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n242 > module 3- (subcutaneous injetions/subcutaneous butterfly/intradermal) > Flashcards

module 3- (subcutaneous injetions/subcutaneous butterfly/intradermal) Flashcards

1
Q

subcutaneous injections involve=

A

depositing medications into the loose connective tissue underlying the dermis

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2
Q

there are less blood vessels in subq than in muscles, so..

A

the medications are absorbed more slowly than with IM injections

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3
Q

what increases the rate of drug absorption?

A

-physical exercise or application of hot or cold compresses

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4
Q

any conditions that _________ is a contraindication for subcutan injections

A

impairs blood flow

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5
Q

doses for subcutaneous?

A

small doses of less than 2ml

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6
Q

describe the solutions of subq

A

isotonic, irritating, non-viscous, watersoluble

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7
Q

infants and children amount?

A

0.5ml one site

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8
Q

examples of subq injections?

A

epinephrine, insulin, allergy medications, opioids

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9
Q

best subq sites?

A

outer aspect of upper arm, abdomen from below costal margins to iliac crests, anterior aspects of the thighs

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10
Q

key aspects for a good subq site?

A
  • large enough to allow rotating multiple injections within each anatomic location
  • easy accessible
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11
Q

injection site should be:

A

free of skin lesions, bony prominences, and large underlying muscles or nerves

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12
Q

what affects the depth of subq layer?

A

patients weight and amt of adipose tissue

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13
Q

what effects the needle length and angle of needle insertion?

A

the patients weight and estimate of subq tissue

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14
Q

generally, what is the needle size and angle?

A

25 gauge 5/8 inch needle at 45 degree OR
1/2 inch needle at 90 degree
for normal patient

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15
Q

if patient is obese what do you do for needle/insertion of subq?

A

-pinch the tissue and use a needle long enough to insert through the fatty tissue at the base of the skinfold

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16
Q

sometimes thin patients have insufficient tissue for injections, so where is the best site?

A

upper abdomen

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17
Q

special considerations: administration of insulin

A
  • type 1 diabetes managed with injections

- not necessary to rotate anatomic site, one area is chosen and systematically rotated within that region

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18
Q

where is insulin most quickly absorbed?

A

abdomen

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19
Q

where is insulin slowest absorbed?

A

thighs

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20
Q

timing of injections is critical to insulin admin, what is it?

A

based on blood glucose levels and when a pt will eat

-must know peak and duration of insulin for effective diabetes plan

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21
Q

special considerations: administration of heprain

A
  • therapeutic anticoagulation to reduce risk of thrombus formation
  • thus, patients are at risk for bleeding
  • before admin assess for pre-existing conditions that contraindicate its use (cerebral aneurysm, CV hemmorrhage, hypertension)
  • assess meds that interact with heparin
  • administer heparin subq or IV
22
Q

where is lowmolec heparin given?

A

to minimize pain and bruising, given subq on right or left side of abdomen at least 5cm from umbillicus
-do not expel the air bubble in syringe before giving the med

23
Q

how can you decrease patients perception of pain?

A

applying ice to site for 1 min

24
Q

administering subq injection steps?

A
  • clean site with antiseptic swab (centre and rotate outward in circular direction for 5cm)
  • remove cap
  • hold skin across injection site or pinch skin with nondominant hand
  • inject needle firmly at 45 or 90 degree, release skin if pinched
  • after needle enters: grasp lower end of syringe barrel with non-dominant hand to stabilize it and move dominant hand to end of plunger and slowly inject med over several seconds
  • apply pressure for several seconds
25
Q

indications for subq butterfly?

A
  • circumstances that preclude or compromise oral admin
  • pain or symptom crisis
  • poor or variable compliance (dementia, delirium, agitated)
26
Q

benefits of subq butterfly?

A
  • avoids multiple injections
  • avoids turning and repositioning patient
  • allows better rest during night
  • absorbs effectively
  • simple and inexpensive
  • if pts at home, family can be taught to give via butterfly
27
Q

how much extra med is taken when admin of subq saf t intima?

A

0.4 ml of med more is taken to prime the saf-t-intima tubing and needless connecter

28
Q

possible complications of subq

A
  • skin irritation
  • infection
  • pain at site
  • bleeding, bruising, swelling
29
Q

change a butterfly..

A

weekly at least and at first site of inflammation, erythema, leakage, bruising or swelling

30
Q

what are intradermal injections typically given for?

A

-skin testing (eg TB or allergy tests)

31
Q

because meds of intradermal are potent, they are injected into dermis where…

A

blood supply is reduced, drug absorption occurs slowly

32
Q

what could happen if intradermal meds enter circulation too fast?

A

-anaphylactic reaction

33
Q

ideal locations for intradermal?

A

inner forearm (lower mid arm) and upper back

34
Q

what needle/syringe for intradermal?

A

tuberculin or small syringe with a short (3/8 to 5/8 inch fine gauge (25-27) needle

35
Q

angle of insertion for intradermal?

A

5 to 15 degrees

36
Q

amount of medication injected for intradermal?

A

small! 0.01-0.1ml

37
Q

why is bleb important for intradermal?

A

if bleb does not appear or if site bleeds after needle withdrawal, med may have entered subq tissue

38
Q

what do you tell pt when giving intradermal injection?

A

may cause slight burning or sting

39
Q

where is the ideal spot exactly for intradermal?

A

three to four finger widths below antecubital space and one hand width above wrist

40
Q

administration of intradermal med?

A
  • with nondominant hand stretch skin over site with forefinger or thumb
  • with needle almost against patients skin, insert slowly at 5-15 degree angle until resistance is felt
  • advance needle through to epidermis approx 3mm below skin surface (you will see bulge of needle tip through skin)
  • insert med slowly, note resistance
  • note the bleb (approx 6mm)
  • after withdrawing needle, apply alcohol swab or gauze gently over site
41
Q

evaluation of intradermal?

A

return to room in 15-30 mins ask about acute pain, burning, numbness, tingling

42
Q

when do you read the TB test site?

A

48 to 72 hours

-look for induration (hard, dense, raised area) of skin around injection site

43
Q

patients with no known risk for TB?

A

15 mm or more

44
Q

recent immigrants, injection drug users, residents and employees of high risk settings?

A

10mm or more

45
Q

HIV positive, fibrotic changes on chest x-ray or immunosuppresed?

A

5 mm or more

46
Q

what size needle for a saf-t intima subq?

A

24 gauge 19 mm

47
Q

max intradermal amount?

A

-0.1 ml

48
Q

most critical potential situation from a nurse administering a injection?

A

anaphylactic reaction which is seen through wheezing, SOB, flushing, nausea or dizziness

49
Q

in selecting an appropriate site for subq the nurse must consider?

A
  • patients age (elderly and pediatric specifically!)
  • condition of skin
  • location of bony prominences
50
Q

implementation of administering a subq butterfly?

A
  • rotate white safety device 360 degrees, ensure bevel is up
  • pinch yellow wings together with dominant hand (textured side down!), pinching skin with non-dominant hand and insert needle at 30-45 degree angle
  • securing wings with nondominant hand, pull back on white safety shield to remove needle
  • apply transparent dressing
  • attach needless syringe and deliver prime (0.4ml) and med if required

n242 (7 decks)

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