C HAPTER 4 E QUIPMENT FOR DOSAGE M EASUREMENT Learning Outcomes 4- Identify equipment used to administer medication. 4- Indicate the appropriate equipment for delivering various types of medicine. 4- Measure medications by using the calibrations on the equipment. 4-4 Describe the method of administration appropriate for each piece of measuring equipment. Chapter Outline 4- Oral Administration 4- Hypodermic Syringes 4- Other Administration Forms Lesson Plan Anticipatory Set Gather as many types of medication administration equipment as possible for a show and tell. You should have medicine cups, syringes, oral syringes, medication spoons, droppers, etc. Local health care facilities may be willing to donate one of each type of equipment or you can try your local drug store. Attach a number to each piece of equipment you gather. Pass each piece of equipment around the room asking the students to make a list of the number and what the piece of equipment is used for as well as what measurements are included on the piece of equipment. Once the equipment has completely gone around the room bring it back to the front. Hold up each piece of equipment and give the students the correct answers. Be certain to discuss the measurement marks and then as necessary pass the equipment around the room again so students can become more familiar with each item. Teaching Strategies Assign and collect the homework for Chapter 4. Check the student s answers to discover the topics within the chapter that require the most focused attention during class time. Have a health care professional visit the class and discuss their role in dosage calculations as well as the importance of math accuracy and preventing medication errors in the health care profession. Have students review the key terms for Chapter 4 using the Audio glossary and Key Term Concentration game on the student CD. Have students in groups of three; review their basic math skills using the Math Challenge game on the student CD. Encourage students to complete each review and practice section in the text/workbook and check their answers. You can also remove the answers from the back of the book and use the review and practice questions as a graded assignment. Use the Critical Thinking on the Job Activities from Chapter 4 as Think-Pair-Share assignments in class. Have student groups discuss their answers and present to the rest of the class. Use the PowerPoint presentation for Chapter 4, found on the student and instructor resource CD-ROM, for a class lecture and/or review. Use the Test Your Knowledge questions for discussion. The online learning center at www.mhhe. com/mathdosagee contains additional activities for each chapter. Links for the Internet activities from at the end of this chapter are provided on this site. Have students navigate to this site to complete the Internet activities. Play the Spin the Wheel on the student CD with individual, small groups or within the classroom in preparation for the final evaluation. Assess Use the Additional Exercises for Chapter 4 found at the end of this document for reinforcement of chapter concepts. These exercises can also be used as chapter quizzes. Students should complete each student CD activity when directed within the text. Have students save, print, or email their completed Progress Report from the student CD for Chapter 4. 46 Instructor s Manual for Math and Dosage Calculations for Health Care
The chapter review should be completed and checked in preparation for the final chapter evaluation. Using the EZTest test bank for Chapter 4, create a written test in two versions for a final evaluation of student s proficiency. Access the Instructor s Manual documents in electronic format and modify to match your curriculum needs. Use the chapter images and labels to create your own worksheets, tests, or PowerPoint presentations. C HAPTER 4 Solutions Critical Thinking on the Job: Use the Correct Dropper: This error could easily be avoided. During the initial visit, the father should have been instructed to use only the dropper that accompanies the medication. When he calls days later, he should be asked if the correct equipment was used. REVIEW AND PRACTICE: 4- Oral Administration. False; putting an oral dose in a hypodermic syringe increases the likelihood that someone might mistakenly inject it. If you must use a hypodermic syringe to measure a dose, the needle should not be attached.. False; you should not use medicine cups for doses less than. Instead use a smaller device, such as a dropper, for accuracy.. False; an oral syringe is often tinted. Its tip may be off-center. An oral syringe is not sterile. Its calibrations include teaspoons. 4. True. False; the size of the openings may vary and, in turn, the size of the drops may vary. Therefore, if you use the wrong dropper, you may give the patient the incorrect dose. 6. False; household spoons vary in size. They are not reliable measures. 7. True 8. True 9. False; equals cc. 0. False; the device can be used after you have converted the prescribed dose s unit of measurement to the unit found on the utensil.. False; liquid in a measuring cup should be measured at the meniscus.. False; droppers can be used to deliver medication to the nose.. True; only measuring devices designed for measuring medications should be used. In emergencies or when no other equipment is available, baking measuring spoons may be used. 4. False; gelcaps and extended-release medications may not be crushed.. D. Most medicine cups do not list cc calibrations. Furthermore, because cc, cc, which is equivalent to tbs, or half a medicine cup. The other measurements listed are equivalent to a full medicine cup. 6. C. Each cc of medication delivers 0 units. You want to administer 0 units or 0 units. Therefore, you need cc or cc to deliver 0 units. (Remember: cc ) 7. D. The size of the openings of droppers vary. Therefore, even though two droppers may measure equal quantities of medication, the size of the individual drops from each utensil may vary. 8. B. is equivalent to. In turn, _ tbs. Thus, _ tbs. 9. C. The dose to be administered is, which is equivalent to tbs. 0 D., tbs, and _ ounce are all equal to. Critical Thinking on the Job: Finishing What You Start: This overdose could be avoided. The first health care professional should check the prescribed dose and immediately discard the extra medication from the syringe. He should personally deliver the dose or in some cases identify its Instructor s Manual for Math and Dosage Calculations for Health Care 47
contents prior to leaving the room. The second health care professional also should take extra precautions. She should confirm directly with the first health care professional the amount to deliver and check the patient s chart before administering medication. She should not have administered from a syringe unless she was certain that its contents matched the amount ordered. REVIEW AND PRACTICE: 4- Hypodermic Syringes. Tenths of a (0. ). Units ( Unit or 0.0 ). Hundredths of a (0.0 ) 4. Two-tenths of a (0. ). True 6. True 7. False; read the calibration that aligns with the leading ring on the plunger. 8. True 9. False; they have the same calibrations. 0. False; insulin syringes measure up to cc. To measure 6 cc of medication, you need a largecapacity syringe.. False; the syringe is inserted directly into the existing intravenous line, not into the patient.. False; the safety syringe does not guarantee that the health care worker will not receive an accidental needlestick. It reduces the chances, but does not eliminate injuries.. True 4. Type: Standard Volume:. Type: Insulin Volume: 49 Units 6. Type: Tuberculin Volume: 0.0 7. Type: Large-capacity Volume: 4. 8. Type: Standard Volume:. 9. Type: Insulin Volume: Units 0. Type: Tuberculin Volume: 0.8. Type: Standard Volume:.0. Type: Large-capacity Volume: 9.. Type: Tuberculin Volume: 0. 4. Type: Large-capacity Volume:.8. Type: Insulin Volume: Unit REVIEW AND PRACTICE 4- Other Administration Forms. Can be delivered in the form of a tablet, suppository, or douche. F. Vaginal. Applied directly to the skin. A. Topical. Delivered by a nebulizer, vaporizer, or metered dose inhaler. E. Mists 4. Medication from a patch is absorbed through the skin. B. Transdermal. Can be delivered in the form of a suppository or enema. G. Rectal 6. Must be marked with your initials, date, and time of administration. B. Transdermal 7. Also known as instillations. C. Drops 8. An atomizer is used to deliver this medication form. D. Sprays 9. Are useful when a patient has difficulty or trouble swallowing oral drugs. F. Vaginal B. Transdermal G. Rectal 0. Are usually delivered to the nose, eyes, and ears. C. Drops Critical Thinking on the Job: Document the Use of Patches: This problem could be avoided if the second nurse is more careful in assessing the patient before placing a second patch. The second nurse should not assume that the patch is not in place. At the same time, the first nurse should indicate clearly on the patient s chart when the patch was placed and its exact location. Because patches are so potent, they make it easy for health care 48 Instructor s Manual for Math and Dosage Calculations for Health Care
workers to give an overdose of the drug. You must carefully document the placement of patches and ensure that no patch is already in place when you administer a new one. 6. False tuberculin and insulin syringes are marked in units 7. CHAPTER 4 HOMEWORK SOLUTIONS 8 dr 6 dr oz / 4 oz. False parenteral refers to all dosage forms except oral. True drams 4 dr dr dr / oz / 4 oz / 8 oz. False prefilled syringes are used for only injection 8. 4. False tuberculin syringes hold only, standard syringes hold. True.0 0.9 0.8 0.7 0.7 0.6 0. 0.4 0. 0. 9. /4 / /4 ml ml ml 4ml 4 ml 0..4 / / /..4 0 0 0 4 0. 8 units....4..6.7.8.9.0 0.8 Instructor s Manual for Math and Dosage Calculations for Health Care 49
CHAPTER 4 REVIEW Check Up. A and C. C. you can see from the medicine cup that. Therefore,. Also, recall from Chapter that tbs. From the cup, you can see that tbs.. D. Recall that oz 0 8 dr tbs. _ oz _ 0 _ 8 dr _ tbs 4 4 4 4 _ oz. 6 dr. tbs 4 4. C and D. A quantity as small as. should be measured in a calibrated spoon, dropper, or syringe. 4. True. True 6. False; prefilled syringes are designed to be used once and discarded. 7. True 8. False; tuberculin syringes are used to measure amounts less than. 9. False; the syringes used to administer medication through already established intravenous lines are typically needleless. 0. False; oral medication may never be injected... D. Drops vary in size depending on the diameter of the dropper. 6. A. In an emergency, Answer B would be acceptable as long as the needle was removed, but Answer A is preferred. 7. C. If the medication strength is mg per, a dose of 0 mg would require of medication. Recalling that cc, you would have to discard 0. cc from a.-cc prefilled syringe. TBS TBS TSP TSP / TSP 0 ML ML 0 ML ML 0 ML ML 0 8. B A 9. A. 0. D. The calibrations of a tuberculin syringe are more precise than the calibrations for other syringes. A standard syringe might measure to the nearest 0. cc. A tuberculin syringe can measure to the nearest 0.0 cc. 8 DR oz. True; while the two measurements are not perfectly equal, they are considered equivalent measures.. False; you should not use medicine cups for doses less than, even if the cup has calibrations less than. Instead you must use a smaller device, such as a dropper, to ensure accuracy. 6 DR 4 DR DR DR / 4 oz / oz / 4 oz / 8 oz oz. False; a calibrated dropper uses the system of measurement of the specified dose. B 0 Instructor s Manual for Math and Dosage Calculations for Health Care
. 4. 0.6.0.0 0.8 0.7 0.6 0. 0.4 0. 0. 0. C D. E 4 6. F 0. 7. G 4 8. H 0. 9. /4 / /4 ml ml ml 4ml ml I Instructor s Manual for Math and Dosage Calculations for Health Care
0. / / 4 6 7 8 9 0 ml J.. / / / cc K.. / / / cc L. 80 units 0 0 0 0 60 70 80 90 00 M 4. 9 8 7 6 4 0 0 0 0 60 70 80 90 00 N 4 units. 0 4 0 0 0 O units 6. 0 4 0 0 0 7. P 7 units....4..6.7.8.9.0 ML Q 0. Instructor s Manual for Math and Dosage Calculations for Health Care
8.....4..6.7.8.9.0 ML R 0. 9. 4 6 7 8 9 0 0 cc S. 4 6 7 8 9 0 0 cc T 7. Critical Thinking. standard, safety, or needleless syringe. U-0 insulin syringe. tuberculin syringe 4. oral syringe. medicine cup, calibrated spoon, or oral syringe 6. standard, safety, or needleless syringe 7. medicine cup, calibrated spoon, or oral syringe 8. large-capacity syringe 9. transdermal patch 0. dropper or oral syringe. calibrated spoon, oral syringe, or teaspoon dropper Case Study The dose to be administered is 0.7. It could be measured in a calibrated spoon. Another acceptable form of administration would be.7 in an oral syringe. The bottle s instructions state that 0 drops.. The emergency medical technician needs 0 drops, or _ 0 drops. Finding _ of. leads to _. 0.7. A calibrated spoon can be used to measure 0.7. If the emergency medical technician did not have a calibrated spoon but had determined that he needed 0.7, he could use another approach and another utensil. Remembering that cc, he would conclude that cc. In turn, knowing that, he would find that cc Multiplying both sides by 0.7 leads to: 0.7 () 0.7 () 0.7.7 The technician can use an oral syringe to administer.7 of the medication. Internet Activity The student s report should indicate knowledge of at least two needleless systems or types of safety syringes. Try www.safetysyringes.com, www.hd.com, or www.index.com. Instructor s Manual for Math and Dosage Calculations for Health Care