NUR 118 CL - Meds B

Question 1

Intradermal Injection:

Angle
Taut/Pinch/NA

Answer 1

• Angle = 5-15 degrees
• Pull skin taut

Question 2

List intradermal injection sites

Answer 2

Anterior forearm
Upper Chest
Back below Scapula

Question 3

Where should intradermal injections go?

Answer 3

Just below the epidermis, into the dermis

Question 4

Should we circle the “bleb”?

Answer 4

No.
This is an identifier and a HIPAA violation. Instead, document where the injection was given.

Question 5

When should the patient return after a PPD?

Answer 5

Within 48-72 hours

Question 6

Subcutaneous Injection:

Angle
Taut/Pinch/NA

Answer 6

• Angle: 45 degrees (thin patient) - 90 degrees (fat patient)
• Pinch skin, insert, inject, remove THEN let go of pinch

Question 7

Subcutaneous injection sites

Answer 7

Abdomen two inches from umbilicus, between the costal margins and iliac crests & anterior to mid axillary line
Outer aspect of the upper arm
Anterior thigh

Question 8

What to do before administering insulin?

Answer 8

Check the patient’s glucose level

Glucose level should read: 70-100 mg/dl
- If below 70mg/dl, administer fast acting carb and recheck glucose in 15 minutes
Ensure insulin is at room temperature
- Rub between hands if necessary
Ensure insulin is being used within 24 hours of opening

Question 9

What should you ensure about the condition of your insulin vial?

Answer 9

Ensure that the insulin is at room temperature
Insulin R is clear, Insulin NPH is cloudy
- Roll NPH vial between hands if settled

Insulin is good for 24 hours, check date
Label insulin if opening

Question 10

INSULIN: When should the client eat?

Answer 10

Client should eat a meal after receiving their insulin

Question 11

Where is insulin absorbed the quickest?

Answer 11

In the abdomen

Question 12

What order to inject air and retrieve Insulin?

Answer 12

Sanitize Vials
Sanitize Injection site
Inject air into NPH, remove needle
Inject air into R (clear), keep needle inside
Remove prescribed amount of R, remove needle
Insert into NPH, remove prescribed amount of NPH

Question 13

Intramuscular Injection

Angle
Pinch/Taut/NA
Order

Answer 13

• Angle: 90 degrees
• Spread skin taut, insert, let go of skin, stabilize syringe, aspirate

Question 14

Intramuscular Injection sites

Answer 14

Deltoid muscle
Vastus Lateralis muscle
Rectus Femoris muscle
Ventrogluteal

Question 15

How to locate the deltoid muscle for an intramuscular injection?

Answer 15

Locate lower edge of acromion process, go two finger breadths below
Locate anterior axillary fold
Make inverted triangle, inject within the “V”

Question 16

How to locate the Vastus Lateralis muscle for an intramuscular injection?

Answer 16

Locate the greater trochanter
Place hand a hand breadth below the greater trochanter
Locate patella (knee), place hand a hand breadth above patella
Locate anterior middle of the muscle for injection
- Divide muscle into three sections and inject into anterior portion

Question 17

How to locate Rectus Femoris muscle for intramuscular injection?

Answer 17

Same initial landmarks as Vastus Lateralis
* Locate the greater trochanter
Place hand a hand breadth below the greater trochanter
Locate patella (knee), place hand a hand breadth above patella
Locate anterior middle of the muscle for injection *

THEN, move both hands forward over to front of thigh
Locate mid area between the hand breadths and inject

Question 18

How to locate Ventrogluteal muscle for intramuscular injection?

Answer 18

(Use right hand for left hip, and left hand for right hip)

Locate the greater trochanter
Place heel of hand on greater trochanter
Point thumb towards patient’s groin
Place index finger on anterior superior iliac spine
Extend middle finger back along the iliac crest towards buttocks
Index finger, middle finger & iliac crest form a V-shaped triangle

Inject into area outlined by the V

Question 19

What is the preferred injection site for children and babies?

Answer 19

The vastus lateralis, as it is very developed in young children

Question 20

How to locate the Greater Trochanter, if you’re having trouble finding it?

Answer 20

Have the patient kick out their leg, indentation should appear

Question 21

Define PPD

Answer 21

Purified Protein Derivative

Question 22

Why do we “lock in” iron / Z- Track?

How is this done?

Answer 22

Because otherwise it can be damaging and cause necrosis

• Inject 0.2mL air with medication to create air lock
• Retract/push skin aside until you remove needle
• Inject slowly for 10 seconds
• Keep needle inserted for 10 seconds

Question 23

List all steps for Intradermal

Answer 23

Pre
- 7 Medication rights
- 3 medications checks
Intra
- Select area to administer
- Clean area with alcohol, let dry
-
- Spread skin taut
- Insert at 5-15 degrees
- Inject
- Dispose needle into sharps container
Post
- Do not massage, cover or circle
- Remove gloves, hand hygiene
- Document administration and location

Question 24

What is the purpose of Z Track and Air Lock?

Answer 24

• Prevents leakage of the medication
• Usually irritating meds like iron
• Displacement of the skin seals drug into muscle tissue
• Air lock ensures all medication from vial enters syringe & seals exit track, so no medication leaks

Question 25

What are the three types of syringes available for this skill?

Answer 25

Intramuscular 3mL
Insulin 100 units
Intradermal 1L