Week 1 and 2 Flashcards
Parenteral Routes
outside of the GI system
List the Parenteral Routes
ID, Subcut, IM and IV
Intradermal Injections
small volume injections
admin skin test
What is the syringe size for ID injections
1 mL syringe
What is the needle gauge for ID injections
25-30 guage
Subcutaneous Injections
nonirritating substances
injected into fatty tissue sites
Insulin and Anticoagulants
How much can be administered with a Subcut injection
1 mL
what is the gauge of the needle for a subcut injection
25-30 gauge
Intramuscular injections
deliver medications for faster absorption
tolerate more concentrated substances
How much can be administered via IM
up to 3 mL depending on patient skin integrity and muscle size
How far away from the umbilicus must you be when giving an injection
at least two inches
Why is the dorsogluteal are not recommended for injections
because of the potential for nerve and vessel damage
What is the basis for selecting a needle
type of medication
size and condition of patient
are of injection
* larger the gauge the smaller the diameter the needle
What is the approximate length for an ID needle
3/8-1/2 inch
What is the approximate length for subcut needle
3/8-5/8 inch
what is the approximate length for an IM injection
5/8-2 inches
What are some examples of diseases that could be contracted because of a needle stick
Hepatitis B, C, and HIV
What must you do before mixing medications
always consult a reference for compatibility or the pharmacist
Where must all liquid medications be measured
at the meniscus
If the vial is multi-dose what must the nurse do
must label it with date, time and amount of diluent used and their initials
When giving IM injections what must you always do
always aspirate
What happens if blood is returned while aspirating
reject the dose and start over
What is the maximum single injection for adults
3 mL
What should you do before administering antiinfectives
check the patients medication history of drug sensitivity
Insulin
an aqueous solution
principal hormone of the pancreas
Diabetes mellitus
deficiency of insulin
Type 1 DM
occurs before age 30
pancreatic beta cells do not produce insulin
insulin injections must be taken daily
Type 2 DM
usually occurs after age 30
pancreas produces some insulin
only 40% take insulin regularly
what is the most common complication of insulin therapy
Hypoglycemia
what is used to treat hyperglycemia
glucose tablets
glucose gel
and glucagon injections
If a patient is over 20 Kg how much glucagon can be injected
1 mL
If a patient is under 20 Kg how much glucagon can be injected
0.5 ml
What is the preferred area for insulin injections
abdomen
what are alternative areas for insulin injections
upper arms, back, or thighs
What are the signs of hypoglycemia
rapid onset cold and clammy skin diaphoretic nervous blood glucose below 70mg/dL
What are the signs of hyper glycemia
several hour onset warm skin flushed dry skin lethargic blood glucose above 300 mg/dL
Rapid Acting Insulin
Aspart (Novolog)
Lispro (Humalog)
Glulisine (apidra)
Aspart characteristics
5-15min, 1-3hr, 3-5hr
when do you take rapid acting
15 min before meals
what can be mixed with rapid acting
NPH
Characteristics of Lispro and Glulisine
15 min, 1-2hr, 3-4 hours
Short- Acting Insulin
Regular (novolin R)
Regular (humulin R)
Regular (Novolin R) characteristics
30-60min, 2-5hr, 6-8hr
Regular (humilin R) charateristics
40-60min, 2-3hr, 4-6hr
What can short-acting insulin mix with
NPH
When should you take short-acting insulin
30min before a meal
Intermediate actin Insulin
NPH (Novolin N)
NPH (humulin N)
NPH Novolin N
90min, 4-12hr, up to 24 hr ** cloudy
NPH Humulin N
2-4hr, 4-10hr, 14-18hr *** Cloudy
When should you take intermediate insulin
30min before a meal
what can be mixed with intermediate insulin
Regular and rapids
Long-acting insulin
Glargine (lantus)
Detemir (levemir)
Glargine (lantus)
3-5hr, peakless, 22-26hr
Detemir (Levemir)
2-4 hr, Peakless, 13-20hr
When should you take Glargine
bedtime
When should you take Detemir
Bedtime or supper time
What can you mix with long-acting
NOTHING DO NOT MIX
How often are premixed insulins taken
Twice a day
Short and intermediate acting 70/30 or 50/50
1-4hr, 2-4hr/6-10hr, 3-4hr/10-16hr, *** cloudy
When do you take short and intermediate mix
30min before a meal
Rapid and intermediate acting
75/25 and 70/30 Novolog mix
75/25 mix-
15min-4hr, 1-2hr/60-10hr, 3-4hr/10-16hr *** cloudy
70/30Novolog Mix
15min-4h, 30-90min/ 6-10hr, 4-5hr/10-16hr ***cloudy
When do you take the rapid and intermediate acting mix
15min before a meal
Why is the combination of NPH and Regular insulin given
give a 24 hour effect
What types of syringes are used when giving insulin
1 ml or 0.5mL
When giving insulin what must you do before administration
Insulin dosage requires two nurses to double check for accuracy
How are insulin dosages drawn up
they are drawn up exactly as ordered
In what order do you draw up insulin
Clear to cloudy
What do insulin pumps do?
Supply a continuous infusion of insulin
What may happen if the insulin is interrupted involving an insulin pump
ketoacidosis
What should you do to prevent ketoacidosis when using a pump
have supplemental insulin ready
how often should blood sugars be checked when using an insulin pump
before meals and at betime
What is the best type of diabetes management
Carbohydrate ratio technique
What type of insulin can be given IV
only clear regular insulin
Sulfonylureas
stimulate the pancreas to make more insulin
Biguanides
decrease the amount of glucose made by the liver
Alpha-glucosidase inhibitors
slow the absorption of the starches you eat
Thiazolidinediones
make you more sensitive to insulin
Meglitinides
stimulate the pancreas to make more insulin
D-phenylalanine
help your pancrease make more insulin quickly
DPP-IV inhibitors
boost incretin gut hormone production to help lower blood glucose levels
Heparin sodium injections
interrupt the clotting process
affects the ability of blood to coagulate
What is Heparin used for
to treat deep vein thrombosis pulmonary embolism cardiac surgery during hemodialysis MI disseminated intravascular coagulation
how is heparin administered
IV or subcut
What is heparin’s half-life
1-6 hours
How is heparin titrated
on the basis of Partial thromboplastin time levels (taken every 6 hours)
what counteracts heparin
protamine sulfate
Lovenox and Framin
are low-molecular-weight anticoagulants
Why are lovenox and framin prescribed
for the prevention and treatment of
DVT
PE
and also after knee and hip surgery
What is the preferred site of administration for lovenox and framin
in the “love-handles” or anterolateral abdominal wall
What must you always do when administering an anticoagulant
always verify dosage with a second nurse for accuracy
Where must lovenox and fragmin never be given
in the deltoid
why must lovenox and fragmin never be given in the deltoid
because they leave large hematomas
Arixtra
non-heparin anticoagulant, not animal origin,
specific inhibitor of activated factor X
what is Arixtra used for
prophylasis of venous thromboembolism, DVT, PE
What can be administered in conjunction with Arixtra
Warfarin to treat acute DVT
Arixtra is not intended for what?
IM use
Why should you not massage the injection sites
because it increases risk of bleeding and hematoma development
What should the subcut dose be for Heparin
dosage should not exceed 1mL
what is heparin made from
pork and beef, CHECK Patients allergies
why are elderly given large doses of heparin
because heparin resistance may occur
What are symptoms of overdose in heparin
nosebleed, bleeding gums, tarry stools, petechiae, and easy bruising
When intermittent or continuous Heparin IV therapy is used what needs to be done
blood should be drawn for PTT and hematocrit levels to determine course of therapy
How are therapeutic anticoagulant dosage regulated
according to PTT results and patients weight
Warfarin
used as prophylaxis after an episode of thrombolytic complications and for atrial fibrillation to prevent blood coagulation.
What is the action of warfarin
it inhibits the activity of vitamin K- which is required for activation of clotting factors
how is the level of warfarin measured in a patient
by International normalized ratio (INR)
What is the normal range for an INR
2-3
what is the antidote for warfarin
Vitamin K, plasma or whole blood
What should a patient taking warfarin avoid
foods rich in vitamin K until INR is stabilized
Clopidogrel (plavix)
an antiplatelet agent that blocks the formation of blood clots by preventing the clumping of platelets
what is plavix used for
prevention of heart attacks, unstable angina, recent stroke or peripheral vascular disease
what is the only PPI safe to use with plavix
Pantoprazole (protonix)
Acetylsalic Acid (aspirin)
prevents the formation of blood clots
Dosing of Aspirin
can be prescribed concurrent with warfarin
at what angle can you give subcut injection
45-90
what angle can you give IM injections
90
what angle can you give ID
5-15
What is the length of the needle for an IM given to the deltoid
1-1.5
What is the length of the needle for an IM given to the VL
5/8-1
What is the length of the needle for an IM given to the VG
1-1.5
What is the most common way to get air into the syringe
by pulling too fast
what can dull a needle
puncturing the vial
how long do you need to clean surfaces before puncturing them
15 seconds
How many rotations must be completed before drawing up insulin
20 rotations
how do you use an insulin pen
prime the needle with 2 units and inject at a 90 degree angle
What are the IM sites
Ventrogluteal
Deltoid
Vastus Lateralis
Ventrogluteal
Good for large volume viscous and irritating medication
What are the sites for Ventrogluteal
gluteus medis and minimus, and greater trochanter, anterior superior illiac crest and dorsal crest of illiac spin
What is the site for Vastus Lateralis
anterior lateral aspect of thigh, greater trochanter or femur, lateral femoral condyle
Deltoid
acromin process
below 1-2 inches
z track method
pull skin to the side of injection with non-dominant hand
insert needle and aspirate
maintain traction for 10 seconds before withdrawing needle
release skin
how fast can you inject a person with medication
10seconds/mL
how is intermittent medication given
through a saline or heparin lock
what things are important for the person administering the IV to know
action of medication, flow rate, adverse reactions and antidotes
Types of IV lines
peripheral
peripheral inserted central catheter
central line
Describe the Peripheral IV line
is usually used for fluid replacement and temporary intermittent medication administration
given in hand, arm or possible leg
describe Peripheral Inserted Central Catheter
longer than a central line,
usually the vein in the antecubital region of the arm
What can the osmolarity be for a PICC line
10% or less osmolarity
Describe central line
inserted by MD or DO directly into the jugular or subclavian vein into the superior vena cava
What type of syringe should be used when flushing Peripheral IV lines
a 10mL syringe - a smaller syringe creates a greater pressure within the line
macrodrops in mL
10 macrodrops in one mL
microdrops in mL
60 drops in mL
how often should you check the IV bag with a pt
every hour
Hypotonic Solution
fluid shifts out of intravascular compartment, hydrating cells
(250 mOsm/L)
Isotonic solution
osmolarity equal to that serum
250-375 mOsm/L
Hypertonic solution
fluid is drawn into the intravascular compartment from the cells
(375 mOsm/L)
What must you do to every port before puncture
clean with antiseptic
what are patient-controlled analgesia (PCA)
allows a specified amount of narcotic to be available to the patient on demand
Total Parenteral Nutrition Device
delivery mode allows the infusion of nutritional elements slowly at the beginning of the administration
this keeps the glucose level from rising too rapidly
Pressure- Flow infusion device
the ambulatory infusion device system was developed for ambulatory use
