subq and intramuscular injections Flashcards
what forms do parenteral meds come in
liquid or powder
powder must be reconsituted
what are some supplies used for injections
-syringe
-ampules
-vials
-cartidges
-pens
-prefilled syringes
where should you draw up medications
at the bedside, immediately prior to administration
will need barcode on vial
who administers the medication?
only the person who prepares the medication
should you leave meds at the bedside?
nope
how do you dispose of unused meds?
per policy
after administering a med, what do you do with the needle?
immediately engage the safety mechanism and dispose use equipment in sharps container
describe parenteral med administration
-invasive
-sterlie/aseptic technique
-requires precise calculation of the dose
-requires accurate site identification
-requires careful technique
-provides rapid response
what are the med administration essentials?
-triple check
-three checks
-six rights
-patient rights
-pre administration assessment
-evaluation
describe the process of withdrawing meds from a vial
-disinfect stopper on the vial
-pull back plunger on syringe equal to the desired amount of fluid
-remove cap from needle, place on table
-pierce stopper with the needle using a 90 degree angle
-keep the tip of the needle in the air at the top of the vial
-inject air into the vial. keep thumb on plunger
-invert the vial and syringe, keeping thumb on the plunger
-retract needle, so that it remains in the fluid
-aspirate the plunger to withdraw the desired amount of fluid
describe mixing medications
-determine compatibility of the medications
-do not contaminate one medication with the other
-ensure the final dose is accurate
-mainatin aspetic technique
what should NPH insulin look like?
cloudy
if its not, roll vial between palms
what happens if you overdraw while mixing medications?
discard and start all over
what order should you draw up the meds when mixing regular insulin and NPH?
regular first, then NPH
describe minimizing discomfort when giving injections
-use smallest suitable needle
-position client comfortably
-select proper site
-use distraction as appropriate
-stabilize the skin
-hold syringe steady
-insert the needle quickly and smoothly
-inject the medication slowly
angle of injection
intramuscular
90 degrees
angle of injection
subQ
-45 degrees or 90 degrees
-depends on the length of the needke and amount of subQ available
angle of injection
intradermal
15 degrees
what syringe is used for subQ injections
insulin
1-3ml syringe
what needle is used for subQ injections
-often pre-attached to syringe
-gauge 25-31
-length 3/8” to 1” (usually 3/8”-5/8”)
-some insulin syringes may have 5/16” needle
where can you find subQ administration sites
-abdomen (at least 1-2” away from the umbilicus)
-outer aspects of upper arms
-outer thigh
-upper buttock
-scapular area
what can you do to prevent tissue damage with subQ administration
-rotate sites
-do no aspirate
-do not massage
-avoid sites with bruising, pitting, and lumps
-use a volume of 1ml or less
what are the symptoms of hyperglycemia
-flushed
-warm to touch
-thirsty
-hungry
-frequent urination
what are some symptoms of hypoglycemia
-sweaty
-cold
-drowsy
-HA
-sweaty
-irritable
what are some generic names of rapid acting insulin
-aspart
-glulisine
-lispro
whats the generic name of short acting insulin
regular
what are some generic names of intermediate acting insulin
-NPH
-isophane
what are some generic names of long acting insulin
-detemir
-glargine
what is the onset of rapid acting insulin?
15-30 mins
what is the peak of rapid acting insulin?
30 mins-2.5hrs
what is the duration of rapid acting insulin?
3-6 hrs
what is the onset of short acting insulin?
30-60 mins
what is the peak of short acting insulin?
1-5hrs
what is the duration of short acting insulin?
6-10hrs
what is the onset of intermediate acting insulin?
1-2 hrs
what is the peak of intermediate acting insulin?
4-12hrs
what is the duration of intermediate acting insulin?
16 hrs
what is the onset of long acting insulin?
3-4hrs
what is the peak of long acting insulin
continuous (none)
what is the duration of long acting insulin?
24hrs
what type of insulin gives less chance to experience a hypoglycemic event?
long acting
what equipment is needed for intramuscular injections?
-gloves
-skin antiseptic
-syringe (3-5ml)
-needle (another card)
what size needle should be used for IM injections?
-gauge 18-25
-length: 5/8”-1.5”
usually 21-23g, 1’-1.5”
how do you determine the gauge and length of needle when giving IM injections?
determine by:
-weight and muscle mass
-age
-injection site
-medication viscosity
-residual effects of the medications
name some approved IM sites?
-deltoid
-ventrogluteal
-vastus lateralis
how much fluid can you inject into the deltoid?
no more than 1 ml
how much fluid can you inject into the ventrogluteal?
up to 3ml
how much fluid can you inject into the vastus lateralis?
up to 2 ml
describe finding the deltiod
-smallest site
-feel for chromium process then go two finger beadths down below
-barely posterior to midline
describe finding the ventrogluteal site
-this is the preferred injection site
-pt should be on side
-place hand on greater trochanter of hip with thumb pointing midline and middle and pointer finger on pelvic bone, inject in between those two fingers
-after finding site you can move your fingers if not comfotable injecting between them
describe finding the vastus lateralis site
middle third of lateral side of thigh
describe z track technique for IM injections
-pull skin to one side over injection site
-put needle in there and inject med
-one plunger is done, let go of skin at same time you remove needle
-causes less irritation to the skin
what are the steps of injectable med administration
-indetify pt, hand hygiene, provide privacy
-review allergies, order, med expiration
-verify 6 rights
-don clean gloves
-select injection site
-clean skin and allow to dry
-remove cap from needle
-stabilize skin
-inject needle into skin
-inject med
-withdraw needle and immediately activate safety using only one hand
-dispose of syringe and needle in sharps container
-document administration
what is evaluation of med administration dependent on?
type of med, changes what needs to be evaluated
what are some types of meds administered via injection?
-anticoagulants
-antibiotics
-antiemetics
-antipsychotics
-immunizations
-insulins
-opioids
what is infiltration of peripheral IV site?
iv fluids surrouding space around venipuncture site
what are the signs and symptoms of infiltration?
-swelling
-pallor
-coolness around site
-pain
what shold you do if you see inflitration of IV site?
infusion must be disconnected, raise extremity, and apply warm compress
what is phlebitis
inflammation of vein
what are some signs and symptoms of phlebitis
-pain
-edema
-errythema
-increase skin temp
-redness travelling path of vein
what should you do if you see phlebitis
infusion must be disconnected, raise the extremity, apply warm compress
what are some risks associated with phlebitis and how do you reduce risk
-risk of developing blood clot
-risk reduced by routine removal and rotation of sites
name two basic peripheral IV site complications
infiltration and phlebitis
