Parentral Medication

Question 1

Accuracy

Answer 1

Most important in parenteral meds; goes directly into blood stream

Question 2

Right or correct med dose

Answer 2

• Policies requiring another RN to double check certain meds:
• anticoagulants (heparin); vasoactive medications: influence cardiovascular effects

-insulin: independent double check, don’t tell other RN the amount, have them tell you the amount

Question 3

Equipment for parenteral admin

Answer 3

• gloves, alcohol wipe, medication, needle

- syringe: disposable injection units (carpuject) or syringe holder

Question 4

Needles

Answer 4

• hollow; size (length in inches) and gauge (diameter)
• the larger the gauge, smaller the needle (opposites)
• the longer the needle, the farther it goes (all needs have hub and shaft and we need to maintain that sterility)

Question 5

Needle safety

Answer 5

-NO recapping of needles!

Question 6

Vial

Answer 6

• Dry powder: reconstituted - diluent (specific diluent for each powder), do not shake, bubbles (be particular with amount of liquid for correct concentration)
• liquid med: air injected-vial only; single dose or multidose/multiuse - alcohol swab -date, time, initial once it’s opened

Question 7

Ampules

Answer 7

• glass
• filter needle
• Safety
• tap top of ampule

Question 8

Types of injections

Answer 8

• Skin (intradermal-ID) 15 degree angle
• Subcutaneous SC 45 degrees
• Muscle (Intramuscular, IM) - 90 degrees
• Intravascular (IV - next semester)

Question 9

Technique and Site selection to minimize risks

Answer 9

• fibrosis; nerve, bone, blood vessel damage

- abscess; tissue necrosis; muscle contraction; gangrene; pain

Question 10

Intradermal

Answer 10

• small volume - TB syringe
• small needle size (25-27) gauge
• length short
• Uncommon for staff nurses
• BLEB forms: only way it’s effective

Question 11

Subcutaneous

Answer 11

• Recommend in abdomen only (Insulin and Haparin & Lovenox)
• All sites: Vaccines
• injections: 45-90 degree angle; syringe appropriate to amount; size: 25 gauge (or smaller, 27 29); length: 3/8 to 5/8 inch long

Question 12

Intramuscular

Answer 12

• Always go in 90 degrees

- Deltoid: acromion process

Question 13

Deltoid

Answer 13

• small dose as muscle not well developed
• fluid volume: no more than.5 to1 mL
• 90 degree angle
• Size: 23-23 gauge
• Length: 1 inch
• Most common: immunizations

Question 14

Ventrogluteal

Answer 14

• preferred for adults
• stretch fingers up toward iliac crest; make a triangle between first 2 fingers and it’s right over the muscle and where you should inject
• gluteus medius and minimus / ileac spine
• deep and away from major nerves and blood vessels
• Larger muscle - more volume of med - 1 to 3 mL/injection for average, well nourished adult
• 90 degrees; size: 21-22 gauge; length: 1.5 inches

Question 15

Vastus Lateralis

Answer 15

• preferred for children
• Muscle thick and well developed
• Middle third of the muscle
• .5 to 2 mL volume; 90 degrees
• ADULTS: size: 21-22 gauge; length: 1-1.5 mL
• PEDS: size: 22-25 gauge; length: 5/8 to 1 inch

Question 16

Choosing the right equipment is the nurse’s job

Answer 16

-Look at your patient - size, muscles, subq tissues
-Medication: volume, viscosity
Determine: syringe size, needle gauge, needle length, location for injection, technique / angle of injection

Question 17

Special techniques with IMs

Answer 17

• Z track: seals medicine in muscle tissue, prevents irritation and discoloration of subq tissue
• Air lock: less irritating with needle withdrawal; only a few meds (lovenox, synthetic heparin); will say on package do not remove air bubble