Parental Medications Flashcards
8 Ways to Reduce Needle Stick Injuries
1 Avoid using needles when effective needleless systems or SESIP safety devices are available.
2 Do not recap needles after medication administration.
3 Plan safe handling and disposal of needles before beginning procedure.
4 Immediately dispose of used needles into sharps disposal
containers.
5 Maintain a sharps injury log (see agency policy).
6 Attend educational offerings regarding blood borne pathogens and take vaccines
7 Report all needlestick and sharps-related injuries immediately
8 Participate in the selection and evaluation of needleless
systems of SESIP devices with safety features within your place of employment whenever possible.
Prevention of Infection in Injections (4)
1) Prevent contamination of solution
- Ampules should not sit open, and medication should be removed quickly
2) Prevent Contamination of needle
- Don’t allow needle or length of plunger to touch anything
3) Prepare Skin
- Use antiseptic swab (+ wash if actually solid) in 5cm radius
4) Reduce Microorganisms
- Hand Hygiene 15s min.
What needs to be checked before mixing parental medication in one syringe
Check Compatibility charts. They are located in drug reference guides, posted within patient care areas, or available electronically. If you are uncertain about medication compatibilities, consult a pharmacist.
Consideration when drawing up mixed parental medication
When using multi-dose vials, do not contaminate the contents of the vial with medication from another vial or ampule.
Need to put air into both vials before drawing up from either
Special Heparin Considerations
Any potential for bleeding (ulcers, trauma, etc)
PT-INR time (More forWarfarin), PTT check (heparin)
How much fluid can be administered SC?
up to 2ml Adult, 0.5ml Pediatric
Which parental med absorbs faster SC or IM?
IM injection route deposits medication into deep muscle tissue, which has a rich blood supply, allowing medica- tion to absorb faster
What influences needle size selection for injections?
viscosity of the medication, injection site, patient’s weight, and amount of adipose tissue influence needle size selection
Basic Range for IM needle gauge choices?
Administer immu-nizations and parenteral medications in aqueous solutions with a 20- to 25-gauge needle. Give viscous or oil-based solution with an 18- to 21-gauge needle. Use a small-gauge (22- to 25-gauge) needle for children
Basic Range for IM needle length choice?
An adult patient who is thin requires a needle length of 5/8 to 1 inch; whereas an average patient requires a 1-inch needle
Two indications for use of SCBF?
Medication of same type and concentration will be given multiple times SC
PO not possible or recommended
Insertion sites for SCBF
Abdomen (5cm from umbilicus), Upper arm (shoulder), anterior thigh
Readings- Supraclavicular or posterior flank as well
Assessments/considerations pre administration of SCBF
What is the additional dose for first admin
Condition of skin at site
Same concentration of med
+ allergies and I.D bracelet
Should the bevel be up for SCBF? What angle?
Yes. Bevel up @ 30 degrees
Written Info on SCBF?
Initials, Med and Concentration, Date Inserted
Will administration of LMWH (low molecular weight heparin) change PTT numbers?
No
What is the primary reason for interdermal injections?
Skin testing - tuberculosis screening and allergy tests.
Why do you administer potent medications into the dermis?
Blood supply is reduced
Drug absorption occurs slowly
What is the typical length of an interdemal needle?
3/8 to 5/8 of an inch.
What guage needle is typically used for interdermal injections?
fine-guage, 25 - 27
What is the angle of insertion for interdermal injections?
5 to 15 degrees
What amount of medication should be injected?
Children?
0.01 - 0.1 mL
Children: 0.1 mL
What does it mean if a bled does not appear?
Medication may have entered the subcutaneous tissues.
Should you needle site bleed after needle withdrawal?
No.
If the needle site bleeds after an interdermal needle it is likely that the medication may have entered the subcutaneous tissues.
Can you delegate an interdermal to nursing assistance?
Nope.
Is it necessary to aspirate during an ID injection?
Hell no. Dermis is relatively avascular. No need to aspirate.
What is a solvent?
A substance (liquid) that dissolves another substance to prepare a solution.
Synonymous term: Diluent
What is a solute?
a substance to be dissolved or diluted.
Can be solid of a liquid
What is a solution?
The resulting mixture of a solution and a solutte.
Why are some medications stored in powdered form?
They are unstable.
They need to be dissolved or reconstituted prior to administration.
Do nurses typically reconstitue drugs?
No.
Pharmacists typically do this, but nurses must understand the process.
What are the two types of reconstituted parenteeral solutions?
Single strength & Multiple Strength
When multiple directions for diluting are given, the ______ the amount of dilutent added, the stronger the resulting solution concentration will be.
Smaller.
Reconstitution Question:
Order: Ceftazidime 250 mg IM q12h
Supply: 1000 mg vial - Instructions: Add 3mL of sterile water for injection. SHAKE WELL. Provides Ceftazidime 280 mL per mL
Calculate the dose to be administered:
Add 3 mL sterile water to solute = 280 mg/mL
Order/Supply x Quantity =
250mg / 280mg/mL x 1 = 0.9 mL IM q12h
What is the purpose of Heparin therapy?
Providing theraputic anticogulation to reduce risk for thrombus formation.
What is the main risk/concern with Heparin patients?
Risk of bleeding
Including - Gums, heatemesis, hematuria.
What pre-existing conditions or test(s) or should be conducted for for a Heparin patient?
Coagulation blood tests - PTT, Platelets
Any conditions with increased risk of bleeding: recent childbirth, severe diabetes, ulcers, lesions (GI, GU).
Name two other drugs that interact with Heparin?
Asprin (ASA), NSAIDs
What two ways can Heparin be administered?
Subcutaneously, Intravenously
Where on the body do you administer Heparin?
The left or right side of the abdomen
At least 5 cm (2 inches) away from the umbilicus
Should you expell the “air bubble” from the pre-filled Heparin syringe?
Naw.
What is an advantage of IM injections?
Rich blood supply - faster adsorption
What is the ideal volume for IM injections?
In children?
Adult = 2mL
Child = 1 mL, unless the child is a fatty (“larger”), then they can endure 2 mL
If you’re using my cue cards and offended, I’m sorry. I’m not really like this, I’m just bored of making cards.
What s the Z-track Method?
What’s it’s purpose? Explain the procedure.
Technique for pulling the skin during an IM injection.
It prevents leakage of medication into subcutaneous tissue and minimizes irritation.
Procedure: Pull skin and subcut tissues 2.5-2.5 cm laterally to the side. Use the ulnar side of the non-dominant hand. Hold until you have administered. Release skin after withdrawing needle.
What should you consider when selecting an injection site?
Location of underlying structure (bones, nerves, blood vessels).
Free of pain, infection, bruising, and abrasions?