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NURS 366 > Exam 1; Week 3 CLINICAL CONCEPT > Flashcards

Exam 1; Week 3 CLINICAL CONCEPT Flashcards

1
Q

What is the single most consistent factor associated with complications and injury with injections?

A

site selection

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2
Q

Where are IM injections administered?

A

into muscle tissue below the dermis and subcutaneous tissue

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3
Q

At what degree is an IM injection given?

A

90 degrees

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4
Q

What does an IM injection promote?

A

rapid injection

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5
Q

What do you want to do if amount of fluid to be administered is MORE THAN the max amount allowed by site?

A

divide into 2 injections

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6
Q

How many cm apart should injections be if giving more than 1 injection is going into the same site?

A

2.5 cm

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7
Q

What kind of needle do you use if drawing a med from a glass ampule?

A

filter needle

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8
Q

What do you ALWAYS want to do before actually pressing the med in when giving an IM injection?

A

ASPIRATE

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9
Q

What happens if there is blood when you aspirate?

A
  1. remove the needle
  2. apply pressure to injection site until bleeding stops
  3. prepare new injection and choose a different site
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10
Q

How much of the needle do you want to insert when doing an IM injection?

A

3/4 at 90 degrees and inject slowly

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11
Q

What is the safest and least painful site?

A

ventrogluteal injection site

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12
Q

What is the ventrogluteal site free of? What is there less of a distribution of?

A

a. major blood vessels and nerves

b. fatty tissue

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13
Q

When do you want to recommend a ventrogluteal injection?

A

for volumes greater than 2 mL and for more irritating meds/solutions

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14
Q

What is a good range of needle gauges for adults for ventrogluteal site?

A

20-23

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15
Q

What is a good range of needle gauges for infants and children for ventrogluteal site?

A

22-25

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16
Q

What size needle should be used in infants and children for ventrogluteal site?

A

1/2-1

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17
Q

What size needle should be used in adolescents and adults for ventrogluteal site?

A

1-1 1/2

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18
Q

What may you need to use in obese and bariatric patients at ventrogluteal site?

A

a longer needle length

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19
Q

What is the max volume for adults in the ventroglutealn injection site?

A

2-5 mL - poor absorption for >3 mL

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20
Q

What is the max volume for older/larger children in the ventroglutealn injection site?

A

2 mL

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21
Q

What is the max volume for smaller children in the ventroglutealn injection site?

A

1 mL

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22
Q

What is the max volume for infants (greater than 18 months) in the ventroglutealn injection site?

A

0.5 mL

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23
Q

How do you want to position people for a ventrogluteal injection?

A

in side-lying or supine position

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24
Q

Where is this site located?

A

with palm of opposite hand at trochanter

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25
Q

What injection site is the preferred/most used site for infants and toddlers?

A

vastus lateralis (only acceptable site for children <7 months old)

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26
Q

What muscle is the vastus laterals prefferred over?

A

rectus femoris muscle

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27
Q

What is a good range of needle gauges for adults for vastus lateralis site?

A

20-23 gauge

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28
Q

What is a good range of needle gauges for infants and children for vastus lateralis site?

A

22-25 gauge

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29
Q

What is a good needle length for neonates in vastus laterals site?

A

5/8 inch

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30
Q

What is a good needle length for infants (1-12 months) in vastus laterals site?

A

1 inch

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31
Q

What is a good needle length for toddlers and children in vastus laterals site?

A

1 - 1 1/4 inch

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32
Q

What is a good needle length for adolescents and adults in vastus laterals site?

A

1 - 1 1/2 inch

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33
Q

What is max volume for vastus lateralis site in adults?

A

2 - 3 mL

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34
Q

What is max volume for vastus lateralis site in older/larger children?

A

2 mL

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35
Q

What is max volume for vastus lateralis site in smaller children?

A

1 mL

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36
Q

What is max volume for vastus lateralis site in infants?

A

0.5 mL

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37
Q

What position is a patient in for a vastus lateralis injection?

A

place patient in supine position with thigh exposed and knee slightly flexed.

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38
Q

What injection site can be used in children 3 years and older?

A

deltoid injection site

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39
Q

How young can a child be to use the deltoid site?

A

12-18 months

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40
Q

What can be done at the deltoid injection site? What can’t be done at this site?

A

a. immunizations/biologicals

b. no antibiotics unless no other available sites

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41
Q

How many fingerbreadths below the acromion process is the deltoid injection site?

A

2-3 finger breadths

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42
Q

What is the max volume for deltoid injection in infants/children?

A

0.5-1 mL

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43
Q

What is the max volume for deltoid injection in adults?

A

2 mL

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44
Q

What is the gauge range for deltoid injection site?

A

22-25 gauge

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45
Q

What is the length of the needles for deltoid injections for children?

A

1/2 - 1 inch

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46
Q

What is the length of the needles for deltoid injections for adults?

A

1 - 1 1/2 inch

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47
Q

What is a method for injecting medication into a large muscle?

A

Z-track injections

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48
Q

What kind of solutions are used with z-track injections?

A

irritating solutions

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49
Q

What kind of injections are administered into the fatty connective tissue below the dermis and above the muscle?

A

SQ injections

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50
Q

true or false: SQ have a slower absorption rate than IM

A

true

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51
Q

What do you never want to do when you are giving your SQ injections?

A

ASPIRATE

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52
Q

What gauge sizes are SQ injections?

A

25-30 gauge

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53
Q

What size needle are SQ injections?

A

5/8 inch

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54
Q

Finish the sentence: only ( ) volumes of water-soluble meds can be given via the SQ route.

A

small - 0.5-1.5 mL

55
Q

If volume of medication for SQ injection is larger than 1.5 what do you need to do?

A

need to divide medication into separate injections

56
Q

What are the primary sites for SQ injections on infants?

A

anterior thigh

57
Q

What are the primary sites for SQ injections on older children and adults?

A

dorsum of the upper arm, abdomen, anterior thigh

58
Q

How do you avoid reaching the muscle in SQ injections?

A

pinch up the fatty tissue

59
Q

What angle should insert an SQ injection if you are only able to grab 2 inches?

A

90 degrees

60
Q

What angle should you insert an SQ injection if you are only able to grab 1 inch of tissue?

A

45 degrees

61
Q

What 5 areas can insulin (SQ injection) be administered?

A
  1. Lateral/posterior aspects of upper arm
  2. Fatty tissue of lower abdomen
  3. Lateral aspect of thigh
  4. Scapular area of upper back
  5. Flank (upper ventrodorsal gluteal areas)
62
Q

How many finger breadths from the umbilicus should a heparin or insulin injection be if it is in the abdomen?

A

2

63
Q

What are intradermal injections used for?

A
  1. tuberculin screening

2. allergy tests

64
Q

What should the skin be free of when giving an intradermal injection?

A
  1. visible veins
  2. lesions
  3. excessive hair
65
Q

What is the gauge range for intradermal injections?

A

25-27

66
Q

What is the size of the needle for intradermal injections?

A

1/2 - 5/8 inch

67
Q

What should be visible when giving an ID injection?

A

the needle point

68
Q

Do you aspirate with ID injections?

A

NO

69
Q

What is the volume range for ID injections?

A

0.01-0.1 mL

70
Q

What are the 3 structures in the upper respiratory tract?

A
  1. oronasopharynx
  2. pharynx
  3. larynx
71
Q

What are the 5 structures in the lower respiratory tract?

A
  1. trachea
  2. bronchi
  3. bronchioles
  4. alveolar duct
  5. alveoli
72
Q

What 2 structures are affected in Croup syndromes?

A
  1. epiglottis

2. larynx

73
Q

What are 5 things to look at when doing a respiratory assessment?

A
  1. rate
  2. depth
  3. ease
  4. labored breathing
  5. rhythm,
74
Q

What are examples of nursing interventions for children with respiratory problems?

A
  1. Ease Respiratory Effort
  2. Promote Rest
  3. Promote Comfort
  4. Prevent Spread of Infection
  5. Reduce Temperature
  6. Promote Hydration
  7. Provide Nutrition
  8. Provide Family Support and 9. Home Care Instructions
75
Q

What is acute viral nasopharyngitis?

A

common cold

76
Q

What is the cause of nasopharyngitis?

A

viruses

77
Q

How is acute viral nasopharyngitis diagnosed?

A

nasopharyngeal swab

78
Q

What are symptoms of acute viral nasopharyngitis?

A
  1. Fever
  2. Poor feeding
  3. Vomiting
  4. Diarrhea
  5. Abdominal pain
  6. Nasal blockage/discharge
  7. Cough
  8. Respiratory sounds
  9. Sore throat
  10. Headache
  11. Neck pain
79
Q

What is 3 forms of nursing care for acute viral nasopharyngitis?

A
  1. Prevention and protection (isolation/PPE)
  2. Comfort, symptom management, hydration, managing secretions
  3. Family support
80
Q

What is the cause of influenza or the flu?

A

orthomyxoviruses

81
Q

how is the flu diagnosed?

A

nasopharyngeal swab

82
Q

What are the symptoms of flu?

A
  1. Dry throat
  2. hoarseness
  3. lack of energy
  4. sudden onset of fever and chills
83
Q

What are 2 complications of flu?

A
  1. viral pneumonia

2. bacterial infections

84
Q

What nursing care is important for the flu?

A
  1. prevention (PPE)/isolation
  2. flu vaccine
  3. symptom management
  4. family support
85
Q

What is the cause of Croup syndromes?

A

viruses like parainfluenza, human metapneumovirus, influenza A and B, adenovirus and measles

86
Q

How is croup syndrome diagnosed?

A

inflammation of larynx, trachea, and bronchi

87
Q

What are symptoms of croup syndromes?

A
  • Epiglottis, laryngitis, laryngothracheobronchitis (LTB), and tracheitis (severe effects on the voice and breathing)
  • Hoarseness, brass, barky cough, inspiratory stridor, respiratory distress
88
Q

1 nursing intervention for croup syndromes:

A

airway protection

89
Q

Acute epiglottis is considered what??

A

MEDICAL EMERGENCY

90
Q

What is acute epiglottis?

A

serious obstructive inflammatory process

91
Q

What can acute epiglottis progress to?

A

severe respiratory distress –> absence of cough, drooling, agitation - anxiety increases as respiratory. distress increases

92
Q

What causes acute epiglottis caused by?

A

H. Influenza B.

93
Q

4 nursing interventions for acute epiglottis:

A
  1. Maintain airway, administer IV antibiotics, Corticosteroids
  2. Positioning, comfort, Possible intubation, reduce anxiety
  3. Family support
  4. HIB Vaccine
94
Q

what is the most common croup syndrome?

A

acute laryngotracheobronchitis

95
Q

What causes acute laryngotracheobronchitis?

A

viruses, rarely bacterial

96
Q

What proceeds acute laryngotracheobronchitis?

A

a URI which descends to other structures

97
Q

What are symptoms of acute laryngotracheobronchitis?

A
  1. Barky cough
  2. retractions
  3. nasal flaring
  4. stridor
98
Q

What are nursing interventions for acute laryngotracheobronchitis?

A
  1. Maintain airway
  2. manage secretions
  3. cool mist
  4. vigilant observation and respiratory assessment
  5. Family support
99
Q

What is a complication of acute laryngotracheobronchitis?

A

bacterial tracheitis

100
Q

What is bronchitis also called?

A

tracheobronchitis

101
Q

What is bronchitis?

A

inflammation of the large airways frequently associated with URI.

102
Q

What causes bronchitis?

A
  1. viruses

2. M. pneumonia in children older than 6 years

103
Q

What are symptoms of bronchitis?

A

Dry hacking non-productive cough (worsens at night)

104
Q

What are nursing interventions for bronchitis?

A
  1. humidity
  2. analgesics
  3. antipyretics
105
Q

What is the most frequent cause of hospitalization in children younger than 1 yr, and a rare occurrence after 2 years?

A

respiratory syncytial virus

106
Q

What is RSV?

A

a respiratory infection of the bronchioles; it is contagious

107
Q

How does someone get RSV?

A

exposure from contaminated secretions

108
Q

What are symptoms of RSV?

A
  1. sneezing
  2. wheezing
  3. tachypnea
  4. apnea
  5. poor air exchange
  6. coughing
  7. pharyngitis
  8. rhinorrhea
  9. cyanosis
109
Q

What are nursing interventions for RSV?

A
  1. Suctioning
  2. isolation (PPE)
  3. oxygen therapy
  4. family support
110
Q

How is RSV prevented?

A

monoclonal antibody - IM injection that is given monthly for high risk patients

111
Q

What is the best way to prevent the spread of RSV?

A

washing hands

112
Q

Diagnoses of RSV is accomplished through what?

A

nasal aspiration

113
Q

What is inflammation of lobes of lungs?

A

pneumonia

114
Q

Viral pneumonia is associated with what?

A

a URI

115
Q

Bacterial pneumonia comes on?

A

abruptly

116
Q

What is the 3rd etiology of pneumonia?

A
  1. viral
  2. bacterial
  3. aspiration
117
Q

What causes pneumonia?

A

Agent inhaled directly into the lungs or comes from the bloodstream and varies according to child’s age

118
Q

What are symptoms of pneumonia?

A
  1. Fever
  2. malaise
  3. non-productive to productive cough
  4. chest pain
119
Q

What are nursing interventions for pneumonia?

A

Supplemental oxygen, antibiotics, fluids, rest

Prevention?

120
Q

What is the most common chronic disease of childhood?

A

asthma

121
Q

define asthma

A

A chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and the epithelial cells.

122
Q

What are 4 categories of asthma?

A
  1. intermittent
  2. mild
  3. moderate
  4. severe
123
Q

What influences the persistence and the severity of asthma?

A

allergies

124
Q

What are symptoms of acute asthma?

A
  1. Prolonged expiratory phase
  2. Wheezing, chest tightness, cough
  3. Tachypnea, accessory muscle use, retractions, nasal flaring
  4. Agitation or altered mental state
  5. Hyperinflation, increased AP diameter
125
Q

What are symptoms of chronic asthma?

A
  1. Chronic cough, especially at night
  2. Prolonged cough with colds and triggers
  3. Allergic symptoms and/or rhinitis
  4. With or without increased AP diameter
  5. Wheeze though it may only be evident during acute episodes or with activity
  6. Atopic dermatitis
  7. Recurrent pneumonia and/or 8. sinusitis
  8. Shortness of breath on exercise
  9. Seasonal pattern
  10. Response to beta agonist therapy
126
Q

What are nursing care options for asthma

A
  • Close observation, working with RT, education, symptom management
  • Lab values (eosinophils)
  • Family support—school action plan
  • Medications: MDI- Albuterol, inhaled corticosteroids (Pulmicort, Flovent)
    Prednisolone
  • Breathing techniques, Yoga, Acupuncture, Diet, Herbal remedies
127
Q

What is a dysfunction of the exocrine glands where thick tenacious mucous is produced?

A

cystic fibrosis

128
Q

Is cystic fibrosis genetic?

A

hereditary; autosomal recessive trait

129
Q

What causes cystic fibrosis?

A
  1. Thick mucous obstructs the respiratory passages, causing trapped air and over inflation of the lungs
  2. Thick mucous obstructs the secretory ducts of the pancreas, liver and reproductive organs
130
Q

How is cystic fibrosis diagnosed?

A
  1. Elevation of Sweat Electrolytes
  2. Sodium and chloride are affected with abnormal
  3. Chloride movement
  4. Family history
  5. Stool analysis
131
Q

What are symptoms of cystic fibrosis?

A
  1. Nutritional deficiencies
    - -> Absence of pancreatic enzymes
  2. Chronic Respiratory problems
    - Wheezing
    - Clubbing of fingers and toes
    - Thick tenacious secretions
  3. Fatty and foul smelling stools
  4. Taste salty when kissed
132
Q

What are treatment options for cystic fibrosis?

A
  1. Treat Respiratory Infection with antibiotics
  2. Pulmonary hygiene – CPT
  3. Pancreatic enzymes with all meals and snacks
  4. Fat soluble vitamins A, D, E, &K,
  5. High calorie diet
133
Q

What are nursing care options for cystic fibrosis?

A
  1. Comprehensive assessment of all affected systems with special focus on pulmonary and gastrointestinal systems
  2. Patients require hospitalization only for pulmonary infections, uncontrolled diabetes or coexisting morbidities – meet emotional needs of child & family
  3. Typically managed at home
    Anticipatory guidance and education crucial

NURS 366 (7 decks)

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