges away from the skin.
