Parenteral Injections

Question 1

Insulin Classification

Answer 1

Antidiabetic hormone
Controls hyperglycemia in clients with diabetes mellitus
There are many types of insulin that vary in their onset, peak, and duration

Question 2

Insulin Action

Answer 2

Simulates glucose uptake in skeletal muscle and fat
Action times:
SQ onset: 30-60 min
Duration: 5 hr

IV onset: 10-30 min
Duration: 30-60 min

Question 3

Insulin Contraindications

Answer 3

Hypoclycemia

Question 4

Insulin Side Effects

Answer 4

HIGH ALERT MED
Systemic - hypglycermia
Local - erythema, swelling pruritus

Question 5

Insulin RN Implication

Answer 5

Double check med!
Check blood glucose q6h
Symptoms of hypoglycemia = TTTIRED
Tired, 
Tingling in mouth, hands, & feet 
Tachycardia
Irritable
Restless
Excessive hunger
Diaphoresis

Early symptoms of hyperglycemia:
Increased thirst
Increased voiding
Glycosuria
Fatigue
Headache
Blurred vision
Late symptoms: fruity breath, N/V
Lab lookout: Fasting BS is 70-100

Question 6

Heparin Sodium Availability & Common dose

Answer 6

10,000 Units/mL
5,000 Units/mL
1,000 Units/mL

Common dose: 5000 units subcut q8-12hr

Question 7

Heparin Sodium Classification

Answer 7

Anticoagulant

Question 8

Heparin Sodium Action

Answer 8

Prevents thrombus formation in deep veins in legs or in lungs.

Question 9

Heparin Sodium Contraindications

Answer 9

Active major bleeding
Recent history of ulcer disease
Advanced renal disease

Question 10

Heparin Sodium Side Effects

Answer 10

HIGH ALERT MED
Med errors have caused serious patient harm and death
Observe injection sites for hematomas, ecchymosis, or inflammation

Question 11

Heparin Sodium RN Implication

Answer 11

Double Check Med
Assess for signs of bleeding & hemorrhage (bleeding gums; nosebleed; unusual bruising; black tarry stools; hematuria; fall in lab values)
Give injections into subcut tissue. Alternate injection sites daily betweek L&R anterolateral and L&R posterolateral abd wall, or upper thigh.
Inject entire length of needle at 45 or 90 degree angle

Lab lookout: Platelets (normal - 150,000-400,000)
PTT - 30-45 sec
INR = 1-3 sec

Question 12

Gentamicin/Garamycin common dose

Answer 12

Common IM dose: 1-2mg/kg/q8hr

Question 13

Gentamicin Classification

Answer 13

Antibiotic

Question 14

Gentamicin Action

Answer 14

Potent antibiotic usually reserved for more serious, life threatening infections

Question 15

Gentamicin Contraindications

Answer 15

Known Allergy
Renal or Hepatic disease
Pre-existing hearing loss

Question 16

Gentamicin Side Effects

Answer 16

NVD
Ototoxicity - as evident in tinnitus, dizziness, vertigo
Nephrotoxicity - as evident in abnormalities in urinalysis

Question 17

Gentamicin RN Implications

Answer 17

Do baseline C&S test before any antibiotic
Draw Peak & Trough levels during therapy for early detection of toxicity
Monitor for infection improvement or failure to resolve infection
Take full course of treatment
Drink plenty of fluids to decrease chance of nephrotoxicity and report tinnitus or hearing loss
For IM doses - Give in deep well-developed muscle
Alternate sites