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Module 2 (Skills) > Parenteral Injections > Flashcards

Parenteral Injections Flashcards

1
Q

Parenteral Injection Equipment (minimum)

A

-Exam Gloves(Not sterile)
-Medication (vials/ampules/pre-packaged others)
-Alcohol Swabs (a lot)
-Appropriate Syringe(s) and Needle(s)
~ Needle to withdraw (blunt/filter)
~ Needle to inject (sharp gauges)
-Medication Labels
-Clean Medication Drawer

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2
Q

If a vial is dark, what can you conclude from the vial?

A

sensitive to light and needs to be given quickly after drawn

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3
Q

With a liquid or powder med that is given through injections, what do you do exclusively for this med?

A

reconstitute with diluent (water or sterile water)

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4
Q

What should you always remember to do when preparing medication from a vial? (5)

A

-Ensure Sealed top
-A secure rubber injection port
-Clean the top before use
-CHECK EXPIRATION!
-Time, Date and Initial Multi-dose vial upon opening

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5
Q

Medication Vials variations

A

-Single or multi-dose
-Plastic or glass (clear or dark)
-Liquid or powder med (reconstituted with diluent)

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6
Q

What is a gauge?

A

“diameter”

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7
Q

What type of a relationship does the needle size and the gauge number?

A

inverted

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8
Q

When the needles are bigger, the number/gauge is

A

smaller

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9
Q

When the number/gauge is bigger, the needle and bevel are

A

smaller

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10
Q

Viscosity means

A

thickness

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11
Q

How to choose parenteral needles?

A
  • Long enough to reach _targeted tissue__ of patients respective to age, weight, and muscle/tissue mass ( to deposit the medicine correctly
  • The gauge (diameter) of the needle should be large enough to deliver the viscosity of the medication
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12
Q

Intradermis (ID) needle length

A

1/2 to 5/8”

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13
Q

Anticoagulants

A

thin the blood
does not dilute the blood

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14
Q

Subcutaneous anticoagulant (SQ) needle length

A

3/8 to 5/8”

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15
Q

Subcutaneous insulin (SQ) needle length

A

1/2 to 5/16”

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16
Q

Muscle (IM) needle length

A

1 to 1 1/2”

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17
Q

What needle length is most common in adults?

A

1 to 1 1/2”

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18
Q

Smaller gauge needles are used for __________ solutions.
- What gauge is used?

A

thinner
- 20-27 g

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19
Q

Larger gauge needles are used for __________ solutions.
- What gauge is used?

A

thicker
- 18-21 g

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20
Q

Non-Parenteral Needles are used for ____________ meds.

A

Withdrawing
Non = not for patient

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21
Q

What are the types of non-parenteral needles?

A

Filter needle
Blunt fill needle

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22
Q

Filter needles

A

small filter in hub catches debris

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23
Q

What needle do you always use with ampules?
= If not available, use what?

A

Filter needle (for preventing glass particles from being aspirated)
= use the smallest needle (29g)

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24
Q

What needle do you always use with vials (rubber stopper)?
= If not available, use what?

A

Blunt fill needle
= use smallest gauge available, or filter needle

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25
Q

After obtaining the necessary medication, what do you do?

A

Remove the non-parenteral needle
Replace with sterile needle for administration

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26
Q

Why do you never use a non-parenteral needle for injection?

A

they have a blunt edge and will harm the patient

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27
Q

What technique do you use when ALWAYS recapping a needle?

A

one-handed recap technique

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28
Q

After recapping the needle, what do you do?

A

Label the needles before leaving the med room

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29
Q

Before placing a needle in a sharps box, what do you do?
a) recapped
b) placed with needle out
c) all of the above - your choice

A

all of the above - your choice

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30
Q

What needles are used to prepare a parenteral medication before placing it in the sharps box?

A

Blunt/filter

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31
Q

T/F: Blunt/Filter needles are allowed in a pt’s room when used for Med Admin.

A

False - blunt/filter needles are only in the med room to prepare meds

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32
Q

Blunt or Filter Needles are never allowed in the room EXCEPT when

A

using a blood withdrawal

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33
Q

What are the different types of one-handed recap techniques?

A

Holding the syringe with one hand
- closing cap against a table, skin

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34
Q

Syringes are calibrated in

A

mL

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35
Q

Where is the 1st calibrated line of a syringe?

A

the first line on the barrel near the hub

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36
Q

The volume ordered stops at the

A

rubber stopper
(read from zero to volume ordered - leading ring)

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37
Q

Volume Ordered stops at what point in the syringe?

A

leading ring of a rubber stopper

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38
Q

Which type of syringe would you use when giving medications?

A

smallest syringe needed to correctly deliver the prescription volume

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39
Q

Most Commonly Used Syringes

A

3 mL
5 mL
10 mL

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40
Q

What parts of the syringe do you maintain asepsis?
Holy and Sacred Parts

A

Hub (tip)
Needles

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41
Q

Where are the med checks? (3)

A

Acknowledge HCP Orders
Remove meds from Pyxis and verify with eMAR screen
Take original med val/ampule with syringe to verify at the bedside

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42
Q

How many patients’ medication do you pull at one time?

A

only one

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43
Q

What is the minimum information included on the prescriber’s orders?

A

name of medication
dosage/amount
route
frequency
if PRN, the reason for giving

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44
Q

Why do you always examine expiration dates and package integrity?

A

ensure nothing has been tampered with

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45
Q

When preparing a medication

A

-Acknowledge HCP Orders – check #1
-Focus and prepare only one patient’s meds at a time
-Clean medication drawer and place cloth
-Remove meds from Pyxis & verify against eMAR on computer screen – check 2
-Check Exp. Date and Pkg Integrity - why?

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46
Q

What do use when selecting the appropriate syringe and needle?

A

Medication
Volume
Injection site
pt assessment

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47
Q

After obtaining the medication what are the steps while in the med room?

A

-Perform Hand Hygiene & don Gloves
~Gloves – required for all preparing all parenteral routes
-Prepare parenteral medication(s)–
-Select Appropriate Syringe and Needle – med, vol., injection site, pt assessment
~Maintain an aseptic state of critical components of equipment during preparation and administration – no exceptions!
~Labelthe syringe with a “Blue Label” - med, dose, time, and initial
-Take the original med vial/ampule with a syringe to verify at the bedside (exception is insulin) - 3rd check

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48
Q

What is included on a “blue label”?

A

drug
strength
date
time
initials

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49
Q

What is charging?

A

inject air equal to amount of medication for withdrawn

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50
Q

Withdrawing a medication Single Dose Vial

A
  • Cleaning top
  • Charge: inject air equal to the amount of medication to be withdrawn (15 secs)
  • Withdraw the entire amount from the vial – why? so no one uses the extra
  • Discard any extra medication to deliver the exact amount of the medication ordered
  • Remove the Blunt Fill needle & attach the sterileneedle
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51
Q

Combining 2 Medications of Vials

A

Vial A and Vial B or Vial/Ampule
Meds must be compatible!
Cannot exceed acceptable volume for intended site/syringe
Select the appropriate syringe and use a BF needle
Select the appropriate needle to administer

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52
Q

What are the 2 exceptions of Combining 2 Medications from Vial and Ampule?

A
  • Need a blunt fill and a filter needle or FN
  • vial 1st, ampule 2nd (charge vial)
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53
Q

Troubleshooting with air and bubbles

A

~ needle - below fluid level
~ Withdraw slowly
Single Dose Vials:
- Withdraw entire volume from the vial - expect air to follow
- Expel the air and medication, if more than required in the syringe, to ensure the exact dose
Multi-Dose Vials:
- Withdraw more med than you need, leaving the needle in vial, then push the med back into the vial for the exact dose
- If still having issues, tap or thump the syringe gently to move air to the top of the syringe then purge air back into the vial

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54
Q

When using an ampule, why do you use a filter needle ONLY?

A

possible glass particles

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55
Q

Ampules

A

Single Dose made of glass (clear/dark)
“sharps” hazard
Scored neck (colored)
Always wear gloves
Need syringe and Filter Needle

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56
Q

Withdrawing from an ampule

A
  • Apply gloves, prepare syringe & attach filter needle
  • Hold the Ampule upright and tap the top to dislodge medication from the neck
  • Place a barrier (gauze pad) around the neck and break away from you
  • Withdraw medication – dispose of excess according to P&P
  • Place glass ampule and syringe/needle in sharps box when finished in pt’s room
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57
Q

How do you open an ampule?

A

Tap at top
Gauze around neck
Break away: bottom away and top to you

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58
Q

Reconstitution

A

is the process of adding a liquid diluent to a dry or liquid-concentrated ingredient (solute) to make a specific concentration of liquid.

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59
Q

Drugs in powder form retain _______ only for a short period of time once reconstituted - _____ _______ ____.

A

potency;
short shelf life

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60
Q

T/F: Reconstituted volumes do not always equal the amount of diluent because the medication itself has volume.

A

True

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61
Q

What dictates which diluent to use?
What diluent is typically used?

A

label or package insert
- NS or sterile water

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62
Q

If IV or IM is a choice, the diluent is

A

different

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63
Q

What technique should you use when adding diluent to solute medication?
What needle do you use?

A

sterile
- Blunt fill

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64
Q

Medication Reconstitution is used for medications in?
What needs to happen before injection?

A

dry forms, such as powders or crystals
-reconstituted with fluid before they are administered.
Mix well then withdraw medication.
Remove BF needle then attach appropriate needle for injection

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65
Q

T/F:NEVER RECAP used needles

A

True - contaminated

66
Q

When you enter the pt’s room, what are the steps?

A
  • Knock … AIDET, assess patient readiness
  • Open the patient’s profile and eMAR - scan the armband and confirm “Scanned” on the screen
  • ID the patient: name, dob, allergies
  • ALWAYS acknowledge/verify information on the screen
  • Compare every medication toeMAR(drug, dose,time, volume,reason,etc) – check 3
  • Patient teaching –The “What and Why” foreach med
  • Scan Medication Barcode -
  • always look at the screen to acknowledge and address all pop-ups! This occurs with almost every injection
  • Prior to Administration, select appropriate site for medication
  • Once the site has been carefully selected
    Hand hygiene, don clean gloves, aseptically clean site in circular motion in and around the site selected
  • Verify integrity of needle and volume
    Inject into a correct landmark, angle, and rate
  • Withdraw Needle at Same Angle Injected
  • Discharge safety mechanism IMMEDIATELY after injection
  • Away from You and the Patient!
  • Dispose of in Sharps – one needle, one time
    NEVER RECAP used needles
  • Saving documentation …..
  • Once a med has been scanned, the screen automatically will say “Given” which means your documentation has been saved

Monitor effects and re-assesspatient, as indicated

67
Q

“Don’ts” at the bedside

A

Don’t place trash or items in pt bed
-Don’t leave equipment or meds administration in a room alone
~ place in a tray and dispose of properly when finished

68
Q

IM Injections sites

A

deltoid, ventrogluteal, or vastus lateralis

69
Q

Inject at a rate of ________________ before removing needle - Why?

A

1 mL/10 sec –wait 3-5 sec

70
Q

IM Injections Guidelines

A
  • Select Appropriate Syringe and Needle Based on Medication, Volume, Injection Site & the patient
  • Position Pt. and landmarks
  • Select muscle to accommodate medication
    deltoid, ventrogluteal, vastuslateralis
  • Visualize and palpate for the “belly” of well-developed, relaxed muscle (densest)
  • Avoid scars, irritations, bruises, lesions in muscle, etc.
  • Post injection, do not rub or massage – Why?
71
Q

Angle for IM Injections

A

90 degree

72
Q

Deltoid Max Volume Recommended

A

1 mL

73
Q

Deltoid Recommended Needle length

A

1”

74
Q

Deltoid Recommended syringe?

A

1-3 mL

75
Q

Deltoid is used for

A

For Smaller Volumes, Less Irritating Medications (ie: Vaccines, B-12, etc.)

76
Q

How do you landmark a site?

A

Position and secure the arm –
Cleanse the site with alcohol & allow it to dry
Assess syringe integrity
Quickly insert a needle into a selected site - 90 angles to the hub
Injectand remove the needle using recommended guidelines

77
Q

For Deep IM Injections, what are the 1st and 2nd choices?

A

Ventrogluteal
Vastus Lateralis

78
Q

Deep IM Injections
Maximum Vol Recommended

A

3 mL

79
Q

Z Track Method

A

Helps deposit the medication and help minimize the risk of medicine going into other tissues

80
Q

Ventrogluteal and Vastus Lateralis is used for

A

thicker,painful, or irritating meds (Deep IM)

81
Q

Deep IM Injection
Recommended syringe?

A

3 - 5 mL

82
Q

For a Deep IM injection Inject at rate of _______________, withdraw needle then release Z-track

A

1 mL ±10 sec, wait 3-5 sec

83
Q

After injecting the medication, what should you do?

A

withdraw needle at the same angle injected then release Z-track

84
Q

Deep IM Injections
Recommended Needle Length

A

1” to 1 ½”

85
Q

If blood returns with aspiration on an IM injection,

A

DO NOT INJECT – Start Over!

86
Q

Deep IM Technique

A
  • Position patient – lean over table, SIMS
  • Select VG or VL site – Always Rotate Sites
  • Landmark – flex the leg
  • Clean site with alcohol pad– turn over & leave the tip of alcohol pad pointed towards injection site
  • Assess syringe for correct vol. and straight needle
  • Place heel of hand next to the injection site and z-track
    Insert needle quickly 90 degree to hub, 3-5 seconds
    If blood returns with aspiration, DO NOT INJECT – Start Over!
87
Q

How do you correctly landmark ventrogluteal muscle?

A
  • Place your palm on the greater trochanter
  • Thumb to groin
  • Middle finger to iliac crest
  • Pinter finger to iliac spine
    *Between the middle and pointer
88
Q

Avoid what type of muscle? Why?

A

dorsogluteal
- close to major veins, arteries, and nerves

89
Q

Vastus Lateralis is located where?

A

Outer, middle 3rd of the side of thigh

90
Q

Insulin needles are unique in being

A

very fragile and permanently attached to syringe

91
Q

SubQ needle length

A

3/8-5/8”

92
Q

Subcutaneous Injections are used for

A

Insulin
Anticoagulants

93
Q

SQ Injection Rule of Thumb:

A

Injectat a 90°angleif you can “bunch” the skin more than 2”; otherwise, inject ata 45°angle

94
Q

Insulins Types and Needs to Know from Med Sheets

A

Multi-Dose Vials
Short Acting
Intermediate Acting
Long Acting

Know purpose (why and when)
Teaching
Side Effects/Adverse Reactions
Post Injection Responsibilities

95
Q

Insulin Rules of Administration

A

= Before administering, Know/Verify BLOOD GLUCOSE Level or trends and next meal
= Administered in units – never mL!
= Administer all insulins within minutes of preparation
**DO NOT SHAKE - roll in palms to mix evenly **

96
Q

Which medication is last to be withdrawn and first to be given due to fast-acting proteins?

A

Insulin

97
Q

Where is insulin administered?

A

adipose “fatty” tissue of arms, abdomen, back, or thighs

98
Q

Lipodystrophy

A

knots under the skin

99
Q

Do Not aspirate, rub or massage any SQ injections- why?

A

displace the dermis and cause hematoma

100
Q

SQ Insulin injection sites
- What do you avoid?

A

Alternate/Separate injection Sites by at least 1”
Avoid Areas of Bruising or Lipodystrophy –
Avoid linea alba and umbilicus by at least ” away -
Do Not aspirate, rub or massage any SQ injections- why?

101
Q

SQ Insulin Administration

A
  • Obtain correct insulin & corresponding label from Pyxis
  • Draw dose based on verified BS or standing order and attach insulin label to syringe
    – leave insulin vial in pyxis
  • TPCNoftentimeswill ask another nurse toverify med, amount
102
Q

Insulin Administration

A

Select Site, Assess, Cleanse with Alcohol & Allow to Dry
Assess needle and syringe – needle is not bent and fluid in syringe recap
- Bunch the Selected Site
- Typically inject at a 90 angle due to needle size – (to the hub)
– release bunch –
- Wait 3-5 sec & withdraw needle at the same angle
- Do not Aspirate, Rub or Massage –
- Engage safety device and place in Sharps box

103
Q

SQ - Enoxaparin Injection Do’s

A

Always:ABDOMINAL Administration –
Properly position pt first – reclining/supine is always best
Assess abdominal “Love Handle” region
– greater than or equal to 4” from the umbilicus
- Avoid Bruised Inj Sites – Must Rotate Sites!
- Administer DEEP – SQ angle is recommended

104
Q

SQ - Enoxaparin Injection NEVER

A

Aspirate
Administer IM

105
Q

Do not Aspirate orExpel Nitrogen Bubbles in which injection medication

A

Enoxaparin SQ

106
Q

SQ - Enoxaparin Injection

A
  • Select Site, Cleanse with Alcohol & Allow to Dry
  • Bunch During Entire Injection
  • Inject90°angle/Deep SQinto”Love Handle” area – to hub
  • Wait 3-5 sec & withdraw needle at same angle
  • Engage safety device and place in Sharps box
  • Safety Device is Very Different
107
Q

What lab value is important for Enoxaparin and what lab value should you not give it?

A

Platelet count
less than 80,000

108
Q

Enoxaparin SubQ anticoagulant

A

Pre-filled by manufacturer
Cannot change needle
Unique built-in safety mechanism
Strict guidelines for administration
Refer to Med Sheets:
Know why, teaching, side/adverse effects, what labs are important?

109
Q

ID Injection is used for

A

allergy testing and TB testing

110
Q

ID Injections steps

A
  • Select site (free of tattoos (if possible), blemishes, hair, scarring, bruises, etc.)
  • Clean area with Alcohol & Allow to Dry
  • Stretch middle 1/3 of forearm relatively taut
  • Inject at almost parallel angle ( 5-15 degrees)
  • Bevel faces up barely under the skin
  • Inject – must form a “ bleb or wheal”
  • Withdraw and release skin
    Do Not Aspirate, Rub, or Massage! –
111
Q

ID “Bleb or Wheal”

A

Indicates medication has been deposited into the targeted tissue site correctly

112
Q

CDC One and Only Campaign

A

Check Your Steps! Make Every Injection Safe
ManagingPatient Safety, One Injection at a Time
Safe Injection Practices – How to Do It Right
Safe Injection Practices for Healthcare Providers

YouTube CDC Videos: https://www.youtube.com/watch?v=Xsxc2LvMoWs

113
Q

What is the rate of absorption from quickest to slowest?
Vascularity

A

Intravenous
Intramuscular
- Ventrogluteal
- Vastus lateralis
SubCutaneous
Intradermal

114
Q

Parenteral Administration definition

A

any route od administration that does not involve frug absorption through the GI Tract

115
Q

Intradermal Injection angle

A

10-15 degrees (form a “bleb”)

116
Q

Intradermal Injection uses

A
  • TB testing and allergies sensitivity
117
Q

Intradermal Injection needle size

A

25-27 gauge

118
Q

Intradermal Injection usual site

A

inner forearm

119
Q

What type of injection should form a “bleb” when injected?

A

Intradermal

120
Q

Subcutaneous Injection angle
Normal to overweight clients

A

90 degrees

121
Q

Subcutaneous Injection angle
Thin clients

A

45 degrees

122
Q

Subcutaneous Injection uses

A

non-irritating, water-soluble medication
– Insulin and heparin

123
Q

Subcutaneous Injection needle size

A

23-25 gauge

124
Q

Subcutaneous Injection usual site

A

abdomen
posterior upper arm
thigh

125
Q

Intramuscular Injection angle

A

90 degrees

126
Q

Intramuscular Injection uses

A

Irritating, solutions in oils, and aqueous suspensions

127
Q

Intramuscular Injection needle sizes

A

22-25 gauge

128
Q

Intramuscular Injection usual site

A

deltoid
vastus lateralis
ventrogluteal
Z track method

129
Q

Do not inject more than ____ mL in vastus lateralis and ventrogluteal.

A

3

130
Q

Do not inject more than ____ mL into the deltoid.

A

2

131
Q

If the intramuscular injection contains a large volume, what should happen?

A

divide the larger volume into two syringes and use 2 different sites

132
Q

Intravenous Injections uses

A

administering medications, fluids, and blood products

133
Q

Intravenous Injections angle

A

25 degrees used when starting an IV

134
Q

Intravenous Injections needle sizes

A

16 gauge: trauma
18 gauge: surgery and blood administration
22-24 gauge: children, older adults, and patients with medical issues or stable post-op

135
Q

Intravenous Injections usual site

A

medial AC
cephalic
basilic
(hand, wrist, foot, scalp)

136
Q

The 16 gauge needle is used for

A

trauma, surgery, rapid fluid administration (bolus)

137
Q

The 18 gauge needle is used for

A

administering blood, rapid infusions (bolus), CT scans with IV dye

138
Q

The 20 gauge needle is used for

A

medications, routine therapies, IV fluids

139
Q

The 22 gauge needle is used for

A

IV fluids, medications

140
Q

The 24 gauge needle is used for

A

pediatric pts, elderly pts, very fragile and small veins

141
Q

Rapid Insulin Names

A

Generic: Lispro, Aspart, Gluslisine
Brand: Humalog, Novolog, Apidra

142
Q

Rapid Insulin
Onset:
Peak:
Duration:

A

~ 5-30 mins
~ 30-90 mins
~ 3-5 hrs

143
Q

Which insulin is at the highest risk for hypoglycemia?

A

Rapid Insulin

144
Q

Short Reaction Insulin Names

A

Regular
Humulian R, Novolin R

145
Q

Regular Insulin
Onset:
Peak:
Duration:

A

~ 30-60 mins
~ 2-4 hrs
~ 5-7 hrs

146
Q

Regular Insulin is only given through what method

A

IV
Regular goes Right into the vein

147
Q

Intermediate Reaction Insulin Names

A

NPH
Humulin N, Novolin N

148
Q

Intermediate Insulin
Onset:
Peak:
Duration:

A

~ 1-2 hrs
~ 4-12 hrs
~ 18-24 hrs

149
Q

Long Reaction Insulin Names

A

Glargine, Detemir
Lantus, Levemir

150
Q

Long-Acting Insulin
Onset:
Peak:
Duration:

A

~ 1-2 hrs
~ None (lowest risk for hypoglycemia)
~ 24+ hrs

151
Q

Which insulin do you not mix with any other insulin?

A

Long-acting

152
Q

Why is insulin only given SubQ or IV?

A

GI Tract will destroy insulin if given PO

153
Q

If the mixture is cloudy, what type of insulin is it?

A

Intermediate

154
Q

If the mixture is clear, what type of insulin is it?

A

Short

155
Q

What insulin is not given IV?

A

Intermediate

156
Q

Mixing Regular and NPH insulin
** You are Not Retired, you are an RN.**

A

NPH - inject air
Regular - inject air
Regular - withdraw insulin
NPH - withdraw insulin

157
Q

Lipoatrophy

A

loss of subcut fat

158
Q

Insulin is what type of hormone

A

growth

159
Q

What is a gauge?

A

“diameter”

160
Q

Volume Ordered stops at what point in the syringe?

A

leading ring of a rubber stopper

161
Q

What do use when selecting the appropriate syringe and needle?

A

Medication
Volume
Injection site
pt assessment

162
Q

CDC’s Campaign says

A

One Needle
One Stick
One Time

Module 2 (Skills) (12 decks)

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