NUR 118 CL - Meds B Flashcards
Intradermal Injection:
Angle
Taut/Pinch/NA
- Angle = 5-15 degrees
- Pull skin taut
List intradermal injection sites
Anterior forearm
Upper Chest
Back below Scapula
Where should intradermal injections go?
Just below the epidermis, into the dermis
Should we circle the “bleb”?
No.
This is an identifier and a HIPAA violation. Instead, document where the injection was given.
When should the patient return after a PPD?
Within 48-72 hours
Subcutaneous Injection:
Angle
Taut/Pinch/NA
- Angle: 45 degrees (thin patient) - 90 degrees (fat patient)
- Pinch skin, insert, inject, remove THEN let go of pinch
Subcutaneous injection sites
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
What to do before administering insulin?
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
What should you ensure about the condition of your insulin vial?
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
INSULIN: When should the client eat?
Client should eat a meal after receiving their insulin
Where is insulin absorbed the quickest?
In the abdomen
What order to inject air and retrieve Insulin?
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
Intramuscular Injection
Angle
Pinch/Taut/NA
Order
- Angle: 90 degrees
- Spread skin taut, insert, let go of skin, stabilize syringe, aspirate
Intramuscular Injection sites
Deltoid muscle
Vastus Lateralis muscle
Rectus Femoris muscle
Ventrogluteal
How to locate the deltoid muscle for an intramuscular injection?
Locate lower edge of acromion process, go two finger breadths below
Locate anterior axillary fold
Make inverted triangle, inject within the “V”
How to locate the Vastus Lateralis muscle for an intramuscular injection?
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
How to locate Rectus Femoris muscle for intramuscular injection?
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
How to locate Ventrogluteal muscle for intramuscular injection?
(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
What is the preferred injection site for children and babies?
The vastus lateralis, as it is very developed in young children
How to locate the Greater Trochanter, if you’re having trouble finding it?
Have the patient kick out their leg, indentation should appear
Define PPD
Purified Protein Derivative
Why do we “lock in” iron / Z- Track?
How is this done?
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
List all steps for Intradermal
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
What is the purpose of Z Track and Air Lock?
- 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
