Ch. 34.3 Medication Administration

Question 1

Insulin

Answer 1

• Insulin comes prepared in a solution with 100 units per ml of solution and is called U-100 insulin
• Must take it parentally, as it would be broken down in the digestive tract

Question 2

Injection pens

Answer 2

• patients can use to self-administer medications (e.g., epinephrine, insulin, interferon) subcutaneously.
• The patient pinches the skin, inserts the needle, and injects a predetermined medication dose.
• CON: increased risk for needle-stick injury

Question 3

Needleless injection systems

Answer 3

• use high pressure to penetrate the skin with the medication into the subcutaneous tissue.

Question 4

The subcutaneous injection device (e.g., Insuflon)

Answer 4

• is inserted into the subcutaneous tissue;
• the needle is then removed, leaving the cannula in the tissue to provide an avenue for administering medications for up to 3 days without the need to puncture the skin with each injection

Question 5

Time-critical medications

Answer 5

are medications which may cause harm or result in substantial suboptimal therapy or pharmacological effect if not administered at scheduled time (must be given no later than 30 minutes before or after the scheduled dose) (e.g., antibiotics, insulin, anticoagulants, anticonvulsants, immunosuppressive agents)

Question 6

Subcutaneous (SC) injections

Answer 6

• Injecting into loose connective tissue underlying the dermis
• Medication absorbed more slowly than IM, less blood vessels
• Do not rub site after administration
• Amount of solution – small volumes 0.5-1ml.

Question 7

hypodermoclysis therapy

Answer 7

CSQI delivers isotonic IV solutions to dehydrated older persons
* continuous subcutaneous infusion

is the administration of fluids through a butterfly catheter and is commonly used for patients with limited IV access, palliative care patients, and patients at risk for or with mild dehydration. It is less invasive than IV. Can be performed in a variety of settings including long-term care. It is easy to initiate and maintain.

Question 8

intramuscular (IM) route

Answer 8

• faster medication absorption than the SQ route
• Amount: adult 2 to 5 mL of medication in larger muscles such as the ventrogluteal. Older persons, thin patients, and children tolerate less.
•

Question 9

Z-track method

Answer 9

• a technique for pulling the skin during an injection

* Pull skin and tissues 2.5-3.5 laterally to the side, keep it taunt during injection, release after withdrawing needle.

Question 10

Deltoid muscle

Answer 10

• palpate the acromium process, 3 fingerwidths below
• Is easily accessible but the muscle is not well developed in most patients
• potential for injury to the brachial artery and to the radial and ulnar nerves

Question 11

Ventrogluteal Muscle

Answer 11

• Well developed muscle
• recommended for volumes greater than 2mL

To landmark:

1. place the heel of your hand over the greater trochanter of the patient’s, Use your right hand for the left hip, and your left hand for the right hip. Point your thumb toward the patient’s groin and point your fingers toward the patient’s head;
2. point your index finger to the anterior superior iliac spine, and
3. extend your middle finger back along the iliac crest toward the buttocks.
4. The index finger, the middle finger, and the iliac crest form a V-shaped triangle; the injection site is the centre of the triangle

Question 12

Vastus Lateralis

Answer 12

• Use the middle third of the muscle for injection
• Lacks major nerves and blood vessels
• Facilitates rapid drug absorption
• Landmark, handbreadth at knee and handbreadth at greater trochanter. Middle third of muscle. Width of muscle is from midpoint of thigh to the midline of the thighs outer side. Lateral to the midline.

Question 13

Intradermal (ID) injections

Answer 13

• allergy testing/tuberculosis
• medication absorbed more slowly and there is reduced blood supply (less chance of anaphylactic reaction)
• Amount: Inject only small amounts of medication (0.01 to 0.1 mL) intradermally.
• If a bleb does not appear, or if the site bleeds after needle withdrawal, the medication may have entered subcutaneous tissue. In this situation, skin test results will not be valid.

Question 14

Large-volume infusions skill

Volume-Controlled infusions

Answer 14

These are mixtures within large volumes of IV fluids – mixing medications with large volumes of fluid,

• i.e. adding vitamins, potassium, administered as total volume is given. are the safest and easiest.
• Risk: if IV infused too fast, patient may develop circulatory overload

Question 15

IV bolus injection

Answer 15

By injection of a bolus, or small volume, of medication through an existing IV infusion line or intermittent venous access (heparin or saline lock); not diluted, most dangerous, no time to correct an error. Administering it directly into the circulation. Can be irritating to tissues around the vein, always verify blood return to make sure the IV is patent as medication is concentrated, may causes damage to tissues if infiltration. Always flush. Because of the small fluid volume, may be used with those with fluid restrictions. Need to use watch, calculate administration time…. For example 4ml over 2 minutes.

While IV push delivers medication within seconds in emergencies and IV bolus takes minutes in less high-stakes situations, they both have something important in common.

Question 16

Volume-control set (VOLU-trol, Pediatrol)

Answer 16

small containters to limit the total amount of volume administered (50-150ml). Often used together with infusion pumps with children. Limit the amount of a solution that can be given. Is kept separate, but still attached to primary infusion

Question 17

Piggyback sets

Answer 17

smaller bag with short tubing connect to the upper port of primary infusion

he piggyback set-up involves halting infusion of the primary solution while. the piggybacked solution infuses and resuming infusion of the primary solution when. infusion of the piggybacked solution is completed

Question 18

Tandem sets

Answer 18

small bag connects to lower port, infuses at the same time as primary, hung at same height as primary. Once medication is finished infusing, must be clamped or primary IV fluid will back flow into the tandem line.

Question 19

Mini-infusors or mini-infusion pump

Answer 19

allows very small amounts of medications (5-60ml) and uses a standard syringe.

Question 20

Intravenous Push

Answer 20

Cleanse the port before attaching the syringe
Attaching the syringe to the intravenous lock
Slowly inject the intravenous push medication through the intravenous lock; use a watch to time the injection
Can aspirate or gently pull back on plunger to see if there is blood return. Then you know you are in a vein
When giving an intravenous push medication through an intravenous line, pinch the tubing just above the injection port
Flush following to clear medication out of line. Usually normal saline (used to use heparin)

While IV push delivers medication within seconds in emergencies and IV bolus takes minutes in less high-stakes situations, they both have something important in common.