insulin & injections

Question 1

What are the 3 most common types of syringes?

Answer 1

Leur-lok syringe
TB syringe
Insulin syringe

Question 2

What are the 3 parts of a needle?

Answer 2

Bevel
Shaft
Hub

Question 3

What are the 3 parts of a syringe?

Answer 3

Plunger
Barrel
Tip

Question 4

What are the differences in calibration with the different types of syringes?

Answer 4

• Leur-lok syringe marked in 0.1 tenths
• Tb syringe long thin barrel- calibrated in sixteenths of a minim and in hundredths of a milliliter- 1 ml capacity
• Insulin syringe Insulin 1ml and calibration in units- pre attached needle (cap often orange)
• Insulin syringe Insulin 0.5 ml and calibration in units- pre attached needle (cap often orange)

Question 5

Why do we wipe away the first drop of blood?

Answer 5

It is typically contaminated with excess tissue fluid and may contain alcohol residue that can hemolyze the specimen. There have been reports of isopropyl alcohol contamination causing errors in blood glucose testing.

Question 6

vials

Answer 6

A vial is a closed system where air must be injected into the vial to assist with easy withdrawal – a blunt needle is used to draw up from vials
Vials can be single or multidose

Question 7

ampules

Answer 7

Ampules contain a single dose of medication and are made of glass that is broken open with a plastic shield – careful not to cut yourself
Air is not injected into ampules to withdraw medication
A filter needle is used to prevent small glass fragments from entering the syringe when drawing up from an ampule

Question 8

the only medication drawn up using the needle tip used for injection

Answer 8

The only medication that is drawn up with a needle attached is insulin – using a filter or blunt needle prevents irritation to tissues upon injection and preserves the sharpness of the needle

Question 9

Insulin Administration max dose
needle size

Answer 9

• 1 mL (sometimes up to 2 mL)
• The standard needle used for subcutaneous injections is 25-gauge 1.6-cm needle inserted at a 45-degree angleor a 1.3-cm needle inserted at a 90-degree angle

Question 10

Where is the correct spot for a TB skin test?

Answer 10

palm side of the forearm
5cm to 10cm below elbow
dose of 0.1 mL of PPD
bevel up
a wheal/bleb forms just under epidermis (surface) skin

Question 11

What other things might be given intradermal?

Answer 11

• allergy test
• influenza vaccine

Question 12

sc syringe size

Answer 12

Common gauge for subcutaneous injections is 25 g and 1.6cm length

Question 13

max amount of volume in sc site

Answer 13

1-2 mL

Question 14

would you draw up from a vial or ampule first if you were mixing medications

Answer 14

When mixing medications from a vial and an ampule, the nurse should prepare medications from the vial first and then withdraw medication from the ampule using the same syringe and a filter needle.

Question 15

what size syringe do we use for IM

Answer 15

1.0 (youth) to 1.5 (adult) inch needle
21-22 gauge

3mL

size of patient
size of muscle

Question 16

Intramuscular Injections: Advantages

Answer 16

• faster absorption; more blood supply
• can be helpful in an emergency situation
• can inject large volumes of medication
• recommended for more viscous medications
• long-lasting duration of effect

Question 17

Intramuscular Injections: Disadvantages

Answer 17

• Greater risk of damage to blood vessels and nerves, therefore accurate landmarking is important
• Depending on the size of the needle the absorption can be erratic
• Needle phobia
• Contraindicated in patients on anticoagulants

Question 18

angle of insertion for an IM injection

Answer 18

90 degrees

Question 19

The volume that can be injected into a normal, well-developed patient (IM)

Answer 19

3 mL
- Smaller muscles like the deltoid should only be injected with up too 2ml of medication

Question 20

Deltoid Site &Landmarking

Answer 20

• Not used in infants or children with underdevelopedmuscles
• Use of the muscle involves potential for injury to thebrachial artery and to the radial and ulnar nerves
• May be used for immunizations of toddlers, olderchildren, and adults
• recommended for hep B vaccines and rabies injections

Question 21

Ventrogleuteal Site & Landmarking

Answer 21

• Offers a deep site, situated away from majornerves and blood vessels
• Offers less chance of contamination inincontinent patients and infants
• Identified easily by prominent bonylandmarks
• Is preferred site for medications (e.g.,antibiotics) that are larger in volume, moreviscous, and irritating for adults, children,and infants
• middle finger at iliac crest
• forefinger at anterior superior iliac spine
• heel of hand on greater trochanter of femur
• injection site in between forefinger and middle finger

Question 22

rate of medication dose per second

Answer 22

10 seconds per mL

Question 23

Vastus Lateralis Site & Landmarking

Answer 23

• Lacks major nerves and blood vessels
• Facilitates rapid drug absorption
• Used frequently with infants (younger than12 months old) receiving immunizations
• May also be used in older children andtoddlers receiving immunizations

Question 24

Benefits of the Z-track Method

Answer 24

• TheZ-track methodis recommended because it minimizes local skin irritation by sealing the medication in the muscle tissue
• This technique leaves a zigzag path that seals the needle track
• The medication cannot escape from the muscle tissue resulting in the full dose being administered
• Injections using the Z-track technique cause less irritation to the skin and subcutaneous tissues