Injections and meds Flashcards
SQ injections
into loose CT under dermis, slower absorption than IM (less vascular), some discomfort - pain receptors
best SQ sites
outer posterior upper arms, abdomen, anterior thighs
alternate SQ sites
scapula, upper ventral or dorsal glueteal
SQ sites should be
free of lesions, bony prominences and large underlying muscles or nerves
LMWH sites
right or left side of abdomen 2 inches from umbilicus (love handles); pinch site, don’t expel air bubble in syringe before inj.
U-100 insulin administered with
U-100 insulin syringe with 25-31g needle
U-500 insulin administered with
TB syringe
insulin sites
upper arm, anterior and lateral thigh, butt and abdomen
intrasite injections
rotating within the same body part for better absorption; 1 inch apart (don’t repeat injection site for a month)
absorption of insulin from fastest to slowest
abdomen, arm, thigh, butt
volume for SQ injections
0.5 to 1.5 mL; water soluble; too much volume = sterile abscess
SQ volume for kids
0.5 mL
SQ needle length and angle selection
based on weight; normal size: 25 g., 5/8 inch needle, 45 deg. or 1/2 inch 90 deg; obese: pinch, longer needle; thin: upper abdomen, under arm (?)
IM injections
faster med absorption than SQ (more vascular), more risks (nerve damage, fibrosis, abscess)
needles for IM injections
longer, heavier g.; very obese- up to 3”, thin - 0.5” to 1”
degree for IM injections
90
volume for IM
2 mL for children, adults and thin; normal adult: 2-5 mL, but larger (4-5mL) unlikely to absorb; children 1 mL, infants 0.5 mL
sites for IM
free of infection, necrosis, bruising, abrasions; locate bones, nerves, vessels; vol to be injected
ventrogluteal site (IM)
safest, away from major nerves, vessels; preferred, esp. for viscous and irritating meds and for vol. > 2 mL; supine or lateral position
vastus lateralis site (IM)
middle third of muscle, often used for vaccines in children
Deltoid site for IM injections
not well developed in many adults; more risk- axillary, radial, brachial and ulnar nerves, and brachial artery lie within upper arm under triceps and along humerus; usually for vaccines; stand or lie down; 1-2 inches below acromion process
volume for deltoid IM injections
small - 2 mL or less
Z track method for IM
minimizes irritation, seals in meds
Intradermal injections
for skin testing - TB, allergy; meds are potent so inj. into dermis slows absorption
Intradermal injections risks
anaphylaxis if meds enter circulation to quickly
site for intradermal injections
visible for color changes and skin integrity; inner forearms and upper back; light pigmented, hairless, no lesions
intradermal injections method
use TB or small hypodermic needle; 5-15 deg., bevel up; if no bleb or site bleeds, SQ likely, invalid results
legislation of meds
FDA ensures safety
State Nurse Practice Acts (NPAs)
most influence, define scope of fn and responsibilities; usu. broad; protect the public
Classification of meds
effect of med on body system, symptoms relieved or desired effect
medication form determines
route of administration; composition enhances absorption and metabolism
topic meds types
ointment, liniment, lotion, paste, transdermal disk or patch
ointment
salve or cream, semisolid, 1 + meds
liniment
usually with alcohol, oil or soapy emolient
lotion
liquid suspension; protects, cools, cleanses
paste
thick ointment, slower absorption; usu. to protect skin
transdermal disk or patch
absorbed via skin over 24 hr, 1 week
parenteral meds
solution or powder; sterile
meds for instillation into body cavities
intraocular disk, suppository
intraocular disk
small, flexible oval (2 outer layers, 1 mid layer with med), slow release when moistened by ocular fluid
suppository
solid dosage form mixed with gelatin, pellet shaped, melts when reaches body temp
pharmacokinetics
study of how meds enter body, reach site of action, metabolize and exit
therapeutic effect requires
taking into body, absorption, distribution, and alteration of physiological fn
pharmacokinetics important for
timing of administration, route, pt’s risk for alterations in action and evaluating response
absorption
passage into blood, influenced by route, dissolvability, blood flow, body surface area, lipid solubility
most rapid absorption
IV; mucosa also quick, oral slow (GI), skin slow
dissolving of meds effect on absorption
liquid solutions and suspensions quicker than solid
acidic meds absorption
quick; pass the GI mucosa rapidly, basic not absorbed until small int.
larger surface area
faster absorption; majority meds absorbed in small int, not stomach
highly lipid soluble meds
cross the lipid layer of cell membrane quickly
Metabolism
biotransformation under the influence of enzymes that detoxify, break down and remove bio active chemicals; occurs mostly in liver; also lungs, kidneys, blood and intestines
liver disease affects metabolism how
slows down; accumulation of meds
excretion
after metabolism, exit via kidneys, liver, bowel, lungs and exocrine glands
to help eliminate anesthetic gases after surgery
deep breathing and coughing
gaseous and volatile compounds exit the body
via lungs (e.g. alcohol, nitrous oxide)
exocrine glands excrete what kind of meds
lipid soluble; may cause skin irritation when meds exit via sweat
GI tract- effect on metabolism
if peristalsis increased (laxatives, enema) faster excretion; inactivity and improper diet prolong meds
main organ for excretion
kidneys; renal failure= risk of toxicity; inc. fluids promote elimination
side effects are
predictable; harmless or not
adverse effects
unintended, unpredictable, severe; report to FDA via MedWatch
ear drops should be instilled at room temp to prevent
nausea, vertigo, dizziness
vaginal instillation forms
suppositories, foam, jellies, creams
pMDIs
pressured metered-dose inhalers
BAIs
breath-actuated metered dose inhalers; good choice for pt’s who have trouble with pMDIs
DPIs
dry powder inhalers; required less dexterity; activated with pt’s breath, no need to coordinate puffs with inhalation; risk of clumping (humid climate); some pts can’t breath fast enough to get entire dose of med
pMDIs, BAIs and DPIs used for
bronchodilation; can cause serious systemic side effects
spacer used with pMDIs
allows the med to slow down and break into smaller pieces, improves absorption in airway
spacers not used with
BAIs and DPIs
parenteral meds should be administered using what technique?
aseptic
syringes sizes
.5mL to 60 mL; unusual to use larger than 5mL for injection
SQ and IM syringe usual size
1-3 mL
larger syringes used for
irrigation of wounds and drainage tubes, administering IV meds
TB syringe
calibrated in hundredths of a mL; 1 mL total capacity; used for intradermal and SQ injections; also for children
Insulin syringe size ranges
0.3 mL to 1 mL, calibrated in units; most insulin syringes are U-100s to be used with U-100 strength insulin
each mL of U-100 insulin contains
100 units of insulin
needles vary in length from
1/4 to 3 inches; 1-1.5” for IM; 3/8 to 5/8” for SQ
U-500 insulin
5 times as potent as U-100; only used in rare cases for very insulin resistant pt’s; use TB syringe
Insulin is classified by
rate of action; rapid, short, intermediate, and long acting; need to know the onset, peak and duration
Only this type of insulin can be given by IV
regular
70/30 insulin
70% NPH (intermediate), 30% regular
Correction (sliding scale) insulin
dose based on blood glucose level; ordered on temporary basis
mixing insulin
2 types of insulin can be mixed if they are compatible; prepare regular insulin first
mixed insulin should be administered within 5 minutes of preparation; why?
because rapid or short acting insulin binds with intermediate or long acting insulin, which reduces the action of the faster-acting insulin
patient characteristics, not GRV assessment, increase aspiration risk. True or false?
true
prevent aspiration with NE; evidence based data
increase head of bed 30 deg +, prokinetic agents, consider post-pyloric feeding if intolerance persists
GRV testing can help with ongoing tube placement verification. true or false?
true
new methods of verifying NG tube placement
bilirubin testing and capnometry (CO2 test)
bilirubin test
bilirubin normally found in intestinal contents, and sometimes in small amounts in stomach; rare in tracheobronchal or pleural fluid; test not available for bedside use
capnometry
CO2 measured; CO2 indicates pulmonary placement; test shows some reliability but needs more work
AACN (American Association of Critical-Care Nurses) recommendations for NG tubes
use several methods to verify placement; watch for signs of respiratory distress, pH testing and visual assessment of aspirate; X ray before meds or feeding (if available); mark tube with marker/ tape; check placement q4h
x ray is esp. important with what types of tubes?
small bore - often no symptoms; risk of perforation by stylet
