injections

Question 1

Critical thinking done before administering the 2 insulins?

Answer 1

Obtaining client’s glucose value prior to administration of insulin
assessment of last injection sites and where the patient will prefer to have the injection
when their last meal was and when the next meal will be
-do a pain assessment to see if the patient is in need of morphine before the injections are administered.

Question 2

Which vial contains the cloudy solution?

Answer 2

NPH

Question 3

What do we clean the rubber caps with?

Answer 3

alcohol swab

Question 4

What is the procedure for preparing the 2 insulins?

Answer 4

Draws into the syringe the amount of air equal to the volume of NPH insulin ordered, injects air into NPH vial, removes needle from vial.
Draws into the syringe the amount of air equal to the volume of Regular insulin ordered, injects air into Regular vial.
Without removing the needle from Regular insulin vial, inverts the vial and withdraws ordered amount of Regular insulin.
Taps syringe to dislodge any air bubbles present in the syringe.
Prior to removing needle from vial double checks Regular insulin dose with a second nurse to ensure correct dosage.
Withdraws needle from the vial and inserts needle into NPH insulin vial. Inverts the vial and withdraws ordered amount of NPH insulin.
Prior to removing needle from vial double checks NPH insulin dose with a second nurse to ensure correct dosage.
Removes needle from vial and using a one-handed technique, replaces cap over needle maintaining sterility.
Checks accuracy of medication dosage against MAR before returning drug to drawer.

Question 5

In what route is insulin given?

Answer 5

subcutaneous (subq)

Question 6

In what order is air put into the insulin vials?

Answer 6

cloudy/nph then clear/reg

Question 7

In what order is medication in insulin vials pulled?

Answer 7

clear/reg then cloudy/nph

Question 8

How is the insulin amount read?

Answer 8

top of the plunger is the desired number

Question 9

What technique is used to dispose of the needle safely?

Answer 9

one handed technique replacing cap over needle maintaining sterility

Question 10

What are the SUBQ sites?

Answer 10

1. ) outer posterior aspect of upper arm
2. ) anterior thigh
3. ) abdomen (sides of navel)
4. ) scapula
5. ) love handles on back (dorsogluteal)

Question 11

Critical thinking done before administering the intramuscular injection?

Answer 11

• verify chart for last time and site the client received the injection
• do assessment with patient and ask where they would prefer the injection and how much pain they are in so you can possibly give them morphine before administering the injection

Question 12

How many times is it required to check the order to the MAR?

Answer 12

3-5 times

Question 13

How is the intramuscular injection prepped?

Answer 13

-a conversion is done (med math dosage) then pull up as much air as put in then pull out with meds on table and cap one handed to maintain sterility

Question 14

What are the intramuscular (IM) sites?

Answer 14

1. ) Deltoid: landmarks are Acromion process and axillary line. In the middle of triangular shaped deltoid muscle is midline of lateral aspect of arm
2. ) Vastus Lateralis: Landmarks are the head of the greater trochanter and the knee. Insert needle into middle third of muscle
3. ) Ventrogluteal: Landmarks are the head of the greater trochanter and the anterior superior iliac spine. Place heel of palm of hand on head of greater trochanter with thumb pointing toward abdomen. Extend index finger up anterior superior iliac spine then spread fingers along crest. Insert needle in the “V” formed between your index and third fingers
4. ) Dorsogluteal: posterior superior iliac spine, greater trochanter (love handles), try to avoid this area since current evidence demonstrated a greater risk for paralysis from sciatic nerve damage with this site rather than the ventrogluteal site.

Question 15

How is the skin prepped before injections?

Answer 15

cleansed with alcohol swab

Question 16

How is an IM injection administered?

Answer 16

-pull skin laterally to the ulnar side (90 degree angle) of the non-dominant hand - z-track method
insert needle at 90 degree angle and aspirate for blood to know if it is in a muscle or blood vessel and inject slowly waiting 10 seconds and withdraw and release the skin

Question 17

What is done with the needle after administration?

Answer 17

don’t recap but activate the safety and discard into the sharps container

Question 18

How is a subcutaneous injection administered?

Answer 18

pinch skin at the site and insert needle into the tissue at a 90 degree angle.
hold needle like a dart
no aspiration and withdraw quickly

Question 19

What do we assess after administration of the injections?

Answer 19

• for morphine: 30 minutes later assess patient’s pain on 1-10 scale
• for insulin check next glucose acucheck order and assess blood/glucose approp. level
• adverse: high blood glucose, lots of pain, low heart rate, low blood pressure, lethargy

Question 20

What do we document after administering the injections and the reassessment?

Answer 20

-Gave patient 1mg morphine IM @ time R. Deltoid, pt. tolerated c/o no pain and gave pt. subq insulin (xNPH xREG) RUQ: Blood Glucose X

Question 21

What are the 6 rights of medication administration?

Answer 21

1. ) right medication
2. ) right route
3. ) right time
4. ) right client (2 patient identifiers name and dob)
5. ) right dose
6. ) right documentation