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Module 2 > Mod 2 Unti Two: Parenteral Injections And Administration > Flashcards

Mod 2 Unti Two: Parenteral Injections And Administration Flashcards

1
Q

What equipment do you need for Parenteral med admin?

A
  1. Exam gloves
  2. Medication (vial/ampules/other)
  3. Alcohol swabs
  4. Appropriate syringe(s) and needle(s)
    -Needle to withdraw
    -Needle to inject
  5. Medication Labels
  6. Clean Medication Drawer
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2
Q

What are some different characteristics of medication vials?

A
  1. Single or multi-dose
  2. Plastic or glass (clear or dark)
  3. Liquid or powder med
  4. Sealed top
  5. Secure rubber injection port
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3
Q

True or false: You should always clean the top of the medication vial before use?

A

True

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4
Q

True or false: You should check the expiration datenof a medication vial before preparing the medication?

A

True

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5
Q

You should always __1__ and __2__ multi-dose vial upon opening?

A

1.Date
2. Initial

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6
Q

The gauge is also referred to as the _____?

A

Diameter

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7
Q

Choosing a Parenteral needle— Your needle should be long enough to reach _____ _____ of a patient respective to age, weight, and muscle/tissue mass

A
  1. Targeted tissue
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8
Q

A dermis (id) needle size—
(Double check wording after lecture)

A
  1. 1/2 to 5/8
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9
Q

A subcutaneous (sq) needle delivering anticoagulants should be what size?

May need to reward after lecture

A
  1. 3/8” to 5/8”
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10
Q

A subcutaneous (SQ) needle used to deliver insulin should be what size?

A
  1. 1/2 “ to 5/16”
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11
Q

A Muscle (IM) needle should be what size?

A
  1. 1” to 1 1/2” (most common in adults)
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12
Q

True or false: The gauge (diameter) of the needle should be large enough to deliver viscosity of medication?

A

True

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13
Q

For smaller gauge needs you want ______ solutions (27-20 g)

A

Thinner

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14
Q

For larger gauge needles— you can use ____ solutions?

A

Thicker— 21-18g

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15
Q

What is a filter needle?

A

Small filter in hub that catches debris

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16
Q

True or false: You should NEVER use filter needels with ampules

A

False— ALWAYS use with ampules— best practice

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17
Q

If you are using an ampule and there are no filter needles available what should you use?

A

Use the smallest gauge needle to draw up medication. NEVER USE A BLUNT FILL REGARDLESS OF THE SITUATION with an ampule.

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18
Q

When is a blunt fill needle typically used?

A
  1. Typically used with vials (rubber stopper)
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19
Q

If a blunt fill needle is not available what else can we use?

A

Filter needle or smallest gauge needle ** double check**

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20
Q

When using non-Parenteral needles such as a filter needle or blunt fill needle it is important that we remove and replace with a sterile needle for administration of the medication…. WHY?

A

One needle, one stick, one time.

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21
Q

True or false- Blunt or filter needles can NEVER be recapped?

A

False- Blunt/filter needles that have been used to prepare a Parenteral medication before placing in the sharps box can be re-capped— your choice

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22
Q

If you choose to recap your blunt/filter needle which technique must you use?

A
  1. The one-handed recap technique
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23
Q

After you recap your blunt or filter needle using the one-handed re-cap technique then what?

A

Discard in the sharps bin.

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24
Q

True or false: No blunt/filter needles are allowed in a patients room when used for med admin?

A

True

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25
Q

When is the only time a blunt/filter needle is allowed in the patients room?

A

Only when used for blood withdrawal

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26
Q

Syringes are calibrated in what measurement?

A

ML

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27
Q

The 1st calibrated line near the hub is what measurement ?

A

Zero

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28
Q

True or false: dosages must be measured accurately?

A

True

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29
Q

Review slide 9 on the parts of a syringe

A

Review slide 9 on the part of a syringe

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30
Q

Slide 11– what parts of our equipment are considered our holy/sacred parts?

A

Tips and ends of our sterile equipment

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31
Q

When preparing medication acknowledge _____ ______?

A

HCP orders

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32
Q

True or false: it is important that you preform hand hygiene and don gloves when preparing meds?

A

True

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33
Q

Step one of withdrawing a medication single dose vial is…..

A

After cleaning the top, inject air equal to the amount of medication to be withdrawn

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34
Q

Step 2 of withdrawing a medication from a single dose vial is…..

A

Withdraw the entire amount from the vial

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35
Q

Why do you want to withdraw the entire amount from a single dose vial? Add after lecture… slide 15

A
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36
Q

Step 3 of withdrawing a medication from a single dose vial is to….

A

1.prepare to deliver the exact amount of the medication ordered….

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37
Q

Step 4 of withdrawing a medication from a single dose vial is….

A

Remove BF needle and attach sterile needle

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38
Q

Troubleshooting air & bubbles include….

A
  1. Make sure needle is below the fluid level
  2. Withdraw the med slowly
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39
Q

For single dose vials…. troubleshooting for air & bubbles include….

A
  1. Withdraw entire volume from vial- expect air to follow
  2. Expel the air and medication, if more than required is in the syringe, to ensure exact dose
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40
Q

In multi dose vials and troubleshooting air & bubbles what should you do?

A
  1. Withdraw more med than you need, leaving needle in vial, push med back into vial via plunger to exact dose
  2. If still having issues, can tap or thumb syringe gently to move air to top of syringe then purge air back into vial
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41
Q

What are things we should know about ampules?

A
  1. Single dose Medication
  2. Made of glass (clear/dark)
    -sharps hazard
  3. Scored neck (colored)
  4. Need syringe and filter needle (use filter in case of any glass particles)
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42
Q

What are the steps from withdrawing from an ampule?

A
  1. Apply gloves, prepare syringe and attach filter needle
  2. Hold ampule upright and tap the top to dislodge medication from neck
  3. Place barrier around neck and break away from you.
  4. Withdraw mediation— dispose of excess according to P&P
  5. Place glass ampule and syringe/needle in sharps box when finished in pts room
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43
Q

Medication are also commonly supplied in a dry form, such as ___1___ or ___2___, that must be reconstituted with fluid before they are administered.

A
  1. Powders
  2. Crystals
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44
Q

Delete

A

Delete

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45
Q

Delivery of patient medication…. At the bedside steps review

A
  1. Knock…. ADIET, assess patients readiness
  2. Open the patients profile and EMAR- scan the armband and confirm patient.
  3. ID the patient: name dob and allergies
  4. Always acknowledge/verify information on screen
  5. Compare every medication to eMAR (drug dose, time , volume, reason etc)
  6. Patient teaching— The what and why for each med
  7. Scan medication barcode- then, always look at the screen to acknowledge and address any pop ups. Which occurs with almost every injection
  8. select appropriate site for medication.
    -landmark, visualize, palpate and always consider medication, age, muscle, tissue mass, last injection site
  9. Once site has been carefully selected preform hh, don gloves, aseptically clean site
  10. Verify integrity of need and volume
  11. Inject into correct landmark, angle and rate
  12. Withdraw needle at same angle injected.
  13. Discharge safety mechanism immediately after injection
  14. Saving documentation- once a med has been scanned the screen automatically will say “given” which means your documentation has been saved.
  15. Monitor effects and re-assess patient as indicated
  16. Don’t at the bedside.
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46
Q

True or false: You should only focus and prepare one patients med at a time?

A

True

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47
Q

True or false: It is not important to clean the patients med drawer or place a cloth.

A

False- Med drawers are disgusting.

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48
Q

Remove meds from Pyxis & verify against EMAR on computer this is your ____ check?

A

2nd

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49
Q

Acknowledge HCP order severs as your _____ check

A

1st

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50
Q

What is the minimum information we need for an order?

A
  1. name of med
  2. Dosage/volume(if an injectable)
  3. Route
  4. Frequency
  5. PRN— what stipulation, range or reason
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51
Q

Check ____date and package ____. Why?

A
  1. Expiration date
  2. Integrity
  3. Ensure that the package has not been tampered with.
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52
Q

True of false: gloves are not required for all parenteral meds

A

False

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53
Q

What all do you need to prepare your parenteral medication?

A
  1. Appropriate syringe, needle to withdrawal, needle to inject, alcohol swabs and medication
54
Q

How do you select the appropriate syringe and needle?

A

Based on what we are giving, patients, where we are giving, volume, injection site eval, patient assessment.

55
Q

True or false: you should maintain aseptic state of critical components of equipment during preparation and administration

A

True

56
Q

Label syringe with a blue label and make sure to include what:

A
  1. Med, dose, time and initial
57
Q

Make sure to take original med vial/ampule to verify at the _____ with the exception of what medication (2)?

A
  1. Bedside
  2. Insulin
58
Q

What are the steps of withdrawing a medication from a single dose vial?

A
  1. After cleaning the top, inject air equal to amount of medication to be withdrawn (charging)
  2. Withdraw the entire amount from the vial (prevent from someone to use it again + OSHA)
  3. Prepare to deliver the exact amount of the medication ordered
  4. Remove BF needle & attach sterile needle
59
Q

What do we need to know about combining two medications in vials

A
  1. Meds must be compatible
  2. Cannot exceed acceptable volume for intended site/syringe
  3. Select appropriate syringe and use a BF needle
  4. Select appropriate needle to administer
60
Q

What should we know about combining two medications (vial and ampule)?

A
  1. Meds must be compatible
  2. Cannot exceed acceptable volume for intended site/syringe
  3. Select appropriate syringe and use a BF needle
  4. Select appropriate needle to administer.
  5. Need a BF and filter need or just a filter needle
  6. Always do vial 1st because you have to charge it.
61
Q

__1___ is the process of adding a liquid __2__ to a dry or liquid concentrated ingredient (__3__) to make a specific concentration

A
  1. Reconstitution
  2. Diluent
  3. Solute
62
Q

Drugs in powder form retain potency only for a short period of time once constituted… this is referred to as having a……

A

Short shelf life

63
Q

True or false: Reconstituted volumes always equals the amount of diluent because the medication itself has volume.

A

False: reconstituted volumes DO NOT always equal the amount of diluent because the med itself has volume

64
Q

How do you know what diluent to use?

A

The medication label or package insert dictates which diluent to use

65
Q

What are the common diluents that we use?

A
  1. Typically NS or sterile water
66
Q

True or false: You should read carefully if IV or IM is a choice because it may differ in amount of diluent?

A

True

67
Q

True or false: Use sterile technique withdrawing diluent to add to solute medication using a blunt-fill needle

A

True

68
Q

True or false: When reconstituting medication you should mix well then withdraw medication. Remove BF needle then attach appropriate need for injection?

A

True

69
Q

True or false: You can shake all reconstituted medications vigorously

A

False- package insert will tell you what to do as far as shaking

70
Q

Review slides 29-32 on what do at the patients bedside when administering mediation (injection)

A

Review

71
Q

What are the IM injection guidelines?

A
  1. Select appropriate syringe and needle which is based on medication,volume, injection site and the patient
  2. Properly position pt. And locate landmarks
    -select the muscle to accommodate medication
    • deltoid,ventrogluteal , vastuslateralis
  3. Visualize and palpate for “belly” of well-developed relaxed muscle.
  4. Inject at a rate of 1mL/10secs- wait 3-5 sec before removing needle
  5. Post injection, do not rub or massage.
72
Q

What are our optional sites for an IM injection?

A
  1. Deltoid
  2. Ventrogluteal
  3. Vasturslateralis
73
Q

Why do we palpate the site of our injections?

A

To ensure that the patient is not having any pain, tenderness and that the site is free of any masses, lumps, or concerning spots.

74
Q

What areas should we avoid when looking for an injection site?

A
  1. Scars
  2. Irritations
  3. Bruises
  4. Lesions
75
Q

True or false: We inject at a slow and steady rate?

A

True

76
Q

Why do we not rub or massage post injection?

A

It can cause tissue damage and change the absorption

77
Q

What is the angle for the MAJORITY of our injections?

A

90 degrees

78
Q

The deltoid muscle is used for __1__ volumes and less __2__ medications (ie. vaccines, B-12 etc.)

A
  1. Smaller
  2. Irritating
79
Q

What is the max volume recommend for the deltoid muscle?

A

1 mL

80
Q

Should you question an order that tells you to give 2 mL IM in the deltoid? Yes or now? Why?

A

Yes, the max recommended volume is 1mL for the deltoid

81
Q

What is the recommended needle length for the deltoid?

A
  1. 1”
82
Q

What is the recommended syringe size? (Remember what the max volume is )

A

1mL or 3mL

83
Q

How do you landmark the deltoid?

A
  1. Place your ring finger on the Acromion process. Go down 2-3 fingers. Palpate for the muscle. Ask patient to relax arm or ask them to pull arm across body
84
Q

True or false: You do not have to assess syringe when you uncap to give injection?

A

False

85
Q

True or false: You want to insert the needle with intent not hesitation?

A

True

86
Q

What angle to do we inject the deltoid?

A

90 degrees

87
Q

True or false: Depending on your patient you may not want to insert your needle all the way to the hub do to the risk of hitting bone?

A

True

88
Q

True or false: You can typically go all the way to the hub in most patients with deltoid IM injections?

A

True— but always assess the patient to be sure

89
Q

Should you choose the ventrogluteal or vastus lateralis first?

A

Ventrogluteal 1st vastus lateralis 2nd

90
Q

The ventrogluteal and vastus lateralis sites are used for ….

A

Thicker, painful or irritating meds (DEEP IM)

91
Q

What is the maximum volume recommended for ventrogluteal and vastus lateralis injection?

A

3mL

92
Q

What is the recommended needle length for ventrogluteal and vastus lateralis injections?

A

1” to 1 1/2”

93
Q

What is the recommended syringe size for ventrogluteal or vastus lateralis injections?

A

3mL or 5mL. Depending on how much your giving

94
Q

It is important to _____ sites with deep IM injections

A

Rotate

95
Q

Why is the ventrogluteal site your 1st choice?

A

Contains more muscle area

96
Q

How do you landmark for a ventrogluteal injection?

A

Palm of hand on the greater trochanter, thumb towards the grown, pointer finger towards the iliac spine and the middle finger towards the iliac creast

97
Q

How do you position a patient for a ventrogluteal injection?

A
  1. Lean over table
  2. Have them lay on side and bend knee like flamingo
98
Q

What is the purpose of a z-track method?

A
  1. Helps reduce the pain threshold with the patient.
  2. Help deposit the medication where its supposed to go. Help minimize any irritation into other tissues should for whatever reason that medicine seeps back up
99
Q

What are you doing when you do the z-track method?

A
  1. You are displacing the SQ tissue over the deposit site of the medication. Once you let go everything moves back over which essentially seals the injection in place
100
Q

To Z-tack you…

A

Place the heel of hand next to injection site and pull slightly away.

101
Q

What angle to you insert ventrogluteal or vastus lateralis injections?

A

90 degrees

102
Q

One of the biggest differences between a deltoid IM injections and a ventrogluteal/vastus lateralis IM injections is that with the ventrogluteal/vastus lateralis is that you have to….

A

Aspirate 3-5 seconds

103
Q

When aspirating during your ventrogluteal or vastus lateralis injection and blood returns with aspiration what do you do?

A

DO NOT INEJCT— pull the needle out and restart with new everything and inject opposite site

104
Q

After an injection how long should we wait before we pull the needle out?

A

3-5 seconds.

105
Q

What is the injection rate for a ventrogluteal or vastus lateralis injections?

A

Inject at rate of 1mL every 10 seconds

106
Q

When do you release “z-track”

A

After injection, waiting 3-5 seconds, and withdrawing the needle

107
Q

Once you landmark your site on the ventrogluteal and you clean your site how can you remember where your injection site is?

A

Turn alcohol pad over & leave tip of alcohol pad pointed towards injection site.

108
Q

Why do we need to avoid the dorsogluteal muscle?

A
  1. It can cause impaired loss and function if injected into the wrong area
  2. Nerve and vessel injury possible
  3. Inadequate deposition of the medication
109
Q

Review slide 43 and 44 for injection site info

A

Review slide 43/44

110
Q

What medications do we typically inject in the SQ?

A

Insulin & Anticoagulants

111
Q

What should we know about Insulin injections?

A
  1. SQ
  2. Syringe is prepacked with needle. Own unique needle and syringe
  3. Needles are very fragile and permanently attached to syringe
112
Q

What needle should we use for a SQ anticoagulant injection?

A
  1. 3/8-5/8” needle
113
Q

What is the SQ injection rule of thumb?

A

Inject at a 90 degree angle if you can “bunch” skin more than 2”; otherwise, inject at 45 degree angle

114
Q

What should we know about insulin?

A
  1. typically in Multi-dose vials
  2. Can be short/rapid acting(SSI), intermediate acting, long acting.
115
Q

In reference to insulin and our medication sheets what should we know?

A
  1. Know purpose (why and when)
  2. Teaching
  3. Side effects/adverse reactions
  4. Post injection responsibilities
116
Q

What is the normal blood sugar range?

A

70-110

117
Q

How long after a patient has there insulin should they eat?

A
  1. 15-20mins
118
Q

True or false: it is not important to know when insulin medication peaks?

A

False: it important to know when it peaks and troughs

119
Q

What are the rules of administration for insulin?

A
  1. Know/verify BLOOD GLUCOSE level or trends first before administering
  2. Administered in units- NEVER mL.
  3. Administer all insulins within minutes of preparation
  4. DO NOT SHAKE INSULIN VIALS
  5. Know your pt & med always
  6. Always do you assessment, teaching, interventions (hypoglycemia edu too)
120
Q

Why do you administer insulin within minutes of preparation?

A
  1. Once it leaves its vial… the properties of the insulin start to break down.
121
Q

Why do we never shake insulin vials?

A
  1. Rotate gently in palms to max evenly- will create micro bubbles and proteins in the insulin that get disrupted and break down the insulin making the dose ineffective
122
Q

SQ insulin injection guidelines include?

A
  1. Administered to the adipose “fatty” areas of the arms, abdomen, back or thigh
  2. Alternate/separate injections sties by at least 1”
  3. Avoid areas of bruising or lipodystrophy
  4. Avoid linea alba and umbilicus by at least 2” away
  5. DO NOT aspirate, rub or massage any SQ injection
123
Q

What are the steps of SQ insulin administration in the MED ROOM.

A
  1. Obtain correct insulin & corresponding label from Pyxis
  2. Draw dose based on verified BS or standing order and attach insulin label to syringe- leave insulin ivial in Pyxis
  3. TPCN oftentimes will ask another nurse to verfy med, amount
124
Q

What are the steps of SQ insulin administration @ the bedside?

A
  1. Select site, assess, cleanse with alcohol & allow to dry
  2. Assess needle and syringe
  3. Bunch the selected site
  4. Typically inject a 90 degree angle due to needle size- (to the hub)- release bunch
  5. Wait 3-5 sec & withdraw needle at same angle
  6. DO NOT aspirate, rub or massage
  7. Engage safety device and place in sharps box
125
Q

What should we know about the SQ- Enoxaparin injection?

A
  1. Always administer in the abdomen
  2. Properly position pt first- reclining/supine is always best
  3. Assess abdominal “love handle” region— less than 4” from umbilicals
  4. Avoid bruised inj sites— must rotate sites
  5. Administer deep SQ at 90 degree angle is recommended
126
Q

What are the SQ enoxaparin injection steps starting at the patients bedside?

A
  1. Select site, cleanse with alcohol & allow to dry
  2. Bunch during ENTIRE injection
    -inject 90 degree angle/deep sq into “love handle area- to hub
  3. DO NOT aspirate or expel nitrogen bubble
    • wait 3-5 sec & withdraw needle at same angle
  4. DO NOT rub or massage
  5. Engage safety device and place in sharps box
127
Q

Since you do not want to expel the nitrogen bubble in the enoxaparin injection how to you remove excess air?

A

To expel air out you have to point the needle down so that the nitrogen bubble travels towards the plunger.

128
Q

What should we know about intradermal injections?

A
  1. Typically used for allergy testing and TB testing
129
Q

What are the steps starting at the patients bedside of injecting a intradermal injection?

A
  1. Select site (free of tattoos if possible, blemishes, hair, scarring, bruises, etc)
  2. Cleanse area with alcohol & allow to dry
  3. Stretch middle 1/3 of forearm relatively
  4. Inject at almost parallel angle (5-15 degrees) until bevel of needle barely disappears under the skin
  5. Inject- ensure a “bleb or wheal”
  6. Withdraw and release
  7. DO NOT aspirate, rub or massage
130
Q

True or false: the direction of the bevel matters with an intradermal injection?

A

True

Module 2 (14 decks)

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