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nursing skills > ch.29 medications > Flashcards

ch.29 medications Flashcards

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1
Q

administration of parenteral medications

A
  • subcutaneous injection
  • intramuscular injection
  • intradermal injection
  • intravenous injection
  • intra-arterial injection
  • intracardial injections
  • intraperitoneal injection
  • intraspinal injection
  • intraosseous injection
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2
Q

subcutaneous injection

A

subcutaneous tissue

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3
Q

intramuscular injection

A

muscle tissue

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4
Q

intradermal injection

A

corium (dermis), under epidermis

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5
Q

intravenous injection

A

vein

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6
Q

intra-arterial injection

A

artery

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7
Q

intracardial injection

A

heart tissue

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8
Q

intraperitoneal injection

A 
peritoneal cavity
(membrane that lines the cavity of the abdomen)
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9
Q

intraspinal injection

A

spinal canal

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10
Q

intraosseous injection

A

bone

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11
Q

needle gauge

A

diameter of the needle
18-30
diameter of needle increases the gauge number decreases

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12
Q

parts of a needle ad syringe

A

-plunger
-barrel
-threads of luer lock
=needle hub
-needle
-safe guard

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13
Q

criteria for choosing equipment for injections

A
  • route of administration (longer needle for intramuscular than for intradermal or subcutaneous)
  • viscosity of solution (meds more viscous require needle with large lumen smaller gauge)
  • quantity to be administered (larger amount of med, larger syringe needed)
  • body size (obese need longer needle, thinner older pt shorter needle)
  • type of med. (ex.insulin syringe only inject insulin)
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14
Q

smaller syringes

A

used as needed for precise dosing bc they provide smaller increments of measurement
never estimate a dose

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15
Q

types of syringes

A
  • standard syringe
  • insulin syringe
  • tuberculin syringe
  • prefilled syringe
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16
Q

standard syringe

A

used for intramuscular or subcutaneous injections

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17
Q

insulin syringe

A

only injecting insulin

18
Q

tuberculin syringe

A

for small volumes of meds and tb test

19
Q

prefilled syringe

A

single dose, ready to use

20
Q

preparing meds for injection types

A
  • ampules
  • vials
  • prefilled cartridges or syringes
  • mixing med in one syringe
  • mising insulins in one syringe
  • reconstituting powdered meds
21
Q

removing med from apule

A

a glass flask contains single dose, discard remainder

  1. place unfiltered needle of appropriate size on syringe b4 giving med
  2. snapping motion to break top of ampule can use gauze
  3. invert or place flat on surface to draw the solution with filter needle, dont contaminate needle by touching rim of ampule
22
Q

reconstituting powered meds

A

drug supplied as a powder in a vial, a liquid or diluent must be added to the powder b4 it is administered as a solution

23
Q

insulin syringe

A
  • available in multidose vial
  • dosages calculated in units
  • scale used is U100 = 100 units of insulin contained in 1 mL of solution
24
Q

mixing insulin in 1 syringe

A

short acting (clear) insulin and intermediate acting (cloudy) insulin

  1. roll and clean
  2. add air to cloudy insulin
  3. add air to clear insulin
  4. withdraw clear insulin FIRST, then cloudy insulin
25
Q

angles of insertion for various injections

A

intramuscular - 90 degree
subcutaneous - 90 or 45 degree
intradermal - 5-15 degree

26
Q

intradermal injections

A
  • into dermis below epidermis
  • longest absorption time of all parenteral routes
  • used for sensitivity test, tb tests, local anesthesia
  • body’s reaction to substance is visible
  • sites: inner forearm and upper back under scapula
  • 1/4” to 1/2”, 25 or 27 gauge needle
  • 5 to 15 degree angle
  • dosage usually less than 0.5 mL
  • spread the skin taut over injection site
27
Q

steps of intradermal injection

A
  • spread skin taut over injection site
  • inserting needle flat against the skin
  • observe for wheal while injecting med.
28
Q

subcutaneous injections

A
  • into adipose tissue
  • sites: outer upper arm, abdomen, anterior aspects of thigh, upper back, upper ventral or dorsogluteal area
  • avoid: bruised, tender, hard, swollen, inflamed, or scarred sites
  • absorption rates: abdomen most rapid, arms somewhat slowly, thighs more slowly, upper ventral or dorsogluteal slowest
  • 25-30 gauge, 3/8” to 1” needle, 3/8 and 5/8 most common
  • choose needle length based on amount of subcutaneous tissue, pts body weight and build
29
Q

subcutaneous injection cont.

A
  • no more tha 1 mL solution more solution adds to pts discomfort and predispose to poor absorption
  • 45-90 degree angle, 45 only for small pts
  • shorter 3/8” needle should be inserted at 90 degrees and longer 5/8” may insert at 45 degree
  • pinching skin advised for thinner pts and when longer needle is used
  • once needle is in release the skin
  • if blood or clear fluid at site apply gentle pressure
  • massaging site is avoided, can damage underlying tissue and increase absorption of med
30
Q

intramuscular injections

A
  • muscles have larger and greater number of blood vessels than subcutaneous allowing faster onset
  • aspiration may be indicated when administering certain meds (non vaccines)
  • consider age of pt, med type and med volume for site
  • injections into deltoid limited to 1 mL of solution up to 2 mL depending size of muscle
  • 90 degree ange
31
Q

sites for intramuscular injections

A

-ventrogluteal
-vastus lateralis
-deltoid muscle
(dorsogluteal no longer recommended)

32
Q

IM injection site age group and med type

A

infants and toddler- vastus lateralis (thigh), biologicals
children- vastus lateralis or deltoid
adults- ventrogluteal or deltoid
child/adults: deltoid for biologicals
meds known to be irritating, viscous or oily: ventragluteal

33
Q

IM injection Z track method

A

recommended for all im injections to ensure med does not leak back along needle track into subcutaneous tissue
-attach clean needle to syringe after syringe is filled with med
-pull skin down or to one side about 1 inch and hold in this position with non dominant hand
,insert needle, inject med slowly, withdraw needle, and release displaced tissue to normal position
-do not massage site may cause irritation
-gentle pressure may be applied

34
Q

intravenous administration of med

A
  • delivers drug directly into bloodstream, has immediate effect cannot be recalled or slowed
  • most often used in emergencies
35
Q

med via intravenous solution

A

med may be added to pts infusion solution

  • receives it slowly over relatively long period
  • disadvantage when pt needs drug quickly
  • check pt receiving for possible adverse effects at least every hour
36
Q

med via intravenous bolus or push

A
  • single injection of concentrated solution directly into intravenous line
  • many drugs administered over a 2 minute time frame
37
Q

med via intermittent intravenous infusion

A
  • drug mixed with small amount of iv solution such as 50 to 100 mL and administered over short period at prescribed interval
  • using iv infusion pump also smart pumps nurse program infusion rate
  • may be achieved by gravity infusion, drops per minute
38
Q

piggyback delivery systems

A
  • some require intermittent or additive solution to be placed higher than the primary solution
  • extension hook provided for easy lowering of the main iv container
  • port on primary has back-check valve that stops flow of primary allowing for secondary or piggyback solution to flow
39
Q

backfilling/back priming

A
  • alternate way to prime secondary tubing, keeps infusion system intact, preventing loss of med or intro of both
  • attach med bag to secondary tubing
  • lower medication bag below main IV solution container and open clamp of secondary, this allows primary to flow up the secondary drip chamber
  • close clamp on secondary, hand med higher than primary
40
Q

drug infusion/ saline lock

A
  • aka intermittent peripheral venous access device, saline lock
  • used for pts requiring intermittent intravenous med but not a continuous infusion
  • catheter connected to short length of extension tubing capped with sealed injection port

nursing skills (1 decks)

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