Midwife Licensure Exam Fundamentals of Care & the Health-Care Process — Medication Administration & Dosage CalculationConcept Map

Concept

Pharmacology Fundamentals

Sub Concepts

• Pharmacokinetics (absorption, distribution, metabolism, excretion)
• Pharmacodynamics (mechanism of action, therapeutic effects)
• Onset, peak, duration
• Half-life and drug accumulation
• Side effects vs adverse effects vs allergic reactions

Relationship To Central

Theoretical foundation for understanding drug behavior and safe administration

Concept

Routes of Administration

Sub Concepts

• Oral (PO) - sublingual, buccal
• Topical/transdermal
• Inhalation
• Instillation (eye, ear, nose)
• Rectal/vaginal
• Parenteral - ID, SC, IM, IV
• Route selection based on patient assessment

Relationship To Central

Determines how medication is delivered and affects onset, peak, duration

Concept

The Ten Rights of Medication Administration

Sub Concepts

• Right patient (two identifiers)
• Right drug
• Right dose
• Right route
• Right time/frequency
• Right documentation (after administration)
• Right reason/indication
• Right assessment (pre-administration)
• Right response/evaluation
• Right to refuse

Relationship To Central

Core safety framework mandated by RA 9173 and nursing standards

Concept

Dosage Calculation & Unit Conversions

Sub Concepts

• Basic formula: D/H × Q
• Weight-based dosing (mg/kg)
• Unit conversions (g, mg, mcg, kg, lb, mL, L, tsp, tbsp, oz)
• IV flow rate calculations (mL/hr, gtt/min)
• Drop factor considerations (macrodrip, microdrip)
• Safe dose range verification

Relationship To Central

Essential clinical skill for preventing medication errors and ensuring therapeutic effectiveness

Concept

Injection Techniques & Site Selection

Sub Concepts

• Intradermal (ID): 10-15° angle, 0.1 mL, bleb formation
• Subcutaneous (SC): 45-90° angle, ≤1 mL, site rotation, no aspiration for anticoagulants
• Intramuscular (IM): 90° angle, 3 mL max, ventrogluteal preferred for adults, Z-track for irritants
• Intravenous (IV): immediate onset, highest risk
• Site complications: infiltration, phlebitis, extravasation

Relationship To Central

Proper technique minimizes tissue damage, ensures absorption, and prevents complications

Concept

IV Therapy Fundamentals

Sub Concepts

• Fluid types: isotonic, hypotonic, hypertonic
• IV access and catheter management
• Compatibility assessment before mixing/co-infusing
• Monitoring for complications
• Fluid balance assessment
• Aseptic technique and infection prevention

Relationship To Central

Critical component of medication delivery requiring specialized knowledge and monitoring

Concept

High-Alert Medications

Sub Concepts

• Insulin - use insulin syringes, clear before cloudy, site rotation, glucose monitoring
• Anticoagulants (heparin, enoxaparin, warfarin) - monitoring, antidotes, no aspiration/massage
• Opioids - respiratory assessment before administration, naloxone antidote
• KCl - never IV push undiluted, always dilute and use pump
• Chemotherapy and neuromuscular blockers
• Concentrated electrolytes

Relationship To Central

Require independent double-checks and heightened vigilance per patient safety protocols

Concept

Error Prevention & Safe Practice

Sub Concepts

• Three checks of medication label
• Verification of patient allergies
• Questioning unclear or unusual orders
• Use of leading zeros, avoid trailing zeros
• Avoiding unsafe abbreviations
• Incident reporting and documentation
• Stop and recheck if patient questions medication

Relationship To Central

Directly addresses patient safety obligations under RA 9173 nursing practice standards

Concept

Special Populations

Sub Concepts

• Pediatrics - weight-based dosing, small volumes, double-check calculations
• Older adults - reduced hepatic/renal clearance, polypharmacy considerations, start low go slow
• Pregnancy/lactation - drug safety categories, breast milk transfer
• Renal/hepatic impairment - altered pharmacokinetics

Relationship To Central

Requires dose adjustments and modified administration techniques for safety

Concept

Assessment & Documentation

Sub Concepts

• Pre-administration assessment (vital signs, relevant parameters)
• Post-administration monitoring (onset, peak, duration, effects)
• Adverse reaction assessment
• Documentation immediately after administration
• Evaluation of therapeutic response
• Patient and family teaching

Relationship To Central

Integral to the nursing process for evaluating therapeutic outcomes and ensuring accountability

To

Routes of Administration

From

Pharmacology Fundamentals

Strength

strong

Relationship

Pharmacokinetic principles determine which routes achieve optimal absorption and distribution for different drugs

To

Injection Techniques & Site Selection

From

Routes of Administration

Strength

strong

Relationship

Each parenteral route (ID, SC, IM, IV) requires specific angle, volume, and site selection to ensure safe administration and therapeutic effectiveness

To

Dosage Calculation & Unit Conversions

From

The Ten Rights of Medication Administration

Strength

strong

Relationship

Right dose verification requires accurate calculations and unit conversions to prevent dosing errors

To

Error Prevention & Safe Practice

From

Dosage Calculation & Unit Conversions

Strength

strong

Relationship

Careful calculation combined with the three-check system prevents medication errors at the point of administration

To

High-Alert Medications

From

IV Therapy Fundamentals

Strength

strong

Relationship

Many high-alert medications are administered IV, requiring special monitoring of flow rates, compatibility, and complications

To

Assessment & Documentation

From

High-Alert Medications

Strength

strong

Relationship

High-alert drugs require enhanced pre-administration assessment and detailed post-administration monitoring and documentation

To

Dosage Calculation & Unit Conversions

From

Special Populations

Strength

strong

Relationship

Pediatric and geriatric patients require weight-based dosing and dose adjustments; special populations need modified calculations

To

The Ten Rights of Medication Administration

From

Error Prevention & Safe Practice

Strength

strong

Relationship

The ten rights framework is the foundation of error prevention strategies in medication administration

To

The Ten Rights of Medication Administration

From

Assessment & Documentation

Strength

strong

Relationship

Assessment is right #8 (pre-administration parameters) and documentation is right #6 (charting after administration); both are critical rights

To

Pharmacology Fundamentals

From

IV Therapy Fundamentals

Strength

moderate

Relationship

IV fluid osmolality and composition directly affect drug distribution and cellular fluid balance based on pharmacokinetic principles

To

Pharmacology Fundamentals

From

Routes of Administration

Strength

strong

Relationship

Route selection affects onset, peak, and duration of drug effects through differential absorption and distribution

To

High-Alert Medications

From

Special Populations

Strength

moderate

Relationship

Pediatric and older adult patients require special monitoring and dose adjustments for high-alert medications due to altered metabolism

To

Assessment & Documentation

From

Injection Techniques & Site Selection

Strength

moderate

Relationship

Proper injection technique prevents complications that must be documented; site assessment is part of pre and post-administration evaluation

To

IV Therapy Fundamentals

From

Dosage Calculation & Unit Conversions

Strength

strong

Relationship

IV flow rate calculations determine mL/hr and gtt/min; accurate calculation ensures correct drug delivery

To

Error Prevention & Safe Practice

From

IV Therapy Fundamentals

Strength

strong

Relationship

IV therapy complications require vigilant monitoring and proper assessment per safety protocols; many high-risk errors occur with IV administration

To

Special Populations

From

Pharmacology Fundamentals

Strength

moderate

Relationship

Understanding pharmacokinetic changes in pediatric and older adult populations guides dose adjustments and monitoring strategies

To

Assessment & Documentation

From

Error Prevention & Safe Practice

Strength

strong

Relationship

Preventing errors requires proper assessment before administration and accurate, timely documentation after administration

To

Assessment & Documentation

From

The Ten Rights of Medication Administration

Strength

strong

Relationship

Assessment (#8) and documentation (#6) are integral rights; evaluation of therapeutic response and monitoring are documentation requirements

To

Error Prevention & Safe Practice

From

High-Alert Medications

Strength

strong

Relationship

High-alert medications require double verification, enhanced monitoring, and knowledge of antidotes as key error prevention strategies

To

Special Populations

From

Routes of Administration

Strength

moderate

Relationship

Some routes are preferred in certain populations (e.g., vastus lateralis IM for infants; modified IV techniques for older adults)