Injections - CSL notes

Question 1

what is the needle angle for IM injections - infants, toddlers, children, adults

Answer 1

72-90 degrees

Question 2

what is the needle angle for SUBQ injections - infants, toddlers, children and adults

Answer 2

45-90 degrees

Question 3

IM injection - what is the needle length and gauge size and location for infants and toddlers

Answer 3

vastus lateralis
length - 5/8-1 1/4”
gauge - 22-25g

Question 4

IM injection - what is the needle length and gauge size and location for children

Answer 4

vastus lateralis or deltoid (preferred)
gauge - 22-25g
length - 5/8 -1 1/4”

Question 5

IM injection - what is the needle length and gauge size and location for adults

Answer 5

deltoid (vaccines) or ventrogluteal (general)
gauge - 20-25g oil based medciations - 18-25g
length - 5/8- 1 1/2”

Question 6

subcutaneous injection - what is the needle length and gauge size and location for ages birth - 12 mos

Answer 6

anterior aspect of thighs
gauge - 23-25g
length 3/8-5/8”

Question 7

subcutaneous injection - what is the needle length and gauge size and location for ages 12 mos - 18 yrs

Answer 7

outer tricep area, anterior aspect of thigh
length 3/8-1”
gauge 25-30g

Question 8

subcutaneous injection - what is the needle length and gauge size and location for ages >18 years

Answer 8

outer tricep area, anterior aspect of thigh abdomen, upper back, upper ventral or dorso-gluteal area
length - 3/8-1”
gauge - 25-30g

Question 9

the higher the number after the G on the needle, the ____ the needle

Answer 9

thinner

Question 10

what is the second number on the needle

Answer 10

length of the needle. usually in inches

Question 11

short needles are usually used for

Answer 11

IV injections

Question 12

what are the parts of a medication order –7

Answer 12

pt’s name
date and time order is written
name of drug to be administered
dosage of drug
route by which drug is to be administered
freq of administration of drug
signature of person writing order

Question 13

rights of medication admin - 11

Answer 13

**know the first 6
1. right medication
2. right pt
3. right dose
4. right route
5. right time
6. right reason
7. right to refuse
8. right assessment data
9. right documentation
10. right response
11. right education

Question 14

the 3 checks of medication admin

Answer 14

1. when nurse reaches container or unit dose package
2. after retrieval from drawer and compare with MAR
3. before giving dose medication to pt at bedside or when replacing multidose container in drawer or shelf

Question 15

if medication error - how to fix

Answer 15

1. check pt condition immediately; obtain vitals
2. notify physician and nurse in charge
3. proper medication error documentation

Question 16

what are the sites for admin of enoxaparin

Answer 16

1. love handles - anterior and posterior

Question 17

sites for IM injections - 3

Answer 17

ventrogluteal
vastus lateralis
deltoid muscle

Question 18

what is CLABSI

Answer 18

central line associated blood stream infection

Question 19

CVS stands for

Answer 19

central venous catheter

Question 20

what does parenternal route mean

Answer 20

medication placed into tissue by injection

Question 21

4 potential routes of parenteral medication admin

Answer 21

IV, IM, SQ, intradermal

Question 22

an antagonist medication will do what

Answer 22

will block affect

Question 23

an agonist medication will

Answer 23

make the effect greater. side effects may be greater

Question 24

waht are some factors that alter drug response in older adults

Answer 24

kidneys slow down so not metabolizing med as fast
decrease muscle mass
less adipose tissue
slow down of gi tract
pH goes down
body water goes down
less protein binding sites = toxicity

Question 25

nursing responsibilities in medication admin

Answer 25

know the 11 rights checking meds to make sure they are accurate know the pt's baseline, vitals, pain assessment, head to toe check order, know why pt is getting med, any contraindications calculations are correct for med use sterile/clean tech using gloves when needed educ pts monitoring pts after giving med

Question 26

what two meds do you hold skin while injecting

Answer 26

heparin, insulin

Question 27

how draw up insulin

Answer 27

air in cloudy, air in clear draw up clear, draw up cloudy

Question 28

what is important to know when giving herapin injections

Answer 28

1. this is high alert med 2. two nurse check before giving it to pt 3. inject two inches away from umbilicus 4. risk of bleeding 5. review lab values, PTT - partial thrombin time, CBC for platelets

Question 29

what is the antidote for heparin

Answer 29

vitamin K

Question 30

3 complications for IV infusions

Answer 30

1. infiltration 2. phlebitis 3. infection

Question 31

pt's IV site is pale, cold, has swelling and pain. what is happening

Answer 31

infiltration. fluid from IV has leaked into tissue

Question 32

pt's IV site is inflamed, has swelling, pus, drainage from IV site, is warm, pt has chills and fever. what is happening

Answer 32

infection at IV site.

Question 33

what is the nursing intervention for infiltration

Answer 33

check IV every time you go into room or every hour discontinue infusion and start a new line if have infiltrations

Question 34

what is nursing intervention of infection

Answer 34

hand hygiene, routine IV checks, use aseptic techniques

Question 35

pt's IV site is red, warm to touch, painful, localized and central to vein. waht is happening

Answer 35

phelbitis

Question 36

what are the nursing interventions for phelbitis

Answer 36

take out IV, move to another location put on warm compress to site

Question 37

do nurses pull central lines of pt

Answer 37

not unless pt has died

Question 38

do you write in report that an incident report was filled out

Answer 38

NO!

Question 39

what do you always check before giving meds

Answer 39

pt's allergies

Question 40

after taking meds out of pixas machine, what do you do

Answer 40

make sure meds aren't expired

Question 41

pt teaching for medications

Answer 41

1. general info - med name, dosage, side effects, adverse effects, intended effects 2. taking meds - what time, with or without food, what to do if miss dose, compliance, etc 3. special considerations - waht to do in case of emergency, how to store meds, keep a list of meds, never stop abruptly 4. teach back method for true understanding of meds

Question 42

routine order means

Answer 42

daily meds until doctor discontinues

Question 43

PRN means

Answer 43

as needed

Question 44

standing order is

Answer 44

running protocols. every pt gets it

Question 45

maximum volume of subcutaneous injection for adult, child

Answer 45

adult: 1 mL child: 0.5mL

Question 46

maximum volume for an adult via IM injection at vastus lateralis, ventrogluteal, deltoid

Answer 46

vastus lateralis: 3mL ventrogluteal: 3mL deltoid: 1mL

Question 47

maximum volume for a child via IM injection at vastus lateralis. know 6-12yrs, 0-5yrs, premature infant

Answer 47

6-12 yrs - 2mL 0-5yrs - 1mL premature infant 0.5mL

Question 48

sequence of doing trach suctioning

Answer 48

1. assess lung sounds to know need for suctioning 2. assess oxygen saturation 3. assess for any trouble breathing 4. assess pain 5. assess cough and if they can bring up mucus themselves 6. history of deviated septum, history of head trauma, nose bleeds, swelling