Parenteral Med Admin Flashcards
1
Q
3 parts of syringe
A
tip, barrel, and plunger
2
Q
slip tip vs leur lock
A
slip tip= no thread/grooves
leur lock = screws on like light bulb
3
Q
2 parts not touch on syringe
A
- tip without needle on it
2. plunger that will go back into barrel
4
Q
Tuberculin syringe, volume, needle
A
- always 1 ml volume
- needle typically 25 g, 5/8” length (small length and gauge needle)
5
Q
Insulin syringe, measurement
A
- only used to draw up insulin
- measured in UNITS not ml
6
Q
Carpuject
A
- prefilled syringe usually with controlled substance
- usually contains IV meds but can use with IM
7
Q
Shaft of needle
A
length of needle
- colors do coordinate with size but varies by manufacturer
- 5/8, 1, 1 1/4
8
Q
gauge of needle size
A
diameter of needle
- smaller gauge needle = larger diameter
- larger gauge needle = smaller diameter
9
Q
When to use larger gauge needle?
A
-increase viscosity of medication = increase size of gauge (smaller #)
10
Q
Bevel of needle
A
diagonal slant in tip of needly
11
Q
Bevel up =
A
hole facing up
12
Q
when can you recap a needle?
A
-unused , clean needle after draw up med
13
Q
one hand scoop technique
A
- lay cap flat on surface
- insert needle into cap laying flat on surface
- pick up needle and pull cap onto needle until you hear snap
14
Q
blunt fill needles
A
used to fill syringe and draw up med
-not as sharp
15
Q
Needles for drawing up vs administering med?
A
- use blunt needle to draw up med
- switch to appropriate length and gauged needle for administration
16
Q
what does changing between blunt need and administration needle prevent?
A
irritation on patient skin from medication outside of needle
17
Q
when reading the measurement on syringe what do you look at?
A
be in middle of first black line, not the hump
18
Q
Can you lay an uncapped needle down?
A
no, change by holding in hand
19
Q
filter needle
A
mechanism inside to filter glass out from glass ampoule
20
Q
when should you use safety needles?
A
at all times in general patient care
21
Q
example of med in ampoule
A
Vitamin K
22
Q
Ampoule Steps
A
- TAP top to get med below neck
- wrap neck in ALCOHOL WRAPPER or gauze
- break neck AWAY from body
- FILTER NEEDLE inserted into solution, instill air
- invert needle or leave on table
- pull back to dose, remove needle
- tap to remove air
- remove excess air or med
- scoop to recap
- change to ADMIN NEEDLE
- Discard ampoule in SHARPS
23
Q
Which way do you break ampoule?
A
away from you
24
Q
which part of ampoule do you break?
A
neck
25
What is unique about a vial?
Pressurized system that you can instill air into
26
Vial steps
1. remove vial COVERING
2. clean with ALCOHOL swab with FRICTION
3. fill syringe with AIR EQUIVALENT to dose
4. insert needle into MIDDLE of rubber stopper
5. INSTILL AIR
6. INVERT vial while providing stability
7. pull back on plunger to desired dose with tip in fluid
8. remove needle/ tap for air bubble
9. recap with scoop
10. change to ADMIN NEEDLE
11. discard blunt needle to SHARPS
27
reconstituting meds- how to mix it?
follow manufacturer instruction for type of liquid and final concentration
28
Mixed dose insulin- 2 types?
Regular and NPH
29
Mixed dose insulin steps
1. INSTILL air in BOTH vials with vial flat on table to needle in not in liquid, have ANOTHER NURSE CHECK calculation
2. draw up REGULAR insulin , have ANOTHER NURSE CHECK
3. Draw up NPH insulin , have ANOTHER NURSE CHECK
30
which insulin can you push back into vial?
1st, regular
| -if push second in = contamination
31
Regular insulin=
clear
fast acting
"pure"
32
NPH insulin=
cloudy
slow acting
contaminated
33
insulin pens
1. DIAL dose
2. INSERT need SubQ
WAIT UNTIL dial returns to ZERO
3. remove needle from patient once dial at zero
34
Intradermal administration: site, volume, equipment, angle
site: inner forearm
volume: 0.1-0.5 ml
equipment: gloves, tb syringe, needle (26-28 gauge, 1/4-5/8 length), alcohol swab
angle: 5-15 degrees
35
When using an alcohol swab how to clean skin?
circle from inside to out
36
Intradermal needle gauge
26-28
37
intradermal needle length
1/4-5/8
38
Bevel for intradermal?
BEVEL UP
39
Needle should be ____ under skin for intradermal injection
visible
40
What do you create with intradermal injection?
WHEAL
| -if no wheal, start over
41
Intradermal- massage or no massage?
do NOT massage
42
what do you do with used needle after administering to patient?
activate safety feature, place in sharps container immediately
43
Sub Q administration:site, volume, equipment, angle
site: deltoid, 1" lateral from umbilicus, scapula, love handle, front of thigh
volume: up to 1 mL typically (can also use up to 3 mL syringe)
equipment: TB/insulin syringe, needle (25-27 gauge, 1/2-5/8" length), gloves, alc swab
angle: 45 to 90 degrees
44
general steps before any injection:
1. prepare med
2. gather supplies
3. identify site
4. don gloves
5. cleanse site with alcohol swab
45
Which 2 injection methods can have the same syringe and needle size?
Sub Q and intradermal
46
How to administer SuBQ injection
1. BUNCH skin
2. hold needle like DART
3. pierce at 45 or 90 degree QUICKLY
4. do NOT ASPIRATE
5. INJECT med SLOWLY
6. QUICKLY REMOVE
47
Which injection method do you bunch skin for?
Sub Q
48
Sub Q onset
w/in a 1/2 hour
49
Intramuscular Injection site, volume, equipment, angle
site: deltoid, vastus lateralis, ventral gluteal, dorsal gluteal
volume: up to 4 mL depending on muscle
equipment: gloves, 1-5 ml syring, needle 21-25 g, 1-3 inch, alc swab
angle: 90 degree
50
Who is responsible for choosing the needle size and gauge?
Nurse
51
sub q needle size selection below waist vs above waist
below waist = > 1 .25- 1.5"
| above waist = 1"
52
palpating deltoid for injection
- place 3 fingers BELOW ACROMION PROCESS (base)
- imaginary line to AXILLA (point of triangle)
- injection site = center of triangle
53
palpating Vastus lateralis for injection
-1 hand on greater trochanter
-1 hand on knee
-midline of anterior thigh and midline of lateral thigh
injection site = middle third of thigh
54
palpating ventral gluteal for injection
- palm/heel of hand on greater trochanter with thumb pointing to peepee
- index finger on anterior superior illiac spine
- middle finger extended up to iliac crest
- injection site= w/in triangle formed by index and middle finger
55
test for ventral gluteal
place heel on ground and move toes left to right, feel muscle move
56
preferred injection site below waist for IM
ventral gluteal
57
least preferred injection site below wait for IM
dorsal gluteal
58
palpating dorsal gluteal for injection
one hand on trochanter and one hand on posterior illiac spin
-imaginary line /w 2
injection site= 1/2 way on imaginary line above and out
59
When to use dorsal gluteal IM site?
only if directed by manufaturer
60
IM admin
1. pull skin TAUT
2. hold needle like DART
3. INSERT QUICKLY at 90 degree
4. stabilize needle
5. ASPIRATE for blood
6. no blood= SLOW AND STEADY inject med
7. QUICKLY REMOVE
8. SAFETY/SHARPS
9. MASSAGE site with ALC swab
10. remove gloves
61
CDC, immunization, aspiration
CDC says do not have to aspirate for immunizations
62
Ztrack, when to use?
method used w/ irritating medications to decrease pain by trapping medication in muscle
63
Z trak steps
1. DISPLACE skin LATERALLY
2. while holding skin aside DART at 90 degree into skin
3. ASPIRATE
4. no blood = inject slow and steady
5. WAIT 10 SECONDS
6. QUICKLY REMOVE needle
7. cover with swab- NO MASSAGE
8. dispose needle
64
IM Complications
- pain
- damdage to tissue: sterile abscess, hematoma, muscle contraction, bruising, skin discoloration
- nerve damage
- bone injury
- speed shock
- infection
65
when does speed shock occur?
complication from IM injection when medication goes into vein or artery
66
which type of injection do you massage site with alc swab afterwards?
IM
67
Which injections = no massage after
z track, sub q, intradermal
68
intradermal needle gauge
26-28 g
69
intradermal needle length
1/4 - 5/8
70
subq needle gauge
25-27
71
subq needle length
1/2 - 5/8
72
sub q angle admin
45 or 90
73
intradermal angle admin
5-15
74
IM needle gauge
21-25
75
IM needle length
1-3 inch
76
IM needle angle admin
90
77
IM syringe volume
up to 4 mL
78
Sub q syringe volume
up to 1 mL
79
intradermal syringe volume
up to 1 mL
