More Med Admin

Question 1

Administration of medication into body tissues. Invasive procedure, pierces skin and risk tissue damage.

Answer 1

Injections.
Use aseptic technique. Effects develop rapidly. Have associated risk. Sites should be rotated if frequent injections. Nurse responsibility to closely observe the patient.

Question 2

Metal cap protects seal. Closed system.

Answer 2

Vials.

Must use alcohol to clean top once seal is broken. Must inject air to prevent vacuums (air=volume to be withdrawn)

Question 3

Glass with a constricted neck. Pre-scored to break easily.

Answer 3

Ampule

Constricted neck must be snapped off. Snap neck away from hands. Must use filter needle.

Question 4

How do you remove a medication from a vial?

Answer 4

Place the vial on a flat surface, remove cap. Clean rubber seal. Fill syringe with needed air, holding like a dart. Insert with beveled tip entering. Inject air, invert vial. Use one hand scoop to recap the needle.

Question 5

Removing medication from an ampule?

Answer 5

Tap top. Place pad just above neck and snap it. Draw up using a filter needle, not allowing it to touch the shaft or rim of the ampule. Aspirate by pulling back on the plunger. One hand scoop to recap. Change needle.

Question 6

What routes are used?

Answer 6

Intradermal: under the skin
Subcutaneous: loose connective tissue under the dermis
Intramuscular: into muscle
Intravenous: into vein

Question 7

What degrees are used for the different routes of injection?

Answer 7

IM and SC: 90 degrees
SC: 45 degrees
ID: 15 degrees

Question 8

The maximum dosage volume per IM site?

Answer 8

Adult 150 lb: 3 mL
Children ages 6-12: 2 mL
Birth to age 5: 1 mL

Question 9

How do you inject an IM deltoid?

Answer 9

Palpate the lower edge of the acromion process, which forms the base of the triangle in line with the midpoint of the aspect of the upper arm. Center of the triangle. Four fingers across the deltoid with top finger along acromion. Site is three finger widths below acromion.

Question 10

How do you inject an IM ventrogluteal?

Answer 10

Position in a supine or lateral position. Place palm over greater trochanter of hip with the wrist perpendicular to the femur. Point thumb toward groin, index toward anterior superior iliac spine, middle along iliac crest towards buttock forming V site in the center of the triangle.

Question 11

How do you inject an IM vastus lateralis?

Answer 11

Located on the anterior lateral aspect of the thigh, extends in adult a hand above the knee to a hand below the greater trochanter

Question 12

When do you use the Z track method?

Answer 12

When administrating an IM injection to minimize local skin irritation by sealing the medication in muscle tissue

Question 13

When do you aspirate?

Answer 13

On all IM injections, except when administrating vaccines.

Not on ID or subcut

Question 14

When do you use what gauge of needle for IM injections?

Answer 14

Viscous: 19g, 18g (oil based, hormone)
Most folks: 20, 21, 22
Elderly and frail: 23

Question 15

How do you minimize patient discomfort when giving an IM injection?

Answer 15

Sharp-beveled needle in the smallest gauge and length you can. Proper site. Vapocoolant spray or topical anesthetic before. Divert patient’s attention. Insert needle quickly and smoothly. Hold syringe steady. Inject slowly and steadily.

Question 16

Explain needle safety.

Answer 16

Never recap needles that have been used on a patient. Use one hand scoop to change needles when preparing meds. Dispose in sharps container. Use single vials only once.

Question 17

Any method of providing nutrition into the GI tract such as tube feedings.

Answer 17

Enteral nutrition

Nasogastric, jejunal, gastric tubes

Question 18

Tube inserted through the nose into the stomach at bedside.

Answer 18

Nasogastric tube.

NG tubes

Question 19

Length of intestine between the duodenum and ileum. Tube radically, surgically, or endoscopically inserted through abdominal wall into the jejunum.

Answer 19

Jejunostomy tubes

J tubes

Question 20

Tube surgically inserted through the abdomen into the stomach.

Answer 20

Gastronomy, G tubes

Question 21

Nutrition provided through an intravenous catheter that is inserted directly into the veins. When the digestive tract cannot be used. For short or long term use, delivers full complement of nutrients

Answer 21

Parenteral nutrition, aka total parenteral nutrition or hyperalimentation
TPN or PN

Question 22

Placing a tube into the stomach percutaneously, aided by endoscopy. Performed as a means of providing food to patients who cannot take food by mouth

Answer 22

Percutaneous endoscopic gastronomy, PEG

Question 23

What are indications of PEG tubes?

Answer 23

Impaired swallowing that leads to an inability to consume sufficient nutrients to meet their daily needs.
Cancer, critical illness, trauma, neurological and muscular disorders, Gi disorders, respiratory failure with prolonged intubation, inadequate oral intake

Question 24

Complications of PEG tubes?

Answer 24

Aspiration, GI disturbances, electrolyte disturbances, infections

Question 25

What is checked for when the concern is delayed gastric emptying?

Answer 25

Gastric residual volume, GRV

Question 26

Hourly rate administered via pump over 24 hours
Administered over ordered time period every 4-6 hours
Administered via a syringe or gravity drip over a few minutes

Answer 26

Continuous feedings
Intermittent feelings
Bolus

Question 27

What do you do before placing a tube?

Answer 27

Verify placement. Draw up 30 mL of air into syringe, inject air into tube. Pull back slowly to determine the amount of residual. Return aspirated contents to stomach unless volume exceeds 250 mL and continue with the feeding.

Question 28

What is the most reliable indicator of correct placement?

Answer 28

X-ray

Question 29

Administration of feeding?

Answer 29

Keep at room temp, start at full strength, slow rate. Increase the hourly rate every 8-12 hours per orders. Keep HOB elevated during and 2 hrs after, placing patient in high fowler’s or elevate at least 30 degrees, preferably 45.

Question 30

How to care for tubing?

Answer 30

Change tubing and administration set every 24 hrs. Flush tubing with 30 mL of water every 4 hrs during continuous feedings. Flush before and after an intermittent feeding. Clamp end when not in use. Keep clean and dry. Assess skin around the insertion site.

Question 31

What is recommended about aspirations?

Answer 31

Immediately stop if aspiration occurs. Withhold feedings and reassess patient tolerance to feedings if residual volume is over 500 mL. Routinely evaluate the patient for aspiration.

Question 32

A fraction expresses strength of a solution made from a liquid concentrate. Explain?

Answer 32

Numerator is number of parts of solute.
Denominator is number of parts of solution.
Difference between the denominator (final solution) and numerator (parts of solute) is number of parts of solvent.

Question 33

Process of mixing and diluting solutions.

Answer 33

Reconstitution. Medications are unstable in liquid form, so they must be dissolved by liquid solvent or diluent and mixed thoroughly.

Question 34

A substance to be dissolved.
A substance that dissolves another substance to prepare it.
The resulting mixture.

Answer 34

Solute
Solvent
Solution

Question 35

When reconstituting injectable medications, you must determine what two things?

Answer 35

Both the type and amount of diluent (solvent) to be used

Question 36

Supply dosage when reconstituting is sometimes referred to as?

Answer 36

Resulting concentration, concentration, or yield.

Question 37

What’s put on a reconstituted label?

Answer 37

Date and time of preparation, supply dosage prepared, length of potency, storage directions, initials