Mod 2 Unti Two: Parenteral Injections And Administration Flashcards
1
Q
What equipment do you need for Parenteral med admin?
A
- Exam gloves
- Medication (vial/ampules/other)
- Alcohol swabs
- Appropriate syringe(s) and needle(s)
-Needle to withdraw
-Needle to inject - Medication Labels
- Clean Medication Drawer
2
Q
What are some different characteristics of medication vials?
A
- Single or multi-dose
- Plastic or glass (clear or dark)
- Liquid or powder med
- Sealed top
- Secure rubber injection port
3
Q
True or false: You should always clean the top of the medication vial before use?
A
True
4
Q
True or false: You should check the expiration datenof a medication vial before preparing the medication?
A
True
5
Q
You should always __1__ and __2__ multi-dose vial upon opening?
A
1.Date
2. Initial
6
Q
The gauge is also referred to as the _____?
A
Diameter
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
- Targeted tissue
8
Q
A dermis (id) needle size—
(Double check wording after lecture)
A
- 1/2 to 5/8
9
Q
A subcutaneous (sq) needle delivering anticoagulants should be what size?
May need to reward after lecture
A
- 3/8” to 5/8”
10
Q
A subcutaneous (SQ) needle used to deliver insulin should be what size?
A
- 1/2 “ to 5/16”
11
Q
A Muscle (IM) needle should be what size?
A
- 1” to 1 1/2” (most common in adults)
12
Q
True or false: The gauge (diameter) of the needle should be large enough to deliver viscosity of medication?
A
True
13
Q
For smaller gauge needs you want ______ solutions (27-20 g)
A
Thinner
14
Q
For larger gauge needles— you can use ____ solutions?
A
Thicker— 21-18g
15
Q
What is a filter needle?
A
Small filter in hub that catches debris
16
Q
True or false: You should NEVER use filter needels with ampules
A
False— ALWAYS use with ampules— best practice
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.
18
Q
When is a blunt fill needle typically used?
A
- Typically used with vials (rubber stopper)
19
Q
If a blunt fill needle is not available what else can we use?
A
Filter needle or smallest gauge needle ** double check**
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.
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
22
Q
If you choose to recap your blunt/filter needle which technique must you use?
A
- The one-handed recap technique
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.
24
Q
True or false: No blunt/filter needles are allowed in a patients room when used for med admin?
A
True
25
When is the only time a blunt/filter needle is allowed in the patients room?
Only when used for blood withdrawal
26
Syringes are calibrated in what measurement?
ML
27
The 1st calibrated line near the hub is what measurement ?
Zero
28
True or false: dosages must be measured accurately?
True
29
Review slide 9 on the parts of a syringe
Review slide 9 on the part of a syringe
30
Slide 11– what parts of our equipment are considered our holy/sacred parts?
Tips and ends of our sterile equipment
31
When preparing medication acknowledge _____ ______?
HCP orders
32
True or false: it is important that you preform hand hygiene and don gloves when preparing meds?
True
33
Step one of withdrawing a medication single dose vial is…..
After cleaning the top, inject air equal to the amount of medication to be withdrawn
34
Step 2 of withdrawing a medication from a single dose vial is…..
Withdraw the entire amount from the vial
35
Why do you want to withdraw the entire amount from a single dose vial? Add after lecture… slide 15
36
Step 3 of withdrawing a medication from a single dose vial is to….
1.prepare to deliver the exact amount of the medication ordered….
37
Step 4 of withdrawing a medication from a single dose vial is….
Remove BF needle and attach sterile needle
38
Troubleshooting air & bubbles include….
1. Make sure needle is below the fluid level
2. Withdraw the med slowly
39
For single dose vials…. troubleshooting for air & bubbles include….
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
40
In multi dose vials and troubleshooting air & bubbles what should you do?
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
41
What are things we should know about ampules?
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)
42
What are the steps from withdrawing from an ampule?
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
43
Medication are also commonly supplied in a dry form, such as ___1___ or ___2___, that must be reconstituted with fluid before they are administered.
1. Powders
2. Crystals
44
Delete
Delete
45
Delivery of patient medication…. At the bedside steps review
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.
46
True or false: You should only focus and prepare one patients med at a time?
True
47
True or false: It is not important to clean the patients med drawer or place a cloth.
False- Med drawers are disgusting.
48
Remove meds from Pyxis & verify against EMAR on computer this is your ____ check?
2nd
49
Acknowledge HCP order severs as your _____ check
1st
50
What is the minimum information we need for an order?
1. name of med
2. Dosage/volume(if an injectable)
3. Route
4. Frequency
5. PRN— what stipulation, range or reason
51
Check ____date and package ____. Why?
1. Expiration date
2. Integrity
3. Ensure that the package has not been tampered with.
52
True of false: gloves are not required for all parenteral meds
False
53
What all do you need to prepare your parenteral medication?
1. Appropriate syringe, needle to withdrawal, needle to inject, alcohol swabs and medication
54
How do you select the appropriate syringe and needle?
Based on what we are giving, patients, where we are giving, volume, injection site eval, patient assessment.
55
True or false: you should maintain aseptic state of critical components of equipment during preparation and administration
True
56
Label syringe with a blue label and make sure to include what:
1. Med, dose, time and initial
57
Make sure to take original med vial/ampule to verify at the _____ with the exception of what medication (2)?
1. Bedside
2. Insulin
58
What are the steps of withdrawing a medication from a single dose vial?
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
What do we need to know about combining two medications in vials
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
What should we know about combining two medications (vial and ampule)?
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
__1___ is the process of adding a liquid __2__ to a dry or liquid concentrated ingredient (__3__) to make a specific concentration
1. Reconstitution
2. Diluent
3. Solute
62
Drugs in powder form retain potency only for a short period of time once constituted… this is referred to as having a……
Short shelf life
63
True or false: Reconstituted volumes always equals the amount of diluent because the medication itself has volume.
False: reconstituted volumes DO NOT always equal the amount of diluent because the med itself has volume
64
How do you know what diluent to use?
The medication label or package insert dictates which diluent to use
65
What are the common diluents that we use?
1. Typically NS or sterile water
66
True or false: You should read carefully if IV or IM is a choice because it may differ in amount of diluent?
True
67
True or false: Use sterile technique withdrawing diluent to add to solute medication using a blunt-fill needle
True
68
True or false: When reconstituting medication you should mix well then withdraw medication. Remove BF needle then attach appropriate need for injection?
True
69
True or false: You can shake all reconstituted medications vigorously
False- package insert will tell you what to do as far as shaking
70
Review slides 29-32 on what do at the patients bedside when administering mediation (injection)
Review
71
What are the IM injection guidelines?
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
What are our optional sites for an IM injection?
1. Deltoid
2. Ventrogluteal
3. Vasturslateralis
73
Why do we palpate the site of our injections?
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
What areas should we avoid when looking for an injection site?
1. Scars
2. Irritations
3. Bruises
4. Lesions
75
True or false: We inject at a slow and steady rate?
True
76
Why do we not rub or massage post injection?
It can cause tissue damage and change the absorption
77
What is the angle for the MAJORITY of our injections?
90 degrees
78
The deltoid muscle is used for __1__ volumes and less __2__ medications (ie. vaccines, B-12 etc.)
1. Smaller
2. Irritating
79
What is the max volume recommend for the deltoid muscle?
1 mL
80
Should you question an order that tells you to give 2 mL IM in the deltoid? Yes or now? Why?
Yes, the max recommended volume is 1mL for the deltoid
81
What is the recommended needle length for the deltoid?
1. 1”
82
What is the recommended syringe size? (Remember what the max volume is )
1mL or 3mL
83
How do you landmark the deltoid?
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
True or false: You do not have to assess syringe when you uncap to give injection?
False
85
True or false: You want to insert the needle with intent not hesitation?
True
86
What angle to do we inject the deltoid?
90 degrees
87
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?
True
88
True or false: You can typically go all the way to the hub in most patients with deltoid IM injections?
True— but always assess the patient to be sure
89
Should you choose the ventrogluteal or vastus lateralis first?
Ventrogluteal 1st vastus lateralis 2nd
90
The ventrogluteal and vastus lateralis sites are used for ….
Thicker, painful or irritating meds (DEEP IM)
91
What is the maximum volume recommended for ventrogluteal and vastus lateralis injection?
3mL
92
What is the recommended needle length for ventrogluteal and vastus lateralis injections?
1” to 1 1/2”
93
What is the recommended syringe size for ventrogluteal or vastus lateralis injections?
3mL or 5mL. Depending on how much your giving
94
It is important to _____ sites with deep IM injections
Rotate
95
Why is the ventrogluteal site your 1st choice?
Contains more muscle area
96
How do you landmark for a ventrogluteal injection?
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
How do you position a patient for a ventrogluteal injection?
1. Lean over table
2. Have them lay on side and bend knee like flamingo
98
What is the purpose of a z-track method?
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
What are you doing when you do the z-track method?
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
To Z-tack you…
Place the heel of hand next to injection site and pull slightly away.
101
What angle to you insert ventrogluteal or vastus lateralis injections?
90 degrees
102
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….
Aspirate 3-5 seconds
103
When aspirating during your ventrogluteal or vastus lateralis injection and blood returns with aspiration what do you do?
DO NOT INEJCT— pull the needle out and restart with new everything and inject opposite site
104
After an injection how long should we wait before we pull the needle out?
3-5 seconds.
105
What is the injection rate for a ventrogluteal or vastus lateralis injections?
Inject at rate of 1mL every 10 seconds
106
When do you release “z-track”
After injection, waiting 3-5 seconds, and withdrawing the needle
107
Once you landmark your site on the ventrogluteal and you clean your site how can you remember where your injection site is?
Turn alcohol pad over & leave tip of alcohol pad pointed towards injection site.
108
Why do we need to avoid the dorsogluteal muscle?
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
Review slide 43 and 44 for injection site info
Review slide 43/44
110
What medications do we typically inject in the SQ?
Insulin & Anticoagulants
111
What should we know about Insulin injections?
1. SQ
2. Syringe is prepacked with needle. Own unique needle and syringe
3. Needles are very fragile and permanently attached to syringe
112
What needle should we use for a SQ anticoagulant injection?
1. 3/8-5/8” needle
113
What is the SQ injection rule of thumb?
Inject at a 90 degree angle if you can “bunch” skin more than 2”; otherwise, inject at 45 degree angle
114
What should we know about insulin?
1. typically in Multi-dose vials
2. Can be short/rapid acting(SSI), intermediate acting, long acting.
115
In reference to insulin and our medication sheets what should we know?
1. Know purpose (why and when)
2. Teaching
3. Side effects/adverse reactions
4. Post injection responsibilities
116
What is the normal blood sugar range?
70-110
117
How long after a patient has there insulin should they eat?
1. 15-20mins
118
True or false: it is not important to know when insulin medication peaks?
False: it important to know when it peaks and troughs
119
What are the rules of administration for insulin?
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
Why do you administer insulin within minutes of preparation?
1. Once it leaves its vial… the properties of the insulin start to break down.
121
Why do we never shake insulin vials?
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
SQ insulin injection guidelines include?
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
What are the steps of SQ insulin administration in the MED ROOM.
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
What are the steps of SQ insulin administration @ the bedside?
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
What should we know about the SQ- Enoxaparin injection?
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
What are the SQ enoxaparin injection steps starting at the patients bedside?
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
Since you do not want to expel the nitrogen bubble in the enoxaparin injection how to you remove excess air?
To expel air out you have to point the needle down so that the nitrogen bubble travels towards the plunger.
128
What should we know about intradermal injections?
1. Typically used for allergy testing and TB testing
129
What are the steps starting at the patients bedside of injecting a intradermal injection?
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
True or false: the direction of the bevel matters with an intradermal injection?
True
