Exam 1; Week 3 CLINICAL CONCEPT Flashcards
What is the single most consistent factor associated with complications and injury with injections?
site selection
Where are IM injections administered?
into muscle tissue below the dermis and subcutaneous tissue
At what degree is an IM injection given?
90 degrees
What does an IM injection promote?
rapid injection
What do you want to do if amount of fluid to be administered is MORE THAN the max amount allowed by site?
divide into 2 injections
How many cm apart should injections be if giving more than 1 injection is going into the same site?
2.5 cm
What kind of needle do you use if drawing a med from a glass ampule?
filter needle
What do you ALWAYS want to do before actually pressing the med in when giving an IM injection?
ASPIRATE
What happens if there is blood when you aspirate?
- remove the needle
- apply pressure to injection site until bleeding stops
- prepare new injection and choose a different site
How much of the needle do you want to insert when doing an IM injection?
3/4 at 90 degrees and inject slowly
What is the safest and least painful site?
ventrogluteal injection site
What is the ventrogluteal site free of? What is there less of a distribution of?
a. major blood vessels and nerves
b. fatty tissue
When do you want to recommend a ventrogluteal injection?
for volumes greater than 2 mL and for more irritating meds/solutions
What is a good range of needle gauges for adults for ventrogluteal site?
20-23
What is a good range of needle gauges for infants and children for ventrogluteal site?
22-25
What size needle should be used in infants and children for ventrogluteal site?
1/2-1
What size needle should be used in adolescents and adults for ventrogluteal site?
1-1 1/2
What may you need to use in obese and bariatric patients at ventrogluteal site?
a longer needle length
What is the max volume for adults in the ventroglutealn injection site?
2-5 mL - poor absorption for >3 mL
What is the max volume for older/larger children in the ventroglutealn injection site?
2 mL
What is the max volume for smaller children in the ventroglutealn injection site?
1 mL
What is the max volume for infants (greater than 18 months) in the ventroglutealn injection site?
0.5 mL
How do you want to position people for a ventrogluteal injection?
in side-lying or supine position
Where is this site located?
with palm of opposite hand at trochanter
What injection site is the preferred/most used site for infants and toddlers?
vastus lateralis (only acceptable site for children <7 months old)
What muscle is the vastus laterals prefferred over?
rectus femoris muscle
What is a good range of needle gauges for adults for vastus lateralis site?
20-23 gauge
What is a good range of needle gauges for infants and children for vastus lateralis site?
22-25 gauge
What is a good needle length for neonates in vastus laterals site?
5/8 inch
What is a good needle length for infants (1-12 months) in vastus laterals site?
1 inch
What is a good needle length for toddlers and children in vastus laterals site?
1 - 1 1/4 inch
What is a good needle length for adolescents and adults in vastus laterals site?
1 - 1 1/2 inch
What is max volume for vastus lateralis site in adults?
2 - 3 mL
What is max volume for vastus lateralis site in older/larger children?
2 mL
What is max volume for vastus lateralis site in smaller children?
1 mL
What is max volume for vastus lateralis site in infants?
0.5 mL
What position is a patient in for a vastus lateralis injection?
place patient in supine position with thigh exposed and knee slightly flexed.
What injection site can be used in children 3 years and older?
deltoid injection site
How young can a child be to use the deltoid site?
12-18 months
What can be done at the deltoid injection site? What can’t be done at this site?
a. immunizations/biologicals
b. no antibiotics unless no other available sites
How many fingerbreadths below the acromion process is the deltoid injection site?
2-3 finger breadths
What is the max volume for deltoid injection in infants/children?
0.5-1 mL
What is the max volume for deltoid injection in adults?
2 mL
What is the gauge range for deltoid injection site?
22-25 gauge
What is the length of the needles for deltoid injections for children?
1/2 - 1 inch
What is the length of the needles for deltoid injections for adults?
1 - 1 1/2 inch
What is a method for injecting medication into a large muscle?
Z-track injections
What kind of solutions are used with z-track injections?
irritating solutions
What kind of injections are administered into the fatty connective tissue below the dermis and above the muscle?
SQ injections
true or false: SQ have a slower absorption rate than IM
true
What do you never want to do when you are giving your SQ injections?
ASPIRATE
What gauge sizes are SQ injections?
25-30 gauge
What size needle are SQ injections?
5/8 inch
Finish the sentence: only ( ) volumes of water-soluble meds can be given via the SQ route.
small - 0.5-1.5 mL
If volume of medication for SQ injection is larger than 1.5 what do you need to do?
need to divide medication into separate injections
What are the primary sites for SQ injections on infants?
anterior thigh
What are the primary sites for SQ injections on older children and adults?
dorsum of the upper arm, abdomen, anterior thigh
How do you avoid reaching the muscle in SQ injections?
pinch up the fatty tissue
What angle should insert an SQ injection if you are only able to grab 2 inches?
90 degrees
What angle should you insert an SQ injection if you are only able to grab 1 inch of tissue?
45 degrees
What 5 areas can insulin (SQ injection) be administered?
- Lateral/posterior aspects of upper arm
- Fatty tissue of lower abdomen
- Lateral aspect of thigh
- Scapular area of upper back
- Flank (upper ventrodorsal gluteal areas)
How many finger breadths from the umbilicus should a heparin or insulin injection be if it is in the abdomen?
2
What are intradermal injections used for?
- tuberculin screening
2. allergy tests
What should the skin be free of when giving an intradermal injection?
- visible veins
- lesions
- excessive hair
What is the gauge range for intradermal injections?
25-27
What is the size of the needle for intradermal injections?
1/2 - 5/8 inch
What should be visible when giving an ID injection?
the needle point
Do you aspirate with ID injections?
NO
What is the volume range for ID injections?
0.01-0.1 mL
What are the 3 structures in the upper respiratory tract?
- oronasopharynx
- pharynx
- larynx
What are the 5 structures in the lower respiratory tract?
- trachea
- bronchi
- bronchioles
- alveolar duct
- alveoli
What 2 structures are affected in Croup syndromes?
- epiglottis
2. larynx
What are 5 things to look at when doing a respiratory assessment?
- rate
- depth
- ease
- labored breathing
- rhythm,
What are examples of nursing interventions for children with respiratory problems?
- Ease Respiratory Effort
- Promote Rest
- Promote Comfort
- Prevent Spread of Infection
- Reduce Temperature
- Promote Hydration
- Provide Nutrition
- Provide Family Support and 9. Home Care Instructions
What is acute viral nasopharyngitis?
common cold
What is the cause of nasopharyngitis?
viruses
How is acute viral nasopharyngitis diagnosed?
nasopharyngeal swab
What are symptoms of acute viral nasopharyngitis?
- Fever
- Poor feeding
- Vomiting
- Diarrhea
- Abdominal pain
- Nasal blockage/discharge
- Cough
- Respiratory sounds
- Sore throat
- Headache
- Neck pain
What is 3 forms of nursing care for acute viral nasopharyngitis?
- Prevention and protection (isolation/PPE)
- Comfort, symptom management, hydration, managing secretions
- Family support
What is the cause of influenza or the flu?
orthomyxoviruses
how is the flu diagnosed?
nasopharyngeal swab
What are the symptoms of flu?
- Dry throat
- hoarseness
- lack of energy
- sudden onset of fever and chills
What are 2 complications of flu?
- viral pneumonia
2. bacterial infections
What nursing care is important for the flu?
- prevention (PPE)/isolation
- flu vaccine
- symptom management
- family support
What is the cause of Croup syndromes?
viruses like parainfluenza, human metapneumovirus, influenza A and B, adenovirus and measles
How is croup syndrome diagnosed?
inflammation of larynx, trachea, and bronchi
What are symptoms of croup syndromes?
- Epiglottis, laryngitis, laryngothracheobronchitis (LTB), and tracheitis (severe effects on the voice and breathing)
- Hoarseness, brass, barky cough, inspiratory stridor, respiratory distress
1 nursing intervention for croup syndromes:
airway protection
Acute epiglottis is considered what??
MEDICAL EMERGENCY
What is acute epiglottis?
serious obstructive inflammatory process
What can acute epiglottis progress to?
severe respiratory distress –> absence of cough, drooling, agitation - anxiety increases as respiratory. distress increases
What causes acute epiglottis caused by?
H. Influenza B.
4 nursing interventions for acute epiglottis:
- Maintain airway, administer IV antibiotics, Corticosteroids
- Positioning, comfort, Possible intubation, reduce anxiety
- Family support
- HIB Vaccine
what is the most common croup syndrome?
acute laryngotracheobronchitis
What causes acute laryngotracheobronchitis?
viruses, rarely bacterial
What proceeds acute laryngotracheobronchitis?
a URI which descends to other structures
What are symptoms of acute laryngotracheobronchitis?
- Barky cough
- retractions
- nasal flaring
- stridor
What are nursing interventions for acute laryngotracheobronchitis?
- Maintain airway
- manage secretions
- cool mist
- vigilant observation and respiratory assessment
- Family support
What is a complication of acute laryngotracheobronchitis?
bacterial tracheitis
What is bronchitis also called?
tracheobronchitis
What is bronchitis?
inflammation of the large airways frequently associated with URI.
What causes bronchitis?
- viruses
2. M. pneumonia in children older than 6 years
What are symptoms of bronchitis?
Dry hacking non-productive cough (worsens at night)
What are nursing interventions for bronchitis?
- humidity
- analgesics
- antipyretics
What is the most frequent cause of hospitalization in children younger than 1 yr, and a rare occurrence after 2 years?
respiratory syncytial virus
What is RSV?
a respiratory infection of the bronchioles; it is contagious
How does someone get RSV?
exposure from contaminated secretions
What are symptoms of RSV?
- sneezing
- wheezing
- tachypnea
- apnea
- poor air exchange
- coughing
- pharyngitis
- rhinorrhea
- cyanosis
What are nursing interventions for RSV?
- Suctioning
- isolation (PPE)
- oxygen therapy
- family support
How is RSV prevented?
monoclonal antibody - IM injection that is given monthly for high risk patients
What is the best way to prevent the spread of RSV?
washing hands
Diagnoses of RSV is accomplished through what?
nasal aspiration
What is inflammation of lobes of lungs?
pneumonia
Viral pneumonia is associated with what?
a URI
Bacterial pneumonia comes on?
abruptly
What is the 3rd etiology of pneumonia?
- viral
- bacterial
- aspiration
What causes pneumonia?
Agent inhaled directly into the lungs or comes from the bloodstream and varies according to child’s age
What are symptoms of pneumonia?
- Fever
- malaise
- non-productive to productive cough
- chest pain
What are nursing interventions for pneumonia?
Supplemental oxygen, antibiotics, fluids, rest
Prevention?
What is the most common chronic disease of childhood?
asthma
define asthma
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.
What are 4 categories of asthma?
- intermittent
- mild
- moderate
- severe
What influences the persistence and the severity of asthma?
allergies
What are symptoms of acute asthma?
- Prolonged expiratory phase
- Wheezing, chest tightness, cough
- Tachypnea, accessory muscle use, retractions, nasal flaring
- Agitation or altered mental state
- Hyperinflation, increased AP diameter
What are symptoms of chronic asthma?
- Chronic cough, especially at night
- Prolonged cough with colds and triggers
- Allergic symptoms and/or rhinitis
- With or without increased AP diameter
- Wheeze though it may only be evident during acute episodes or with activity
- Atopic dermatitis
- Recurrent pneumonia and/or 8. sinusitis
- Shortness of breath on exercise
- Seasonal pattern
- Response to beta agonist therapy
What are nursing care options for asthma
- 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
What is a dysfunction of the exocrine glands where thick tenacious mucous is produced?
cystic fibrosis
Is cystic fibrosis genetic?
hereditary; autosomal recessive trait
What causes cystic fibrosis?
- Thick mucous obstructs the respiratory passages, causing trapped air and over inflation of the lungs
- Thick mucous obstructs the secretory ducts of the pancreas, liver and reproductive organs
How is cystic fibrosis diagnosed?
- Elevation of Sweat Electrolytes
- Sodium and chloride are affected with abnormal
- Chloride movement
- Family history
- Stool analysis
What are symptoms of cystic fibrosis?
- Nutritional deficiencies
- -> Absence of pancreatic enzymes - Chronic Respiratory problems
- Wheezing
- Clubbing of fingers and toes
- Thick tenacious secretions - Fatty and foul smelling stools
- Taste salty when kissed
What are treatment options for cystic fibrosis?
- Treat Respiratory Infection with antibiotics
- Pulmonary hygiene – CPT
- Pancreatic enzymes with all meals and snacks
- Fat soluble vitamins A, D, E, &K,
- High calorie diet
What are nursing care options for cystic fibrosis?
- Comprehensive assessment of all affected systems with special focus on pulmonary and gastrointestinal systems
- Patients require hospitalization only for pulmonary infections, uncontrolled diabetes or coexisting morbidities – meet emotional needs of child & family
- Typically managed at home
Anticipatory guidance and education crucial
