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Chapter 19 Pharmacology and Drug Administration 461
Procedure 19-8 Instilling Eye Medications
Equipment: Physician's order, correct medication, sterile
gauze, tissues, and gloves.
1. Wash your hands and gather your supplies. Check
the medication label three times. The medication
label must specify ophthalmic use. Medications
formulated for other uses may be harmful to the
eyes.
2. Greet the patient and verify the patient’s name.
Explain the procedure. Ask the patient about any
allergies not recorded in the chart.
3. Position the patient comfortably in a lying or sitting position with the head tilted slightly back. The
level of the affected eye should be slightly lower
than the unaffected eye. This will keep the medication from running into the unaffected eye.
4. Put on gloves. You may come into contact with uids from the patient’s eye.
5. Using sterile gauze, pull down the lower eyelid to
expose the conjunctival sac (the space between
the membrane covering the eye and the membrane inside the eyelid). Ask the patient to look up.
Looking away from the medication will reduce the
blink reex.
6. Check the medication label for a second time to be
sure it’s the right medication. Instill the medication.
Ointment. Discard the rst bead of ointment
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from the container onto a tissue. It’s considered
contaminated. Do not touch the tissue because
the tissue can contaminate the tip. Moving from
the inner canthus (inner corner) outward, place a
thin line of ointment across the inside of the eyelid. Placing the ointment in the sac avoids touching the eye with the tip of the ointment tube.
Twist the tube slightly to release the ointment.
Drops. Hold the dropper about half an inch from
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the conjunctival sac, not touching the patient.
Release the proper number of drops into the sac.
Discard any medication left in the dropper to prevent contamination of the rest of the container.
7. Release the lower eyelid. Ask the patient to close
the eye and gently roll it to disperse the medication.
8. Wipe off any excess medication with the tissue.
Instruct the patient to apply light pressure to the
puncta lacrimalis (the opening in the eyelid where
tears drain) for several minutes. This prevents the
medication from running into the nasolacrimal sac
and duct (tear duct).
9. Properly care for and dispose of equipment and
supplies. When disposing of or putting away the
medication, check the label for a third time. Clean
the work area and wash your hands.
10. Document the procedure.
Procedure 19-9 Instilling Ear Medications
Equipment: Correct otic medication and cotton balls.
1. Wash your hands and gather your supplies. Check
the medication label to be sure it’s the right medication three times. The label should specify otic
preparation.
2. Greet the patient and verify the patient’s name.
Explain the procedure.
3. Ask the patient to sit with the affected ear tilted
upward. This position helps the medication ow
through the canal to the tympanic membrane.
4. Check the medication label again. Draw up the
amount of medication ordered.
5. Straighten the ear canal.
Adults. Pull the auricle (outer ear) slightly up
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and back.
Children. Pull the auricle slightly down and
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back.
6. Insert the tip of the dropper without touching the
patient’s skin. This avoids contamination. Let the
medication ow along the side of the ear canal. The
medication should ow gently to avoid discomfort.
7. Ask the patient to sit or lie with the affected ear up
for about 5 minutes after the instillation. The medication should rest against the tympanic membrane
for as long as possible.
462 Section IV Clinical Medical Assistant Skills
Procedure 19-9 Instilling Ear Medications (continued )
8. If the medication is to be retained in the ear canal,
gently insert a moist cotton ball into the external
auditory meatus (opening in the ear). The cotton
ball keeps the medication in the canal. Because it is
moist, it won’t wick the medication out.
9. Properly care for and dispose of equipment and
supplies. Check the medication label again. Clean
the work area and wash your hands.
10. Document the procedure in the patient’s chart.
Procedure 19-10 Instilling Nasal Medications
Equipment: Gloves, correct nasal medication, and
tissues.
1. Wash your hands and gather your supplies. Check
the medication label three times to be sure it’s
the right one. It must be formulated for nasal
instillation.
2. Greet the patient and verify the patient’s name.
Explain the procedure. Tell the patient that the
procedure may be uncomfortable, but it shouldn’t
be painful. Ask about any allergies not recorded in
the chart.
3. Position the patient in a comfortable, recumbent
(lying down) position. Extend the patient’s head
beyond the edge of the examination table or place
a pillow under the shoulders. Support the patient’s
neck to avoid strain as the head tilts back. Tilting
the head back allows the medication to reach the
upper nasal passages.
4. Put on gloves. Administer the medication.
Drops. Hold the dropper upright just above the
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nostril. Dispense one drop at a time without
touching the patient. Keep the patient recumbent
for 5 minutes to allow the medication to reach
the upper nasal passages.
Spray. Place the tip of the bottle at the naris
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opening without touching the patient’s skin
or nasal tissues. Ask the patient to take a deep
breath; spray as the patient is inhaling. If the
patient breathes out while the medication is
being sprayed, it won’t reach the nasal passages.
5. For the patient’s comfort, wipe away any excess
medication from the skin with tissues.
6. Properly care for and dispose of equipment and
supplies. Check the medication label as you do so.
Clean the work area, remove your gloves, and wash
your hands.
7. Record the procedure in the patient’s chart.
Preparing for Externship
Regardless of the type of medical facility where you
perform your externship, more than likely you will
encounter information regarding drugs and drug
terms. This can be difcult for most new students to
grasp, understand, and remember. The drug names
are usually long and unfamiliar. Start writing down
the various drugs you encounter during the externship and research information on each one. You can
use the Internet to locate information including the
purpose for the drug, side effects, route of administration, and typical dose. Use individual index cards
for each drug and write this information. These cards
will become a quick way to refresh your memory and
you will be amazed how soon the drugs will become
more familiar to you.
Chapter 19 Pharmacology and Drug Administration 463
Chapter Recap
● Medical assistants must be knowledgeable about
different medications, their uses, side effects, and
potential abuses. The medical assistant may need to
administer medications under a physician’s supervision
and educate patients about using them correctly.
● Most over-the-counter and prescription medications
have a chemical name, a generic name, and a trade
name. Drugs are manufactured from natural sources
and from synthetic materials.
● The Controlled Substances Act of 1970 regulates the
manufacture and distribution of dangerous drugs.
Physicians who prescribe or administer controlled
substances must obtain a registration number from
the U.S. Drug Enforcement Agency (DEA).
● Special documentation is required for controlled
substances in the medical ofce. Careful records must
be kept of drug purchases, prescriptions, and disposal.
Separate dispensing records must be kept for all
Schedule II drugs. Federal law requires that an inventory
of controlled substances be taken every 2years.
● Medical assistants sometimes prepare prescriptions
for the physician’s signature. They also may phone
prescription orders to pharmacies or handle
prescription requests from patients. The medical
assistant may not sign off on rell requests and it
must be seen and initialed by the physician unless
there are written standing orders.
● Patients should receive written and verbal instructions
regarding their medications. Patients should be
encouraged to call the medical ofce if they have any
questions.
● A medication may have a local effect or a systemic
effect. The body’s reaction depends on the route of
administration, the absorption rate, drug metabolism,
and excretion. Factors inuencing drug effects are age,
weight, sex, existing illnesses, and degree of tolerance.
● Drug interactions can occur with other prescribed
drugs, over-the-counter medications, herbal
supplements, alcohol, and food. In some cases,
interactions can produce unwanted effects.
● To calculate dosages, medical assistants may need to
convert between different systems of measurement.
The most commonly used systems of measurement
are the metric system and the household system. The
household system is only used by patients at home.
● The ratio method and the formula method can be used
to calculate medication dosages for adults. Several
formulas are used to calculate children’s dosages.
● Medication administration can be divided into two
main groups—enteral and parenteral. Enteral routes
include medication taken by mouth and medication
administered rectally. Parenteral routes include any
route other than the enteral ones—for example,
injections, intravenous administration, and vaginal
application.
● Strict aseptic technique must be followed when
administering medication by injection. The three main
types of injections are intradermal, subcutaneous,
and intramuscular.
● The medical assistant must select the right needle
length and gauge for the injection type. Different
types of injections have different injection sites and
different angles of insertion.
● Intravenous medications are injected through a
catheter into the patient’s bloodstream. In some
cases, medical assistants must set up equipment and
uids for IV. They need to watch for inltration of
the IV uid into the tissues surrounding the vein.
● Some medications are inhaled using an inhaler or
nebulizer. Others are absorbed by the skin through a
transdermal patch. Many eye, ear, and nasal medications
are instilled drop by drop to produce a local effect.
● Rectal medications are packaged in the form of
suppositories or enemas. They are rarely administered
in the medical ofce. They may have local or systemic
effects. Vaginal medications usually have local
effects.
● Steps for preparing and administering medications
must be performed carefully to avoid making errors.
Checking the seven “rights” is a good way to reduce
the possibility of errors. Any medication errors
should be reported to the physician immediately and
documented in the patient’s chart.
Online Resources for Students
Resources for students available on thepoint.
lww.com include the following:
● Audio Glossary
● Animations
● Competency Evaluation Forms
● Harris CareTracker Case Studies
● Interactive Games & Activities
● Certication Preparation Question Bank
● Videos
464 Section IV Clinical Medical Assistant Skills
Exercises and Activities
Certication Preparation Questions
1. Which of these is a parenteral method of
administration of medication?
a. Oral
b. Subcutaneous
c. Topical
d. Sublingual
e. Rectal
2. Which of these drug classications is associated
with medications used to treat infections and kill
bacteria in the body?
a. Anticonvulsant
b. Antibiotic
c. Antifungal
d. Anticoagulant
e. Antiemetic
3. How many milliliters are equal to 0.01 L?
a. 0.1 ml
b. 1 ml
c. 10 ml
d. 100 ml
e. 1,000 ml
4. Which of these is the abbreviation for the organization that issues a registration number to a health care
provider in order to prescribe controlled drugs?
a. BSA
b. FDA
c. DEA
d. CIA
e. NKA
5. How much medication would you give a patient if
the physician orders 750 mg and the drug strength
is 0.5 g per tablet?
a. ½ tablet
b. 1 tablet
c. 1 ½ tablets
d. 2 tablets
e. 3 tablets
6. Which of these is an injection site located in the
thigh?
a. Deltoid
b. Ventrogluteal
c. Vastus lateralis
d. Dorsogluteal
e. Gluteus medius
7. Which of these is the process of getting the
medication into the bloodstream?
a. Secretion
b. Metabolism
c. Distribution
d. Administration
e. Absorption
8. Which of these locations is appropriate for the
instillation of medication?
a. On the skin
b. In the rectum
c. In the vagina
d. In the eyes
e. Under the tongue
9. A primary reason to administer medication using
the parenteral method is that:
a. it is easier to administer.
b. it costs less than using the oral method.
c. there is a rapid response time to the medication.
d. there is a possibility of accidental injection into
a vein.
e. there is a rapid allergic reaction.
10. Which levels of controlled substance drugs are
limited to rells of up to ve times in a 6-month
period and can be called into the pharmacist?
a. I and II
b. II and III
c. III and IV
d. IV and V
e. V only
P
S
Y
CareTracker Activities Related to This Chapter
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CareTracker Connection
Entering Prescriptions and
Documenting Patient Medications
Case Study 12: Create and Print Prescriptions
NOTE: Case Study 12 has prerequisite cases (in addition to Cases 1 to 11), which must be completed rst. See
Case Study 12 on thePoint for the list of prerequisites.
Many patients today are on multiple prescription medications. Accurately documenting a patient’s
Chapter 19 Pharmacology and Drug Administration 465
medications and entering prescriptions for new ones
is a major responsibility of the medical assistant.
CareTracker facilitates these tasks by including a
Medications application within the patient’s medical
record, in which current medications may be recorded
and new ones may be ordered electronically.
Tasks discussed in this chapter that can be performed
in CareTracker include the following:
Documenting a patient’s current medications
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Adding new medications to the patient’s record
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Documenting the administration of medications per-
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formed during an ofce visit
Clicking on the + Patient Med icon causes a new win-
dow will appear.
Reordering current medications
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Entering new medication prescriptions on the basis of
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a primary care provider’s order
Many of these tasks are discussed in CareTracker
Connection features in other chapters. A task we’ll consider here is entering a new prescription.
New prescriptions may be entered in the
Medications application of a patient’s Medical Record
module. (Note, however, that the student training version of CareTracker, which you are using, does not
allow actual faxing or electronic transmission of
prescriptions.)
You would then select the name of the patient’s provider and click on the search icon next to the Medications
eld, which causes the Medication Search window to
appear. In this window, you would enter the medication
desired (such as “Glucophage” in this example) into the
Search Text eld and set other parameters as indicated
in the image below. On clicking Search, a list of related
medications will appear.
466 Section IV Clinical Medical Assistant Skills
You would then select the desired medication, such
as “MetFORMIN HCl Oral Tablet Extended Release
24 Hour 750 MG.” This will cause the Drug Interaction
Back in the main Medication Order screen, you would
enter the number of units, form, duration, number of
box to appear. After examining the information, you
would select any relevant drug interactions and enter
any needed notes, as shown below.
rells, dispense ll quantity and unit, and prescription
start and end dates, as shown below.
Chapter 19 Pharmacology and Drug Administration 467
When done, you would click Save. The medication
would now appear in the patient’s clinical record, as
shown below.
You’ll get a chance to practice this task in Case Study
12: Create and Print Prescriptions.
To access Case Study 12, go to http://thepoint.lww.
com, log in using your username and password, search
for The Complete Medical Assistant, click on “Student
Resources,” nd the Harris CareTracker materials, and
click on “Case Study 12.”
Diagnostic Testing
20
Chapter Objectives
● Explain the difference between radiolucent and
radiopaque, using examples.
● List ways to protect patients and yourself from
radiation hazards.
● Describe how to prepare patients for routine x-ray
examinations.
● Discuss how to teach patients about contrast
examinations.
● List the general steps in a routine radiographic
examination.
● Compare and contrast uoroscopy, MRI, and CT
scans.
● List three typical uses for sonography.
● Describe the medical assistant’s role in radiographic
procedures.
● Explain how to handle and store radiographic lm.
CAAHEP & ABHES Competencies
● Contrast invasive and noninvasive techniques for
cardiological diagnosis.
● Describe the placement of electrocardiogram
electrodes.
● Perform electrocardiography.
● Identify the main wave forms used for interpretation
on an electrocardiogram tracing.
● Discuss three types of electrocardiogram artifacts
and how to prevent them.
● Describe how to apply a Holter monitor.
● Dene tidal volume and forced expiration.
● Perform basic respiratory testing.
● Briey describe bronchoscopy and arterial blood gas
tests.
● Explain how to teach a patient to use a peak
owmeter.
CAAHEP
● Prepare a patient for procedures and/or treatments.
● Schedule patient admissions and/or procedures.
● Perform within scope of practice.
● Perform electrocardiography.
● Perform pulmonary function testing.
ABHES
● Identify diagnostic and treatment modalities as they
relate to each body system.
● Comply with federal, state, and local health laws
and regulations as they relate to health care settings.
● Schedule of inpatient and outpatient procedures.
Chapter Terms
Chapter 20 Diagnostic Testing 469
Artifact
Cardiologist
Cassette
Contrast medium
Dosimeter
Dyspnea
Echocardiogram
Fluoroscopy
Murmurs
Radiographs
Abbreviations
ABG
ALARA
COPD
CT
ECG
Case Study
Melissa Barber, a 42-year-old female patient, is
experiencing mild chest discomfort and short-
ness of breath. The physician orders an electro-
cardiogram. She has never had an ECG performed
and is worried about the procedure as well as the
results of the test. Ms. Barber’s father died of a
GI
MI
MRI
NPO
PAC
Radiography
Radiologists
Radiology
Radiolucent
Radiopaque
PACS
PAT
PET
PTCA
PVC
heart attack at the age of 45, and she is afraid
that she might be having a heart attack. David
Carter, the medical assistant, reassures Ms.
Barber about the procedure and that the physician will see her after the ECG to explain the
results of the test.
Rhythm Strip
Spirometer
Teleradiology
Ultrasound
X-rays
SOB
SPECT
C
O
G
Sometimes, a physician orders specic medical tests to
help diagnose a patient’s illness. As a medical assistant,
it’s likely that you’ll have to assist with or help educate
patients about several different types of diagnostic tests,
such as:
r
r
r
lowing up test results after the procedures have been
performed.
DIAGNOSTIC TESTING
Radiology, which is a medical specialty that uses
different imaging techniques to diagnose and treat
diseases
Cardiovascular tests, which are used to diagnose disorders of the heart
Pulmonary (respiratory) tests, which are used in the
diagnosis and treatment of respiratory conditions
You also may be responsible for screening and fol-
C
O
G
Among the most common diagnostic tests are those that
create a visual image of internal body structures. Because
of changing technology, new procedures are continually being developed to help visualize body structures.
Physicians who specialize in interpreting these images
are called
radiograph.
nal structures. They’re digital or processed on a type of lm
similar to photography lm. The images are created using
x-rays—invisible, high-energy waves that can penetrate
dense objects. The process of making these lms is called
radiography. Figure 20-1 shows a radiograph of the chest.
themselves are commonly referred to as x-rays. Patients
RADIOLOGY AND THE
MEDICAL ASSISTANT
radiologists.
Probably the most common radiology technique is the
Radiographs are shadow-like images of inter-
The process of radiography and the radiographs
470 Section IV Clinical Medical Assistant Skills
Figure 20-1 Radiograph of chest. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
usually more frequently understand the term x-ray
instead of radiograph. It is important to use terminology
that patients can comprehend.
In some states, a medical assistant is allowed to take
and process simple images such as chest x-rays or x-rays
of bones. The training required to do this varies. In other
states, only licensed radiographers may take and process x-rays. You should be familiar with your state laws
and comply with any regulations. Although you may not
perform radiological diagnostic procedures, you have an
important role in preparing and educating the patient.
Your responsibilities may include
Preparing patients for radiology procedures
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Performing basic x-ray procedures in the medical
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ofce (where permitted by law)
Assisting in educating patients about general radiol-
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ogy processes
Scheduling the procedures
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The medical community is making an effort to have
procedures and treatments performed on an outpatient
basis. Some medical ofces have on-site x-ray equipment.
Outpatient diagnostic imaging centers also have been created to offer a variety of radiology services. Some companies even specialize in providing basic x-ray services to
patients in long-term care facilities or in patients’ homes.
X-rays and X-ray Machines
X-rays are produced by electricity of extremely high
voltage inside an x-ray tube. The x-rays exit the tube
in one direction as a beam and pass though a device
designed to control the beam’s size. During an x-ray, a
beam of light also shines on the patient. This light is
not part of the x-ray beam. It’s a guide to help the x-ray
technician direct and position the x-ray beam.
Many modern x-ray machines are designed to work
with computers to produce digital images of the body. Most
permanently installed radiography units include a special
table. Some tables can be electronically rotated from the
horizontal to the vertical to help position the patient.
Before x-ray lm is used, it’s placed in a special x-ray lm
holder called a
sette slides into a slot or opening in the table. Once the lm
inside the cassette has been exposed to x-rays, the cassette
is placed in a special machine that removes the lm and
processes it. The processed lm is the radiograph, or x-ray.
cassette to protect it from light. The cas-
X-rays and the Body
Images form as the x-rays either pass through the body
and strike the lm or are absorbed by body tissues.
Radiolucent substances allow x-rays to pass through
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them. These structures are not dense and don’t absorb
much radiation. They show up as black on the lm.
An example is the air in the lungs.
Radiopaque substances don’t allow x-rays to pass
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through them. Some tissue is dense and absorbs much
of the radiation beam instead. Such tissue appears white
on x-ray lm. For example, bone is a radiopaque tissue
that absorbs radiation. It shows up as white on an x-ray.
Other body substances vary in density. Examples are
r
muscle, fat, and uid. They appear as different shades
of gray on a radiograph, because of the way each substance absorbs the x-rays.
Patient Positions
A radiograph is a two-dimensional image. However, the
human body is a three-dimensional structure. For this
reason, x-ray exams usually require at least two exposures taken at 90-degree angles to each other. For example, a chest x-ray generally involves one exposure from
the back and another from the side. Chest x-rays can
help in the diagnosis of pulmonary problems, such as
pneumonia, lung cancer, emphysema, tuberculosis, and
pulmonary edema, or uid in the lungs.
Other exams may require three or more x-rays from different angles. The projection refers to the body’s position
in relation to the x-ray beam and the lm. Table20-1 demonstrates the standard projections used in x-ray exams.
Each projection requires the patient to be placed in a specic position. If you are legally allowed to position patients
for x-rays, you should be familiar with positioning terms:
Erect—standing
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Recumbent—lying down
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Supine—lying on the back
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Prone—lying face down
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Anterior—on the front
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Posterior—on the back
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Lateral—on the side
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