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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5519_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 19 Pharmacology and Drug Administration 451
Figure 19-21 Examples of suppositories and the proper
method used to insert a rectal suppository into the
anus well beyond the internal sphincter. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Medication Errors
There are many steps for calculating, measuring, and
administering medications. You need to perform each
step carefully to avoid making errors that could harm
your patients. Even so, all human beings occasionally
make mistakes. If you notice that you’ve made a medication error, it’s important that you report it to the physician as soon as possible.
Some medication errors might include the following:
Giving the wrong medication to the patient
r
Giving a medication to the wrong patient
r
Giving the wrong amount of a medication
r
Giving the medication using the wrong route of
r
administration
Medication errors and corrective actions must be
documented in the patient’s medical record. You’ll also
need to ll out an incident report to le in the ofce. The
incident report veries that all possible precautions were
taken for the patient. It also can be reviewed to determine if steps can be taken to make sure similar errors
don’t happen in the future.
You can avoid medication errors by preparing and
administering medications carefully. By observing seven
Figure 19-22 Example of vaginal suppository and
applicator. Insertion of vaginal cream using an
applicator. (Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
“rights” when giving any medication, you’ll eliminate
the possibility of many errors. Here’s the “right” list to
follow:
1. Right patient—Ask the patient to state her name.
Some patients may answer to any name. So if you
simply say the name, it won’t ensure you have the
right patient.
2. Right time—Medications ordered to be given in the
ofce must be given before the patient leaves. Some
patients may have to be told when the next dose is
due.
3. Right dose—Check doses carefully. Many medications come in various strengths.
4. Right route—Medications are administered by
a variety of routes. Check the physician’s order to
ensure the proper route for a particular medication:
oral, intramuscular, or topical medication.
452 Section IV Clinical Medical Assistant Skills
5. Right drug—Many medication names are very much
alike. For instance, Orinase and Ornade may be confused if you’re not careful. Always look up unfamiliar medications in a drug reference book such as the
Physician’s Desk Reference (PDR).
6. Right technique—Check how the medication needs
to be given, such as orally with or without food.
Intramuscular, subcutaneous, and intradermal injections should be given only after carefully choosing a
site and using the right procedure.
7. Right documentation—The medical record is a legal
document. Make sure the medication is documented
after it’s administered, not before. Check to be sure
you’re documenting it in the right medical record.
All medications given in the medical ofce must be
documented immediately with the name of the medication, dose, route, and site (if injected). Don’t forget your signature. When appropriate, the patient’s
response should be charted as well.
Documenting Errors
You’ve been working hard all day. Suddenly, you realize you made an error in the medication you gave to a
patient. What should you do?
Even if you’re extremely careful, you may make an
error when administering a medication. Don’t try to hide
the mistake or solve the problem on your own. Report the
error to the physician right away. If you’ve given too much
or given an incorrect medication, it might harm the patient.
If you report the error right away, immediate action
can be taken to resolve the problem. For example,
if you’ve given the wrong medication or the wrong
amount, the physician may want you to monitor the
patient for adverse reactions. If the patient didn’t receive
the intended medication, you may need to administer it.
You’ll need to document the error and all the actions
taken to correct it in the patient’s medical record. You
also must complete an incident report. The report is kept
on le in the medical ofce.
Procedure 19-1 Administering Oral Medications
Equipment: Physician's order, correct oral medication,
disposable calibrated cup, glass of water, and patient's
medical record.
1. Wash your hands and gather your supplies.
2. Check the medication label and compare it to
the physician’s order. Note the expiration date.
Remember to check the medication label three
times—when taking it from the shelf, when measuring, and when returning it to the shelf.
3. If necessary, calculate the correct dose.
4. For a multidose container, remove the cap from
the container. Touch only the outside of the lid
to avoid contaminating the inside. Single, or unit
dose, medications come individually wrapped.
Packages may be opened by pushing the medication through the foil backing or by peeling back a
tab on one corner.
5. According to your calculations and the label,
remove the correct dose of medication.
A. For solid medications:
Pour the correct dose into the bottle cap to
r
prevent contamination.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Transfer the medication to a disposable cup.
r
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Chapter 19 Pharmacology and Drug Administration 453
Procedure 19-1 Administering Oral Medications (continued )
B. For liquid medications:
Open the bottle and put the lid on a at sur-
r
face. The open end of the lid should face up
to prevent contamination of the inside of the
cap.
Palm the label to prevent liquids from drip-
r
ping onto the label. You don’t want the label
to become unreadable.
With the opposite hand, place your thumb-
r
nail at the correct calibration on the cup.
Holding the cup at eye level, pour the proper
amount of medication into the cup. Use your
thumbnail as a guide.
6. Greet and verify the patient’s name to avoid errors.
Explain the procedure. Ask the patient about any
medication allergies that may not be noted on the
chart.
7. Give the patient a glass of water to wash down the
medication, unless contraindicated (as in the case
of lozenges or cough syrup). Hand the patient the
disposable cup containing the medication.
8. Remain with the patient to be sure all the medication is swallowed. Observe any unusual reactions
and report them to the physician.
9. Thank the patient and give any additional instructions as necessary.
10. Wash your hands and record the procedure in the
patient’s medical record.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Procedure 19-2 Preparing Injections
Equipment: Physician’s order, medication for the injection in an ampule or vial, antiseptic wipes, a needle and
syringe of appropriate size, a small gauze pad, a biohazard sharps container, and the patient’s medical record.
1. Wash your hands and gather your supplies. Choose the
needle and syringe according to the route of administration, type of medication, and size of the patient.
2. Review the medication order and compare it to the
label on the medication container. Check the expiration date. Remember to check the medication
label three times—when taking it from the shelf,
while drawing it up into the syringe, and when
returning it to the shelf.
to the syringe by grasping the needle at the hub
and turning it clockwise on the syringe. A needle
that isn’t rmly attached may come off during the
procedure.
3. Calculate the correct dose, if necessary.
4. Open the needle and syringe package. Assemble if
necessary. Make sure the needle is attached rmly
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
454 Section IV Clinical Medical Assistant Skills
Procedure 19-2 Preparing Injections (continued )
5. Withdraw the correct amount of medication.
A. From an ampule:
With the ngertips of one hand, tap the stem
r
of the ampule lightly to remove any medication in or above the neck.
Wipe the neck of the ampule where the break
r
will occur with an alcohol wipe. Wrap a piece
of gauze around the neck to protect your ngers from broken glass. Snap the stem off the
ampule with a quick downward movement
of the gauze. Be sure to aim the break away
from your face. Dispose of the ampule top in
a biohazard sharps container.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Remove the needle guard. Pull back on the
r
plunger to ll the syringe with a small amount
of air equal to the amount of medication to
be removed from the vial.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
After removing the needle guard, insert a
r
ltered needle into the ampule. The needle lumen should be below the level of
medication.
Withdraw the medication by pulling back on
r
the plunger of the syringe. Take care not to
touch the needle to the contaminated edge of
the broken ampule. After you’ve withdrawn
the correct amount, discard the ampule in the
biohazard sharps container.
Hold the syringe with the needle up. Remove
r
any air bubbles by gently tapping the barrel
of the syringe until the bubbles rise to the
top. Draw back on the plunger to add a small
amount of air. Then, gently push the plunger
forward to eject the air from the syringe. Be
careful not to eject any medication.
B. From a vial:
Cleanse the stopper of the vial with an anti-
r
septic wipe.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Insert the needle into the vial through the
r
center of the cleansed vial top. Inject the air
from the syringe into the vial above the level
of the medication so that you don’t make
bubbles or foam in the medication. Injecting
air into the vial prevents a vacuum from
forming in the vial, which would make it difcult to withdraw the medication.
Chapter 19 Pharmacology and Drug Administration 455
Procedure 19-2 Preparing Injections (continued )
Gently tap the barrel of the syringe with
r
your ngertips to displace any air bubbles.
Remove the air by pushing the plunger slowly
and forcing the air into the vial.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
With the needle inside the vial, invert the vial,
r
holding the syringe at eye level. Aspirate, or
withdraw, the desired amount of medication
into the syringe.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
6. Place the needle guard on a hard, at surface.
Without contaminating the needle, insert the needle
into the cap and scoop up the cap with one hand.
Recapping the needle protects the sterility of the
needle until you administer the medication. You
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
should use one hand to recap the needle to prevent
needlestick injuries.
Procedure 19-3 Administering an Intradermal Injection
Equipment: Physician’s order, medication for the injection in an ampule or vial, antiseptic wipes, a needle and
syringe of appropriate size, a small gauze pad, a biohazard sharps container, clean examination gloves, and the
patient’s medical record.
1. Wash your hands and gather supplies.
hasn’t passed. Remember to check the medication
label three times—when taking it from the shelf,
while drawing it up into the syringe, and when
returning it to the shelf.
3. Prepare the injection according to the steps in
Procedure 19-2.
2. Review the physician’s order and select the correct
medication. Check the order carefully against the
medication label. Make sure the expiration date
4. Greet and identify the patient. Explain the procedure and ask the patient about any known medication allergies.
456 Section IV Clinical Medical Assistant Skills
Procedure 19-3
Administering an Intradermal Injection
(continued )
5. Select the appropriate site for the injection.
Recommended sites are the anterior forearm and
the middle of the back.
6. Prepare the site by cleansing with an antiseptic
wipe. Use a circular motion, starting at the injection site and working toward the outside. The circular motion will carry microorganisms away from
the site. Don’t touch the site after cleansing.
7. Put on gloves. You must follow standard precautions for your protection.
8. Remove the needle guard. Using your nondominant hand, pull the patient’s skin taut. Stretching
the patient’s skin allows the needle to enter with
little resistance and secures the patient against
movement.
9. With the bevel of the needle facing upward, insert
the needle at a 10- to 15-degree angle into the
upper layer of the skin. This angle ensures that penetration occurs within the dermal layer.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Hold the syringe steady; moving the needle will
r
be uncomfortable for the patient.
11. Remove the needle from the skin at the angle of
insertion.
Don’t use an antiseptic wipe or gauze pad when
r
withdrawing the needle.
Don’t press or massage the site. Pressure on the
r
wheal may press the medication into the tissues
or out of the injection site.
Don’t apply a bandage—it may cause redness or
r
swelling that could result in an inaccurate reading of the test.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
The bevel of the needle must be facing up for a
r
wheal to form.
Stop inserting the needle when the bevel of the
r
needle is under the skin. The needle should be
slightly visible below the skin.
10. Inject the medication slowly by depressing the
plunger.
A wheal will form as the medication enters the
r
dermal layer of the skin.
12. To reduce the risk of an accidental needlestick,
don’t recap the needle. If a safety device is attached
to the needle, engage it according to manufacturer
directions to cover the needle. Dispose of the needle
and syringe in a biohazard sharps container.
13. Remove your gloves and wash your hands.
14. Depending upon the type of skin test administered,
the length of time required for a reaction, and the
policies of your medical ofce, perform one of the
following:
Read the test results. Inspect and palpate the site
r
for the presence and amount of induration.
Tell the patient when to return (date and time) to
r
the ofce to have the results read.
15. Document the procedure, site, and results.
Document any instructions to the patient.
Chapter 19 Pharmacology and Drug Administration 457
Procedure 19-4 Administering a Subcutaneous Injection
Equipment: Physician’s order, medication for the injection in an ampule or vial, antiseptic wipes, a needle and
syringe of appropriate size, a small gauze pad, a biohazard sharps container, clean examination gloves, an
adhesive bandage, and the patient’s medical record.
1. Wash your hands and gather supplies.
2. Review the medication order, select the correct
medication, and compare it to the label on the
medication container. Check the expiration date.
Remember to check the medication label three
times—when taking it from the shelf, while drawing it up into the syringe, and when returning it to
the shelf.
3. Prepare the injection according to the steps in
Procedure 19-2.
4. Greet and identify the patient. Explain the procedure and ask the patient about any known medication allergies.
5. Select the appropriate site for the injection.
Recommended sites include the upper arm, thigh,
back, and abdomen.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
9. With a rm motion, insert the needle into the tissue at
a 45-degree angle to the skin surface. Make sure the
bevel of the needle is facing upward. Hold the barrel
between the thumb and index nger of the dominant
hand and insert the needle completely to the hub. A
quick, rm motion is less painful to the patient.
6. Prepare the site by cleansing with an antiseptic wipe. Use a circular motion starting at the
intended injection site and working toward the
outside. The circular motion will carry microorganisms away from the site. Don’t touch the site
after cleansing.
7. Put on gloves. You must follow standard precautions for your protection.
8. Remove the needle guard. Using your nondominant hand, hold the skin surrounding the injection
site in a cushion fashion.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
10. Remove your nondominant hand from the skin.
Holding the syringe steady, pull the syringe (aspirate) gently.
If blood appears in the hub or the syringe, you’ve
r
entered a blood vessel. If this happens, don’t
inject the medication. Injecting the medication
into a blood vessel means that the medication
may be absorbed too quickly. Remove the needle
and prepare a new injection.
If blood doesn’t appear, you may continue with
r
the procedure.
458 Section IV Clinical Medical Assistant Skills
Procedure 19-4
Administering a Subcutaneous Injection
(continued )
11. Inject the medication by slowly pressing down on
the plunger. If you press down on the plunger too
quickly, the pressure will cause discomfort and possibly tissue damage to the patient.
12. Place a gauze pad over the injection site and remove
the needle at the angle of insertion. With one hand,
gently massage the injection site with the gauze pad
and with the other hand, discard the needle and
syringe into the sharps container. Don’t recap the
used needle. If available, engage the safety device on
the needle. Apply an adhesive bandage, if needed.
13. Remove your gloves and wash your hands.
14. An injection for allergy desensitization means the
patient must stay in the ofce for at least 30 minutes
so you can observe any reaction the patient might
have. Note: If a patient has any unusual reaction after
any injection, let the physician know immediately.
15. Document the procedure, site, and results, as well
as any instructions to the patient.
Procedure 19-5 Administering an Intramuscular Injection
Equipment: Physician’s order, medication for the injection in an ampule or vial, antiseptic wipes, a needle and
syringe of appropriate size, a small gauze pad, a biohazard sharps container, clean examination gloves, an
adhesive bandage, and the patient’s medical record.
1. Wash your hands and gather supplies.
2. Review the medication order and select the correct
medication. Check the order carefully against the
medication label. Make sure the expiration date
hasn’t passed. Remember to check the medication
label three times—when taking it from the shelf,
while drawing it up into the syringe, and when
returning it to the shelf.
7. Put on gloves. You must follow standard precautions for your protection.
8. Remove the needle guard. Choose one of the following ways to hold the skin surrounding the injection site.
Using your nondominant hand, hold the
r
skin surrounding the injection site taut with
the thumb and index or middle fingers. This
makes the needle easier to insert in an average
or overweight individual.
3. Prepare the injection according to the steps in
Procedure 19-2.
4. Greet and identify the patient. Explain the procedure and ask about any known medication allergies.
5. Select the appropriate site for the injection.
Recommended sites include the deltoid, vastus lateralis, dorsogluteal, and ventrogluteal areas. Take
into account the patient’s age and size, as well as
the medication, when choosing a site.
6. Prepare the site by cleansing with an antiseptic
wipe. Use a circular motion starting at the injection site and working toward the outside. The
circular motion will carry microorganisms away
from the site. Don’t touch the site after cleansing.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Using your nondominant hand, grasp the mus-
r
cle. This produces a deeper mass for the injection in a person who is very thin with little
body fat.
Chapter 19 Pharmacology and Drug Administration 459
Procedure 19-5
Administering an Intramuscular Injection
(continued )
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
9. Hold the syringe like a dart. Use a quick, rm motion
to insert the needle into the tissue at a 90-degree
angle to the surface. Hold the barrel between the
thumb and index nger of your dominant hand and
insert the needle completely to the hub. This way,
the medication will go into the muscle tissue.
10. Remove your nondominant hand from the skin.
Holding the syringe steady, pull back the syringe
(aspirate).
If blood appears in the hub or the syringe, you’ve
r
entered a blood vessel. Don’t inject the medication. Injecting the medication into a blood vessel means the medication may be absorbed too
quickly. Place a gauze pad over the injection site
and remove the needle. Prepare a new injection.
If blood doesn’t appear, you may continue with
r
the procedure.
11. Inject the medication by slowly pressing down on
the plunger. If you press down on the plunger too
quickly, the pressure will cause discomfort and possibly tissue damage to the patient.
12. Place a gauze pad over the injection site. Remove
the needle at the angle of insertion. With one hand,
gently massage the injection site with the gauze
pad. Massaging helps to distribute the medication.
If needle has a safety device, engage it then, discard
the needle and syringe into the biohazard sharps
container. Don’t recap the needle.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
Procedure 19-6
Administering an Intramuscular Injection
Using the Z-Track Method
Equipment: Physician’s order, medication for the injection in an ampule or vial, antiseptic wipes, a needle and
syringe of appropriate size, a small gauze pad, a biohazard sharps container, clean examination gloves, an
adhesive bandage, and the patient’s medical record.
1. Follow steps 1 to 7 as described in Procedure 19-5.
The ventrogluteal, vastus lateralis, and dorsogluteal sites work well for the Z-track method, but the
deltoid does not.
13. Apply an adhesive bandage to the site, if needed.
Remove your gloves and wash your hands.
14. Observe the patient for any reactions. If the patient
has any unusual reactions, let the physician know
immediately.
15. Document the procedure, site, and results, as well
as any instructions to the patient.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
460 Section IV Clinical Medical Assistant Skills
Procedure 19-6
2. Remove the needle guard. Rather than pulling the
skin taut or grasping the muscle tissue, pull the top
layer of skin to the side and hold it with the nondominant hand throughout the injection.
3. Hold the syringe like a dart and use a quick, rm
motion to insert the needle into the tissue at a
90-degree angle to the skin surface. Hold the barrel
between the thumb and index nger and insert the
needle completely to the hub.
4. Aspirate by withdrawing the plunger slightly. If
no blood appears, push the plunger in slowly and
steadily. Count to 10 before withdrawing the needle. This allows time for the tissues to begin absorbing the medication.
Administering an Intramuscular Injection
Using the Z-Track Method
5. Place a gauze pad over the injection site. Remove
the needle at the same angle at which it was inserted
while releasing the skin. Don’t massage the area.
Engage the safety device, if available, and discard
the needle and syringe into the biohazard sharps
container.
6. Apply an adhesive bandage to the site, if needed.
Remove your gloves and wash your hands.
7. Observe the patient for any unusual reactions.
Note: If a patient has any unusual reaction after
any injection, let the physician know immediately.
8. Document the procedure, site, and results, as well
as any instructions to the patient.
(continued )
Procedure 19-7 Applying Transdermal Medications
Equipment: Physician's order, the medication, clean
examination gloves, and the patient's medical record.
1. Wash your hands and gather supplies.
2. Review the medication order and select the correct
medication. Check the order carefully against the
medication label. Make sure the expiration date
hasn’t passed. Remember to check the medication
label three times—when taking it from the shelf,
when opening the medication package, and when
returning it to the shelf.
3. Greet and identify the patient. Explain the procedure
and ask about any known medication allergies.
4. Select the appropriate site for the medication. The
usual sites are the upper arm, the chest or back, and
behind the ear. These sites should be rotated.
5. Perform any necessary skin preparation. Make
sure the skin is clean, dry, and free from any irritation. Trim any hair close with scissors, but don’t
shave areas with hair. Shaving may wear away the
skin and cause the medication to be absorbed too
quickly.
6. Open the medication package by pulling the two
sides apart. Don’t touch the area of medication.
It may be absorbed into your skin, causing an
unwanted reaction.
(Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive
Medical Assisting. 5thed. Philadelphia, PA: Wolters
Kluwer; 2016.)
7. Apply the medicated patch to the patient’s skin following the manufacturer’s directions. Starting at the
center, press the adhesive edges down rmly all the
way around. Starting at the center eliminates air
spaces. If the edges do not stick, fasten with tape.
8. Wash your hands and document the procedure,
including the site of the patch.