202B Test #1 Flashcards
what you need for drawing up medications
syringe safety needles alcohol wipe filter devices (when working with ampules) needless entry device
what are the parts of a syringe
Barrel: outer portion. the measurement portion
Plunger: the inner device to push the fluid
TIP: either a luer lok or non lure lok(needle presses on)
what are the 3 types of syringes and their sizes
Standard: 3, 5, 10mL
Tuberculin: 1mL
Insulin: calibrated to match the dose strength in units
what do you want to avoid touching on a syringe
the plungers inner barrel(shaft of plunger) and the tip
what is special about the tuberculin syringes
they can accurately measure amounts given in very small doses- up to the 100ths
what is the insulin syringe used for?
INSULIN ONLY- it has a needle already attached to the syringe
what do the longer lines on the syringe indicate on 3mL syringe
1/2 and full mL measures
what do the shorter lines on the syringe indicate on 3mL syringe
0.1 mL measures
on 5mL and 10mL syringes what do the longer and shorter lines indicate
longer lines= full mL measures
shorter lines=0.2 mL measures
what do the long and short lines indicate on a tuberculin syringe
longer = 0.1mL shorter = 0.01mL (hundreths)
parts of a needle
Bevel- tip
shaft
hub-goes onto the syringe
safety device
needle length range
0.4-3inches
common needle lengths
3/4inch, 1 inch, 1.5 inch
when giving an injection how far should you insert the needle
all the way to the hub
how to choose the length of the needle
depends on where you are trying to reach
subQ shorter length
IM longer length
age/size of patient (there is potential to hit bone)
what is a filter straw/needle
a filter device that filters out any particulate matter. Mostly used when drawing up from ampules
how to select the right syringe
- how much volume you are giving
- what type of injection
- whether or not you can accurately measure amount with that syringe
what is an ampule and how do you open it
a glass bowling pin shaped vile that is opened by placing a alcohol wipe still in the package over top and snap top off away from anyone.
withdrawing from an ampule
- choose appropriate syringe and filter needle
- make sure all med is out of top of ampule
- open ampule and set on flat surface
- insert needle into ampule while avoiding touching the rim
- slowly draw up medication
- invert syringe and expel any air
- extra med into med waste container
- remove filter needle and attach needle for injection or sterile cap
- discard filter needle and ampule into sharps
- label syringe
what do you label the syringe after you have drawn up from ampule
name of med
dose in mg
your initials
what do you need to do prior to drawing up medications from a vial
wipe off the top with an alcohol swab.
withdrawing from a vial
- remove cap, cleanse with alcohol
- choose appropriate syringe and needle
- draw air into syringe equal to the amount of med you are going to draw up
- inject air into vial
- invert vial, ensure needle is within solution and draw up desired amount
- expel air and insure accuracy of dose
- use the scoop technique and recap the needle
in addition to bringing the syringe of medication you have drawn up into the patient room what is an important thing you also need to have
the vial of medication you drew from that way you can scan it for the MAR
how to prime a saline flush
- open package but leave syringe in package
- loosen the cap
- pull back on the diaphragm a little
- get rid of bubble
what does it mean if you try to flush a saline lock and you meet resistance
it could mean the saline lock is clamped or that the catheter has clotted
how much do you flush a saline lock with
3-5mL of saline
but follow your facilities policies
why have a saline lock be positive pressure
to prevent clotting of the catheter
do you add saline flush as intake when measuring I&O
No
how often do you flush a saline lock if the pt is not on an IV
- Q8H so the lock doesn’t clot off
- before and after medications
why would you flush a pediatric patients with heparin
to ensure patency that way you don’t have to start another IV
heparin lock flushes are only used on who
pediatric patients
what is the saline lock flush technique
- select syringe with appropriate amount of saline
- purge syringe of air(draw back to break seal)
- wash hands
- explain procedure
- swab injury port with alcohol
- attach syringe
- inject saline
- discard syringe
purpose of flush
to prevent blood backing into the IV catheter which might cause an occlusion
what to assess for when flushing saline lock
assess for pain, swelling and resistance
what heparin solution should be used
typically 10units/mL
do you need an order for a saline flush
no. it is the only order we perform without a MAR
steps to convert to saline lock
- D/C IV fluids
- remove tubing
- Keep end of IV tubing sterile in case it is needed later(sterile cap)
- Flush the device.
what should you know ahead of time prior to mixing medications
- Compatibility
- Parameters for final concentration
- calculations
- how long the solution is stable
what is physical incompatibility
formation of precipitate, haze, cloudiness, crystal formulation
What is chemical incompatibility
change potency or integrity of drug
Therapeutic incompatibility
increased or decreased therapeutic response
how long is a medication mixture good for when mixed in a syringe
15 minutes
where does the majority of reconstitution happen
in the pharmacy
what will you need for reconstitution
- EMAR
- medication & diluent
- correct size syringe
- needless entry device or needle
- alcohol wipes
- IVPB
Steps for reconstituting medications
- draw up correct amount and type of diluent per vial instructions
- add diluent to powdered medication
- inspect to insure all med has been dissolved- NO LUMPS
- withdraw correct dose for admin
- wast leftover properly
how do you mix the powder and diluent
rotate and roll
DO NOT SHAKE
when you are adding medications to an IV solution what do you need to check beforehand
- check the solution compatibility
- check the amount of IV solution needed
procedure for IV admixture
- determine if med is OK to add to IV solution
- draw up correct med to be added
- cleanse IV inj portal w/ alcohol
- inject med
- gently agitate the bag
- Label the bag
how should you label a syringe
- med
- dose
- date & time
- your intitials
how should you label IV bags
- pt name
- room #
- med
- dose
- date and time
- your initials
what is the first thing you want to do when doing any skills with a pt
ID YOUR PATIENT
name dob and allergies
what is an IVPB for
used to administer meds infused over intermediate timeframes
what is the typical volume of IVPB
50-250mLs
what is the timeframe the IVPB is infused
usually over 15-60minutes
vancomycin minimum infusion is 60min
what do you need to assess when hanging IVPB
- why pt is receiving med
- pertinent labs
- adverse effects of the med
- contraindications
- interactions w/other meds
- nsg implications
- compatibilities with other meds/fluids
- Rate for administration
- verify safe dose
- verify safe strength
- pt education
what should you teach the pt about the IVPB
- name of med and why they are receiving it
- adverse effects
- s/s of infiltration
what are the advantages of IVPB
- rapid onset of action
- predictable therapeutic levels can be achieved
- can give larger doses than IM
- Can rapidly terminate drug admin if necessary
- can use for meds that can’t be administered other routes
what are disadvantages of IVPB
- expensive
- keeping IV site patent
- increases risk of adverse reactions- speed shock extravasation, phlebitis
what is speed shock
headache, chest tightness, shock, cardiac arrest
all caused from too rapid administration
what are safety measures for implementation of IVPB
- check label on IVPB
- the rate is safe
- the concentration is safe
- the dose is safe
- compatibilities of solution
- checking for allergies
where do you hook up the IVPB
above the pump so the pump can control the rate
if you hook it up below the pump, the roller clamp is the only thing regulating the flow
why do you want to hang the primary IV solution lower than the IVPB
because the pump pulls from what has the most pressure (gravity) so the IVPB that is higher will cause more pressure and the pump will pull from that first
what does the back check valve do
prevents secondary med from going back into the primary IV bag
what do you do with IVPB tubing that is already used when you need to hang a 2nd IVPB
when the IVPB is empty and you are changing the IVPB bag:
- pause the pump
- do not administer med in the line to the pt
- make sure new IVPB is compatible with old
- lower old IVPB lower than the pump to prime the line
- take old bag off, spike new bag and hang it up(with clamp on)
- unclamp
- on pump-click 2ndary-go to library and click med
- make sure rate and infusion is safe
- click start
what are the 2 things you want to check before leaving the pt after hanging IVPB
- make sure you see drip from correct bag
- check IV site to make sure its not leaking, hurting, etc
how frequently do you change the line
q3-4days
depending on facility policy
how do you set up a new IVPB with new tubing
- get your new tubing and IVPB
- close clamp
- lower primary IV
- spike IVPB
- alcohol Y site on primary IV
- connect tubing
- pause infusion
- lower IVPB and prime new tubing
- Hang IVPB higher than primary
- program pump for 2ndary IV rate, volume,
- start infusion
what is back flush
flushing the IVPB line back into the IVPB bag. its used to prime the line with primary IV solution when switching the IVPB bags
what do you need to do when administering IVPB via saline lock
flush with saline first
then administer med
then flush with saline after med admin is complete
how do you do IVPB via saline lock
- need primary solution (NS) aka flush bag
- prime primary tubing
- connect to pt
- set primary rate the same as the IVPB
- program primary flush to infuse 2x the mL amount of IV tubing
- open 2ndary tubing, close clamp
- lower primary bag
- spike IVPB
- alcohol swab Y site
- prime 2ndary line
- hang IVPB higher than primary
- program pump for IVPB
- start infusion
how do you manage incompatibility between IVPB
back flush the secondary tubing into the OLD IVPB bag 3 TIMES
how long are IV bags usually good for
24 hours
should you use IV tubing if it is having over the pump plugged into the lower port
Not usually. the sterility is not guaranteed
what do you do if the IVPB never infused
notify the MD.
it is a missed dose and a medication error so it needs to be reported.
if you have 2 IVPBs to administer at the same time how do you know what to infuse first
- if one is an abx that has to be on a specific schedule, you would want to do that first to keep the time right.
- if you have one that is QD or Q6hours, you may do that 2nd b/c you still have the 30 minute window
- you would want to hang the one that has smaller amount or shorter infusion time first
If the IV site is burning to the pt what could be causing this
- check the catheter and IV site to make sure it looks ok
- could be an irritant in the medication
- K+ can cause pain
If the pt complains of burning what can you do to relieve it
slow the IV rate
warm compress on the arm
explain to pt that (if it is the med) that is normal with that medication and try to relieve burning
when using the syringe pump for IVPB where do you hook up the tubing to on the primary IV
hook in to the lower Y site on the primary tubing (below the pump) because the syringe pump is controlling the rate of infusion
how do you prime the 2ndary tubing when using a syringe pump
you would have to prime it with the medication you are giving
routes of heparin
can be given subQ and IV
what route do you never want to give heparin
intramuscular because it will cause hematomas
what do you do if you already have a primary IV solution going and need to start a Heparin infusion
you need to have its own IV tubing and pump.
it has to be run as a primary IV line. NOT as an IVPB.
once you set up its own pump you can attach it to the Y site BELOW the primary solution pump
what % of water are children
70%
which means the child can be easily depleted of water leading to dehydration, electrolyte imbalance and vascular collapse
what is the normal HR and respiration's in a full term newborn infant toddler school age/adolescent
Full term: HR 100-160(higher in preterm) RR: 30-60
Infant: HR 80-120 RR 30-60
toddler: HR 70-100 RR 24-40
school age/adolescent: HR 60-100 RR 15-26
what is an appropriate O2 sat on a child
95% or above.
anything lower indicates decreased oxygenation of tissue.
why can a pulse ox give you a false high reading
because the pulse ox reads the amount of hgb that is saturated with o2 therefore a pt with anemia can have a false high because it takes less oxygen to saturate hgb.
what are important indicators of sepsis in a newborn or young infant
a subnormal body or elevated temp and poor feeding
when can you perform a temporal temperature on a child
after 90 days.
prior to that the methods are either rectal or axillary
what can cause a very high HR in a child
fever, anxiety, medications, dysrhythmias
what can cause a slow HR
dysrhythmias, cold submersion, Digoxin toxicity
why do infants have a low BP
because they have very little peripheral vascular resistance
what head circumference should be in relation to chest circumference in
a newborn
a 1-2 yr old
older child
newborn: HC should exceed the chest circumference by 2-3 cm
a 1-2 yr old: HC should equal chest circumference
older child: chest circumference exceeds HC by 5-7cm
what does it indicate if the HC is less than the 5th percentile or greater than the 95th percentile
if its less than it can indicate lack of expected brain growth
if greater than it can indicate hydrocephaly or increased intracranial pressure
up until what age do we measure head circumference
birth to 36 months (3 yrs)
what should the head circumference be in boys
from 32 to 37cm at birth to 46-51cm at 24 months
what should the head circumference be in girls
from 32-36cm at birth to 45-50cm at 24 months
along with the systems assessment what other assessment should we perform
psychosocial developmental level sleep/rest safety appetite/nutrition accurate weight
what does it mean if the fontanels are bulging or sunken in
if they are bulging it indicates increased intracranial pressure or fluid excess (however bulging when crying is normal)
if they are sunken in it indicates a fluid deficit
what is congenital dermal melanocytosis
bluish spots on the lower back/buttock region
usually seen on east asian and dark skinned infants
what is a hemangioma
a benign tumor usually appearing as a bright red rubbery nodule of excess blood vessels in the skin.
occurs in small % of infants and most disappear. usually resolves by age 10-12
why are infants more prone to respiratory problems
because they have smaller, narrow, shorter trachea and bronchi which are more easily collapsable or being obstructed.
it is a shorter distance for pathogens to travel
and its difficult to isolate adventitious lung sounds because they are so small
what are some abnormal respiratory assessment findings
cough hoarsness nasal flaring diminished breath sounds adventitious breath sounds sternal retractions circumoral cyanosis -cyanosis of lips
what needs to be verified prior to adding K+ to IV fluids
the presence or renal function has to be established because in children who have a condition that might predispose to renal failure such as dehydration, there can be a build up of K+ in the body if the renal system is not functioning properly
what is the normal urine output in pediatric patients
0.5-2mL/kg/hr
what are acute signs of neonatal pain
facial expressions, diaphoretic, guarding, change in sleeping and eating habits
changes in vitals- increased HR and respirations
what scale do you use to assess neonatal pain
NIPS-neonatal infant pain scale
it assesses facial expression, cry, breathing, arms, legs and alertness
maximum score is seven points- consider pain at or greater than 4
why would you distract a toddler when doing a painful procedure.
they can’t focus on multiple things. The distraction works like imagery in the sense that it diverts pain signals and the pleasure signals then become faster than the pain signals
what is the FLACC pain scale
face, legs, activity cry consolability
used for 3mo-7yrs
what is acrocyanosis
blueness of the hands and feet in babies that can last up to several days of age resulting from immature circulatory system completing the switch from fetal to extrauterine life.
