IM/SQ

Question 1

CYANOCOBALAMI

Answer 1

INTRAMUSCULAR
INDICATION: vitamin B12, pernicious anemia

CONTRAINDICATIONS: hypersensitivity

SIDE EFFECTS: diarrhea, headache, pain and itching at intramuscular site
ADVERSE EFFECTS: anaphylaxis, pulmonary edema and heart failure

NURSING CONSIDERATION: assess patient for signs of vitamin b12 deficiency such as inflamed tongue, neuropathy and psychosis before and periodically during drug therapy

PATIENT TEACHING:

• teach patient about foods enriched in vitamin B12 such as seafood, cheese and meat
• encourage patient to comply with these diet recommendations
• Encourage patient for follow up exams and evaluations because pernicious anemia requires a lifelong need for vitamin B12 replacement.

Question 2

ENOXAPARIN / LOVENOX

Answer 2

SUBCUTANEOUS
INDICATION: prevention of VTE, DVT, PE, MI

CONTRAINDICATION: past hypersensitivity, active bleeding benzyl alcohol

SIDE EFFECTS: edema, nausea, vomiting
ADVERSE EFFECTS: hemorrhage, heparin induced thrombocytopenia

NURSE CONSIDERATION: assess patient for any sign of bleeding, asses patient for evidence or increase in thrombosis

PATIENT CONSIDERATION: instruct patient correct self injection technique, care and disposal

• advise patient to follow up with any unusual bleeding, bruising or rash
• advise patient not to take aspiring or ibuprofen without talking tot a doctor

Question 3

HEPARIN

Answer 3

SUBCUTANEOUS
INDICATIONS: treatment of VTE, pulmonary emboli, atrial fibrillation

CONTRAINDICATION: uncontrolled bleeding, open wounds
ADVERSE EFFECTS: heparin induced thrombocytopenia (HIT)

NURSE CONSIDERATION:

• assess patient for any sign of bleeding.
• assess patient for evidence or increase of thrombosis
• monitor platelet count every 2-3 days during therapy

PATIENT TEACHCHINGS

• Advise patient to report any signs of unusual bleeding or bruising
• Advise patient not to take aspirin or NSAIDs while on therapy
• Avoid IM injections and activities that may lead to injury

Question 4

INSULIN

Answer 4

SUBCUTANEOUS
INDICATION: control of hyperglycemia in type 1 and 2 diabetes

CONTRAINDICATIONS: hypoglycemia, renal impairment

SIDE EFFECTS: swelling and itching at injection site
ADVERSE EFFECT: hypoglycemia and anaphylaxis

NURSING CONSIDERATION:

• assess patient periodically for signs and symptoms of hypoglycemia, tingling in lips feet tongue which can indicate overdose
• Monitor patients body weight periodically during therapy which may require change in insulin dose

PATIENT TEACHING

• instruct patient correct self-injection technique, care and disposal
• Advise patient to carry source of sugar with them at all times
• Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.