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NURS 2532 > Lab 2 > Flashcards

Lab 2 Flashcards

1
Q

what is parental administration

A
  • administartion by injection
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2
Q

how must parental meds be administered? why?

A
  • must be performed with aspectic technique

- bc once the pt’s skin is pierced, the patient is at a risk of infection

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3
Q

how can we prevent infection during parental administration (4)

A
  1. to prevent contamination of the solution, draw the med quickly –> do not let it sit open
  2. to prevent needle contamination, do not let it touch a conatminated surface
  3. to prevent syringe contamination, avoid touching the inner part of the barrel & keep the tip covered with a cap or needle
  4. wash soiled skin with water & soap and then clean the skin with an alcohol wipe from the center of the site and move outward in a 5cm radius
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4
Q

what is a syringe

A
  • consists of a close-fitting plunger & cylindrical barrel with a tip designed to fit the hub of a hypodermic needle
  • used to draw the med
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5
Q

what are the 2 categories of syringes

A
  1. Leur-Lok

2. non-Leur-lok

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6
Q

what is a leur-lok syringe? what does it prevent?

A
  • syringe that requires a special needle
  • the needle is twisted onto the tip & lock in place
  • prevents the inadvertent removal of the needle
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7
Q

what is a non-leur-lok syringe?

A
  • require needles that slip onto the syringe
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8
Q

how are syringes filled?

A
  • filled by aspiration (drawing back) by pulling the plunger outward
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9
Q

describe how you can handle a syringe to maintain sterility?

A
  • handle the outside of the syringe barrel, and the handle of the plunger
  • do not tip the inside of the barrel, the shaft of the plunger, the hub or the needle
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10
Q

what size range do syringes come in?

A
  • anywhere from 0.5 mL to 60 mL
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11
Q

what size syringe is used for subcut or intramusclar injection?

A

1-3 mL

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12
Q

what size of syringe is not often used for injection? why? what are larger syringes used for?

A
  • use of a syringe larger than 5mL
  • larger fluid volume = discomfort
  • larger syringes are used administer IV solution or to irrigate wounds
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13
Q

what sizes are insulin syringes available in? how are they calibrated?

A
  • sizes from 0.3 - 1 mL

- calibrated in units

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14
Q

how many units in a 0.3 mL insulin syringe? 1 mL? what are these called?

A
  • 0.3 mL = 30 units = low-dose syringe

- 1mL = 100 units = U-100

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15
Q

what is the tuberculin syringe? what is it’s capacity?

A
  • syringe with a long, thin barrel with a preattached thin needle
  • capacity = 1 mL
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16
Q

what can tuberculin syringes be used for?

A
  • small amts of meds (ID, subcut)
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17
Q

list and describe the parts of a syringe (3)

A
  • plunger –> what you used to push the med in and out
  • barrel –> what actually contains the fluid
  • tip –> what the needl attaches to
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18
Q

what are the 3 parts of a needle?

A
  1. the hub –> fits onto the tip of the syringe
  2. shaft –> the long part of the needle, connects to the hub
  3. bevel –> tip of the needle, always slanted
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19
Q

what length do needles vary from?

A
  • 0.6 to 7.6 cm
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20
Q

how are needles chosen? (2)

A

according to:

  • patient’s size & weight
  • the type of tissue the med is being administered into
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21
Q

in general, a shorter needle is used for…? a longer needle for…?

A
  • shorter = child or slender adult, subcut

- longer = intramusclar injections

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22
Q

how is needle diameter measured?

A
  • by gauage
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23
Q

what does a small gauge mean? large?

A
  • small gauge = larger diameter
  • large gauge = smaller diameter

ex. 22 gauge has a bigger diameter than 28

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24
Q

how is gauge size selected?

A
  • depends on viscosity of the fluid to be injected
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25
Q

what gauge does an IM injection usually used? what is most common? needle length? vol for deltoid? vastus lateralis & ventrogluteal?

A
  • gauge can be anywhere from 18-27
  • 22-25 most common
  • needle length = 1” (2.5 cm) to 1.5” (3.8cm)
  • deltoid = up to 2 mL
  • others = up to 3 mL
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26
Q

what size gauge is used for subcut? needle length? what volume of liquid?

A
  • 25-31
  • length = 1/2” (1.3 cm) to 5/8” (1.6cm)
  • vol = 0.5 - 1mL
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27
Q

what size gauge is used for intradermal? needle length? volume?

A
  • gauge = 26-31
  • length = 3/8” (1cm) to 5/8 (1.6 cm)
  • volume = 0.1 mL
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28
Q

what is the angle of insertion for IM injections?

A

90

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29
Q

what is the angle of insertion of subcut injections?

A
  • 45 or 90
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30
Q

what is the angle of insertion for ID injections?

A

5-15

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31
Q

what is an ampule

A
  • glass container with a consitricted neck that contains single doses of liquid meds
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32
Q

what needs to be done to the neck to use an ampule? what kind of needle must be used?

A
  • the neck must be snapped off

- uses a filtered syringe to avoud getting glass into the med

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33
Q

what is a vial

A
  • a single or multi dose container with a rubber seal at the top
  • uses a metal cap to protect the med until it is ready to be used
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34
Q

what kind of meds can be stored in vials?

A
  • liquid or dry
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35
Q

what kind of system is a vial? what does this mean?

A
  • closed system = air must be injected to the vial to allow easy withdrawal of the solution
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36
Q

describe the steps in preparing an ampule (2)

A
  • tap the top of the ampule to get any fluid out of the neck
  • place a gauze or unopened alcohol wipe around the neck and snap the neck away from your hands
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37
Q

describe the steps/important point in drawing meds from an ampule (6)

A
  • draw the med quickly (to avoid contamination) using a filtered needle
  • hold the amp upside down or flat on a surface
  • place the needle in, do not allow it touch the rim of the ampulse
  • aspirate the med into the syringe by pulling back on the plunger
  • keep the needle tip under the surface of the liquid
  • remove the needle from the ampule, draw back on the plunger (allows fluid within the needle to enter the barrel) & then push the plunger upward to eject the air (do not eject fluid!)
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38
Q

describe the steps/important point in drawing meds from an ampule (8)

A
  • draw the med quickly (to avoid contamination) using a filtered needle
  • hold the amp upside down or flat on a surface
  • place the needle in, do not allow it touch the rim of the ampulse
  • aspirate the med into the syringe by pulling back on the plunger
  • keep the needle tip under the surface of the liquid
  • remove the needle from the ampule, draw back on the plunger (allows fluid within the needle to enter the barrel) & then push the plunger upward to eject the air (do not eject fluid!)
  • cover the needle with a safety cap
  • replace the filtered needle with the needle you will use for injection
39
Q

what do you do if air bubble are aspirated while drawing meds from an ampule

A
  • do not expel air into the ampule –> it will break the seal
  • remove the needle from the ampule, hold the syringe pointing up, and tap the side of the syringe to remove the bubbles
40
Q

what do you do if you have excess fluid when drawing meds from an ampule (3)

A
  • dispose of it in a sink
  • hold the syringe vertically with a slight slant towards the sink
  • slowly eject the excess fluid
41
Q

describe the steps to draw a med from a vial (9)

A
  • remove the cap covering the vial
  • firmly & briskly wipe the rubber seal with an alcohol swab & let dry
  • find your needle, remove the cap, and pull back on the plunger to draw an amount of air equal to the volume of med you’ll be administering
  • place the needle into the vial on a flat surfacethru the center of the rubber seal
  • inject the air into the vial’s airspace to pevent bubbles
  • hold the vial upside down, keep the tip of the needle under the fluid level & obtain the amt of solution needed
  • remove needle & hold at 90* angle to ensure you have the correct volume
  • pull back on plunger to remove fluid from needle & then push up to eject air , do not lose fluid
  • change needle to appropriate needle for injection
42
Q

how do you remove bubbles/ excess air when drawing meds from a vial?

A
  • place the needle into the vial’s airspace & tap on the side of the syringe barrel
  • eject excess air into the vial
43
Q

describe the steps to draw med from a vial containing a powder

A
  • remove cap covering both the vial of powder & proper dilutent
  • wipe both seals with alcohol swab & dry
  • draw the dilutent into the syringe using the same steps for normal fluid meds out of a vial
  • insert the tip of the needle thru the sea of the vial with the powder; inject & remove needle
  • mix the med by rolling it in your palms, do not shake
  • draw the new med following the same steps
44
Q

what should we check before injecting meds? (6)

A
  • MAR
  • pt name
  • med name, route, dose, time of amdin
  • pt’s medical & medication history
  • allergies
  • expirary date
45
Q

what should we observe during/after the infection? what about specifically for subcut or IM

A
  • verbal & nonverbal response
  • subcut = circulatory shock, reduced local tissue perfusion
  • IM = muscle strophy, reduced blood flow, circulatory shock
46
Q

describe the general steps to injecting med: (8)

A
  • perform necessary med checks, med prep, and hand hygeine
  • describe the steps & let them know they may feel a slight stinging sensation
  • select an appropriate injection site & inspect the site for any bruises, inflammation, edema
  • assist the pt to a comfortable position
  • locate the injection site using landmarks
  • clean the site with an alcohol wipe
  • hold a swab or gauze with non dom hand
  • administer the injection
47
Q

what are some things to consider when choosing a site for subcut (2)

A
  • palpate the site for masses or tenderness

- for insulin, rotate the injection site daily

48
Q

what are some things to consider when choosing a site for IM (3)

A
  • integrity & size of muscle
  • palpate for tenderness or hardness
  • if injection is given frequently, rotate the site
49
Q

what are some things to consider when choosing a site for ID

A
  • note any lesions or discoloration
50
Q

what position do you want pt’s to be in for subcut

A
  • relax the arm, leg, or abdomen depending what site yu are using
51
Q

what position do you want pts to be in for IM

A
  • position them depending on the site chosen
52
Q

what position do you want pts in for ID

A
  • extend the elbow & support the elbow and forearm on flat surface
53
Q

describe the steps to adminsiter a med subcut (5)

A
  • for average sized pt: spread the skin tightly or pinch the skin with nondom hand
  • inject the needle firmly & quickly at 45-90*
  • hold skin fold unti the needle has been withdrawn from skin
  • for obese pt: pinch the skin & inject at 90
  • administer the med slowly
54
Q

describe the steps to administer a med IM

A
  • pull the skin down about 2.5-3.5 cm with the ulnar side of hand to create a z-track
  • continue to hold the z-track until the med is injected
  • inject med at 90
55
Q

how fast should you adminster med? why?

A
  • 1mL/10 sec

- to avoid pain & tissue trauma

56
Q

what do you do with IM meds to ensure you did not place the needl into an vein?

A
  • after the needle places the skin, pull back on the plunger to look for blood
  • if no blood appears, inject the med slowly, wait 10 sec, then remove the needle
57
Q

describe the steps to administer a med ID (5)

A
  • with nondom hand, stretch the skin over the injection site with thumb & forefinger
  • insert the needle bevel up at 5-15* until resistance is felt (the needle tip can be seen thru the skin)
  • inject the med slowly, should feel resistance
  • notice the small bleb of ~6m in diameter on the skin surface
  • withdraw the needle
58
Q

describe the steps to injecting meds post-injection (7)

A
  • remove the needle
  • wipe the site with gauze or an alcohol wipe, apply gentle pressure but do not massage
  • assist pt to comfortable position
  • discard the needle, remove gloves
  • hand hygeine
  • pbserve the patient for 3-5 min for adverse reactions
  • continue to observe the pt & site periodically & during med onset, peak, and duration
59
Q

what are some recommendations to prevent needle stick injuries (5)

A
  • never recap needles
  • never move an exposed needle tip towards an unprotected hand
  • immediately disposed of needles
  • maintain a needle stick injury reporting protocol
  • plan safe handling & disposal of needles before beginning procedure
60
Q

how can we help minimize patient’s discomofrt with injections? (6)

A
  • use a sharp bevelled needle in smallest length & gauge
  • postion the pt comofrtbaly to reduce muscular tension
  • divert the pt’s attention
  • insert the needle quickly & smoothly
  • hold the syringe steady
  • inject the med slowly &steadily
61
Q

what is a subcutaneous injection

A
  • the administration of meds in loose CT under the dermis (into the fat)
62
Q

how fast are meds given subcut absorbed? why?

A
  • subcut tissue is not as richly supplied with blood as muscle
    = med given subcut are absorbed more slowly than meds given by IM
63
Q

list the injection sites for subcut (5)

A
  • outer, posterior aspect of upper arms (like where the fat hands down when you lift your arm)
  • the abdomen from below the costal margins to iliac crests
  • anterior aspects of the thigh
  • scapular areas of upper back
  • upper ventral or dorsal gluteal areas
64
Q

what is the most frequently recommended site for heparin injection

A
  • abdomenn
65
Q

a subcut injection site should be free of…

A
  • skin lesions
  • bony prominences
  • large underlying muscles or nerves
66
Q

give 2 examples of meds given subcut

A
  • insulin

- heparin

67
Q

what are the recommended sites for insulin injection? which has the quickest absoprtion?

A
  • abdomen –> quickest
  • upper arm
  • anterior & lateral portions of the thigh, buttocks, and abdomen
68
Q

patients with diabetes who inject insulin should practice…. why?

A

intrasite rotation:

  • rotating injection sites within the same body part
  • this provides greater consistency in the absorption

note: no injection site should be used againf or at least 1 month

69
Q

how do you determine whether to do a 90 or 45* angle for subcut

A
  • if you can grasp 5 cm of tissue = 90

- if you can grasp 2.5 = 45

70
Q

what volume of doses should be given subcut? why?

A
  • small doses –> 0.5-1 mL

- bc the tissue is sensitive to irritating solutions & large volumes

71
Q

what is a pro and con to IM injections

A
  • pro = quick absorption

- con = many risks = make sure the injection is justified

72
Q

list 2 things administered IM

A
  • flu & pneumonia vaccines
73
Q

what volume of med can be used IM? why?

A
  • normal pt can tolerate 3 mL into a larger muscle w severe discomofrt
  • children, older adults, and thin patients can tolerate 2
  • small children & older infants = 1 mL
  • no more than -.5 for smaller infants
  • bc it is less sensitive to irritating & sensitive meds
74
Q

what influences needle size for IM

A
  • body weight

- amt of adipose tissue

75
Q

describe what you should do before IM injection

A
  • assess muscle integrity –> should have no tenderness

- palpate for hardened lesions

76
Q

how can we reduce pain during IM injections?

A
  • put the pt in a relaxed position to reduce muscle strain
  • distraction
  • apply pressure to the site
77
Q

what are the 3 sites of injection for IM

A
  1. ventrogluteal
  2. deltoid
  3. vastus lateralis muscle
78
Q

what are the characteristics of the ventrogluteal site for IM (5)

A
  • deep site
  • away from major nerves or blood vessels
  • identified easily w bony landmarks
  • preferred site for meds that are larger in vol
  • offers less chance of contamination for incontinent patients & infants
79
Q

describe how to landmark the ventrogluteal site

A
  • place the palm of your hand over the greater trochanter on the pt’s hip
  • use right hand for left hip, and left for right
  • point your thumb towards the groin
  • point your index finger towards the anterior superior iliac spine
  • extend ur middle finger along the iliac crest toward the buttocks
  • injection site = in middle of the triangle ur fingers form
80
Q

what position should the pt be in for ventrogluteal? what helps to relax the muscle?

A
  • their side or back

- flexing the knee & hip

81
Q

describe the characteristics of the vastus laterlis muscle for IM (4)

A
  • lacks major nervs & blood vessels
  • facilitates rapid drug absorption
  • used frequently in infants (younger than 12 m) receiving immunizations
  • may also be used in older children & toddlers receiving immunications
82
Q

describe how to landmark the vastus lateralis muscle

A
  • place on hand above the knee
  • and one hand below the greater trochanter
  • use middle third for injection
83
Q

what position do we want pts in for vastus lateralis amdin

A
  • sitting

- lie flat with legs extended

84
Q

what are the characteristics of the deltoid muscle site frr IM (6)

A
  • easily accessible
  • not well developed in most pts
  • not used in infants or children w underdeveloped muscles
  • use of the muscle involves potential for injury to the brachial artery & radial and ulnar nerves
  • recommended site for hep B vaccine & rabies injections
  • only for small med volumes
85
Q

describe landmarking of the deltoid muscle

A
  • expose the upper arm & shoulder
  • palpate the lower edge of the acromion process
  • move 3-5 cm below (3 fingerwidths below)
86
Q

what position should a pt be in for injection into the deltoid muscle

A
  • may sit, stand, or lie down
87
Q

what is the technique used for IM admin called? why is it used?

A

Z-track method

  • it minimizes local skin irritation by sealing the med into the muscle tissue
  • also causes less discomfort & fewer lesions
88
Q

describe how to do the z-track method

A
  • pull the overlying skin & subcut tissue 2.5-3.5 cm laterally to the side
  • hold the skin with your nondom hand
  • check for blood using aspiration
  • if no blood, slowly inject the med
  • leave the needle in the skin for 10 sec to allow the med to disperse evenly
  • then withdraw the needle & release the skin
89
Q

what are ID injections often used for?

A
  • skin testing

ex. allergy & tuberculin tests

90
Q

why are some meds administered ID?

A
  • the meds are potent so they are administered ID where blood supply is reduced & med absorbs slowly
  • if it entered to quick, they could have an anaphylactic rxn
91
Q

what 2 ideal locations for ID

A
  • inner forearm

- upper back

92
Q

what should the skin look like for ID injections

A
  • should be able to see the injection site clearly to detect changes in color & tissue integrity
  • lightly pigmented, free of lesions, relatively hairless
93
Q

what should appear when you inject an ID med? what does it mean if it doesnt

A
  • a small bleb

- if it doesnt, then the med may have entered the subcut tissue & the results would be valid

94
Q

what is the angle of insertion for ID

A

5-10

NURS 2532 (5 decks)

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