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Skills Lecture > skills lecture 7 > Flashcards

skills lecture 7 Flashcards

1
Q

to safely and accurately administer medications, you need knowledge related to what

A

-legal aspects of health care
-pharmacology/pharmacokinetics
-life sciences
-pathophysiology
-human anatomy
-mathematics

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2
Q

legal aspects of health care in regards to medication administration

A

scope of practice
controlled substance regulations

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3
Q

pharmacology/pharmacokinetics in regards to medication administration

A

how the medication works

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4
Q

life sciences in regards to medication administration

A

how medications work in the body
how underlying issues have an impact on medications

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5
Q

pathophysiology in regards to medication administration

A

how medications work in the body
how underlying issues have an impact on medications

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6
Q

human anatomy in regards to medication administration

A

how to safely give a medication

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7
Q

mathematics in regards to medication administration

A

how to calculate doses

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8
Q

what are the three types of drug names

A

-chemical
-trade
-generic

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9
Q

provides the exact description of medications composition that is rarely used in nursing

A

chemical name

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10
Q

the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. pharmacopeia

A

generic name

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11
Q

also known as brand or proprietary name this is the name under which a manufacturer markets the medication

A

trade name

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12
Q

Effect of medication on body system, Symptoms the medication relieves, Medication’s desired effect are examples of what

A

classification of a medication

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13
Q

what is the classification for lisinopril?

A

treatment for htn

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14
Q

what is a combination medication

A

a medication that includes two or more active ingredients combined in a single dosage form

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15
Q

how are combination drug names listed on medications packs?

A

list the trade name followed by the generic name of each drug

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16
Q

how is the dosage listed for a combination medication

A

in order of the generic names listed

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17
Q

norco

A

hydrocodone-acetaminophen

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18
Q

percocet

A

oxycodone/acetaminophen

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19
Q

the passage of medication molecules into the blood from the site of administration

A

absorption

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20
Q

factors that influence absorption

A

-route of administration
-ability of a medication to dissolve
-blood flow to the site of administration
-body surface area

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21
Q

exercise and heat can increase blood flow to a site, speeding up and increasing what

A

medication absorption

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22
Q

why does parenteral medications absorb quicker than oral medication

A

because it goes in the blood and not in the stomach

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23
Q

what is pharmacokinetics

A

a drugs journey through the body

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24
Q

what are the pharmacokinetics of medication actions

A

-absorption
-distribution
-metabolism
-excretion

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25
Q

how medication is moved through the body

A

distribution
circulation

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26
Q

medications are _________ into a less-potent or an inactive form

A

metabolized

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27
Q

what organ is important in medication metabolism

A

liver

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28
Q

if there is decreased liver function medication will not be metabolized and can cause what

A

toxic affects

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29
Q

excretion of medications occurs through what?

A

kidney and bowels

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30
Q

if kidneys are not filtering out the medication what happens to it?

A

it stays in the blood

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31
Q

what tests can be ran to determine if the kidneys are filtering out medications

A

egfr

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32
Q

how does age affect drug-receptor interaction

A

brain receptors become more sensitive making psychoactive drugs very potent

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33
Q

how does age affect circulation of medication

A

vascular nerve control is less stable

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34
Q

how does age affect metabolism of medication

A

liver mass shrinks, hepatic blood flow and enzyme activity decline.
metabolism drops to one-half to two-thirds the rate of young adults
enzymes lose ability to process some drugs thus prolonging drug half-life

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35
Q

how does age affect absorption of medication

A

gastric emptying rate and gastrointestinal motility slows. absorption capacity of cells and active transport mechanism decline

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36
Q

how does age effect excretion of medication

A

in kidneys, renal blood flow, glomerular filtration rate, renal tubular secretion and reabsorption and number of functional nephrons decline. blood flow and waste removal slow. age-related changes lengthen half-life for renally excreted drugs. antidiabetic drugs, among others stay in the body longer

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37
Q

how does age affect distribution of medication

A

lean body mass falls. adipose stores increase. total body water declines, raising the concentration of water-soluble drugs, such as digoxin, which can cause heart dysfunction. plasma protein diminishes reducing sites available for protein bound drugs and raising blood levels of free drugs

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38
Q

types of medication actions (9)

A

-therapeutic effect
-adverse effect
-side effect
-toxic effect
-allergic reaction
-medication interactions
-medication tolerance
-medication dependence
-psychological dependence

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39
Q

what do we expect the medication to do, expected or predictable outcome

A

therapeutic effect

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40
Q

unpredicted outcome or undesired outcome

A

adverse effect

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41
Q

predictable secondary undesirable response

A

side effects

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42
Q

accumulation of the medication in the blood stream, undesirable affect

A

toxic effect

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43
Q

adverse effects that cannot be explained by the known mechanisms of action of the drug, do not occur in most patients, and develop mostly unpredictably in susceptible individuals only

A

idiosyncratic reaction

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44
Q

who is at risk for toxic effects of medication and why?

A

older adults because everything slows down

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45
Q

unpredictable medication reaction

A

allergic reaction

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46
Q

one medication modifies the action of another

A

medication interactions

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47
Q

more medication is required to achieve the same therapeutic effect

A

medication tolerance

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48
Q

the body needs it

A

medication dependence

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49
Q

the body thinks you need the medication

A

psychological dependence

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50
Q

if a patient has an allergic reaction to a medication what does the nurse need to do

A

-assess
-assess respiratory
-document
-notify provider

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51
Q

A postoperative patient is receiving morphine sulfate via patient-controlled analgesia (PCA). The nurse assesses that the patient’s respirations are depressed. The effects of the morphine sulfate can be classified as:
A. allergic.
B. idiosyncratic. SPECIFIC GROUP OF PEOPLE
C. therapeutic.
D. toxic. BECAUES THE PT IS GETTING TOO MUCH AND IT IS DEPRESSING THE RESPIRATORY

A

d toxic

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52
Q

polypharmacy

A

-takes two or more medications to treat the same illness
-takes two or more medications from the same chemical class
-uses two or more medications with the same or similar actions to treat several disorders simultaneously
-mixes nutritional supplements or herbal products with medications

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53
Q

who determines the medication the patient needs, places the order for the medication

A

provider

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54
Q

what info does the provider need to include on an order

A

-patients name
-order date
-medication name
-dosage
-route
-time of administration
-drug indication
-prescriber’s signature

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55
Q

types of orders

A

-standing or routine
-prn
-single
-stat
-now
-prescriptions

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56
Q

administered until the dosage is changed or another medication is prescribed

A

standing or routine

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57
Q

given when the patient requires it

A

prn

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58
Q

given one time only for a specific reason

A

single one time dose

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59
Q

given immediately in an emergency

A

stat

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60
Q

when a medication is needed right away but not stat

A

now

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61
Q

medication to be taken outside of the hospital

A

prescriptions

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62
Q

who prepares and distributes medication

A

pharmacists

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63
Q

what are a nurses role for medications

A

-determines medications ordered are correct
-ensure medication to be administer is correct
-determines medication timing
-administers medications correctly
-closely monitors effects
-provides patient teaching

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64
Q

can you delegate medication administration to assistive personnel?

A

no

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65
Q

can you hand medication to patient then leave the room?

A

no

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66
Q

who can you delegate medication pass to?

A

another RN

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67
Q

if you think it is not safe to give a medication what should you do?

A

hold medication and contact dr

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68
Q

when medications are given more than once a day, it is important they are what?

A

spaced out evenly

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69
Q

scheduled medications are to be given what times?

A

at specific times

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70
Q

what is the time window medications can be given?

A

one hour before and one hour after it is scheduled

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71
Q

use critical thinking and organization skills to group medication administration ________ if possible

A

together

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72
Q

medications that can be given so many times a day, that is dependent on the order and can be found on the mar

A

prn medications

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73
Q

when preparing to administer a prn medication it is important to determine what?

A

when the last time it was given

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74
Q

any preventable event that may cause inappropriate medication use or jeopardize patient safety

A

medication error

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75
Q

when a med error occurs what do you need to do

A

-first asses the patients condition, then notify the health care provider
-when the patient is stable, report the incident
-prepare and file an occurrence or incident report

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76
Q

do you need to report near misses and incidents that cause no harm?

A

yes

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77
Q

examples of medication errors

A

-wrong dose
-wrong patient
-wrong time
-wrong medication
-expired medication
-wrong preparation
-wrong route
-forgetting to sign off correctly
-signing off before the patient takes the medication
-signature without credentials
-not verifying the controlled substance count on the correct log
-not signing out the controlled substance on the correct log

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78
Q

if a nurse experiences a problem reading a physicians medication order, the most appropriate action will be to

A

call the physician to verify the order

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79
Q

seven rights of medication administration

A

-medication
-dose/amount
-patient
-route
-time
-documentation
-indication/reason

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80
Q

what are the patients rights of medication administration

A

-to be informed about a medication
-to refuse a medication
-to have a medication history
-to be properly advised about experimental nature of medication
-to receive labeled medications safely
-to receive appropriate supportive therapy
-to not receive unnecessary medications
-to be informed if medications are part of research study

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81
Q

if a patient refused a medication what are the next steps

A

-ask why and find out the problem and see if there is a way to fix it, educate, document

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82
Q

Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following?
A. Medication before administering it.
B. Medication after administering it.
C. Rationale for administering it.
D. Prescriber rationale for prescribing it.

A

b medication after adminstering it

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83
Q

control substances scheduled

A

schedule I
schedule II
schedule III
schedule IV
schedule V

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84
Q

examples of schedule I drugs

A

heroin
marijuana
ecstasy

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85
Q

examples of schedule II drugs

A

vicodin
cocaine
methamphetamine
methadone
dilaudid
oxycontin
fentanyl
adderall
ritalin

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86
Q

examples of schedule III drugs

A

tylenol with codeine

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87
Q

examples of schedule IV drugs

A

ativan
ambien
tramadol

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88
Q

examples of schedule V drugs

A

lyrica

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89
Q

medications that have the potential for abuse and have a high safety concern when adminstering

A

controlled substances

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90
Q

what are the controlled substances that will be on med pass that we need to know

A

-tramadol
-hydrocodone
-oxycodone
-ativan (lorazepam)
-norco (hydrocodone with acetaminophen)
-percocet (oxycodone with acetaminophen)

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91
Q

lorazepam

A

ativan

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92
Q

hydrocodone with acetaminophen

A

norco

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93
Q

oxycodone with acetaminophen

A

percocet

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94
Q

as soon as you access a controlled substance for a patient you must verify what

A

the count

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95
Q

what do you document on the controlled substance log

A

current count
amount popped
date
time
initials

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96
Q

when do you document on the controlled substance log?

A

when you pop the medication

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97
Q

when documenting on the controlled substance log what are you indicating?

A

that you have pulled and dispensed a controlled substance

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98
Q

documenting on the controlled substance log does not indicate what?

A

that the patient took the medication

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99
Q

if you have to waste a controlled substance what must occur

A

another nurse must witness and sign off on it

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100
Q

rules on wasting medications will depend on what

A

the facilities procedure

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101
Q

do not leave medication cart before you ________ it is the correct medication

A

verify

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102
Q

when comparing the controlled substance log with the medication in hand what must the nurse look at to ensure accuracy?

A

-patients name
-patients dob
-medication name
-medication dose
-medication route

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103
Q

you do not perform _______ with the controlled substance log

A

tramped

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104
Q

common over the counter medications found in nursing homes

A

community medications

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105
Q

if you place a community medication cap of a bottle face down what does this cause

A

asepsis issues

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106
Q

medications that cannot be crushed

A

-extended release
-sustained release
-delayed release
-enteric coated
-timed release
-controlled release

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107
Q

why should you not crush time released medications

A

they are designed to slowly release medication and crushing them can be harmful

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108
Q

what do you do if some medications can be crushed and some cannot?

A

a consult to see if medication can be changed to a liquid

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109
Q

how can you administer medications that cannot be crushed in a way the patient can easily take them?

A

put it in pudding or applesauce to see if they can swallow it or see if it comes in liquid

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110
Q

when preparing a patients medication what should you ask them?

A

their preference on how they like their medications

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111
Q

what is a reason pills will be split?

A

medication dose is lower than medication strength

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112
Q

whats the smallest you should split a medication?

A

in quarters

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113
Q

acronym followed to ensure the seven rights of medication administration are covered each and every time a medication is passed

A

tramped

114
Q

what are you comparing when doing the tramped process

A

the mar and the medication pack

115
Q

how many times is the tramped process performed

A

3 times

116
Q

what is apart of a medication order but not apart of the tramped process

A

frequency and allergies

117
Q

when the medication is a scheduled medication there is not need to mention the ________

A

frequency

118
Q

when is frequency of a medication vital to discuss?

A

when giving a prn medication

119
Q

medication administration steps

A

-before administering medications always assess the patient first
-make sure the patient is awake and alert, and ready for their medication
-get a set of vitals and an overall general survey
-go to the nurses station to prepare for medication pass
-check orders/mar before getting medication
-collect appropriate medications for the time
-collect all appropriate supplies
-perform tramped process twice by yourself
-get instructor for third tramped
-perform tramped for the last time with the instructor present

120
Q

in a long-term care setting if it is time for mr bobs morning medications what would you ideally do?

A

get him up and out of bed for medications

121
Q

what supplies might you need for medication administration

A

-cup
-straw
-medication cup
-water
-spoon
-applesauce
-pudding
-crusher
-pill splitter

122
Q

why do we want to do full set of vitals and head to toe or general survey before giving meds

A

to determine what medications are appropriate to give for the patients current condition

123
Q

after medications are prepared what are your next steps in the medication administration process

A

-after 3 tramped process prep the med
-once all meds are prepper and ready to go clean the area
-gather necessary supplies and go to patient
-ask name, date of birth and allergies before medication administration
-verify with mar
-educate patient on what you are giving them
-administer medications
-document administration

124
Q

never leave medications __________

A

unattended

125
Q

document on mar _________ after patient takes med

A

immediately

126
Q

when will you document on narrative charting?

A

when a patient refuses medication or you have to hold a medication due to a finding during vitals or assessment
-if giving a prn medication

127
Q

how do you document a PRN medication

A

on narrative charting with DAR
-what lead up to pt getting prn med
-when prn med was given
-the results of the prn medication

128
Q

how do you document a refusal of medication on the mar

A

initial spot on mar, circle it

129
Q

when you are paper charting on MAR what are things to remember

A

-it is a legal piece of documentation
-no erasable pens
-must be legible and correct
-initial box for correct date/time
-ensure full name, credentials and initials are on the mar signature box

130
Q

how would you document a prn med being given on the MAR?

A

-initial in box for correct date and prn frequency administered
-include time administered

131
Q

if an error is made on a MAR how should you correct it?

A

cross it out, initial and then write the correct info next to the error

132
Q

never use ______ on a mar to correct a mistake

A

white out

133
Q

select medications for administration at a certain time

A

scheduled medications

134
Q

how do you document a scheduled medication on electronic MAR

A

-select medication for administration, ensure correct date/time
-click option for “administer”
*this will be different for all systems

135
Q

how do you document prn medications on electronic mar

A

-select medication for administration, ensure correct date/time
-select reason why medication is being given

136
Q

because you are using your personal login for electronic MAR your name and credentials is

A

already included with your username attached

137
Q

never use _______ ________ log on to sign off medications

A

another individuals

138
Q

if you notice a trend with your resident and medication refusal what should you do

A

ask your resident if they will take their medications before you go prep them all

139
Q

if a patient with dementia initially refuses medications what shoudl you do

A

try a different approach
walk away and come back

140
Q

if a resident with dementia doesnt know their name dob or allergies what should you do

A

still ask them
then verify with instructor or staff member

141
Q

5 keys to medication accuracy

A

-avoid
-administer
-document
-use
-check

142
Q

explain avoid of keys to medication accuarcy

A

avoid distractions and follow the same routine

143
Q

explain administer of keys to medication accuracy

A

administer only medications you prepare and never leave prepared medications unattended

144
Q

explain document of keys to medication accuracy

A

document medications immediately after administration

145
Q

explain use of keys to medication accuracy

A

use clinical judgement in determining the nest time to administer prn medications

146
Q

explain check of keys to medication accuracy

A

when preparing medications check the medication container label against the medication administration record three times

147
Q

what order should you tramp medications in?

A

the order of the mar

148
Q

routes of medication administration

A

-by mouth
-sublingual
-buccal
-topical
-nasal inhalation
-oral inhalation
-ophthalmic
-suppository
-intramuscular
-intravenous
-subcutaneous

149
Q

what is the easiest and most desired route of medication administration

A

oral

150
Q

when would oral medication administration be avoided?

A

-GI issues
-pt cant swallow
-pt unconscious

151
Q

food can sometimes affect medication ________ when taken orally

A

absorption

152
Q

when giving oral medications what position should patient be in

A

high fowlers

153
Q

types of oral meds

A

-solids/pills
-liquids

154
Q

medications that are delivered orally but not swallowed

A

-sublingual
-buccal

155
Q

sublingual and buccal medications are absorbed where

A

directly into the blood through the oral tissue

156
Q

where does a sublingual medication go

A

under the tongue

157
Q

where does a buccal medication go

A

in the cheek

158
Q

medications that are applied to the skin providing local effect and absorbs slowly

A

topical

159
Q

types of topical medications

A

-ointments
-lotions
-paste
-transdermal patch

160
Q

what should you do before applying a topical medication

A

clean and dry skin

161
Q

how to apply a transdermal patch

A

-assess skin
-when applying a transdermal patient ask the patient if they have an existing patch on
-apply gloves before old patch removal and new patch application
-remove old patch before applying new patch
-cleanse old area and new area
-apply new patch in a different location
-document the location of the new patch
-date time and initial the new patch

162
Q

topical medication should not be put on skin that has what

A

compromised integrity

163
Q

medication inhaled through nostrils for local effect

A

nasal inhalation

164
Q

what are nasal inhalation medications administered for

A

-nasal congestion
-allergies
-sinus issues

165
Q

nasal inhalation medications do not have any effect on the ________ and _______

A

lungs and bronchioles

166
Q

how to administer nasal inhalation medications

A

-help pt into upright position with head tilted slightly forward
-instruct or assist pt to insert tip of nasal spray into appropriate nares and occlude other nostril with finger
-point spray tip toward side and away from center of nose
-have patient spray medication into nose while inhaling through nose
-help patient remove nozzle from nose and instruct to breathe out through the mouth
-offer facial tissue to blot runny nose but caution patient against blowing nose for several minutes

167
Q

medication route inhaled through mouth for medication to enter lung tissue

A

oral inhalation

168
Q

types of inhalers

A

-metered dose inhalers
-dry powder inhalers

169
Q

the use of metered-dose inhalers requires hand ______ and ________ coordination

A

-strength
-hand-breath

170
Q

if a patient does not rinse their mouth out after using inhaler what can it cause

A

thrush

171
Q

how long does a nebulized mist treatment take

A

10-15 minutes

172
Q

what to remember when giving ophthalmic medications

A

-avoid the cornea
-avoid touching eye or eyelid with droppers or tubes
-avoid placing drops to inner or outer corners of the eye

173
Q

where should you administer ophthalmic medication

A

in the conjunctival sac

174
Q

how do you administer ophthalmic medications

A

-hand hygiene
-don gloves
-tilt patients head back
-pull down lower lid
-administer drops in the conjunctival sac

175
Q

medications that exert local effects when administered

A

suppositories

176
Q

two places suppositories’ can be inserted where

A

-vaginal
-rectal

177
Q

what position does patient need to be in for vaginal suppository insertion

A

dorsal recumbent position

178
Q

what position does patient need to be in for rectal suppository insertion

A

lateral sims

179
Q

enema administration steps

A

-explain the procedure, positioning, precautions to avoid discomfort and length of time necessary to retain the solution before defecation
-position patient in left sims
-insert tip
-administer slowly

180
Q

a patient will most likely experience ________ when getting an enema

A

cramping

181
Q

a blood glucose level should be done before adminstering what

A

insulin

182
Q

what is a normal blood glucose level?

A

74-106

183
Q

what is a critically high blood glucose level

A

450

184
Q

what is a critically low blood glucose level

A

40

185
Q

necessary equipment needed to obtain a blood glucose level

A

-gauze - at least two
-alcohol prep pad
-lancet
-glucometer
-test strip

186
Q

steps to take a blood glucose level

A

-clean hands
-choose site to puncture
-clean site and let it dry
-instruct pt not to move
-insert test strip in glucometer
-don gloves
-hold area to be punctured in dependent position
-stick site with lancet
-lightly squeeze around puncture site until drop of blood is formed
-wipe first drop with gauze
-lightly squeeze around puncture site again until blood has formed
-collect blood using test strip
-interpret appropriately
-place lancet in sharps and throw trash

187
Q

when should you document blood glucose level in the patients chart and why

A

immediately so you can verify why you gave the amount of insulin you did

188
Q

distribution of medication directly into systematic circulation

A

parenteral

189
Q

when is parenteral route used over other routes

A

-when oral routes are contraindicated
-more rapid absorption is needed

190
Q

parenteral medical asepsis techniques

A

-hand hygiene
-gloves during administration
-clean skin with alcohol prep in a circular motion

191
Q

how should you clean the area of skin you are injecting into?

A

start at the center of the injection site and rotate outward in a circular direction for approximately 2 inches

192
Q

reasons you should use oral route instead of parenteral route

A

-least invasive
-less infection rate
-cheaper

193
Q

four major sites of injection

A

-subcutaneous
-intramuscular
-intradermal
-intravenous

194
Q

if a patient is injected routinely the sites must be rotated why

A

-maintain appropriate skin and tissue integrity
-decrease infection risk

195
Q

ways to make sure different injection sites are being used

A

-ask patient where last shot was
-check the mar for where it was given
-alternate the sites

196
Q

if you do an injection in the same spot every time what can it cause

A

tissue atrophy

197
Q

place the four major injection sites in order of fasted to slowest absorption rate

A

-intravenous
-intramuscular
-subcutaneous
-intradermal

198
Q

equipment required for an injection

A

syringe
blunt needle
injection needle
alcohol pad
gauze
bandaid

199
Q

types of syringes

A

-luer-lok
-non-luer-lok

200
Q

parts of a needle

A

-hub
-shaft
-bevel

201
Q

which part of a syringe is considered sterile and what should you not do to it

A

plunger and do not touch it with bare hands

202
Q

what length of needle is used for subcutaneous and intradermal injections

A

3/8 to 5/8 inches

203
Q

what length of needle is used for intramuscular injections

A

-1 inch to 1 1/2 inches

204
Q

once the injection is complete, the priority is to activate the safety with ______

A

one hand

205
Q

what needle should be used to draw medication out of ampules

A

blunt filter needle

206
Q

to place a needle in the sharps container put it in using _________ only with needle facing ______ or _______

A

one hand
down
away from you

207
Q

how are facilities charged for removal of sharps

A

by weight

208
Q

always use _____ when analyzing volume in a syringe never use _____

A

decimals
fractions

209
Q

each injection route differs based on the types of what

A

tissues the medication enters

210
Q

before injecting know:

A

-the volume of medication to be administered
-the characteristics and viscosity of the medication
-the location of anatomical structures underlying the injection site

211
Q

how can you minimize patient discomfort during an injection

A

-use a sharp-beveled needle in the smallest suitable length and gauge
-position patient comfortably as possible to reduce muscular tension
-select the proper injection site using anatomical landmarks
-divert the patients attention from the infection through conversation using open-ended questions
-insert the needle quickly and smoothly to minimize tissue pulling
-hold the syringe steady while the needle remains in tissues
-inject the medication slowly and steadily

212
Q

if you do not administer injections correctly, what occurs

A

negative patient outcomes

213
Q

failure to select an injection site in relation to anatomical landmarks results in what during needle insertion

A

nerve or bone damage

214
Q

inability to maintain stability of the needle and syringe unit can result in what

A

-pain
-tissue damage

215
Q

injecting too large a volume of medication for the site selected causes what

A

-extreme pain
-local tissue damage

216
Q

steps in preparing an injection from a vial using blunt needle

A

-perform hand hygiene
-check expiration date
-remove cap from vial
-connect blunt needle to syringe
-draw up air
-remove cap correctly
-with vial on hard surface insert the needle into the top of the vial
-inject air from syringe into the vial
-turn vial and needle upside down and bring to eye level and draw meds up
-verify amount with instructor
-place vial on hard surface and carefully pull syringe from the vial
-slide needle into cap using swoop method
-twist off blunt needle place in sharps
-replace blunt needle with an appropriate size needle for injection

217
Q

controlled substances are meds that have a potential for ____ and have a high ________ when administered

A

abuse
safety concern

218
Q

preparing an injection from a vial without changing the needle

A

-perform hand hygiene and gather supples
-check expiration date
-remove cap from vial or clean it
-draw up same amount of air as volume you will draw up
-remove needle cap correctly
-with vial on a hand surface, insert the needle into the top of the vial
-inject air from syringe into the vial
-turn vial and needle upside down bring vial and needle to eye level
-draw up med
-verify amount with instructor
-place vial onn hard surface carefully pull syringe from the vial
-slide needle into cap using swoop method
-administer injection

219
Q

a glass container with medication in it

A

ampule

220
Q

how many doses are in an ampule

A

single dose

221
Q

if you dont use all medication in an ampule what do you do with it

A

discard it

222
Q

some medications are placed in ampules because they cannot come in to contact with what

A

rubber stopper on vials

223
Q

where do you discard of an ampule vial

A

sharps container

224
Q

when preparing an injection from an ampule vial how does it differ from a regular vial

A

you do not need to inject air because the ampule is open to air already

225
Q

degree that you give intramuscular injection

A

90 degrees

226
Q

degree that you give subcutaneous injections

A

45 degrees or 90 degrees

227
Q

degree that you give intradermal injections

A

15 degrees

228
Q

before doing an injection you must always do what

A

perform hand hygiene and don gloves

229
Q

when doing an injection you must _______ the location on patient

A

stabilize

230
Q

what do you need to do after you stabilize locationon patient but before you perform injection

A

clean site thoroughly

231
Q

injection that occurs in the fatty layer of skin below the dermis and above the muscle

A

subcutaneous

232
Q

needle length used for a subcutaneous injection

A

3/8 to 5/8

233
Q

needle gauge for subcutaneous injection

A

25 or 27 gauge

234
Q

if you can grab _____ inches of tissue you can use 90 degree angle for subcutaneous

A

2

235
Q

medications administered subcutaneously

A

insulin
heparin
lovenox (enoxaparin)

236
Q

subcutaneous injection sites

A

-upper arms
-lower back
-upper back
-lower abdomen
-upper legs

237
Q

when performing a subcutaneous injection do not stop what

A

squeezing the fatty area until the injection is completed after you cleaned the area

238
Q

subcutaneous injection must be given two inches away from the ________

A

umbilicus

239
Q

subcutaneous injection pens things to know

A

-every patient receives their own pen
-twist on a new needle with each administration
-dial in correct amount of medication vs drawing up

240
Q

using a subcutaneous injection pen reduces what

A

risk of error

241
Q

when injecting subcutaneous injection with pen how do you inject it

A

inject slowly and steadily and after hearing the click count to 5 to deliver the full dose

242
Q

enoxaparin

A

lovenox

243
Q

which route is lovenox given

A

subcutaneous

244
Q

where is lovenox administered on the body

A

the abdomen only

245
Q

when injecting lovenox subcutaneously you must inject what so it forces the medication deeper into the tissue

A

air bubble

246
Q

when you have given a lovenox injection you remove needle from patient and then what

A

turn it away from the patient and point need at the wall then push the plunger hard to activate the safety

247
Q

common intramuscular injections

A

-vaccines
-antibiotics
-sedatives
-steroids

248
Q

volume amount for injection depends on ______ and _______used

A

patient
site

249
Q

gauge size for intramuscular injections

A

21 to 25 gauge

250
Q

performed with large muscle groups to prevent leakage of medication into sensitive tissues

A

z-track method

251
Q

when is z-track method used

A

when a patient tells you they have irriation with medications

252
Q

what medication is given im vastus lateralis in adults

A

epinephrine

253
Q

what does the z track method do to the muscle

A

seals medication in the muscle and minimizes irritation

254
Q

how many inches do you pull the skin over for z track method

A

1 to 1 1/2 inches

255
Q

IM injection sites

A

-deltoid
-vastus lateralis
-ventrogluteal

256
Q

where is deltoid injection given on the body

A

arm

257
Q

where is the vastus lateralis injection given on the body

A

leg

258
Q

here is the ventrogluteal injection given on the body

A

buttocks

259
Q

when selecting an IM injection site consider the following

A

-is the area free of infection or necrosis
-are there local areas of bruising or abrasions
-what is the location of underlying bones, nerves and major blood vessels
-what volume of medication is to be administered

260
Q

pros for using the deltoid muscle

A

easily accessible

261
Q

cons for using deltoid muscle for injection

A

not well developed in adults
risk for coming in to contact with nerves and arteries

262
Q

volume that can be given in the deloid injection

A

less than 2ml

263
Q

what landmark do you go off of for a deltoid injection

A

acromion process

264
Q

injection point of a deltoid is ______ below acromion process

A

1 to 2 inches

265
Q

where is the ventrogluteal injection given

A

gluteal medius muscle

266
Q

pros of using ventrogluteal injection site

A

-deep miscle, away from major nerves and blood vessels
-preferred and safest site for all adults childen and infants

267
Q

cons of using vventrolgluteal injection site

A

-can be difficult to access
-patient may be hesitant

268
Q

hat volume can be administered with a ventrogluteal injection

A

5 ml

269
Q

index and ring finger will form a v shaped triangle with what body landmark

A

iliac crest

270
Q

vastus lateralis injection technique

A

-fully expose the patients leg
-to help relax the muscle, ask the patient to lie flat with the knee slightly flexed and foot externally rotated or to assume a sitting position
-anterolateral aspect of thigh
-hand breadth above the knee to a hand breadth below the greater trochanter of the femur
-use the middle third of available area to inject

271
Q

these injections are used for skin testing

A

intradermal

272
Q

what skin testing is done using intradermal route

A

tb
allergies

273
Q

skin testing requires the nurse to be able to clearly see the injection site for _______

A

changes

274
Q

location of intradermal injections

A

choose skin testing site that allows you to easily access for changes in color and tissue integrity
-need to be lightly pigmented free of lesions and relatively hairless
-inner forearm and upper back are ideal locations

275
Q

what size gauge do you need to use for intradermal injecion

A

25 or 27

276
Q

what length of needle is used for an intradermal injection

A

3/8 to 5/8 inch

277
Q

bevel should be facing which way when giving an intradermal injection

A

up

278
Q

what do you need to do after you administer medication

A

follow up and assess

279
Q

how long after giving an oral med do you need to reassess patient

A

30 minutes to an hour

280
Q

how long after giving a parenteral medication should you reassess

A

within 30 minutes

Skills Lecture (7 decks)

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