NP III Flashcards
Units
1g = 1000 mg 1 mg = 1000 mcg 1kg = 1000 gm 1kg = 2.2 lbs 1L = 1000 ml 5mL = 1 tsp 1 TBSP = 15 mL 30 mL = 1 oz
Tab/Capsule/ Injection
Doctors order/ Dose on hand X Tab
(50 mg/ 25 mg x tab)
(3000,000/ 200,000 x 5mL)
IV Pump
Total infusion (ml)/ Hours of infusion (1000ml/8hr = 125 ml/hr)
If the time is less than an hour
mL/ min X 60 min = XmL/hr
IV Flow Rates by Gravity
Step 1: Calculate ml/Hr
Step 2: Amount of soon/hr x drop factor/ time in minutes = X gtts/min
Needle Selection
Length:
IM 1 - 1 1/2 inches
Subcut 3/8 - 5/8 inch
Intradermal 1/4 inch, 1/2 inch needle, or a special needle and syringe for allergens
Gauge:
25-27 G
Intradermal 25 G
Syringe:
1-3 mL
50 U - 100 U Insulin Syringe
Intradermal - Tuberculin syringe or 1 mL
Mixing Insulins
Inject air into cloudy or long acting insulin then remove syringe
Inject air into Regular or clear insulin then withdraw amount needed
Insert needle into cloudy insulin and withdraw ordered dose
Insulins: Rapid-Acting
Humalog (Lispro) ON: 15-30 min P:30-90 min DUR: 3-5 HR
Novolog (Aspart) ON: 10-20 min P:40-50 min DUR: 3-5 HR
Apidra (Glulisine) ON: 20-30 min P: 30-90 min DUR: 1-2 1/2 HR
Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with longer-acting insulin
Insulins: Short-Acting
Regular R (Humulin or Novolin) ON: 30 min-1 HR P: 2-5 HR DUR: 5-8 HR
Velosulin (for use in the insulin pump) ON: 30 min - 1 HR P: 2-3 HR DUR: 2-3 HR
Short-acting insulin covers insulin needs for meals eaten within 30-60 minutes
Insulins: Intermediate- Acting
NPH (N) ON: 1-2 HR P: 4-12 HR DUR: 18-24 HR
Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with rapid-or short-acting insulin
Insulins: Long-Acting
Lantus ( Insulin glargine) ON: 1- 1 1/2 HR P: No peak time; insulin is delivered at a steady level DUR: 20-24 HR
Levemir ( Insulin Detemir) ON: 1-2 HR P: 6-8 HR DUR: Up to 24 HR
Long-acting insulin covers insulin needs for about one full day. This type of insulin is often combined, when needed, with rapid-or short-acting insulin
Insulins: Pre-Mixed
Humulin 70/30 ON: 30 min P: 2-4 HR DUR: 14-24 HR
Novolin 70/30 ON: 30 min P: 2-12 HR DUR: Up to 24 HR
Novolog 70/30 ON: 10-20 min P: 1-4 HR DUR: Up to 24 HR
Humulin 50/50 ON: 30 min P: 2-5 HR DUR: 18-24 HR
Humalog mix 75/25 ON: 15 min P: 30 min - 2 1/2 HR DUR: 16-20 HR
These products are generally taken two or three times a day before mealtime
*PREMIXED INSULINS ARE A COMBINATION OF SPECIFIC PROPORTIONS OF INTERMEDIATE-ACTING AND SHORT-ACTING INSULIN IN ONE BOTTLE OR INSULIN PEN (THE NUMBERS FOLLOWING THE BRAND NAME INDICATE THE PERCENTAGE OF EACH TYPE OF INSULIN)
IM Sites: Ventrogluteal
1: Place palm of the hand over the greater trochanter of the femur
2: Point index finger towards the anterior superior iliac spine
3: Point other fingers towards iliac crest, forming a “V” between index and middle finger
4: Palpate “V” - if you palpate the hip bone, slide hand back until you can no longer palpate the hip bone
5: “Z Track”
6: Inject
IM Site: Vastus Lateralis
1: Place RT hand on patella (outer thigh)
2: Place LT hand over greater trochanter
3: “Z Track”
4: Inject syringe between two hands
IM Site: Deltoid
1: Palpate acromion process
2: Measure 3 finger widths under acromion process
3: Form a “V”
4: “Z Track”
5: Inject syringe
S+S of Hypoglycemia (2.8-3.9 mmol/L)
Trembling Palpitations Sweating Anxiety Mood/ behaviour changes Hunger Nausea Tingling Confusion Weakness Vision changes Headache Dizziness Fatigue, tiredness Difficulty speaking and/or concentrating
Factors Affecting Infusion Rate
Height of fluid container over the PTs heart Volume of fluid in the container Viscosity of the fluid Cannula diameter Venting of the fluid container Position of the extremity
IV Therapy Assessment
Determine the prescribed rate of flow, and assess the actual flow rate
Inspect the infusion site for edema, pallor or redness, bleeding, and drainage
Palpate ste for edema and warmth or coolness
Ask the patient if the infusion site is painful
Take PTs VS and compare the readings c previous findings to detect increased pulse and blood pressure
Measure and record the fluid intake and output, and auscultate the PTs lungs for crackles
Complications of IV Therapy
Tissue trauma Infiltration Inflammation Infection Fluid Volume Excess Bleeding Embolism
Infiltration
Infusion slows, insertion site cool to touch, pale & pain
Can be caused by leakage where cannula enters vein or by puncture of a second site in the vein by the cannula
PT may report pain or burning
Site may be pale and puffy or feel hard and cool
Stop the infusion and restart it in a different vein
Elevate the affected arm on a pillow
