INSTRUCTOR MANUAL FOR Administering Medications, 8e Donna Gauwitz

C H A P T E R 1: Orientation to Medications Learning Outcomes 1-1 Define terms to understanding administration of medications.

1-2 List the major sources and uses of drugs.

1-3 Define drug standards, indicating how they are determined and why they are necessary.

1-4 List names by which drugs are known.

1-5 List drug references, explain how to use at least one, and make a drug card.

1-6 List the major drug laws and their main features.

1-7 List the federal agencies that enforce the drug laws and the importance of enforcing them.

Chapter Outline Key Terms Introduction to Pharmacology Pharmacology Drug Sources Drug Uses Drug Standards Drug Names Drug References Preparing Your Own Drug Cards Drug Legislation You and the Law Chapter Summary Chapter 1 Review Teaching Strategies § Ask students to identify the key terms they are already familiar with. Discuss the definitions of all the terms and be certain that students are clear about the meanings.

Point out any similarities that may be confusing to them and tell them to memorize those words to avoid confusion later on. Ask volunteers to share their methods of learning medical key terms. § Ask students to list the major sources of drugs and give examples of each. § If possible, obtain a film from the library or a pharmaceutical company explaining the process of drug trials. Show the film to the class. § Take a field trip to a pharmaceutical company in your area to observe the step-by-step process of manufacturing drugs. Ask students to summarize why, as health care workers, they should understand the drug manufacturing process. Discuss how the company followed drug legislation. § Invite a pharmacist into class (or visit a pharmacy) to discuss the process of testing for generic drugs. Ask students why it is important they understand this process. § Ask a pharmaceutical representative to speak to the class about how he or she can make a difference in patient care. § Visit a local pharmacy or invite a pharmacist into class to discuss what pharmacists teach patients when they dispense a drug. Ask for print material that is sometimes given to patients. Discuss in class how this material could be beneficial or harmful to the patient. § When students begin work in a health facility, ask them to make a list of all the drug references that are available to them in their work environment. Are the materials up-todate? Why are up-to-date references important to the patient and the health care worker? § Ask students to complete the Chapter 1 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with. § Administer and grade the Chapter 1 Test in this Instructor’s Manual. § Develop and administer a performance test for preparing a drug card.

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Critical Thinking Activity You are admitting a patient who frequently changes physicians. The patient has an unlabeled bottle of pills that she has been taking. She says that a doctor she no longer sees prescribed them for her. She does not know why she was taking the drug or the name of the drug. What should you do to determine the drug’s name, action, and therapeutic purpose?

Answers to Chapter 1 Review 1. Chemical substance used in the diagnosis, treatment, cure, or prevention of a particular disease 2. The study of drugs: sources, chemical makeup, uses, how to prepare them, and so on 3. The structure of the body and its parts 4. The science that deals with the functions of cells, tissues, and organs of living organisms 5. Rules concerning the strength, quality, and purity of drugs 6. Physicians’ Desk Reference®, a drug reference 7. United States Pharmacopeia/National Formulary, a drug reference containing the standards for official drugs 8. Enforcement agency that enforces the Patriot Improvement and Reauthorization Act of 2005.

9. The absorption, distribution, metabolism, and excretion of drugs 10. Drug sources include: ▪ Plants—digitalis, opium, belladonna, vitamin C, gums, oils ▪ Animals—insulin, heparin ▪ Minerals—iron, iodine, salt, calcium ▪ Synthetic drugs—Bactrim, Septra, biotechnology, Humulin® insulin, vaccines 11. Drug uses: ▪ Prevent diseases—vaccines ▪ Maintain health—insulin, vitamins ▪ Diagnose disease—radiopaque dye, barium ▪ Treat disease—aspirin, antihistamines ▪ Cure disease—antibiotics ▪ Prevent pregnancy—contraceptives ▪ Palliative—chemotherapy 12. Drug laws and agencies: ▪ Pure Food and Drug Act of 1906, no agency ▪ Food, Drug, and Cosmetic Act of 1938, enforced by the FDA ▪ Controlled Substances Act of 1990, enforced by the DEA 13. OTC drugs can be bought and sold without a prescription. Prescription drugs need a doctor’s written or verbal order to be bought and sold. Controlled substances have restrictions on who can prescribe, and how, and how often they can be prescribed.

14. c 15. b 16. a 17. d 18. f 19. e 20. e 21. b 22. a 23. d 24. c 25. b 26. b 27. c.

28. d 29.a 30. Metamucil is a bulk-forming laxative of plant origin.

Digitalis is a cardiac glycoside used in the treatment of congestive heart failure.

It is also of plant origin.

Insulin is used in the treatment diabetes mellitus. It is of animal source.

Bactrim is a synthetic drug to treat an infection.

Iron is a mineral given as a supplement generally for a deficiency in the diet.

31. Nitroglycerin is the generic name and Nitrostat is the brand name.

A healthcare provider may order a drug by either a generic or brand name.

A generic name allows the pharmacist to dispense from nonbrand name drugs.

A drug only has one generic drug name but may have several brand names.

For example, nitroglycerin has the other brand names of Nitro-bid or Nitrong.

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Although memorizing all the generic and brand names for drugs is not possible, be familiar with both the generic and brand names.

32. Janie should study the federal and state laws controlling medication administration. She should also study the nursing home’s own regulations, and she should find out who is in charge so that she knows to whom questions should be addressed.

33. Answers will vary 34. White 35. About 17 (this will vary from year to year) 36. Acetaminophen 37. Answers will vary

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C H A P T E R 2: Principles of Drug Action Learning Outcomes 2-1 Identify the basic drug actions and the body processes that affect drug actions.

2-2 Identify the factors influencing drug action.

2-3 Distinguish between systemic and local drug effects.

2-4 Summarize the differences between therapeutic effect, side effects, synergism, antagonism, and potentiation.

2-5 Explain the difference between psychological and physical drug dependence.. .

Chapter Outline Key Terms Pharmacokinetics Drug Action Factors Affecting Drug Action Drug Effects Adverse Reactions Drug Dependence or Drug Abuse?

Chapter Summary Chapter 2 Review Teaching Strategies ▪ Discuss the definitions of the key terms and have the students give an example of how each term is used.

▪ Ask students to use a drug reference to find side effects that are not adverse reactions.

This activity is more meaningful if you select a drug one of the students is taking or has recently taken.

▪ Obtain and show a film on drug addiction. Ask the students to summarize the difference between physical and psychological dependence.

▪ Make arrangements for the class to visit a community-based psychiatric hospital or clinic to observe patients who have been abusing drugs.

▪ Arrange for a panel discussion to include drug counselors, crisis center ▪ workers, former addicts, and alcoholics to provide the students with the opportunity to obtain firsthand knowledge from the victims of abuse.

▪ Ask students to attend an AA meeting and write a summary of the experience. Also ask them to bring back any literature that is available.

▪ Discuss the potential of drug abuse in health care workers. Discuss what is the worker’s responsibility if he or she suspects a fellow health care worker to have a drug abuse situation.

▪ Develop a class discussion on how a health care worker might help a drug-impaired health care worker.

▪ Have students work in cooperative learning groups to make a display that describes the local and systemic processes of drug effects in the body.

▪ Ask students to explain the difference between synergism, antagonism, and potentiation.

▪ Divide students into two cooperative learning groups. Identify five drug categories. After group one has identified the therapeutic effects of those identified drugs and group two has identified the side effects of the same drugs, have a class discussion on the differences.

▪ Ask students to complete the Chapter 2 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 2 Test in this Instructor’s Manual.

Critical Thinking Activity Have each student imagine caring for a patient who started on a new drug a week ago and was given information on the side effects of that medication. The patient now says that he is Gauwitz, Administering Medications, 8e

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experiencing all of the side effects mentioned a week ago. Ask the student to consider if the patient is suggestible or really suffering from the side effects of that drug. Ask the student what should be done.

Answers to Chapter 2 Review 1. The study of a drug during absorption, distribution, metabolism, and excretion 2. Effects 3. Passage of a substance into the bloodstream from the site of administration 4. Movement of drugs into cells and into spaces between cells 5. Breaking down drugs into different substances that can be excreted 6. Removal of waste products from the body 7. Systemic 8. Local 9. Speeding up (stimulating), slowing down (depressing), stopping or destroying 10. Replacing 11. Absorption, distribution, biotransformation, excretion 12. Kidneys, large intestine, lungs, milk glands 13. Therapeutic and side effects 14. Any three of the following: skin rashes, itchy eyes, itchy skin, wheezing, fever, nasal drainage 15. An inactive substance that has no pharmacological effect 16. Self-administration of a drug in chronically excessive amounts resulting in psychological and/or physical dependence 17. Overuse or improper use of any drug 18. Abnormal or peculiar response to certain drugs 19. Five of the following: narcotics and opium; barbiturates, sedatives or hypnotics, and alcohol; amphetamines, cocaine, and other stimulants; LSD and other hallucinogens; marijuana 20. Consult the nurse in charge.

21. A condition in which the body must have a drug in order to function because it is so used to having the drug 22. A feeling of being unable to get along without a drug 23. Dose of a drug that is too large for the patient’s size, age, or physical condition 24. Symptomatic and supportive 25. Laxative, acetaminophen, aspirin, nicotine, alcohol 26. Breathing and heart stop.

27. Shortens the time needed for symptoms to appear; potentiates the effect of the drug 28. Drug that has the opposite effect and can reverse the overdose symptoms 29. — 30.

31. — 32.

33.

34.

35. — 36. — 37.

38.

39.

40.

41.

42.

43.

44. — 45.

46. — 47. — 48. b 49. c 50. a 51. a 52. d 53. Absorption is the passage of a drug from the site of administration into the bloodstream.

Subcutaneous drug such as insulin is injected just below the skin.

It is absorbed slowly. For example, slower than an intramuscular drug.

54. Increase fluids Avoid taking laxatives because they speed up the drug excretion Improper diet and lack of exercise slow drug excretion After general anesthesia, coughing and deep breathing help eliminate the anesthesia more quickly Keep the skin clean to avoid irritation from drugs eliminated through the sweat glands Chew gum or suck hard candy, such as lemon drops, to decrease the unpleasant effects of drugs eliminated through the saliva Gauwitz, Administering Medications, 8e

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If pregnant, discuss all drugs including over-the-counter drugs with their physicians to avoid the possible risk to the fetus 55. Tolerance 56. Cumulative effect 57. Potentiation (or synergism) 58. Drug dependence 59. Antagonism 60. Idiosyncrasy 61. Drug allergy 62. Drug interaction 63. Overdose 64. Adverse Event Report 65. In back of PDR® and is allowed to be copied 66. Vaccine Adverse Event Reporting System 67. To compare it with the patient’s history and the conditions at hand

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C H A P T E R 3: Measurement and Dosage Calculations Learning Outcomes 3-1 Solve problems utilizing fractions and decimals.

3-2 Identify the most common equivalents among apothecary, metric, and household measures 3-3 Solve Fahrenheit to Celsius temperature conversion and vice versa.

3-4 Calculate the number of tablets, capsules, and injectable medications to give when the available dose differs from the ordered dose.

3-5 Calculate a child’s dose of medication.

3-6 Calculate drops per minute for IV therapy.

Chapter Outline Key Terms Math Review: Fractions Systems of Measurement Converting Among Measurement Systems Dosage Calculation Chapter Summary Chapter 3 Review Teaching Strategies ▪ Discuss the meanings of the key terms. Be sure students understand all of the terms before proceeding.

▪ Ask students to make cards, posters, flashcards, or displays that can be used to help them learn the abbreviations and equivalents found in Tables 3-1 through 3-7 in the text.

▪ Encourage students to share their learning tools and to use them as needed.

▪ Calculate dose using a procedure for converting between different units of measurement.

▪ Set up stations in the lab to resemble a patient room, a medicine room, and an emergency cart that includes IV equipment. At each station arrange appropriate forms of medications with dosage labels. Make cards that require students to calculate the proper dosage. On the back of the cards place the answers. Have students in groups or individually go to each station and calculate the various dosages. Ask them to repeat any of the calculations they missed.

▪ Perform a calculation relay race. Divide the students into two equal lines and line them up in front of the bulletin board. Have medication calculations on index cards. Give the first student a card to work the calculation as quickly as possible on the blackboard. It the student cannot get the answer only the second student can help the first student. When the student gets the answer, the second student gets a card. Repeat the process through all the students.

▪ Ask students to complete the Chapter 3 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 3 Test in this Instructor's Manual.

Critical Thinking Activity Calculate a dose of medication to be administered to a patient intramuscularly. When you go to give the medication, the patient says the syringe you are using is too big and contains more medicine than usual. What should you do?

Answers to Chapter 3 Review 1. The different amounts of a drug that will produce therapeutic effects but not serious side effects or toxicity 2. Basic unit of weight in the apothecary system 3. A decimal system of measurement in which the basic unit of length is the meter, the basic unit of volume is the liter, and the basic unit of weight is the gram 4. Basic unit of volume in the apothecary system Gauwitz, Administering Medications, 8e

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5. Basic unit of volume in the metric system 6. Basic unit of length in the metric system 7. A mathematical way of talking about an amount that is part of a whole or a ratio between two numbers 8. One-hundredth of a meter 9. One-thousandth of a liter, the same as a cubic centimeter 10. The bottom number of a fraction 11. A fraction in which the value of the numerator is greater than or equal to the value of the denominator. The value of the improper fraction is greater than or equal to 1.

12. a 13. a 14. b 15. a 16. b 17. Min 18. gr 19. dr 20. fldr 21. oz 22. gtt change to gt 23. pt 24. T, tbsp 25. lb 26. mg 27. mL 28. L, l 29. g, gm 30. 4 fluidrams 31. 1 1⁄2 grains 32. 2 minims 33. 9 fluidrams 34. One 35. One 36. 15 37. 1 38. 60 39. 1000 40. One 41. 500 42. One 43. ½ 44. 1/3 45. ¾ 46. ¾ 47. ¼ 48. 5/9 49. 2 2/3 50. 2 ½ 51. 1 5/12 52. 2 ¾ 53. 4 ½ 54. 22 2/3 55. 3 ½ 56. 5 2/5 57. 3/100 58. 1 ¼ 59. 4 1/6 gr 60. 5/12 61. 1 11/24 62. 180 mg 63. ¾ 64. 1/180 65. 1 1/8 66. 600 67. 0.5 68. 0.25 69. 0.75 70. 0.25 71. 0.023 72. 0.333 73. 0.667 74. 0.6 75. 0.89 76. 3.75 77. ¾ 78. 1 ½ 79. 1/200 80. 1/5 81. 5 2/3 82. 3/8 83. 4.5 84. 0.045 85. 0.3 86. 0.45 87. 0.275 88. 3 89. 100 90. 30 91. 0.325 92. 3 93. 2500 94. 125 95. 1.2 96. 0.005 97. 36.3º 98. 37.2º 99. 37.8º 100. 38.8º 101. 38.9º 102. 40º 103. 95.8º 104. 99.3º 105. 102.6º 106. 104º 107. 105.6º 108. 107.6º 109. 68.2 110. 39.1 111. 49.5 112. 106.3 113. 99 114. 3.64 115. 35.2 116. 70.4 117. 176 118. 11 119. 206.8 120. c 121. a 122. c 123. d 124. a 125. All numbers less than 1 must be documented with a zero prior to the decimal point. A math problem must always be labeled with the appropriate unit of measure.

All weights must be rounded to the tenth place. Round medications to the hundredth place.

If the last number in rounding is less than 5, round down.

If the last number in rounding is greater than 5, round up.

126. Assumed the vehicle (V) is one when it may be greater for example two. Always double check the vehicle to correctly determine it before setting up your calculation.

127.1/600 131. 2 ½ 135.

128. 1/120 132. 300

129. 1 133. 15

130. 1/15 134. 0.5

D X = H V

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50 g X = 100 g 1 ml 100X = 8 50 ÷ 100 = 0.5 mL X = 0.5 mL 136.

D X = H V 8,000 units X = 10,000 units 1 ml 10X = 8 8 ÷ 10 = 0.8 mL 137.

X D = V H Conversion is 1 g = 1000 mg

600 mg X = 600 mg 1 tablet 600X = 600 600 ÷ 600 = 1 X = 1 tablet 138.

X D = V H 12.5 mg X = 1 tablet 25 mg 25X = 12.5 12.5 ÷ 25 = 0.5 X = ½ tablet 139.

D X = H V 450,000 units X = 300,000 units 1 mL 45 X = 30 1 45 ÷ 30 = 1.5 mL X = 1.5 mL 140.

D X = H V Gauwitz, Administering Medications, 8e

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20 mg X = 25 mg 2 mL 25X = 40 40 ÷ 25 = 1.6 X = 1.6 mL 141.

D X = H V 3 mg X = 4 mg 1 mL 4X = 3 3 ÷ 4 = 0.75 X = 0.75 mL 142.

X D = V H 3,000 mg X = 10,000 mg 1 mL 3 X = 10 1 10X = 3 3 ÷ 10 = 0.3 X = 0.3 mL 143.

X D = V H 400 mg X = 500 mg 2.5 mL 4 X = 5 2.5 5X = 10 10 ÷ 5 = 2 X = 2 mL 144.

X D = V H 15 mg X = 10 mg 1 mL 3 X = 10 1 10X = 15 Gauwitz, Administering Medications, 8e

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15 ÷ 10 = 1.5 X = 1.5 mL 145.

D X = H V 600 mg X = 120 mg 5 mL 120 X = 3,000 12X = 300 300 ÷ 12 = 25 25 mL 146.

X D = V H Conversion is 1 g = 1000 mg

1.5 g X = 0.75 g 1 tablet 0.75X = 1.5 1.5 ÷ 0.75 = 2 X = 2 tablets 147.

X D = V H 6,000 units X = 10,000 units 1 mL 6 X = 10 mL 10X = 6 6 ÷ 10 = 0.6 mL X = 0.6 mL 148.

Change 0.75 g to mL 3 mL of the prepared solution = 1 g The equivalent fraction = 0.75 g X

3 mL 1g

3 mL = 2.25 mL 1g

2.25 mL of the prepared solution contains 0.75 g of Mefoxin 149.

D X = H V Gauwitz, Administering Medications, 8e

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75 mg X = 100 mg 2 mL 100X = 150 150 ÷ 100 = 1.5 X = 1.5 mL 150.

Demerol

D X = H V 60 mg X = 100 mg 2 mL 100X = 120 120 ÷ 100 = 1.2 X = 1.2 mL Vistaril

25 mg X = 25 mg 1 6 X = 10 mL 25X = 25 25 ÷ 25 = 1 X = 1 mL Demerol 1.2 mL and Phenergan 1 mL is a combined does of 2.2 mL Demerol and Phenergan are compatible and may be administered in one syringe.

151.

X D = V H 500 mg X = 5 250 mg 6 X = 10 mL 25X = 250 250 ÷ 25 = 10 X = 10 mL 152.

D X = H V 0.3 mg X = 0.3 mg 1 mL 0.3 X = 0.3 0.3 ÷ 0.3 = 1 X = 1 mL Gauwitz, Administering Medications, 8e

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153.

X D = V H 10 mEq X = 20 mEq 15 mL 10 X = 20 15 20X = 150 150 ÷ 20 = 7.5 X = 7.5 mL 154.

X D = V H 100 X = 50 1 50X = 100 100 ÷ 50 = 2 X = 2 tablets 155.

X D = V H 15 mg X = 20 mg 2mL 20X = 30 30 ÷ 20 = 1.5 X = 1.5 mL 156. .

X D = V H 650mg X = 325mg 1tablet 325X = 650 650 ÷ 325 = 2 X = 2 tablets 157.

X D = V H Conversion is 1 g = 1000 mg

750mg X = 500mg 1tablet 75 X = 1 50 Gauwitz, Administering Medications, 8e

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50X = 75 75 ÷ 50 = 1.5 X = 1 ½ tablets 158.

X D = V H Conversion is 1 mg = 1000 mcg

200mcg X = 100mcg 1 mL 100X = 200 200 ÷ 100 = 2 X = 2 mL 159.

X D = V H Conversion is 1 g = 1000 mg

250mg X = 500mg 1 mL 25 X = 50 1 50X = 25 25 ÷ 50 = 0.5 X = ½ tablets 160.

X D = V H 5,000 units X = 10,000 units 1 mL 5 X = 10 1 mL 10X = 5 5 ÷ 10 = 0.5 X = 0.5 mL 161.

X D = V H 50mg X = 25mg 1 tablet 25X = 50 50 ÷ 25 = 2 X = 2 tablets 162.

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X D = V H Conversion is 1 g = 1000 mg

250mg X = 500mg 1 mL 25 X = 50 1 50X = 25 25 ÷ 50 = 0.5 X = 0.5 mL 163.

X D = V H 35mg X = 100mg 1 mL 100X = 35 35 ÷ 100 = 0.35 X = 0.35 mL 164.

X D = V H 800,000 units X = 2 1,000,000 units X 8 = 10 2 10X = 16 16 ÷ 10 = 1.6 mL 165

X D = V H Conversion is 1 g = 1000 mg

60 mg X = 30 mg 1tablet 30X = 60 60 ÷ 30 = 2 tablets 166.

X D = V H Conversion is 1 mg = 1000 mcg

100mcg X = 50 1tablet 50X = 100 Gauwitz, Administering Medications, 8e

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100 ÷ 50 = 2 X = 2 tablets 167.

D X = H V 0.6mg X = 0.3mg 1tablet 0.3X = 0.6 0.6 ÷ 0.3 = 2 X = 2 tablets 168.

X D = V H 2.5mg X = 1tablet 5mg 5X = 2.5 2.5 ÷ 5 = 0.5 X = 1 ½ tablet Chapter 3 Measurement and Dosage Calculations Answers to Practice Problems for Pediatric Patients 169.

0.1 mg X 35.5 = 3.55 mg/day 0.2 mg X 35.5 = 7.1 mg/day The safe dosage range of Duramorph for a child weighing 35.5 to 7.1 mg/day.

10 mg is not a safe dose range for this child and you should contact the physician.

170.

20 mg X kg = dose in 24 hours 20 mg X 22 kg = 440 mg in 24 hours 440 divided by 2 doses = 220 mg per dose You should give 220 mg every 12 hours.

171.

2 mg X kg = dose in 24 hours 2 mg X 26 kg = 52 mg in 24 hours 52 divided by 4 doses = 13 mg per dose You should give 13 mg per dose every 6 hours or in 4 divided doses.

172.

25 mg X kg = dose in 24 hours 25 mg X 9 kg = 225 mg in 24 hours 225 divided by 4 doses = 56 mg in each dose You should give 56 mg every 6 hours or in 4 divided doses.

173.

1 mg X kg = dose in 24 hours 1 mg X 56 kg = 56 mg in 24 hours 3 mg X 56 kg = 168 mg in 24 hours Gauwitz, Administering Medications, 8e

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Every 6 hours is equivalent to 4 doses 56 mg divided by 4 = 14 mg 168 mg divided by 4 = 42 mg The safe dosage range in 4 divided doses is 14 mg to 42 mg per dose.

174.

50 mg X kg = dose in 24 hours 50 mg X 19 kg = 950 mg in 24 hours 950 divided by 4 = 237.5, which should be rounded up to 238 mg You should give 238 mg in 4 divided doses.

175.

6 mg X kg = dose in 24 hours 6 mg X 18 kg = 108 mg/day 7.5 mg X kg = dose in 24 hours 7.5 mg X 18 kg = 135 mg/day The safe dosage range is between 108 mg to 135 mg/day.

108 mg divided by 4 = 27 mg 135 mg divided by 4 = 34 mg The safe dosage range in 4 divided doses is between 27 to 34 mg.

176.

25 mg X kg = dose in 24 hours 25 mg X 20 kg = 500 mg/day 50 mg X kg = dose in 24 hours 50 mg X 20 kg = 1000 mg/day 500 mg to 1000 mg is a safe dosage range.

177.

10 mg X kg = dose in 24 hours 10 mg X 20 kg= 200 mg in 24 hours 200 mg in 4 divided doses = 50 mg per dose 178..

BSA (m2) =

27 X 17 459 = = 0.382 = 0.38 m2 3131 3131

179.

BSA (m2) =

93 X 17 1581 = = 0.662 = 0.66 m2 3600 3600

180.

1000 mL = 250 mL/hour 4 hours 250 mL X 15 (drop factor) = 63 gtts/min 60 min 181.

200 mL = 100 mL/hour 2 hours Gauwitz, Administering Medications, 8e

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200 mL X 15 (drop factor) = 42 gtts/min 60 min 182.

1000 mL = 167 mL/hour 6 hours 167 mL = 15 (drop factor) = 42 gtts/min change gtts to gtt 60 min 183.

1000 mL = 42 mL/hour 24 hours 42 mL X 15 (drop factor) = 11 gtts/min change gtts to gtt 60 min

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C H A P T E R 4: Administering Parenteral Medications Learning Outcomes 4-1 Describe the major routes, sites, and procedures of injectable medications.

4-2 Use standard precautions.

4-3 Identify the parts of a syringe needle and the sizes of needles while identify doses.

4-4 Draw up medications from vials and ampules and reconstitute medications.

4-5 Identify the most common injection sites for intradermal, subcutaneous, and intramuscular administration.

4-6 Identify the various types of intravenous solutions, indications, advantages, disadvantages, and signs and symptoms of complications.

Chapter Outline Key Terms Orientation to the Parenteral Route Standard Precautions Equipment Drawing Up Medications Common Injection Sites General Procedure for Injections Special Instructions for Injections Principles of Intravenous Therapy Chapter Summary Chapter 4 Review Teaching Strategies ▪ Ask students to identify the key terms they are unfamiliar with. Discuss the definitions and be certain that students are clear about meanings.

▪ Show any films or slides you may have of administering medications by the parenteral routes.

▪ Review Table 4-1 on Universal Blood and Body Fluid Precautions and discuss their importance in the practice of administering parenteral medications.

▪ Have students practice giving injections a number of times before they are tested on the performance of the tasks. (You will need standard hypodermic 3 cc/mL syringes with 3/8 to 1½ inch, 22 to 25 gauge needles, insulin syringes, tuberculin syringes, Tubex syringes, and alcohol swabs.) Purchase sterile empty ampules and vials from a pharmaceutical company if you cannot buy them at a medical supply company. Label them as insulins, narcotics, and other medications, such as vitamins and antibiotics.

Purchase puncture-resistant containers.

▪ Hang posters, charts, and different types of visual aids showing proper ▪ handwashing technique; intradermal, subcutaneous, and intramuscular ▪ routes, and equipment and procedures.

▪ Develop and administer performance tests for giving intradermal, subcutaneous, and intramuscular injections.

▪ Ask students to complete the Chapter 4 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 4 Test in this Instructor's Manual.

▪ Divide the class into three groups and assign the first group, isotonic intravenous solutions. Assign the second group, hypertonic solutions and the third group, hypotonic solutions. Ask the students to outline the characteristics and examples of each type of IV solution to which they are assigned. Have a representative from each group report back to the whole group.

▪ Have the students make posters on the advantages and disadvantages of intravenous therapy and its complications.

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Critical Thinking Activity 1. You are preparing to give a patient an injection. The patient is afraid. What can you do to help the patient?

2. Discuss what you would do differently when giving a subcutaneous injection to an obese patient.

3. You are caring for a patient who has an intravenous solution that is running slow and there is no blood return when the IV bag is lowered below the heart. The patient complains of pain at the IV site that also appears edematous. What action should you take?

Answers to Chapter 4 Review 1. Consistent application of procedures for contact with blood and body fluids of all patients 2. To suction; to pull back on the syringe plunger to check for entry into a blood vessel 3. Thick and sticky 4. Thin and watery 5. The administration of fluids, electrolytes, medications, blood, or nutrients through a vein 6. a. Tip b. Barrel c. Flange d. Plunger e. Bevel f. Needle cover or sheath g. Shaft, stem, or cannula h. Hub 7. a. 2.2 mL b. 0.15 mL c. 49 units d. 32 U 8. a. Standard hypodermic b. Tuberculin c. Insulin 9. Intradermal Subcutaneous Intramuscular a. skin, dermis subcutaneous, fatty tissue muscle b. tuberculin standard hypodermic standard hypodermic or insulin c. 3/8-inch 3/8 – 5/8-inch 1 – 1½ -inch d. 25–26G 24–26Gaqu.

21–23G visc. 18–20 G e. 15° 45° or 90° 90° 10. Because rapid absorption is desired; because the drug is destroyed by digestive juices if taken orally, and because the patient is unable to swallow,is unconscious, or has nausea, vomiting, or intestinal obstruction 11. To pull back on the plunger and check for blood in the syringe after the needle is inserted into tissue; done to see whether the needle has entered a blood vessel 12. Never administer a syringe with blood. Dispose of the syringe and start over.

13. Crystalloids, colloid solutions, hypertonic-hyperosmolar preparations, and blood or blood components 14. Fluid volume maintenance, fluid volume replacement 15. Redness, warmth, discomfort along the vein.

16. d 17. a 18. c 19. b 20. sciatic 21. up 22. air 23. broken off 24. time, date, strength 25. Intracellular, interstitial 26. F 27. T 28. T 29. T 30. T 31. d 32. c 33. a 34. c 35. b 36. Reconstituted drugs are stored in powder form because they lose freshness and effectiveness in liquid form. Reconstitute with sterile water or saline solution depending on the package insert. After adding fluid to a vial, gently roll the vial between your hands to dissolve or disperse the medication completely.

37. Dislodged IV needle from the vein Edema at the site No blood return when the IV bag is lowered below the heart Discomfort at the IV site Significant slowing or complete stoppage of the flow Notify you supervisor Gauwitz, Administering Medications, 8e

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Discontinue the IV and have an RN change the IV site 38. See text.

39. Redness, rash, lumpiness, sloughing, necrosis, abscess 40. Do not give the injection, but chart the appearance of the skin and consult the nurse in charge 41. Answers will vary.

42. Notify the nurse, because the patient is experiencing a pyrogenic reaction.

43. Ceftazidime 44. Aerobes, gram-negative and gram-positive, anaerobes 45. Lower respiratory tract infection, skin and skin structure, urinary tract infections, bacterial septicemia, bone and joint infection, gynecological infections, intra-abdominal infections, and central nervous system infections 46. When the patient is hypersensitive to ceftazidime

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C H A P T E R 5: Medication Therapy Learning Outcomes 5-1 Describe the various forms of medication, ranging from liquids to solids and their abbreviations.

5-2 Describe the routes for administering medications.

5-3 Describe the routes of administration of medication and their abbreviations, including use of military clock, types of drug orders and general medical terms.

5-4 Carry out setting up medications following proper procedure.

5-5 Explain the rules for giving medications identifying the parts of the medication label and utilizing single dose packing.

5-6 Describe the problem-oriented medical record and the subjective–objectives–assessment– plan method of charting and how the medication record is used to communicate medication order.

5-7 Carry out accurate, complete, and organized charting.

Chapter Outline Key Terms Forms of Medication Routes of Administration The Medication Order Types of Drug Orders Questioning a Medication Order Standard Medical Abbreviations Ordering Drugs From the Pharmacy Drug Packaging Storage and Disposal of Drugs Keeping Track of Medication Orders Setting Up Medications The Seven Rights: Rules for Giving Medications Charting Medications Reading and Understanding Medication Labels The POMR Principles of Charting Chapter Summary Chapter 5 Review Teaching Strategies ▪ Discuss the meaning of key terms. Be sure students understand all of the ▪ terms before proceeding.

▪ Ask the Nursing State Board or the State Department of Education to send a representative to your class to discuss the procedures that can be performed by the various members of the health care team. Focus on RNs, ▪ LPNs, Medication Assistants, and Medical Assistants.

▪ Ask students who are employed (in a health care facility) to research the ▪ policies of their workplace in regard to who is allowed to administer medications, who is allowed to administer PRN or parenteral medications, and who can chart and count narcotics.

▪ Obtain a film relating to medication therapy and show it to your class. Ask students to summarize the film and analyze its effectiveness in writing.

▪ Make arrangements for the class (as a group or individuals) to visit the computer lab and see a demonstration on computer use in health care. If this is not possible, ask students to visit a doctor’s office or a clinic (with an appointment) to interview the office staff about the use of computers. Ask students to summarize what they learned in writing.

▪ Obtain samples of various forms of medications from a local pharmacist, doctor, or pharmaceutical representative. Display these in class. Ask students to identify the various forms.

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▪

▪ ▪ ▪ ▪

▪ ▪ ▪

Ask students to work in four cooperative learning groups. Assign each group one of the following: Table 5-1, Table 5-2, Table 5-3, or Table 5-4. Ask each group to make a chart, flashcards, or individual cards that can be used to learn the medical abbreviations. Make the “projects” available to students who want to use the devices to learn the abbreviations.

Have students individually, or in cooperative learning groups, make a display of all the routes of medication administration. Tell them they can use whatever resources they can locate such as books, magazines, journals, lab equipment, catalogs, etc.

Obtain a film relating to routine responsibilities, such as the “seven rights” rule. Show the film to the class. Ask students to summarize the film in writing and to discuss its benefits.

Obtain copies of actual drug labels and ask the students to identify the different parts of the label.

Make copies of a controlled substances proof-of-use record, pharmacy requisitions, a medication error form, and several different charting forms including some that make use of computers. Have students practice completing them. Then have students share forms to critique them. Discuss any problem areas.

Have students practice the procedures listed as competencies for this chapter.

Ask students to complete the Chapter 5 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

Administer and grade the Chapter 5 Test in this Instructor's Manual.

Critical Thinking Activity You are caring for a patient with osteoarthritis and diabetes. Because the patient does not have a cardiovascular disease, you determine an order for Lanoxin is an incorrect medication order.

What should you do?

Answers to Chapter 5 Review 1. The ingredient in a product that produces the therapeutic effect 2. Rinsing a body cavity with water or other solutions 3. Administering drugs by way of droplets or mist that is breathed in 4. Placing drops of liquid into the eyes, ears, nose, or some other body cavity 5. Patient who is not hospitalized or institutionalized; a walk-in (or ambulatory) patient 6. A form for writing out medication orders, located in the patient’s chart 7. Drug order in which the ordered drug is administered until a discontinuation order is written or a specified termination date is reached 8. Drug order that outlines a specific patient condition in which a certain drug is to be administered 9. Order for a drug to be given when a patient needs it 10. Drug order carried out immediately and only once 11. f 12. e 13. g 14. d 15. h 16. c 17. i 18. b 19. k 20. j 21. a 22. e 23. f 24. c 25. g 26. d 27. b 28. a 29. h 30. e 31. b 32. c 33. f 34. a 35. g 36. d 37. Extract 38. Syrup 39. Tincture 40. Suppository 41. Spirit 42. Fluidextract 43. Capsule 44. Elixir 45. Tablet 46. Solution 47. Suspension 48. Pleasant-tasting tablet made to dissolve in the mouth for a local effect 49. Drug held in a base such as cocoa butter that melts at body temperature; designed for insertion in the vagina, rectum, or urethra 50. Capsule containing multiple doses of medicine that are released gradually for a sustained effect 51. Tablet with a groove down the middle for easy dividing 52. Medicine dropper or medicine glass 53. a dark place 54. alcohol 55. shaken 56. solution Gauwitz, Administering Medications, 8e

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57. suspension 58. enteric 59. liniments 60. rectum, vagina, urethra 61. alcohol 62. delayed-release or timed-release 63. older adults as well as the young 64. added ingredients 65. food or drink 66. topical 67. parenteral 68. sterile 69. 0700 hours 70. 11:00AM 71. 1:30PM 72. 1400 hours 73. 8:00PM 74. If you question a medication order, ask the doctor or the nurse in charge to explain the reasons for the order.

75. Physician’s assistants and nurse practitioners 76. Do not dissolve the contents of a delayed-release capsule in food or drink; this action could cause an overdose.

77. Patient’s full name, date of the order, drug name, dosage, time and frequency, route of administration, signature of physician 78. Darvon capsules, 65 mg every 4 hours as necessary for pain 79. Phenobarbital elixir, 1 teaspoon (20 mg) at bedtime 80. Keflex 250-mg capsules every 6 hours orally 81. Lotrimin 1 percent cream twice a day for 2 weeks 82. Bacitracin ophthalmic ointment in the right eye three times a day for conjunctivitis 83. Propantheline bromide tablets, 15 mg before meals 84. Heparin 5000 units intravenously immediately 85. Acetaminophen 120-mg rectal suppository four times a day 86. e 87. a 88. b 89. d 90. c 91. One 92. Problem, Interventions, Evaluation 93. Controlled substances 94. Narcotics, barbiturates, amphetamines, hallucinogens, etc.

95. In a locked cabinet or in the automated dispensing system 96. There is less chance of error because no mixing, pouring, or handling of drugs is needed.

Unused doses can be returned to the pharmacy for credit.

97. In a labeled cabinet separate from the drugs for internal use 98. With a pill cutter 99. Right patient, right drug, right dose, right time, right route, right technique, and right documentation 100. Give medication from labeled containers. Read the label three times.

101. It serves as a means of communication among members of the health care team. It is a legal document, and an official record of health care given. It is used for research, teaching, and evaluation of health facilities.

102. Charting Subjective comments of the patient, Objective tests of the patient’s condition, the health care worker’s Assessment of the problem, and a Plan of action.

103. This depends on the agency. One way is to cross out the scheduled time and initial it.

104. This depends on the agency. One way is to circle the scheduled time and initial it.

Answers to Chapter 5 Review Drug Calculations 105.

D X = H V 50 mg X = 25 mg 1 tablet 25X = 50 50 ÷ 25 = 2 X = 2 tablets Gauwitz, Administering Medications, 8e

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106.

X D = V H 500 mg X = 250 mg 5 mL 250X = 2500 2500 ÷ 250 = 10 X = 10 mL 107.

D X = H V 200 mg X = 100 mg 1 mL 100X = 200 200 ÷ 100 = 2 X = 2 mL 108. d 109. c 110. a 111.b 112. c 113.Notify your supervisor Standing order Retake the temperature and administer followed by reassessing it in a hour 114.Notify your supervisor Fill out an incident report (medication error form) The incident report does not become part of the permanent chart It is used to report and monitor the frequency of medications errors so as to take corrective measures to prevent them in the future 115 – 117. See text 118- 120. Refer to PDR

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C H A P T E R 6: Vitamins, Minerals, and Herbs Learning Outcomes 6-1 Explain the food groupings according to Choose My Plate.

6-2 Distinguish between the fat-soluble and water-soluble vitamins, and the various vitamins.

6-3 List the various minerals, their functions, food sources, and the recommended daily allowances while performing calculations.

6-4 Explain the importance of water and electrolytes.

6-5 Identify herbal supplements, their uses, and their potential dangers.

Chapter Outline Key Terms Recommended Daily Allowance (RDA) Vitamins Minerals Electrolytes Herbs Chapter Summary Chapter 6 Review Teaching Strategies • Ask students to demonstrate their knowledge of key terms.

• Obtain and show a film on vitamins and minerals. Make sure it includes the functions, food sources, and RDA and the symptoms of deficiency and excess states.

• Divide students into 4 equal learning groups. Have group 1 work on the functions for each vitamin, group 2 on the food sources and RDA for each vitamin, group 3 on the symptoms of deficiency for each vitamin, and group 4 on the symptoms of excess for each vitamin. Have each group prepare a poster and present their findings to the whole class.

• Ask a dietitian to come to the class and discuss the importance of vitamins and minerals in the diet and how a hospital or community setting serving meals ensures the required RDAs. • Ask a representative from a “health food” store to come to the class and discuss herbs.

• Have a student develop flashcards with an herb on one side and prescription drug interactions on the other side. Devote a portion of the class to having a student hold up a flashcard with an herb on it and have a classmate identify the prescription drug interactions.

Critical Thinking Activity • Arrange for the class to visit a hospital kitchen to observe how patient meals are prepared.

• Ask students to complete the Chapter 6 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

• Administer and grade the Chapter 6 Test in this Instructor's Manual.

1. An 80-year-old patient lives alone since the death of his wife and is proud that he prepares his own meals. His typical diet includes: Breakfast—egg, toast, jelly, coffee Lunch—lunchmeat sandwich, potato chips, tea Dinner—canned stew or hash, coffee He avoids buying fresh fruits and vegetables because he says they spoil before he can use them. a. Discuss how this diet is deficient in the various vitamins and minerals. b. Develop a plan to incorporate fruits and vegetables into his diet.

2. A 30-year-old woman is in the hospital after breaking her leg skiing. She tells you that she is afraid she broke her leg because she has osteoporosis. She tells you that both her grandmothers have osteoporosis. Think of all the ways you can help this patient.

Answers to Chapter 6 Review 1. d 2. e 3. b 4. a 5. c 6. RDA 7. Trace elements 8. USDA 9. B complex and C 10. Fortified milk, whole milk products, green leafy vegetables, yellow fruits and vegetables, fish, liver oil, and sunlight

1

11. A, D, E, K 17. c 18. a

12. potassium 13. d 19. d 20. b 21. c

14. c 22. a

15. b 23. d

25.

D X = H V 30 mcg X = 100 mcg 1 mL 30 ÷ 100 = 0.3 100X = 30 X = 0.3 mL 26.

X D = V H 0.5 mg X = 1 mL 2 mg 2X = 0.5 0.5 ÷ 2 = 0.25 X = 0.25 mL 27.

X D = V H 40 mEq X = 10 mEq 1 tablet 10X = 40 40 ÷ 10 = 4 X = 4 tablets 28.

X D = V H 325 mg X = 325 mg 1 tablet 325X = 325 325 ÷ 325 = 1 X = 1 tablets 29.

D X = H V 650 mg X = 1250 mg 1 tablet 1250X = 650 650 ÷ 1250 = ½ X = ½ tablets

2

16. a 24. b

30. c 35.

31. b 32.a 33. d 34. a Life root It is a unsafe herb and toxic to the liver Notify your supervisor 36.

An adult over the age of 51 years needs 1500 mg a day Calcium is rich in milk, milk products, leafy green vegetables, sardines, clams, and sardines 37. Vitamin B1 38. Vitamin C 39. Vitamin A 40. Calcium 41. Iodine 42-43. Answers will vary depending on the edition of the PDR® or drug reference book used.

3

C H A P T E R 7: Antibiotics, Antifungals, and Antivirals Learning Outcomes 7-1 Distinguish between the external and internal immune systems.

7-2 Explain why drug resistance, hypersensitivity, and superinfection are important concerns in antibiotic drug therapy.

7-3 Identify the most common types and uses of antibiotics.

7-4 Describe the antifungal and antiviral drugs and infectious diseases.

7-5 Describe the correct procedure for administering a medication to a patient in isolation.

7-6 Describe the primary ways a healthcare worker can be exposed to hepatitis B virus and human immunodeficiency virus.

Chapter Outline Key Terms Infection and Immunity Antibiotic Drugs Antifungal Drugs Antiviral Drugs Isolation Procedures Universal Blood and Body Fluid Precautions Chapter Summary Chapter 7 Review Teaching Strategies ▪ Discuss definitions of the key terms.

▪ Have the students brainstorm a list of terms used for “germ.”

▪ Ask students to explain the concept of immunization. For whom is it most important?

(Consider the increase in TB.) ▪ Ask students to refer to the Representative Drugs table at the end of the chapter. Discuss ways in which this resource will be helpful. Ask students if they have any difficulty reading it. If so, take time to answer their questions.

▪ Have the students use one or more drug resources to look up two or three penicillin G products. Ask them to list the most common infections each product is used for.

▪ If possible, obtain a medical ID bracelet. Discuss the kinds of information commonly printed on the bracelet.

▪ Discuss answers students may give to patients who ask why the doctor replaced one antibiotic with another after a week of therapy. (Consider the culture, sensitivity testing, and broad- versus narrow-spectrum antibiotics.)

▪ Ask students to refer to Table 7-1 and match as many diseases as possible from memory to an antibiotic category from Table 7-2.

▪ Ask students to work in cooperative learning groups to develop visuals showing the universal blood and body fluid precautions. Ask groups to critique the various presentations.

▪ Have the students work in cooperative learning groups to develop charts illustrating standard, airborne, droplet, and contact precautions. Ask them to cover the criteria for diseases under each category, and the barrier protection to be used for each.

▪ In the lab, have students set up an isolation patient room. Have students practice administering medications to an isolation patient. Monitor their work. Develop a checklist from Practice Procedure 7-1 (found in the text) to use in your assessment.

▪ Ask students to complete the Chapter 7 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 7 Test in this Instructor’s Manual.

Critical Thinking Activity Gauwitz, Administering Medications, 8e

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You are admitting a patient for major surgery. You notice the patient has a productive cough and he says it has been a problem for 6 weeks with blood in the sputum. The patient says a family member was recently diagnosed with TB. What should you do?

Answers to Chapter 7 Review 1. Substance produced in the body to kill specific microorganisms 2. Injection or vaccination to stimulate antibody formation against a certain microorganism 3. Harmful microorganism, one that can cause infection 4. Ability to inhibit growth of microorganisms 5. Ability to kill microorganisms 6. Symptoms relating to anaphylaxis 7. Enzyme produced by microbes that makes them resistant to penicillin 8. By killing microorganisms directly and by slowing the growth of microorganisms 9. There is a risk of nerve damage that can cause deafness; the kidneys may also be damaged.

10. Macrolides 11. The results of a Gram stain determine the choice of an antibiotic that will be most effective for a specific pathogen.

12. Isolation procedures protect the patient from microorganisms that health care workers are carrying, and protect health care workers from microorganisms that the patient is carrying.

13. Strict, respiratory, and reverse (protective) 14. c 15. e 16. f 17. b 18. g 19. d 20. a 21. c 22. f 23. d 24. a 25. b 26. e 27.

X D = V H 200 mg X = 125 mg 5 mL 125X = 1000 1000 ÷ 125 = 8 X = 8 mL 28.

X D = V H Conversion is 1 g = 1000 mL

500 mg X = 500 mg 1 tablet 500X = 500 500 ÷ 500 = 1 X = 1 tablet 29.

X D = V H 500 mg X = 250 mg 1 tablet 250X = 500 500 ÷ 250 = 2 X = 2 tablets Gauwitz, Administering Medications, 8e

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30.

X D = V H Conversion is 1 g = 1000 mg

1000 mg X = 1 tablet 500 mg 500X = 1000 1000 ÷ 500 = 2 X = 2 tablets 31.

D X = H V 750 mg X = 500 mg 1 tablet 500X = 750 750 ÷ 500 = 1.5 X = 1.5 tablets 32. d 33. a 34. c 35.b 36. a 37. Erythromycin is a macrolide.

Take all the medication at prescribed times until the medicine is gone.

Usual course of treatment is 5 days.

Take the medication on an empty stomach (1 hour before or 2 hours after meals) with a full glass of water, because food decreases absorption.

Monitor patient closely if there is a diagnosis of liver impairment.

38. The patient is experiencing the most common side effects such as nausea, vomiting, and diarrhea. Sulfonamides also may cause crystals to form in the urine, which can cause urinary complications.

Take the full course of medication even after feeling better Take the medication on an empty stomach with a full glass of water to enhance absorption.

Avoid taking the medication with antacids because they decrease absorption of the sulfonamide.

Drink at least 3 quarts of fluids per day avoiding acidic juices such as orange juice and vitamin C, because they cause the urine to be acidic.

Report any skin reactions, such as rash or itching.

Fever and joint pain may occur after 7 days and must be reported immediately to the physician.

Avoid direct sunlight.

Bactrim is a sulfonamides.

39. Infections in hospitals are dangerous because drug-resistant microorganisms that live in some health care facilities cannot be killed by antibiotics. In hospitals, a large number of at-risk patients are gathered into one place. Microorganisms easily attack patients with skin wounds and lowered resistance. Medical staff can carry microorganisms from patient to patient as they work.

40. Through mucous membranes, through nonintact skin, by needlesticks 41. Allergic reaction; superinfection; some penicillins are poorly absorbed by the oral route and/or excreted quickly; microbes develop resistance by secreting penicillinase.

42. The patient is probably allergic to penicillin and is going into anaphylactic shock. You should get emergency help immediately.

43. Antacids and dairy products prevent the proper absorption of tetracyclines from the gastrointestinal tract.

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44.. Secretions from the nose and mouth; secretions coughed up from lungs; feces or anything touched by feces; drainage from wounds; infected blood.

45 – 47. Answers will vary depending on the drug reference book or edition of the PDR® that is used.

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C H A P T E R 8: Drugs for the Eye and Ear Learning Outcomes 8-1 Identify the external parts of the eye and ear.

8-2 Describe the major disorders of the eye and ear for which medications are given.

8-3 Describe the actions of the following drug groups: miotics, carbonic anhydrase inhibitors, beta-adrenergic blocking agents, eye antibiotics, mydriatics, and ear antibiotics.

8-4 Carry out administering eye and ear medications while performing calculations.

8-5 Carry out instilling eye drops, eye ointments, and ear drops.

Chapter Outline Key Terms Structure and Function of the Eye Eye Disorders Drug Therapy for Eye Disorders Structure and Function of the Ear Ear Disorders Drug Therapy for Ear Disorders Chapter Summary Chapter 8 Review Teaching Strategies ▪ Discuss the meaning of the key terms. Be sure students understand all of the terms before proceeding.

▪ Ask students to make flashcards with key terms on one side and definitions on the opposite side. Devote a portion of a class period to having students take turns holding up a word and having a classmate give the definition.

▪ Show a film covering the basic anatomy of the eye and ear.

▪ Demonstrate the administration of eyedrops, eye ointment, and ear drops.

▪ Emphasize the importance of gloves to protect against drainage and contact with patient’s body fluids.

▪ Arrange for a lab experience in which each student has the opportunity to do a return demonstration of the administration of eyedrops, eye ointment, and ear drops. Develop a checklist from Practice Procedure 8-1 and 8-2 (found in the text).

▪ If available, reserve the eye and ear structures from the health science department at your school or hand out an illustration of the structures covered in the film.

▪ Arrange for an ear and eye physician to visit the class and speak to students about the care of patients with disorders of the eye and ear.

▪ Ask students to complete the Chapter 8 Review. Discuss answers and review any material students had difficulty with.

▪ Administer and grade the Chapter 8 Test in this Instructor’s Manual.

Critical Thinking Activity 1. You are discharging an older adult patient who is vision impaired and needs instructions on the daily administration of antiglaucoma ophthalmic drops.

Develop a plan to teach the patient how to administer the drops.

2. A mother asks you how to administer antibiotic drops to her baby and if it is safe. What should you tell her?

Answers to Chapter 8 Review 1. e 2. b 3. c 4. d 5. a 7. Pertaining to hearing or sound 8. Dizziness 9. Pertaining to the ear 10. Pertaining to the eye or sight 11. Ringing in the ears Gauwitz, Administering Medications, 8e

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12. Double vision 13. Malleus, incus, stapes 14. Eyelid 15. Eustachian tube 16. Constricts the pupil and increases aqueous humor outflow 17. Dilates the pupil 18. b 19. e 20. d 21. c 22. a 23. Blurriness 24. Cleaned and dried 25. Warmed 26. “Sterile—for Ophthalmic Use” 27. Keep objects out of ears; avoid environmental noise; get all immunizations; report any vertigo, nausea, or vomiting; report mouth breathing.

28. See Table 8-1, Effects of Aging on Visual Structures Loss of pigmentation in brows and lashes Weakened muscles and loss of orbital fat of eyelids Formation of small yellow spots on conjuctiva Yellow sclera Burred vision Decreased tear production Decreased pupil size Cataracts Changes in color perception Floaters 29.

X D = V H 375 mg X = 250 mg 1 tablet 250X = 375 375 ÷ 250 = 1.5 X = 1.5 tablets 30.

X D = V H 1% solution X = 0.5% solution 1 drop 0.5X = 1 1 ÷ 0.5 = 2 X = 2 drops 31.

D X = H V 0.5% solution X = 0.25% solution 1 drop 0.25X = 0.5 0.5 ÷ 0.25 = 2 X = 2 drops Gauwitz, Administering Medications, 8e

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32. c 33. a 34. c 35.b 36. a 37. Do not put objects in the ear.

Avoid environmental noise, such as loud music, equipment, and airplanes.

Get all childhood and adult immunizations, particularly mumps, measles, and rubella.

Congenital deafness can occur if a pregnant woman is exposed to rubella during the first 16 weeks of gestation.

Report any hearing loss, vertigo, nausea, vomiting, or a spinning sensation in the head while sitting.

Enlarged adenoids may result from chronic mouth breathing. The eustachian tubes may be blocked which predispose a patient to infection.

Report any hearing loss such as asking other s to speak up, answering questions inappropriately, and increased sensitivity to even slight changes in noise level.

38. Earwax Softens earwax Fill the ear canal with solution and insert cotton ball Redness and itching 39. External otitis 40. Cerumen 41.. Glaucoma 42. Conjunctivitis 43 – 44. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 9: Drugs for the Skin Learning Outcomes 9-1 List the layers of skin tissue and main functions of the integumentary system.

9-2 Describe the major skin disorders and symptoms.

9-3 Articulate the actions of the following topical medication categories: keratolytics, protectives, astringents, antipruritics, topical corticosteroids, vasoconstrictor/venous insufficiency treatments, antiseptics, topical anesthetics, miticides, and transdermal patches.

9-4 Understand the instructions for medicating the skin Chapter Outline Key Terms Integumentary System Skin Disorders Topical Medications General Instructions for Medicating the Skin Chapter Summary Chapter 9 Review Teaching Strategies ▪ Discuss definitions of key terms. Be sure students understand all the terms before proceeding.

▪ Obtain and show a film about skin disorders. Ask students to make a list of common symptoms.

▪ Invite a dermatologist to speak to the class and show slides of as many skin disorders as possible. Ask about the most common OTC medications used in the office, as well as the most commonly used prescription drugs. Have students summarize the visit by listing all the disorders and drugs mentioned by the speaker.

▪ Ask a plastic surgeon to visit the class and speak to the students about burn patients, showing slides of first-, second-, and third-degree burns. Encourage a dialogue between the physician and the students about the type of person who can care for a burn patient or work with a burn patient in the many types of therapy that will usually be necessary.

(Include skin medications.)

▪ Make arrangements for the students, either as a group or individually, to visit a burn unit at a hospital. Do the caregivers appear to have the characteristics mentioned by the physician above? Why or why not?

▪ Assign each student a drug category from the Representative Drugs table in the text and ask them to prepare a patient case study. If they are working in a health care facility, they can select a patient they are caring for; if not, they will need to do some library research.

Point out that students are encouraged to work in health care while they are completing this program. Some assignments will be directly related to work experiences.

▪ Ask students to bring to class the sunscreen they usually use. Divide them into cooperative learning groups and have them compare the various sunscreens. Who is most likely to have proper protection from the sun? Why is this so? What percentage of the class is using this type of sunscreen? What percentage will change to this type? What should they teach patients about sunscreen? What resources are available?

▪ In the lab, display as many topical medications as possible (creams, lotions, liniments, ointments, aerosol sprays, foams, beads, and paste). Have students practice applying these medications using Practice Procedure 9-1. Develop a checklist from the Practice Procedure to use in your assessment.

▪ Using the Representative Drugs table, ask students to summarize the “special instructions” column and the “side effects and adverse reactions” column with regard to administering these medications and teaching patients about them.

▪ Ask students to complete the Chapter 9 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 9 Test in this Instructor's Manual.

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Critical Thinking Activity 1. Develop a teaching plan for the mother of a young child diagnosed with head lice. Include an emphasis on how to prevent contaminating others and preventing future episodes.

2. Develop a teaching plan on how to prevent burns.

Answers to Chapter 9 Review 1. a 2. f 3. e 4. b 5. d 6. c 7. Itching 8. Redness 9. Swelling 10. Protein contained in cells of the epidermis, nails, and hair 11. Organism that lives on or in another organism 12. Skin condition caused by pores being plugged with sebum 13. An agent that inhibits the growth of microorganisms 14. Oil in the skin 15. To relieve itching 16. To soften hardened skin and promote peeling and shedding 17. To form a film over the skin 18. a 19. f 20. b 21. e 22. h 23. d 24. g 25. c 26. i 27.

X D = V H 25 mg X = 50 mg 1 tablet 50X = 25 25 ÷ 50 = 0.5 X = ½ drops 28.

X D = V H 100 mg X = 50 mg 1 tablet 50X = 100 100 ÷ 50 = 2 X = 2 drops 29. c 30. b 31. c d. 32.a 33. a 34. Never smoke in bed Install smoke detectors in kitchens and near bedrooms Keep a fire extinguisher in an easily accessible place.

Avoid cooking when wearing loose-fitting clothing.

Avoid setting the water heater too high to prevent scalding.

Use a microwave oven appropriately.

Identify fire exits when in public places.

35. Calamine, Caladryl, Ivy Dry Cream, and Ziradryl.

They act as an antipruritic and antihistamine 36. Eczema (dermatitis) 37. Psoriasis 38. Seborrheic dermatitis 39. Decubitus 40. Pediculosis 41– 42. Answers will vary depending on the edition of the PDR® used.

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CHA P T E R 10: Drugs for the Cardiovascular System Learning Outcomes 10-1 Identify the parts and functions of the cardiovascular system.

10-2 List the names of instruments used to measure blood pressure and to record the heartbeat.

10-3 List the main components of blood and the functions of the lymphatic system.

10-4 Identify the major disorders and common symptoms of the cardiovascular system.

10-5 Describe the actions and special procedures for administration of these drug groups: adrenergics, vasodilators, diuretics, antihypertensives, calcium channel blockers, antilipemics, cardiac glycosides, antiarrhythmics (antidysrhythmics), anticoagulants, thrombolytics, hemostatics, hematinics, and antiplatelets.

10-6 Know the difference between an initial dose and a maintenance dose.

10-7 Illustrate administering oral and sublingual medications to patients with cardiovascular disorders.

Chapter Outline Key Terms Cardiovascular System Cardiovascular Disorders Drugs for Cardiovascular and Blood Disorders Giving Cardiovascular Medications Chapter Summary Chapter 10 Review Teaching Strategies ▪ Discuss the definitions of the key terms, making certain students are clear about their meaning.

▪ Have students work in cooperative learning groups to practice taking each other’s pulse and blood pressure. Have them check each other for accuracy. Report abnormal readings.

▪ Show a film about the cardiovascular system.

▪ In the lab, display posters, charts, and other visuals of the heart and vascular system.

Have students review them and name the classifications of cardiovascular drugs that affect the parts of the cardiovascular system. Using visuals, ask students to show where certain disorders appear most often and what drugs are administered. Refer to the Representative Drugs table in the text.

▪ Set up an area in the lab for students to practice doing EKGs on each other. Ask them to compare their EKGs with one found in a reference text.

▪ Make arrangements for students to visit the EKG department of a hospital. Have them write a summary of what they learned. Discuss the drugs often used after an EKG. ▪ Ask the American Heart Association to send a speaker into class to discuss the proper care of the heart (smoking, diet, etc.). Ask the speaker to bring visuals for the presentation. Ask students to summarize the presentation in writing.

▪ Ask a nurse or physician from a Coronary Care Unit to talk with the students about the most commonly used cardiovascular drugs. Discuss how students will play an important role in the administration of these drugs or in helping other professionals administer them (pulse, BP, charting, older adult patients, etc.).

▪ In the lab, provide drug forms of various cardiovascular medications.

▪ Using the PDR® or other references, provide the manufacturer’s label and picture for the following: Catapres patches; Lanoxin tabs; Lanoxicaps; ▪ Sorbitrate sublingual tabs; Cardizem tabs; Isoptin IV; and Mevacor tabs. Have students demonstrate administering them according to the following: Want: Have: Give: Catapres 0.1 mg, 0.2 mg (3) 0.2 mg patch 0.6 mg Lanoxin tabs 125 micro 2 tabs Gauwitz, Administering Medications, 8e

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250 micro Lanoxicaps 200 micro 3 caps 600 micro Sorbitrate subl.

2.5 mg 1 subl. tab 2.5 mg Cardizem tabs 30 mg 4 tabs 120 mg Isoptin IV 10 mg 2.5 mL/ampules 4 vials Mevacor tab (10) 20-mg tabs 2.5 tabs 50 mg ▪ Have students demonstrate Practice Procedure 10-1. Develop a checklist from the Practice Procedure to use in your assessment.

▪ Using charts, show the lymphatic system and compare its function to the cardiovascular system’s function (location, filtering).

▪ Ask students to make posters (individually) showing the most common symptoms present in cardiovascular disease. Using the Representative ▪ Drugs table in the text, ask students to name the drugs most often administered for each disease.

▪ Arrange a trip to the emergency room of a hospital for a day. Have students record the patients they observe and the medications the patients are given.

▪ Ask them to write a summary of their observations including dose, actions, adverse effects, and special implications.

▪ Ask students to complete the Chapter 10 Review. Discuss answers and correct any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 10 Test in this Instructor’s Manual.

▪ Develop and administer a performance test on administering oral, sublingual, and buccal medications.

Critical Thinking Activity 1. You are caring for a patient who is being started on sublingual nitroglycerin tablets. The client experiences chest pain whenever he is under stress. What is the most likely cause of the angina?

What instructions should you give the patient?

2. A patient in the hospital has just started taking an anticoagulant drug.

What are your primary responsibilities to the client who is taking an anticoagulant?

Answers to Chapter 10 Review 1. Lymph system organ that works in the body’s defenses, produces red blood cells, stores platelets, and serves as a reservoir for blood 2. Rapid heartbeat (over 100 beats per minute) 3. Slow heartbeat (fewer than 60 beats per minute) 4. High blood pressure, two or more systolic readings above 140 mm/Hg 5. Low blood pressure, systolic reading falls to 90 mm/Hg or below 6. b 7. a 8. e 9. d 10. c 11. Point of maximum impulse 12.120/88 mmHg, 60-1- bpm 13. Deoxygenated 14. Oxygenated 15. Shock 16. Atherosclerosis 17. Arteriosclerosis 18. Thrombophlebitis 19. Embolism 20. Angina pectoris 21. Myocardial infarction 22. Tighten the blood vessel walls and raise blood pressure 23. Relax the blood vessel walls, dilate the arteries and veins Gauwitz, Administering Medications, 8e

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24. Strengthen the myocardium, increase force of contraction, slow the heart, improve muscle tone of myocardium 25. Stabilize heart muscle so it does not beat too rapidly 26. Prevent the blood clotting process 27. Promote blood clotting 28. Replace iron needed for red blood cell production 29. a 30. b 31.

D X = H V 0.6 mg X = 0.3 mg 1 tablet 0.3X = 0.6 mg 0.6 ÷ 0.3 = 2 X = 2 tablets 32.

X D = V H 100 mg X = 1 tablet 50 mg 50X = 100 100 ÷ 50 = 2 X = 2 tablets 33.

X D = V H 10 mg X = 20 mg 1 tablet 20X = 10 10 ÷ 20 = 0.5 X = ½ tablet 34.

X D = V H 0.125 mg X = 1 tablet 0.25 mg 0.25X = 0.125 0.125 ÷ 0.25 = 0.5 X = ½ tablet 35.

D X = H V Gauwitz, Administering Medications, 8e

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6000 units X = 7500 units 1 mL 7500X = 6000 6000 ÷ 7500 = 0.8 X = 0.8 mL 36.

D X = H V 15 mg X = 10 mg 1 tablet 10X = 15 15 ÷ 10 = 1.5 X = 1.5 tablets 37. d 38. c 39. a 40. c 41.b 42. Avoid alcoholic beverages.

Identify situations that precipitate attacks requiring use.

Take a dose 5 or 10 minutes before an activity known to cause an attack.

Side effects include dizziness, lightheadedness, and mild headache.

Report severe headache, dry, mouth, and blurred vision to the physician; they are symptoms of overdose.

Air, heat, and moisture inactivate nitrates.

Discard unused tablets after 6 months.

Prevent tolerance by removing paste or patch for 8 hours – a “no nitrate” time.

If pain occurs during the day, use the nitrate during the day and remove it at night.

If pain occurs during the night, use the nitrate during the night.

43. Capoten is an angiotensin-converting enzyme inhibitor (ACE inhibitor) which causes blood vessels to become wider and the blood pressure decreases.

Notify your supervisor Rise slowly from a sitting or lying position to avoid dizziness and fainting.

Avoid hot baths and hot showers because if the vasodilating effect.

44. Bleeding, hemorrhage 45. Nitroglycerin 46. 60 per minute 47. Faint, dizzy 48. Stain 49 -50. Answers will vary depending on the edition of the PDR® used and the specific drugs selected.

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C H A P T E R 11: Drugs for the Respiratory System Learning Outcomes 11-1 Describe the parts and normal functions of the respiratory system.

11-2 Describe the major disorders and the common symptoms of the respiratory system.

11-3 Describe nicotine dependency and methods for smoking cessation.

11-4 Describe the actions of the following drug groups: antitussives, expectorants, decongestants, antihistamines, and bronchodilators.

11-5 Understand the procedures of chest physiotherapy; operating a pulse oximeter; and administering nose drops, inhalants, and oxygen.

Chapter Outline Key Terms Respiratory System Respiratory System Disorders Nicotine Dependence and Smoking Cessation Drugs for Respiratory Disorders Giving Respiratory Drugs Chapter Summary Chapter 11 Review Teaching Strategies ▪ Ask students to identify the key terms they are unfamiliar with. Discuss the definitions and be certain that students are clear about the meanings. Point out any similarities that may be confusing to students and tell them to memorize these words to avoid confusion later on.

▪ If possible, show films about the upper and lower respiratory systems.

▪ Discuss the physiology of the respiratory system and show its need for a normal functioning cardiovascular system to supply oxygen to the body.

▪ Demonstrate a noninvasive procedure for checking blood gas using an oximeter monitor on the ear, nose, and finger.

▪ Discuss medical implications for oxygen therapy that must be considered as the students administer medications to a patient on oxygen (i.e., checking for sores around mouth or nose, proper patient positioning after administering drugs, maintaining appropriate rate flow, and checking for toxicity signs or restlessness).

▪ In the laboratory, have the students make a display of the heart/lung anatomy.

Encourage them to work in cooperative learning groups. Have them memorize the way the blood travels from the lungs to the heart and back from the heart to the lungs and out into the body. They can make posters or use simulated lungs and heart that can be purchased.

▪ Invite a representative from the American Lung Association or state lung association to speak to the class. Ask the individual to bring pamphlets, slides, films, and/or lung models showing the damage done to the body by smoking. Have the students discuss in class what they have seen and how they can help in the battle against smoking.

▪ Ask the respiratory therapy department of your clinical sites to allow individual students to visit to see the therapy given to patients in these units. Have students write a summary of the patients and the treatments observed. What rate of respirations was normal for each of the patients as related to the particular disorder?

▪ Ask a heart and lung specialist to visit the class and talk about the most common respiratory diseases or disorders. Have the doctor show slides of different diseases and disorders and discuss the relationship of the environment to the disorders.

▪ Have students work in cooperative learning groups to design a “Stop ▪ Smoking” campaign for your school or clinic. Ask groups to share their plans. Encourage students to select one campaign and implement it.

▪ Have a speaker from the public health department visit and explain the rules and regulations that have not been followed in the past, and what new regulations are being Gauwitz, Administering Medications, 8e

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▪ ▪ ▪

implemented now because of the increase in many of the old communicable diseases such as tuberculosis. What does the future hold for the health care worker in relation to care and drugs to be given for these diseases?

Ask a pharmacist to come to class to discuss the Federal Legislation on the sale of pseudoephedrines.

Ask students to complete the Chapter 11 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

Administer and grade the Chapter 11 Test in this Instructor’s Manual.

Critical Thinking Activity 1. You are teaching a mother how to give nose drops to a toddler. The mother is afraid to instill the drops and says it is mean to hold the toddler down to put the drops in. What should you do?

2. You have been assigned to teach a class to a group of high school students on the dangers of smoking. What should you teach?

Answers to Chapter 11 Review 1. Pertaining to the lungs 2. Labored or difficult breathing 3. Rapid breathing 4. Stopped breathing 5. Breathing too rapidly or deeply, hyperventilation 6. abnormal condition in which the patient must sit or stand to breathe deeply and comforatbly 7. Membranes lining the lungs and lung cavities 8. Symptoms returning in worse form after a drug has worn off 9. Device that measures the air flowing out of the lungs, which measures how well asthma is under control 10. Physical vulnerability of the body to the chemical, nicotine, which is brought on by tobacco products 11. Respiration 12. Between 12 and 25 times per minute 13. Larynx 14. Epiglottis 15. Trachea 16. It is a productive reflex to clear the trachea, bronchi, and lungs of secretions and irritants 17. Alveoli 18. Stethoscope 19. Nebulizer or atomizer 20. Pulse oximetry 21. USA Patriot Improvement and Reauthorization Act of 2005 (Combat Meth Act) 22. Suppress coughing 23. Liquify and reduce the viscosity of tenacious secretions 24. Vasoconstrictors that shrink engorged nasal mucous membranes 25. a 26. d 27. b 28. c 29. d 30. c 31. e 32. b 33. a

34.

X D = V H 500 mg X = 400 mg 5 mL 400X = 2500 2500 ÷ 400 = 6.25 mL X = 6.25 mL 35.

D X = H V Conversion is 1 g = 1000 mg 0.5 g X 1000 mg = 500 mg Gauwitz, Administering Medications, 8e

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500 mg X = 500 mg 1 tablet 500X = 500 500 ÷ 500 = 1 X = 1 tablet 36.

D X = H V 270 mg X = 250 mg 5 mL 250X = 1350 1350 ÷ 250 = 5.4 X = 5.4 mL 37.

X D = V H 600 mg X = 300 mg 1 tablet 300X = 600 600 ÷ 300 = 2 X = 2 tablets 38.

X D = V H 500 mg X = 200 mg 5 mL 200X = 2500 2500 ÷ 200 = 12.5 X = 12.5 mL 39. d 40. a 41. b 42. c 43. b 44. The patient is experiencing an unproductive cough. It is caused by when mucus is clogged in the lower respiratory tract or when irritation in the throat stimulates repeated coughing.

Dimetapp is a nonnarcotic antitussive which is prescribed to suppress the cough.

Patient education should include increasing fluids and inhalation of steam.

These measures may thin and increase the production of secretions.

45. The patient is experiencing side effects of the theophylline.

Notify your supervisor.

46. The increase in HIV infection (HIV weakens the immune system), the development of drug resistant strains of tuberculosis, the immigration of people from countries where tuberculosis is prevalent, and the fact that many cases go untreated and are spread to others 47. Expectorants keep sputum moist and thin. Bronchodilators promote coughing up sputum that may be clogging the air passages.

48. Tuberculosis 49. Asthma 50. Emphysema 51. Bronchitis 52. Pneumonia 53 - 54. Answers will vary depending on the edition of the PDR® that is used.

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C H A P T E R 12: Drugs for the Gastrointestinal System Learning Outcomes 12-1 Describe the five main functions and the major parts of the gastrointestinal system.

12-2 Describe the major disorders and symptoms of gastrointestinal system.

12-3 Describe the actions of the following drug groups: antacids, histamine H2-receptor antagonists, digestants, antiflatulents, emetics, antiemetics, anticholinergics and antispasmodics, antidiarrheals, laxatives, antihelmintics, anorexiants, and weight-loss drugs.

12-4 Identify the important conditions to be aware of when giving medications for the gastrointestinal system.

12-5 Describe and follow proper procedure for inserting rectal suppositories and giving medications through a nasogastric or gastrostomy tube.

Chapter Outline Key Terms Gastrointestinal System Disorders of the Gastrointestinal System Drugs That Affect the Gastrointestinal System Giving Gastrointestinal Medications Chapter Summary Chapter 12 Review Teaching Strategies ▪ Ask students to identify the key terms they are familiar with. Have volunteers use those terms in sentences. Discuss definitions of the unfamiliar terms and be certain that students are clear about the meanings. Point out any similarities that may be confusing.

▪ If possible, obtain and show a film, video, or slides of the gastrointestinal tract. Review the anatomy and physiology.

▪ If possible, obtain and show videos showing procedures for administering drugs via suppositories, colostomies, or a nasogastric and gastrostomy tube.

▪ Invite a nurse specializing in colostomy care to visit the class. Ask the nurse to discuss or to bring a patient who can talk about his or her condition. Discuss drugs taken pre- and postoperatively. Ask students to summarize in writing the positive and negative benefits of a colostomy.

▪ Assign the students the project of listing the most common adverse effects of the OTC drugs listed in Table 12-1 in the text.

▪ Invite the nursing educator from the dietary department of one of your clinical sites to speak to the students about the most popular diets on the market now and the pros and cons of their effects.

▪ Arrange with a gastroenterologist’s office for your students to individually observe the procedures performed in this office. Have the students summarize their visits and discuss the GI medications used most often for the most common disorders. Have students share their findings in class.

▪ Ask students to visit a health food store and bring back literature distributed there. How does it compare to medical information?

▪ Using Table 12-2 in the text, have each student choose a category that does not have a drug listed and list a drug from the Representative Drugs table that is in that category. If a drug is not listed, use the pharmacology resources to name some of them.

▪ In the laboratory, provide drug forms of gastrointestinal drugs, and the equipment needed to administer them. Use the PDR® picture section or any other resource. Try to get real gastrointestinal drug labels so you can put them on empty containers and ask the students to practice administering them. Ask for the following labels: Dulcolax 10 mg suppositories, Tagamet suspension 50 mg/mL, Zantac prefilled syringe of 2 mL/50 mg (25 mg/mL), Tigan 250 mg tab, Cefobid 2 g IV. ▪ Ask students to demonstrate administering the sample drugs using the following: Have: Want: Give: Gauwitz, Administering Medications, 8e

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Dulcolax 10 mg supp.

20 mg (2 supp) Tagamet 50/mg susp.

150 mg PO (3 mL) Zantac 2 mL/50 mg IM 50 mg IM (2 mL) prefilled syringe or 2 mL/50 mg IM vial or ampule Zantac (as above) 25 mg IM (1 mL) Tigan 250 mg tab.

1 g PO (4 tabs) Cefobid 2 g vial IM/IV 1 g IM (1⁄2 vial) ▪ Develop and administer a performance test for this activity.

▪ Ask students to complete the Chapter 12 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 12 Test in this Instructor's Manual.

Critical Thinking Activity 1. Simethicone (Mylicon) has been prescribed for a patient with flatulence.

What else can you teach this patient to reduce flatulence? Give the rationale for your answer.

2. An older adult client has been taking sodium bicarbonate for indigestion and heartburn. Why is this of concern?

Answers to Chapter 12 Review 1. c 2. f 3. b 4. e 5. d 6. g 7. a 8. Digestive 9. Digestive tract, gastrointestinal tract, or alimentary canal 10. Peristalsis 11. Digestive juices, or enzymes 12. Small intestine 13. Saliva 14. Esophagus 15. Vomiting, or emesis 16. Duodenum 17. Villi 18. Feces, or stools 19. Anus 20. Liver 21. Gallbladder 22. Pancreas 23. Crohn’s disease 24. Breaking up food, transporting food through the system, secreting digestive enzymes, absorbing nutrients into the blood, and excreting solid wastes 25. Enzyme secretion and peristalsis are controlled by the autonomic nervous system, which is also influenced by emotional stress.

26. Nausea, vomiting, indigestion, bloating, cramping, belching, flatus, constipation, abdominal pain, diarrhea, anorexia, weight loss, and changes in the appearance of stools 27. Intestinal motility is the speed and force of peristalsis. Changes in motility lead to either diarrhea or constipation.

28. If eating and chewing are painful because of these problems, people will not eat correctly, and poor nutrition and constipation will result.

29. Sulfasalazine (Azulfidine) 30. Neutralize stomach acid 31. Supplement or replace digestive juices 32. Reduce gassiness and bloating 33. Stop vomiting and nausea 34. Slow peristalsis and block secretion of stomach acid 35. Relieve diarrhea by soaking up fluids or slowing peristalsis 36. Stimulate bowel movements or clear out the intestines 37. Destroy intestinal parasites (worms) 38. Suppress the appetite 39. T 40. F 41. F 42. T 43. F 44. f 45. b 46. e 47.a 48.h 49. d 50. g 51. c 52. i 53. j 54. k 55. l 56. m Gauwitz, Administering Medications, 8e

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57.

X D = V H 50 mg X = 25 mg 1 mL 25X = 50 50 ÷ 25 = 2 X = 2 mL 58.

D X = H V 2.5 mg X = 5.0 mg 1 tablet 5X = 2.5 2.5 ÷ 5 = 0.5 X = ½ tablet 59.

X D = V H 800 mg X = 400 mg 1tablet 400X = 800 800 ÷ 400 = 2 X = 2 tablet 60.

X D = V H 4 mg X = 2 mg 1 mL 2X = 4 4÷2=2 X = 2 mL 61.

X D = V H 15 mg X = 10 mg 5 mL 10X = 7.5 7.5 ÷ 10 = 7.5 mL X = 7.5 mL 62. c 63. b 64. a 65. d 66. a 67. Prilosec suppresses the gastric acid in the final stage in acid production Administer Prilosec 15 – 20 minutes before meals Gauwitz, Administering Medications, 8e

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Headache, dizziness, diarrhea, abdominal pain, and nausea are the most common side effects 68. Tetracycline and antacids interact when given together therefore administer the antacid two hours before or after the Tetracycline.

Maalox is a combination of an magnesium based and an aluminum based antacid which cancels out the side effects of diarrhea and constipation.

69. Softening feces, stimulating peristalsis, adding bulk to the diet, and coating or lubricating 70. Bland diet; 1500–2000 mL fluids daily; getting enough exercise; reducing nervous tension; giving up smoking, coffee, and alcohol 71. Give medications at the proper time (before, after, or with meals or at bedtime). Give the right amount of liquid with each. Be wary of giving PRN medications for abdominal pain.

72. Provide privacy, explain what you are going to do, lubricate the suppository, and insert it gently and smoothly.

73. Signs of pain or infection, appearance of stools, and bowel movement too soon after insertion 74. Crush tablets between two spoons or in a mortar and pestle and then mix with 1 oz of water.

Open capsules and dissolve in water. Do not crush and dissolve timed-release tablets or capsules.

75. Signs of inflammation or leakage around the stoma or poor tube drainage 76. Promotes defecation 77. Maalox, Mylanta, Gelusil 78. Hemorrhoids 79. Hepatitis 80. Gallstones 81. Cirrhosis 82. Gastritis 83. Duodenal ulcer 84. Peritonitis 85. Irritable bowel 86-89. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 13: Drugs for the Urinary System and Fluid Balance Learning Outcomes 13-1 Describe three functions of the urinary system.

13-2 Identify the parts and functions of the urinary system.

13-3 Describe how abnormal alteration in the urine gives an indication to disorders in the urinary system.

13-4 Describe the major disorders and symptoms of the urinary system.

13-5 Identify imblances of body fluids, electrolytes, and pH. 13-6 Describe the actions of the following drug groups: urinary antiseptics, diuretics, and replacement electrolytes and fluids.

13-7 Carry out administering diuretics using correct procedures.

13-8 Describe the causes and treatment of dehydration in the pediatric patient.

13-9 Illustrate administering medications through an indwelling catheter.

Chapter Outline Key Terms Urinary System Disorders of the Kidneys and the Urinary Tract Imbalances of Body Fluids, Electrolytes, and pH Drugs for the Urinary Tract and Fluid Imbalances Giving Drugs That Affect the Urinary System Chapter Summary Chapter 13 Review Teaching Strategies ▪ Ask students to define the key terms. Discuss the definitions, and be certain that students are clear about the meanings.

▪ Show a film or video of the urinary system. Discuss the physiology and the disorders of the urinary system.

▪ Have students work in cooperative learning groups in the laboratory to practice administering medications through a urinary catheter.

▪ Develop and administer a performance test for administering medications through a urinary catheter.

▪ Ask students to make a visual display of the urinary system. Have them work in small groups to memorize the functions of the loop of Henle as it relates to proper fluid balance of the body.

▪ In the laboratory, provide the drug forms of the urinary drugs as well as the equipment needed to administer them. Use the PDR® or other resources for pictures or labels that can be put on the containers, or ask a pharmacist to supply labels. Ask for Bactrim DS; HydroDIURIL 25 mg tabs; Lasix 40 mg/4mL vial, ampule, or prefilled syringe; Furosemide 40 mg/4 mL vial, ampule, or prefilled syringe; Lasix susp., 10 mg/mL; Hydrochlorothiazide 25 mg and 50 mg tabs; Macrodantin 100 mg tabs. Have students demonstrate administering the sample drugs using the following: Have: Want: Give: Bactrim DS/Regular Bactrim DS PO (1 DS or 2 reg tabs) HydroDIURIL 25 mg tabs HydroDIURIL 100 mg PO (4 tabs) Lasix 40 mg/4 mL/IM Lasix 40 mg IM (1 4-mL amp or 4 mL from vial or prefilled syringe) Furosemide 10 mg/mL/IV prefilled

Furosemide 10 mg IV

(1-mL amp, vial or

syringe) Gauwitz, Administering Medications, 8e

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Furosemide 10 mg/mL/IM Furosemide .01 g IM (1-mL amp, vial or prefilled syringe) Lasix 15/mL mg susp.

15 mg/mL susp.

(1 mL) Hydrochlorothiazide 0.1 g PO (2 50-mg tabs) 25–50 mg tabs Macrodantin 100 mg tabs.

0.1 g PO (1 100-mg tab) ▪ Using the Representative Drugs table in the book, discuss the condition of CHF and the relationship of diuretics.

▪ Ask the students to complete the Chapter 13 Review. Discuss answers, ▪ clearing up any misconceptions students may have. Review any material ▪ students had difficulty with.

▪ Administer and grade the Chapter 13 Test in this Instructor’s Manual.

Critical Thinking Activity 1. What are two potential problems that may occur with diuretic therapy?

What can you do to prevent these problems?

2. Discuss why small children are more susceptible to the effects of diuretics and fluid and electrolyte imbalances.

3. A10-month-old infant has a fever, vomiting, and three times as many stools as usual. The stools are watery in consistency. The child is evaluated to be dehydrated because of acute infectious diarrhea. What is the recommended treatment in this situation?

Answers to Chapter 13 Review 1. Blood in the urine 2. Pus in the urine 3. Inability to control urination 4. Inability to urinate even when the bladder is full 5. Painful urination 6. No production of urine 7. b 8. a 9. d 10. c 11. Ureters 12. Urethra 13. Urinate, or void 14. 1500–2000 15. 250 16. Potassium 17. Bananas or oranges 18. Indwelling, retention, or Foley 19. Excreting waste products of metabolism (urea, mineral salts), regulating the amount of water in the body, and regulating the pH 20. Electrolytes are ions of mineral salts that provide the chemical transport system for cell metabolism. Examples: calcium, sodium, potassium, magnesium, chloride, bicarbonate, phosphate, and sulfate 21. By controlling the reabsorption process so that excess electrolytes and fluids are excreted in the urine 22. Input: water, juice, IV fluids, gastrostomy fluids Output: urine, vomitus, wound drainage, stomach suction, diarrhea 23. e 24. g 25. c 26. d 27. h 28. a 29. b 30. f 31.

D X = H V Conversion is 1 g = 1000 mg

1000 mg X = 500 mg 1 capsule 500X = 1000 1000 ÷ 500 = 2 Gauwitz, Administering Medications, 8e

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X = 2 Capsules 32.

D X = H V 200 mg X = 100 mg 1 tablet 100X = 200 200 ÷ 100 = 2 X = 2 tablets 33.

D X = H V 250 mg X = 500 mg 1 tablet 500X = 250 250 ÷ 500 = 0.5 X = ½ tablet 34.

X D = V H 15 0mg X = 10 0mg 1 tablet 10X = 150 150 ÷ 100 = 1.5 X = 1½ tablets 35.

X D = V H 15 mEq X = 20 mEq 1 tablet 20X = 250 250 ÷ 20 = 12.5 X = 12.5 mL 36. d 37. a 38. d 39. b 40. c 41. Hypokalemia and hyponatremia Hydrodiuril Thiazide diuretic that inhibits the reabsorption of sodium in the distal tubules of the nephron that promotes the excretion of sodium, chloride, potassium, and water.

Avocado, banana, beets, cantaloupe, lima beans, raisins, spinach, squash, prunes 42. Potent loop diuretic Edema associated with congestive heart failure Special indications for older adult Begin treatment with the lowest possible dose Closely monitor the patient at night because there may be an increased need to urinate Gauwitz, Administering Medications, 8e

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Check with the healthcare provider before increasing fluids because of the heart failure Monitor the patient for side effects such as lightheadedness, dizziness, fatigue, and muscle weakness Discontinue gradually to prevent fluid retention 43. Renal failure 44. Kidney stones 45. Cystitis 46. Pyelonephritis 47. Electrolyte imbalance 48-49. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 14: Drugs for the Reproductive System Learning Outcomes 14-1 Identify the functions of the male and female reproductive systems.

14-2 Identify the main parts and functions of the female and male internal and external genitalia using correct medical terminology. medical terminology while performing calculations.

14-3 Recall hormones produced by the female and male gonads and describe their function.

14-4 Describe the actions of gonadotropins, oxytocin, and prolactin.

14-5 Describe major disorders that affect the reproductive system.

14-6 Describe the main uses and side effects of sex hormones in drug therapy.

14-7 Summarize the various types of contraceptives available, including the effects on adolescent patients.

Chapter Outline Key Terms Reproductive System Disorders of the Reproductive System Use of Sex Hormone in Drug Therapy Chapter Summary Chapter 14 Review Teaching Strategies ▪ Ask students to identify key terms they are unfamiliar with. Discuss the definitions and be certain that students are clear about the meanings.

▪ Show a film on the reproductive system. Discuss the physiology of the system. If possible, show a film that demonstrates administering medications vaginally. Have the students work in small groups in the laboratory practicing administering medications vaginally. Develop and administer a test for administering medications vaginally.

▪ Ask the students to make a display of the reproductive system. Let them work in small groups to memorize the hormones that regulate reproduction.

▪ Have the students break into small learning groups. Have each group take a different method of contraception available and identify the advantages and disadvantages. Have a representative from each group present the information to the whole class.

▪ In the laboratory, provide the reproductive drugs and the equipment needed to administer them. Use the PDR® or other resources for pictures or labels that can be put on the bottles and other containers. Use the following drugs and drug doses: Femstat 2 percent vaginal cream, Monistat 0.2 supp, Estraderm patch 0.05 mg, Premarin 2.5 mg tabs, Flagyl 250 mg tabs, Demulen 1/35, 21–28 tabs, Provera 5 mg tabs. Have students demonstrate administering the sample drugs using the following: Have: Want: Give: Femstat 5 g of 2% vag. cr.

5g (1 applicator) Monistat 0.2g supp 0.2 g (1 supp) Estraderm 0.05 mg/patch 0.10 mg (2 patches) Premarin 2.5 mg tabs 10 mg (4 tabs) Flagyl 500 mg tabs 1g (2 tabs) Demulen 1/35, 21–28 1/35 (1 tab) Provera 5 mg tabs 2.5 mg (½ tab) ▪ Use the Representative Drugs table in the text to discuss the present theory on prescribing hormones for menopause because of surgery or because of natural menopause.

▪ Ask the students to complete the Chapter 14 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 14 Test in this Instructor’s Manual.

Critical Thinking Activity Gauwitz, Administering Medications, 8e

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1. Why are oxytocics such as Pitocin used in the postpartum period?

2. Discuss ways of obtaining educational materials for both schools and communities on sexually transmitted diseases.

Answers to Chapter 14 Review 1. Drug that induces or strengthens labor 2. Painful menstruation 3. Swelling of breasts with milk or swelling of the penis prior to ejaculation 4. Lining of the uterus 5. Anything used to terminate pregnancy 6. Human immunodeficiency virus 7. Acquired immune deficiency syndrome 8. produce milliond of tiny sex cells called spermatoza 9. Ovaries 10. Testes 11. Vagina 12. Uterus 13. Mammary 14. Contraceptive 15. Urethra 16. Estrogen and progestin 17. vulva and anus 18. Bartholin’s glands 19. d 20. b 21. a 22. c 23. Easing menopausal symptoms, osteoporosis, amenorrhea, prevention of breast engorgement, senile vaginitis, uterine bleeding, endometriosis, contraception, breast and prostate cancer, hormone replacement, reversal of tissue wasting 24. Nausea, breakthrough bleeding, water retention, vaginal infections, headache, risk of blood clots, possible cancer link, feminization of males 25. Masculinization of females, water retention 26. F 27. F 28. T 29. T 30. F 31. T 32. T 33. T 34. T 35. T 36. F 37.

X D = V H 0.625mg X = 1 tablet 1.25mg 1.25X = 0.625 0.625 ÷ 1.25 = 0.5 X = ½ tablet 38.

D X = H V 8 units X = 10 units 1 mL 10x = 8 8 ÷ 10 = 0.8 X = 0.8 mL 39.

D X = H V Gauwitz, Administering Medications, 8e

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5mg X = 2.5mg 1 tablet 2.5X = 5 5 ÷ 2.5 = 2 X = 2 tablets 40.

D X = H V 75 0mg X = 50 0mg 1 tablet 500x = 750 750 ÷ 500 = 1.5 X = 1½ tablets 41.

X D = V H Conversion is 1 g = 1000 mg

100 0mg X = 1 mL 40 0mg 400X = 1000 1000 ÷ 400 = 2.5 X = 2.5 mL 42. c 43. d 44. b 45. a 46. b 47. Estrogens are generally administered in cycles such as 3 weeks on and 1 week off Tell you supervisor who will notify the healthcare provider Tell the patient to avoid smoking Tell the patient to report side effects such as headache, blurred vision, chest pain, shortness of breath, or leg pain Weigh once or twice a week and report any sharp increase in weight or fluid Retention Maintain good oral hygiene Avoid excessive sun exposure 48. Hypertension, migraine headaches, depression, dizziness, amenorrhea during and after the treatment, and changes in the menstrual flow The side effects of the pill are due to the estrogen component To stop smoking 49. Cervicitis 50. Benign prostatic hypertrophy (BPH) 51. Endometriosis 52. Acquired immune deficiency syndrome (AIDS) 53. Genital herpes simplex 54- 55.Answers will vary depending on the edition of the PDR® that is used.

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C H A P T E R 15: Drugs for the Endocrine System Learning Outcomes 15-1 List the hormones produced by the seven major glands.

15-2 Describe the major disorders of the endocrine system, the symptoms, and drugs used for treatment.

15-3 Identify which hormones are lacking in the condition of diabetes mellitus, diabetes insipidus, Addison’s disease, and hypothyroidism.

15-4 Define the parts of the endocrine system and symptoms of hormone imbalances.

15-5 List the types of insulin available for treatment of diabetes mellitus.

15-6 Identify the signs and symptoms of hyperglycemia and hypoglycemia.

15-7 List several uses of corticosteroids.

15-8 Identify five possible side effects of long-term corticosteroid therapy.

15-9 Describe the procedure for administering regular and intermediate-acting insulin in one syringe, and what factors affect the insulin needs of a diabetic patient.

Chapter Outline Key Terms Endocrine System Disorders of the Endocrine System Hormone Therapy Administering Insulin Chapter Summary Chapter 15 Review Teaching Strategies ▪ Ask students to demonstrate their knowledge of key terms.

▪ Discuss the physiology of the endocrine system and the common disorders.

▪ Show a film on administering insulin. Discuss the procedures, then let the students practice administering insulin in small groups. Develop and administer a performance test.

▪ Have the students prepare a list of drugs that commonly interact with insulin.

▪ Ask a representative from the American Diabetes Association to visit the class and discuss the various aspects of diabetes and its management. Have the representative distribute brochures to the students.

▪ Using the Representative Drugs table in the text, ask the students to identify the different drugs given for diabetes insipidus and diabetes mellitus.

▪ In the laboratory, provide the drugs and equipment needed to administer them. Use the PDR® or other resources for pictures or labels that can be put on the containers. Use drugs as follows: Glucotrol 10 mg tabs, Deltasone 2.5mg and 5 mg tabs, K-Lor 20 mEq packs, Regular insulin 100 units vial, Lente insulin 100 units vial, Calcimar 200 IU/mL vial, Synthroid 200 mcg IV and diluent, Levothroid 25 mcg tabs. Develop and administer a performance test for administering the following: Have: Want: Give: Glucotrol 10 mg tabs.

20 mg (2 tabs) Deltasone 2.5 mg tabs.

5 mg (2 tabs) K-Lor 20 mEq 60 mEq (3 tabs) Regular insulin 100 U/vial 50 units (Use insulin syringe and give 0.5 mL) Lente insulin 100 U/mL per mL

22 units

(Use insulin syringe and give 22

units) Gauwitz, Administering Medications, 8e

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Regular and Lente insulin

5 U Reg.

(See insulin 100 U vial each 25 U Lent and mix wanted dose—

R first then add L)

Calcimar 200 IU/mL Synthroid 200 mcg

▪ ▪

100 IU/Subcut (0.5 mL Subcut) 200 mcg (See PDR® for diluent and amount)

Levothroid 25 mcg tabs 75 mcg (3 tabs) Ask students to complete the Chapter 15 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

Administer and grade the Chapter 15 Test in this Instructor's Manual.

Critical Thinking Activity 1. A 200-pound, 35-year-old woman has just been diagnosed with Type I diabetes mellitus. The physician placed her on a 1500-calorie diabetic diet and 30 units of NPH insulin at 7:30AM every day. At 4:00PM, the patient states she is weak and sweaty. How would you explain these symptoms to the patient?

2. Discuss the similarities and differences in caring for Type I diabetes mellitus and Type II diabetes mellitus.

Answers to Chapter 15 Review 1. Muscle spasms or twitching 2. Sugar in the urine 3. Low blood sugar 4. Hormone secreted by the beta cells in the islets of Langerhans in the pancreas; regulates the use of sugar by body cells 5. Hormone secreted by the pancreas that raises the level of blood sugar; counteracts the effects of insulin 6. Form of sugar stored in the liver or muscles for release as the body needs it 7. c 8. e 9. d 10. a 11. b 12. Thyroid 13. Adrenal 14. Insulin 15. Antidiuretic 16. Adrenal, or corticosteroid 17. L 18. I 19. O 20. F 21. O 22. I 23. O 24. F 25. I 26. L 27. Oral hypoglycemics stimulate the pancreas to produce more insulin.

28. The main factors are diet, exercise, and emotions. Infection, ketoacidosis, and other disorders are also factors.

29. Glucocorticoids regulate the use of fat and sugar by the body, and mineralocorticoids regulate the salt/water balancing function of the kidneys.

30. Hormone replacement, suppression of immune response, inflammation and allergic reaction, skin inflammations, eye and respiratory diseases 31. Delayed wound healing, peptic ulcer, rounded (moon) face, euphoria, weight gain, insomnia, edema, muscle weakness, hypokalemia 32. Humulin R insulin 33. a 34. c 35. b 36. d 37. Inject 20 units of air into the NPH insulin vial then remove the needle. Inject 8 units of air into the Regular insulin vial leaving the needle in the vial. Turn the vial of Regular insulin upside down and withdraw to the 8-unit mark on the syringe.

After rolling the vial of NPH insulin in your hands to mix it, insert the needle into the NPH vial, turn it upside down and withdraw back to the 28-unit mark (8 U Regular insulin and 20 U NPH insulin).

Be careful not to withdraw more than 28 units.

Administer 28 units of insulin (8 units of Regular insulin and 20 U NPH) to the patient.

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38.

X D = V H 250 0mg X = 100 0mg 1 tablet 1000x = 2500 2500 ÷ 1000 = 2.5 X = 2½ tablets 39.

X D = V H Conversion is 1 mg = 1000 mcg 0.05 mg X 1000 mcg = 50 mcg

5 0mcg X = 25 mcg 1 tablet 25x = 50 50 ÷ 25 = 2 X = 2 tablets 40.

X D = V H 15mg X = 10mg 1 tablet 10x = 15 15 ÷ 10 = 1.5 tablets X = 1½ tablets 41.

X D = V H 200 0mg X = 100 0mg 1 tablet 1000x = 2000 2000 ÷ 1000 = 2 X = 2 tablets 42. c 43. a 44. d 45. a 46. c 47. Notify the nurse in charge Administer some sugar in an easily digestible form such as 120-180 mL of orange juice, 180-240 mL of regular soft drink, two packets of sugar or 5 or hard candies.

48. Addison’s disease Chronic inflammatory diseases such as rheumatoid arthritis, in skin, gastrointestinal, blood disorders, in combination with other drugs for cancer, kidney, eye, and respiratory disorders Weight gain, sodium retention, edema, hypertension, rounding of the face (moon face), easy bruising, thinning of the skin, and failure of wounds to heal Gauwitz, Administering Medications, 8e

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49. Problem: Elevated blood glucose. Give insulin.

50. Problem: Low blood glucose. Give sugar (orange juice, soft drink, candy, etc.).

51 - 52. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 16: Drugs for the Musculoskeletal System Learning Outcomes 16-1 Describe major parts, functions, and disorders of the musculoskeletal system.

16-2 Describe major disorders that affect the musculoskeletal system.

16-3 Describe the actions and side effects of drug groups commonly used in the treatment of gout, osteoarthritis, and rheumatoid arthritis.

16-4 Describe malfunctions of bone marrow and their effects on blood.

16-5 Describe the usual nursing care of patients with musculoskeletal disorders.

Chapter Outline Key Terms Musculoskeletal System Disorders and Drug Treatment for the Musculoskeletal System Care of Patients with Musculoskeletal Disorders Chapter Summary Chapter 16 Review Teaching Strategies ▪ Ask students to define each of the key terms. Discuss the definitions and be certain that students are clear about the meanings.

▪ Discuss the physiology of the musculoskeletal system.

▪ Show a film on disorders of the musculoskeletal system.

▪ Divide the students into designated groups on osteoarthritis. Have each group develop a plan of care including drug management. Have a representative from each group present the information to the whole class.

▪ In the laboratory, provide the drugs and equipment to administer drugs for the musculoskeletal system. Use the PDR® or other resources for pictures and labels that can be put on the containers. Use the Representative Drugs table in the text for the following drugs and doses to practice giving in the laboratory: Aspirin 325 mg tab, Ibuprofen 25 mg tab, Indomethacin 25 mg tabs, Naproxen 500 mg tabs, Aspirin 325 mg supp. Have students demonstrate administration of the following: Have: Want: Give: Aspirin 325 mg tabs Aspirin 325 mg (1 tab) Ibuprofen 25 mg tabs Ibuprofen 100 mg (4 tabs) Indomethacin 25 mg tabs Indomethacin 50 mg (2 tabs) Naproxen 500 mg tabs Naproxen 750 mg (1½ tabs) Aspirin 325 mg supp Aspirin 325 mg supp (1 supp) ▪ Ask students to complete the Chapter 16 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 16 Test in this Instructor's Manual.

Critical Thinking Activity 1. You are caring for a postmenopausal woman. Develop a plan to educate the patient on the prevention of osteoporosis.

2. Develop a daily menu for a patient with gout.

Answers to Chapter 16 Review 1. Drug that reduces the formation of uric acid 2. A drug that controls muscle spasms 3. Wasting and decrease in size of muscle (e.g., atrophy of a muscle due to lack of use) 4. An injury that can occur when muscles or tendons are subjected to stress, especially if stress lasts for a period of time 5. An injury that can result from violent stress on a ligament 6. Small, fluid-filled sacs that cushion spots where bones and muscles rub together 7. Move 8. Ligaments 9. Calcium Gauwitz, Administering Medications, 8e

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10. Tendons 11. Marrow 12. Protect, support 13. Skeletal 14. Tone 15. Sprains 16. e 17. b 18. d 19. c 20. a 21. f 22. F 23. T 24. T 25. F 26. F 27. T 28. T 29. T 30. T 31. T 32. F 33. T 34. Gastrointestinal bleeding, hypertension, ulcers, chest pain, tachycardia 35. Generally taken once a month 36. Drink 8 glasses of water daily to wash away uric acid crystals, low purine diet, weight reduction, and avoidance of alcohol 37. Sardines, meat soups, chicken, pork, veal, crab, beef, bacon, and ham 38.

X D = V H Conversion is 1 g = 1000 mg 1.5 g X 1000 mg = 1500 mg

150 0mg X = 1 tablet 750 mg 750X = 1500 1500 ÷ 750 = 2 X = 2 tablets 39.

X D = V H 5 00mg X = 250 mg 1 tablet 250x = 500 500 ÷ 250 = 2 X = 2 tablets 40.

X D = V H 5 0mg X = 25 mg 5 mL 25x = 250 250 ÷ 25 = 10 X = 10 mL 41.

D X = H V 35 mg X = 70 mg 1 tablet 70x = 35 35 ÷ 70 = 0.5 X = ½ tablets 42.

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X D = V H Conversion is 1 g = 1000 mg 0.2 g X 1000 mg = 200 mg

20 0 mg X = 100 mg 1 tablet 100x = 200 200 ÷ 100 = 2 X = 2 tablets 43. c 44. a 45. d 46. b 47. a 48. The pain produces a dramatic relief of pain within 24 to 48 hours.

Drink large amounts of fluids to wash away the uric acid and crystals. Drink eight glasses of water a day.

Weight reduction Avoidance of alcohol Because uric is the major end product of catabolism of purines, a low-purine diet should be followed.

Avoid high-purine foods such as sardines, meat soups, chicken, salmon, crab, veal, bacon, pork, beef, and ham.

Moderate – purine vegetables are asparagus, shell beans, lentils, mushrooms, peas, and spinach.

49. Premenopausal women should take 1000 mg of calcium per day.

Postmenopausal women should take 1500 mg of calcium of day.

Regular exercise is important to keep bones strong.

High calcium foods include milk, yogurt, cottage cheese, ice cream, sardines, spinach, and turnip greens.

Ask the healthcare provider about calcium supplements.

50. Give pain medications on time, move patients carefully, don’t bump the bed; meet their psychological needs 51. Osteoporosis 52. Osteomyelitis 53. Bursitis 54. Gout 55 - 56. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 17: Drugs for the Nervous and Sensory Systems Learning Outcomes 17-1 List the main divisions and parts of the nervous system.

17-2 Identify the basic functions of the autonomic nervous system.

17-3 Know the correct medical terms for symptoms of nervous system disorders.

17-4 Recognize descriptions of the major nervous system disorders for which medications are given.

17-5 Articulate to patients how to prevent strokes.

17-6 Describe the actions of the following drug groups: central nervous system stimulants, analgesics, anticonvulsants, antiparkinsonian, and anesthetic drugs.

17-7 Know the principles for administering pain medications, long-term medications, stimulants, and emergency drugs.

Chapter Outline Key Terms The Nervous and Sensory Systems Nervous System Disorders Drugs That Affect the CNS Giving Medications for the Nervous and Sensory Systems Chapter Summary Chapter 17 Review Teaching Strategies ▪ Ask students to identify the key terms they are familiar with. Discuss all of the definitions and be certain that students are clear about meanings. Point out any similarities that may be confusing to students.

▪ Show a film on the nervous system. Discuss the physiology of the main neurological disorders.

▪ Have students get in groups and explore their feelings and attitudes toward the use of analgesics and their potential for abuse.

▪ In the laboratory, provide drug forms of respiratory medications. Using the PDR® or any other source, provide the original manufacturer’s label or pictures for the following medications and have the student demonstrate administering these.

Have Want Give 12.5 mg Phenergan Rectal (2 supp) suppositories suppositories25 mg 25 mg tabs Phenergan 100 mg PO (4 tab) 120 mg Tylenol/ Tylenol with Codeine (15 mL) 12 mg codeine/5mL Elix. 1 T (1 pint total) 30 mg tabs Morphine Sulfate (½ tablet) SR 15 mg 100 mg/4 mL Roxanol Oral Solution (1 mL) 25 mg 50 mg/5 mL Dilaudid-HP 25 mg (2 ½ mL) Subcutaneous ▪ Develop and administer a performance test for this project.

▪ Request a flow sheet for patient-controlled analgesia from your clinical sites. Discuss how this is filled out.

▪ Ask students to complete the Chapter 17 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 17 Test in this Instructor's Manual.

Critical Thinking Activity Gauwitz, Administering Medications, 8e

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1. You are caring for a patient in the terminal stages of breast cancer. Discuss the role of a patient-controlled analgesic (PCA) pump in this patient’s pain management.

2. Develop a teaching plan to be used with patients on the prevention of strokes.

3. Develop a teaching plan on the management of Alzheimer’s disease.

Answers to Chapter 17 Review 1. Shakiness, trembling 2. Dizziness 3. Inability to move 4. Deep sleep out of which a person cannot be roused 5. Dazed condition, mental sluggishness 6. Sleeplessness 7. Slowness of movement 8. Uncontrolled large muscle movement 9. Central, peripheral 10. Spinal cord 11. Autonomic 12. Impulses or messages 13. Relieve pain.

14. Reduce fever. 15. Control or prevent seizures.

16. d 17. f 18. b 19. c 21. a 22. e 23. h 24. Take their medication regularly 25. Toxicity or poisoning 26. On time 27. Discard 28. Temperature 29. Candy or sugarless gum 30.

20. g

X D = V H 1.5 mg X = 1.0 mg 1 mL 1X = 1.5 1.5 ÷ 1 = 1.5 mL X = 1.5 mL 31.

X D = V H Conversion is 1 g = 1000 mg 0.75 g X 1000 mg = 750 mg

75 0 mg X = 250 mg 5 mL 250x = 3750 3750 ÷ 250 = 15 X = 15 mL 32.

X D = V H 10 mg X = 20 mg 1 tablet 20X = 10 10 ÷ 20 = 0.5 Gauwitz, Administering Medications, 8e

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X = ½ tablet 33.

D X = H V 75 mg X = 100 mg 1 mL 100x = 75 75 ÷ 100 = 0.75 X = 0.75 mL 34.

D X = H V 20 0 mg X = 100 mg 1 tablet 100x = 200 200 ÷ 100 = 2 X = 2 tablets 35. c 36. b 37. a 38. b 39.d 40. Sudden onset of neurological deficit resulting from disease of the blood vessels that supply the brain.

Memory loss, dizziness, headache, fainting, weakness, blurred vision, speech difficulty, and partial paralysis Have regular blood pressure checks Take blood pressure medication as prescribed Reduce dietary salt intake Stop smoking Reduce and control weight within a normal range Decrease the intake of foods high in saturated fats and cholesterol Avoid drinking alcohol Encourage be monitored by the healthcare provider if taking oral contrceptives Increase daily activity Increase fruits and vegetable in the diet 41. Memory loss that affects job skills Difficulty performing familiar tasks Problems with language such as forgetting a word or speaking inappropriate words, making their language difficult to understand Disorientation to time and place Poor or decreased judgment such as inappropriate dressing for the weather Problems with abstract thinking such as difficulty recognizing numbers or performing basic calculations Misplacing items followed by no memory of how they got there Significant changes in mood or behavior for no apparent reason Changes in personality, including becoming less tolerant or angry, suspicious, or fearful in an otherwise easygoing individual Loss of initiative or interest in many areas of life that they were once engaged in 42. Parkinson’s disease 43. Multiple sclerosis (MS) 44. Stroke or CVA 45. Alzheimer’s disease 46. Epilepsy 47. Meningitis 48 - 49. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 18: Psychotropic Drugs Learning Outcomes 18-1 Describe the biochemical mechanisms of the central nervous system that affect emotions.

18-2 Define the symptoms of mental disorders.

18-3 Recognize descriptions of the major mental disorders.

18-4 Distinguish between when a sedative is recommended and when a hypnotic is recommended.

18-5 Describe the actions of the following drug groups: antidepressants, sedatives/hypnotics, antipsychotics, antianxiety drugs, and antimanics.

18-6 Illustrate administering sedatives/hypnotics, antidepressants, antianxiety drugs, antipsychotics, and antimanics.

18-7 Identify drugs that are often involved in drug abuse.

Chapter Outline Key Terms The Nervous System and Emotions Mental Disorders Selection and Use of Psychotropic Drugs Giving Medications Chapter Summary Chapter 18 Review Teaching Strategies ▪ Ask students to define key terms they are unfamiliar with. Discuss the definitions and be certain that students are clear about the meanings.

▪ Arrange students into four cooperative learning groups. Have a different group discuss why a patient would receive an antipsychotic, antianxiety, antidepressant, or antimanic drug.

▪ Have each group develop a table on the use, usual dose, contraindications, side effects, and interventions of their drug. Bring the groups back together and have each group discuss their assigned drug.

▪ Show the video One Flew Over the Cuckoo’s Nest. Point out that portrayals of patients in psychiatric settings are often uncomfortable. After the film, have students discuss the feelings the film evoked.

▪ Ask students to discuss the myths and stigmas about psychiatric patients and their treatment. Discuss how they can dispel these misconceptions.

▪ Ask students to explore how they would feel if they were told they needed to take a psychiatric drug.

▪ Ask a psychologist to visit the class and discuss both pharmacological and nonpharmacological methods of treating depression, manic-depressive disorder, schizophrenia, and alcoholism.

▪ Administer and grade the Chapter 18 Test in this Instructor's Manual.

Critical Thinking Activity 1. Discuss why it is necessary to obtain a nutritional history before administering a monamine oxidase (MAOI) inhibitor to a patient.

2. Develop a plan to eliminate the extrapyramidal side effects that may occur with antipsychotic drugs.

3. Develop a teaching plan for a patient taking Lithium.

Answers to Chapter 18 Review 1. d 2. c 3. b 4. a 5. A state of feeling apprehensive, uneasy, uncertain, or a fear of the unknown 6. Disorder characterized by a sense of worthlessness or hopelessness Gauwitz, Administering Medications, 8e

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7. Mood disorder characterized by grandiose behavior, flight of ideas, poor judgment, and aggressiveness 8. Disorder in which psychosis is a classic feature 9. acetylcholine, norepinephrine 10. Neurohormones 11. Inhibitory, excitatory 12. Used in treatment of bipolar disorders 13. Relieve depression 14. Produce sleep 15. Produce feelings of calm in tense or nervous (but not psychotic) patients 16. Control agitated, hyperactive, destructive mentally ill patients 17. Another term for antipsychotic 18. b 19. a 20. f 21. c or d 22. e 23. c or d 24. Extrapyramidal symptoms 25. Alcohol 26. Salt 27. Disulfiram (Antabuse) 28. Reduce the noise level. Give a warm bath or a back rub. Listen to the patient’s concerns.

Give the patient enough exercise.

29. Hallucinogens, narcotics, sedatives and tranquilizers, and stimulants.

30. Alcohol, cheese, liver 31. Vititrol 32.

X D = V H 30 0 mg X = 1 tablet 150 mg 150X = 300 300 ÷ 150 = 2 X = 2 tablets 33.

X D = V H 2.5 mg X = 5.0 mg 1 mL 5X = 2.5 2.5 ÷ 5 = 0.5 X = 0.5 mg 34.

D X = H V Conversion is 1 g = 1000 mg 0.2 g X 1000 mg = 200 mg

20 0 mg X = 100 mg 1 tablet 100X = 200 200 ÷ 100 = 2 X = 2 tablets Gauwitz, Administering Medications, 8e

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35.

X D = V H 5 0 mg X = 100 mg 1 tablet 100X = 50 50 ÷ 100 = 0.5 X = ½ tablet 36.

D X = H V 3 mg X = 5 mg 1 mL 5X = 3 3 ÷ 5 = 0.6 X = 0.6 mL 37. c 38. d 39. a 40. c 41. a 42. Extrapyramidal symptoms Dystonia is the muscle spasms of the face, tongue, neck, jaw, or back.

Akathisia is the term for motor restlessness Tardive dyskinesia is the involuntary muscle movements around the mouth, lips, and tongue. Also included are parkinsonian-like symptoms such as shuffling gait, drooling, tremors, and increased rigidity.

Report to your supervisor No – Prevention of tardive dyskinesia is essential cause this is a permanent side effect The most common side effects of antipsychotics include sedation, blurred vision, orthostatic hypotension, dry mouth, tachycardia, urinary retention, constipation, and disorientation.

43. Avoid certain foods such as cheese, liver, and alcohol Report to healthcare provider if taking antiasthmatics, antihypertensives, allergy and cold medications Monoamine oxidase inhibitors 44. Anxiety 45. Psychosis 46. Depression 47. -48. Answers will vary depending on the edition of the PDR® used.

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C H A P T E R 19: Antineoplastic Drugs Learning Outcomes 19-1 Define cells, tissues, organs, and body systems.

19-2 Identify the characteristics of all cancers.

19-3 Describe how chemotherapy works.

19-4 List common antineoplastic drugs and their effects on the cell cycle.

19-5 List the side effects and associated care for patients receiving chemotherapy.

Chapter Outline Key Terms Body Systems Necessary Substances Immunity Cancer and Chemotherapy Administration of Chemotherapy Side Effects of Chemotherapy and Associated Care Chapter Summary Chapter 19 Review Teaching Strategies ▪ Discuss definitions of the key terms. Point out any similarities that may be confusing to students.

▪ Ask students to refer to the Representative Drugs table at the end of the chapter. Discuss ways in which this resource will be helpful. Ask students if they have any difficulty reading it. If so, take the time to answer their questions.

▪ Divide students into two groups. Have one group develop a chart outlining the characteristics of benign tumors. Have the other group develop a chart outlining the characteristics of cancerous tumors. Have a representative from each group present the differences.

▪ Discuss the health care worker’s responsibility in helping to prevent extravasation by antineoplastics and why it seems to be more important with this type of drug classification.

▪ Ask students to list the major complications of antineoplastic drug therapy. Discuss the care for each.

▪ Ask students to list different methods of oral hygiene suitable for cancer patients.

(Consider where the cancer is located.)

▪ Invite an individual who is on or has recently completed chemotherapy to speak to the class about his or her experiences including how health care workers were helpful and how they were not helpful. Ask students to write a summary of the presentation including their own reactions. Discuss how caring for a patient with cancer is different from caring for other patients.

▪ Have students write up a case study on a patient with cancer. Tell students to include all cancer drugs the patient is taking and reasons for the use of multiple drugs.

▪ Ask students to complete the Chapter 19 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

▪ Administer and grade the Chapter 19 Test in this Instructor's Manual.

Critical Thinking Activity 1. You are caring for a chemotherapy patient. Develop a plan of care for this patient.

2. How can you help a patient psychologically who has been diagnosed with cancer?

Answers to Chapter 19 Review 1. Reduction in the number of leukocytes in the blood, 4000 or less 2. Basic unit of structure of all living things 3. Poisonous to cells Gauwitz, Administering Medications, 8e

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4. Abnormal lump or mass of tissue 5. Drug therapy for cancer symptoms 6. Ability of malignant cells to spread to other parts of the body 7. Cancerous 8. Loss of hair 9. A well-defined tumor that is contained and will not spread to other parts of the body 10. Cancerous, able to spread to other parts of the body 11. Irritation of the mucous membrane of the mouth 12. c 13. a 14. b 15. d 16. e 17. f 18. They grow and divide more rapidly than normal cells. They invade nearby healthy tissues.

They metastasize (spread) to other parts of the body.

19. 30 minutes 20. Parts of the body where cells are dividing rapidly, such as the blood-forming areas of the bones 21. c 22. a 23. d 24. b 25. e 26.

X D = V H 210 mcg X = 300 mcg 1 mL 300X = 210 210 ÷ 300 = 0.7 X = 0.7 mL 27.

X D = V H 15 mg X = 50 mg 2 mL 50X = 30 30 ÷ 50 = 0.6 X = 0.6 mL 28.

D X = H V 15 mg X = 10 mg 1 tablet 10X = 15 15 ÷ 10 = 1.5 X = 1.5 tablets 29.

X D = V H 150 mg X = 100 mg 1 tablet 100X = 150 Gauwitz, Administering Medications, 8e

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150 ÷ 100 = 1.5 X = 1.5 tablets 30.

D X = H V 100 mg X = 1 tablet 50 mg 50X = 100 100 ÷ 50 = 2 X = 2 tablets 31. c 32. b 33. d 34. a 35. d 36. Alopecia Destruction of the hair follicles Suggest use of hairpieces and scarves Avoid excessive shampooing, brushing, combing, and hair dryers Cutting the hair before therapy may help 37. Antineoplastics irritate the gastrointestinal tract from the mouth through the rectum, making eating both uncomfortable and unpleasant.

Avoid eating within 1 hour of chemotherapy because this is the time most vomiting occurs. May last for 24 hours.

Provide a pleasant environment Select desirable foods Avoid foods with strong odors such as onions and red meats Encourage a glass of wine with meals because it may stimulate appetite Offer frequent high protein meals that are high in calories that are better tolerated Offer a antiemetic 30 minutes before meals 38. Gastrointestinal upset (nausea, vomiting, diarrhea), pain, fever, and infections 39. Monitor temperature. Instruct patient to avoid large crowds. Instruct patient on good handwashing.

40 – 48. Answers will vary depending on the edition of the PDR® that is used.

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CHAPTER 20: Drugs for the Pediatric Patient Learning Outcome 20-1 Define terms pertinent to drugs for the pediatric patient.

20-2 Describe the physiological alterations in the pediatric patient.

20-3 Identify the safeguards critical to the safe administration of pediatric medications.

20-4 Describe the methods of administration for oral, intramuscular, subcutaneous, intradermal, intravenous, optic, otic, nasal, nasogastric, or gastrostomy medication in the pediatric patient.

20-5 Know the new pediatric medications.

Chapter Outline Key Terms Drugs for the Pediatric Patient Physiological Alterations in the Pediatric Patient Safeguards to Safe Administration of Pediatric Medications Chapter Summary Chapter 20 Review Teaching Strategies ▪ Ask the students to define the key terms they are unfamiliar with. Discuss the definitions and be certain that students are clear about the meanings.

▪ Using Table 20-1 in the text, ask students to outline strategies to enhance acceptance of giving an oral drug to a child.

▪ Invite a pediatric supervisor to the class to discuss the role of the medication aide to the pediatric patient.

▪ Discuss, in class, the physiological alterations in the pediatric patient.

▪ Divide the students into four learning groups to outline the procedure for medication administration. Have the first group outline the procedure for oral medication administration. Have the second group outline the procedure for injectable medications (intramuscular, subcutaneous, intradermal, and intravenous). Have the third group outline the procedure for optic, otic, nasal, and rectal medication administration. Have the fourth group outline the procedure for nasogastric or gastrostomy medications. Bring the groups back together and have a representative from each group present the important points in each of the designated methods of medication administration.

▪ Have the students write a paper on the safeguards to safe administration of pediatric medications.

▪ Show a film, if possible, on the administration of medications to the pediatric patient.

▪ Ask students to complete Chapter 20 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students have difficulty with.

Critical Thinking 1. Discuss why medication administration is less predictable in the pediatric patient.

2. Develop a plan for administering medications to pediatric patients.

Answers to Chapter 20 Review 1. d 2. a 3. f 4. b 5. c 6. f 7. F 8. T 9. F 10. F 11. T 12. T 13. F 14. T 15. T 16. F 17. F 18. Intravenous 19. Pediatric and the person administering the drug 20. Choking 21. Milliliters 22. Z-track 23. 23G 24. Medial 25. Preverbal 26. Dropper 27. Oral 28. Subcutaneous and intradermal 29.

10 mg X 27 kg = 270 mg Gauwitz, Administering Medications, 8e

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270 mg X = 1 mL 50 mg 270 ÷ 50 = 5.4 X = 5.4 mL 30.

3 mcg X 21.36 kg = 64.08 mcg

64 mcg X = 50 mcg 1 mL 50X = 64 64 ÷ 50 = 1.28 mL 1.28 ÷ 2 = 0.64 mL in each dose 31.

55 lbs. ÷ 2.2 kg = 25 kg

200 mg X = 250 mg 5 mL 250X = 1000 X = 4 ml 32. BSA (m2) = 33. BSA (m2) =

75 X 10.2 765 = = 0.460 m2 = 0.46 m2 3600 3600 25 X 10 250 = = 0.282 m2 = 0.28 m2 3131 3131

34. c 35. b 36. a 37. c 38. d 39. Offer a popsicle to numb the tongue before administering the medication.

Offer a carbonated beverage before or after the drug to decrease the nausea.

Pinch the nose and encourage drinking through a straw to decrease the unpleasant taste and smell.

Mix the medicine with approximately one teaspoon of a sweetened substance like jam or pudding to enhance acceptance.

Avoid mixing with essential foods like cereals, formulas, or milk because this may result in the child refusing these foods.

Offer water, juice or flavored drink immediately after the drug to decrease the unpleasant taste.

40. Vastus lateralis 5/8 inch and 25 G is the appropriate size for a infant under 4 months 1 mL 41. Administer the medication in a flavored suspension or mix the medicine with 1 teaspoon of sweetened substance.

42. Pinch the nose and drink through a straw.

43. Thoroughly wash and dry pill crusher.

44. Double check the drugs with another person.

45. Check the child’s identification band with the medication label.

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C H A P T E R 21: Drugs for the Geriatric Patient Learning Outcomes 21-1 Describe the major changes that take place in the various body systems during aging.

21-2 Describe the effects of aging on absorption, distribution, metabolism, and excretion of drugs.

21-3 Explain why the presence of multiple diseases in older patients makes drug therapy more complicated, including adverse reactions.

21-4 Discuss an older patient’s medical and medication history with him or her.

21-5 Explain how older adults how older adult are affected by the attitudes and actions of health care workers.

21-6 Describe safe medication administration practices and the principles that are specific for the older adult patient.

21-7 List ways that patients can take an active part in their own medication therapy.

Chapter Outline Key Terms Drugs and the Older Adult The Aging Process Pharmacokinetics in the Older Adult Obtaining a Medical and Medication History Administering Medications to Older Adult Patients Engaging Patients in Their Care Chapter Summary Chapter 21 Review

Teaching Strategies ▪ Ask students to define the key terms they are unfamiliar with. Discuss the definitions and be certain that students are clear about the meanings.

▪ Using Table 21-1 in the text, ask students for the common interactions of drug therapy they have seen in older family members or those patients they may already be caring for.

▪ Contact the Department of Education in your state and ask about the guidelines for health care workers administering medications in long-term care facilities. Ask specifically about Certified Medication Aide. Does the state have a written Medication Aide Course with a required number of hours of administering medications under supervision? Have health care workers taken a course in Nurse Aide training? (This is important because they must learn to take vital signs to be able to administer some drugs, such as Lanoxin.)

▪ Invite a director of nurses from a long-term care facility who is involved with the supervision of medication aide students to visit the class. Have him or her explain the importance of this new allied health worker. Be sure the director is supportive of this team member and is working with the state to upgrade the care in the long-term care facility.

Discuss the reality of patients taking their own medications in long-term care facilities.

▪ Invite a home care supervisor into class to discuss the role of the medication aide. If the supervisor does not give medications, discuss how to supervise the patient as he or she takes medications. (Many Certified Medication Aides are Certified Nurse Aides also.)

▪ If possible, show a film about older adult patients. Show how the pharmacokinetics of aging affects their reaction to the effects of drugs. Ask the students to summarize the material in relation to their working with older adult patients and giving them medications.

They can do this in different ways—writing papers, demonstrating body changes using posters or simulated organs, or acting out adverse drug effects.

▪ Ask a gerontologist or a nurse specializing in gerontology to talk to the class. Ask the students to prepare a list of questions regarding the number of doctors, pharmacists, and family members involved in older adult patients’ care. How can students cooperate in the care so patients are not abusing drugs?

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▪ ▪

▪ ▪

Have students write a paper or discuss in class why almost all older adult patients are special-risk patients (organ impairment, arthritis, and other common diseases of the older adult patient).

Assign the students to research the present attitudes about the aging population as compared to attitudes twenty five years ago. What percentage of hospital patients are over 65? Will this be changing? What are the government, state, or local authorities doing to help this group of patients?

Ask students to complete the Chapter 21 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with.

Administer and grade the Chapter 21 Test in this Instructor's Manual.

Critical Thinking Activity 1. Discuss why drug absorption and distribution are slower and less predictable in older adult patients.

2. Develop a plan for administering medications to older adult patients.

Answers to Chapter 21 Review 1. Branch of medicine that deals with diseases and disorders of older adults 2. Study of the problems of older adults 3. A number of different drugs used by a patient who may have several different health problems 4. Over the counter, available without a prescription 5. The skin becomes thinner and dryer and loses its suppleness. The fatty layer under the skin disappears, causing wrinkles and folds and giving less protection against cold and injury. Bruising is more common. Spots of color appear on the skin, and small vessels are likely to burst, causing “spiders.” Sweating decreases, and there is less blood flow to the skin. Older adult bedridden patients are at a high risk of developing decubitus ulcers, or pressure sores.

6. The heart pumps less forcefully and pumps less blood with each beat, even though the number of beats per minute increases. The heart has less ability to gear up for action when the body is under stress. Various parts of the heart and the blood vessels lose their elasticity, and fatty substances may be deposited on the inner layers of arteries. These deposits give more resistance to the pumping action of the heart, so hypertension may develop. There is less blood flow to all parts of the body.

7. Collagen settles in the lungs, lessening their ability to expand. Along with a reduced flow of blood to the lungs, this makes respiration less efficient, and not as much oxygen is supplied to the body. In order to make up for this deficiency, an older adult must breathe faster than the normal 16–20 times per minute. Breathing is also shallower.

8. Brain cells die and there is less blood flow to the brain, affecting memory and the ability to make decisions. Confused thinking and changes in personality may result from the poor supply of oxygen to the brain.

9. Sensory messages do not come in strong and clear. The eyes have a harder time adjusting to changes in light. The ears do not hear the higher sounds and hearing aids may be needed. Taste and smell are dulled so that eating is less pleasurable. The sense of touch is dulled.

10. The secretions and muscular movements of the digestive tract slow down, and older adults produce less stomach acid than normal. These changes make food harder to digest and slower to move through the system. Indigestion and constipation are common problems. If teeth are lost or inflamed, eating may become difficult or uncomfortable. The absorption of nutrients from the intestines is less efficient, so nutrition may be affected.

11. There is less blood flow to the kidneys, and there are changes within the kidneys themselves.

They do not filter the blood as efficiently, so wastes are excreted more slowly. They cannot adapt as quickly as before to changes in the fluid/electrolyte balance.

12. All the glands secrete less of their hormones. As a result, body cell metabolism is not as well regulated and the body cannot react as quickly to stress. Most older adults develop some degree of diabetes.

13. Usually after age 48 or 50, females no longer menstruate or conceive babies. In both men and women, sex hormone production decreases, with resulting physical changes. However, Gauwitz, Administering Medications, 8e

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because attitudes and emotions, not just hormones, determine sexual enjoyment, older people can still enjoy an active sex life.

14. Muscles lose strength and flexibility. There is also an increase in the percentage of body fat, replacing muscle. The bones become lighter and more porous, so they are more apt to fracture easily and heal slowly. Ligaments and joints are subject to stiffening and thickening. Diseases of bones, joints, and ligaments are more common.

15. T 16. F 17. T 18. F 19. F 20. T 21. The dose is usually smaller and given less often to make up for changes in absorption, distribution, metabolism, and excretion in the older adults. This is the general rule, but drug treatment must be individualized for each patient.

22.

X D = V H 3 mg X = 4 mg 1 mL 4X = 3 3 ÷ 4 = 0.75 X = 0.75 mL 23.

X D = V H 250 mg X = 500 mg 1 tablet 500X = 250 250 ÷ 500 = 0.5 X = ½ tablet 24.

X D = V H 3000 units X = 5000 units 0.5 mL 5000X = 1500 1500 ÷ 5000 = 0.3 X = 0.3 mL 25.

X D = V H 80 mg X = 40 mg 1 tablet 40X = 80 80 ÷ 40 = 2 X = 2 tablets 26.

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X D = V H 10 mg X = 5 mg 1 tablet 5X = 10 10 ÷ 5 = 2 X = 2 tablets 27. d 28. a 29. b 30. d 31. c 32. Take a mediation history The patient is taking a antipsychotic, antiparkinsonian drug, antidepressant, and antihistamine. All of these drugs have anticholinergic properties.

Notify the healthcare provider.

33. The digestive tract slows down.

Prune juice, increasing fiber and fluids in the diet, and increase the activity level.

34. They differ because people age at different rates, and different body systems age at different times. This means that each man’s medication therapy must be individualized according to the systems that have aged the most.

35. There has been a gradual loss of elasticity in the lungs because of deposits of the protein collagen. As this means less oxygen intake with each breath, Ms. Peach must breathe more often to get the same amount of oxygen as before.

36. His confusion might be due to the effects of some of the medications on his nervous system, or there might be a lack of oxygen in the brain due to the poor circulation that comes with aging.

37. Let Mrs. Nimitz participate in her own medication plan, pour her own water if she can, and take her own pills under supervision. You will explain the procedure and the reason for medication so that Mrs. Nimitz is fully informed.

38. Poor liver function would slow down the metabolism of the drugs, and poor kidney function would slow excretion. The adverse reactions to look out for would be drug cumulation and possibly toxicity.

39.. Inform her that both aspirin and tranquilizers could be dangerous while she is on anticoagulants because of drug interactions. She should turn over the medications until the doctor says that they are safe to use. She should discard the tranquilizers, since they were prescribed for her sister and not for her.

40. Putting off the charting until later might lead to medication errors; for example, another staff member may give a patient a PRN medication even though you gave it an hour ago.

41. He may have a hearing problem. You could try speaking slowly and clearly, standing so that he can see your face (to read lips). If that does not work, you might try writing down the instructions for him (in large, clear letters). There is also the possibility that he may not understand English, so you might need someone to translate.

42. Explain what the medications are and what they do. Sit with Ms. Brill to gain her confidence and ease her fears. If she still refuses, do not force her to take the medications, but inform the nurse in charge and await further instructions.

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