Parenteral Conscious Sedation I

Question 1

Administered and absorbed through the GI tract.

Answer 1

Enteral

Question 2

Bypasses the GI tract.

Answer 2

Parenteral

Question 3

Enteral routes.

Answer 3

Oral, rectal, and sublingual

Question 4

Parenteral routes.

Answer 4

IV
IM
Intranasal
Submucosal
Subcutaneous

Question 5

When to use intramuscular route.

Answer 5

• If pt can’t take oral meds.
• No veins are accessible.
• Uncooperative patients.
• Mentally ill patients.
• To administer adjunctive or emergency meds.
• Preoperative sedation for minor procedures not requiring general anesthesia.

Question 6

How to identify landmarks for IM administration.

Answer 6

PALPATION

Question 7

Avoid injection here for IM.

Answer 7

Deep subcutaneous tissue.

Want the belly of the muscle.

Question 8

How to hold the syringe for IM.

Answer 8

Like a dart (index finger and thumb).

Make sure you aspirate.

Question 9

Onset and presictability of IM route.

Answer 9

Greater than oral meds, but less than IV administration.

Question 10

Adv of IM

Answer 10

• Cannot be lost from vomiting.

- Avoids GI tract, first pass hepatic metabolism, and good in stomach.

Question 11

Can IM be titrated?

Answer 11

NO!

Question 12

Can IM be easily reversed?

Answer 12

No

Question 13

IM injection sites.

Answer 13

1) Gluteus Maximus
2) Ventrogluteal area
3) Deltoid
4) Vastus lateralis

Question 14

Patient position for gluteus maximus injection.

Answer 14

Lying prone because the muscle is not relaxed while standing.

Question 15

Injection site for gluteus maximus.

Answer 15

Upper outer quadrant

Question 16

What do you avoid hitting when in the upper outer quadrant.

Answer 16

Sciatic nerve and superior gluteal artery.

Question 17

Located in lower inner quadrant.

Answer 17

Sciatic nerve

Question 18

Located in upper inner quadrant.

Answer 18

Sacral plexus

Question 19

Located in lower outer quadrant.

Answer 19

Femur

Question 20

This IM injection site is contraindicated in infants, bc paralytic complications may not be recognized until walking begins.

Answer 20

Gluteus Maximus

Ventrogluteal area

Question 21

This IM injection is farthest from all major nerves and vessels.

Answer 21

Ventrogluteal area

Question 22

The advantage of this injection site is that it can be used in any position.

Answer 22

Ventrogluteal area

Question 23

3 bony landmarks for ventrogluteal area

Answer 23

1) Anterior superior iliac spine
2) Iliac crest
3) Greater trochanter of the femur

Question 24

Where to give the deltoid injection and why.

Answer 24

Between the upper and lower portions of the deltoid to avoid the radial nerve.

Question 25

Avoid this nerve in the deltoid injection.

Answer 25

Radial nerve

Question 26

Muscle injection that cane be given from one hand width below the greater trochanter, to one hand width above the knee.

Answer 26

Vastus lateralis.

Question 27

This injection is given prone or supine.

Answer 27

Vastus lateralis Ventral gluteal

Question 28

No important nerves or vessels in this IM site.

Answer 28

Vastus Lateralis

Question 29

This lower body injection is good for kids and infants.

Answer 29

Vastus lateralis

Question 30

Complications of IM Technique

Answer 30

- Local tissue injury - Injury to major nerves - Intravascular injection - Hematoma - Broken needles (don't insert to hub). - Infection/abscess

Question 31

Avoid this type of injection in an anticoagulated patient.

Answer 31

Intramuscular

Question 32

Uses for the intravenous route of administration.

Answer 32

1) Conscious sedation, deep sedation for minor to moderate invasive surgical or diagnostic procedures. 2) To administer adjunctive meds (antibiotics, corticosteroids), or emergency meds. 3) Pre-medication prior to general anesthesia

Question 33

Intravenous solutions.

Answer 33

1) Normal saline (0.9%) 2) 1/2 normal saline (0.45%) 3) Lactated Ringer's Sol'n

Question 34

Components of saline solution

Answer 34

Na+ Cl- Dextrose additive

Question 35

Components of Lactates Ringer's solution

Answer 35

K+ Ca 2+ Dextrose additive

Question 36

The puncture of a vein to draw blood or administer an IV.

Answer 36

Venipuncture

Question 37

Locations of a venipuncture.

Answer 37

Dorsal hand Antecubital fossa

Question 38

"Elbow" in Lain

Answer 38

Cubitus

Question 39

Elbow pit where venipuncture is done.

Answer 39

Antecubital fossa.

Question 40

A device to stop the flow of blood through a vein or artery, typically by compressing a limb with a cord or bandage.

Answer 40

Tourniquet

Question 41

Technique for IV

Answer 41

- Apply tourniquet - Cleanse skin with antiseptic - Stabilize the vein distally - Puncture the skin at about 30 degrees with the needle bevel UP in adults. - Decrease the angle to enter the vein, and verify VENOUS entry. - Insert catheter over the needle, and cannulate the vein. - Remove the tourniquet. - Attach IV line, verify VENOUS entry. - Start flow of solution. - Secure with tape.

Question 42

Arm-brain circulation time with an IV.

Answer 42

20-25 SECONDS

Question 43

Can IV's be titrated?

Answer 43

YES!

Question 44

It's easier to determine the dose for this parenteral technique.

Answer 44

IV

Question 45

This parenteral technique has a shorter recovery time than with IM techniques.

Answer 45

IV.

Question 46

Potential for this in IV administration.

Answer 46

Bloodborne pathogen exposure.

Question 47

These patients must be NPO for this parenteral technique.

Answer 47

IV This is why you can't eat before getting blood taken (done by IV).

Question 48

Associated with which parenteral route? - Potential systemic complications are immediate. - Happen fast and are more difficult to treat.

Answer 48

IV

Question 49

Inflammation of the walls of a vein.

Answer 49

Phlebitis

Question 50

Potential local IV complications:

Answer 50

- Chronic pain - Hematoma - Phlebitis Thrombophlebitis - Phlebothrombosis - Burning on drug injection. - Extravasation, infiltration, skin injury. - Intra-arterial injection