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NRSG 202 > Week 4 - subcutaneous, intramuscular injections and subcutaneous device > Flashcards

Week 4 - subcutaneous, intramuscular injections and subcutaneous device Flashcards

1
Q

what do syringes have?

A
  • tip
  • barrel
  • plunger
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2
Q

What can syringes have?

A

luer lok - they are threaded

non-luer lok - slip tip

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3
Q

what are the normal ranges for syringes?

A

0.5mL-60mL

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4
Q

What do nurses usually use for subcut and IM injections?

A

1-3mL

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5
Q

What do small syringes have?

A

non-removable needle

ex. insulin, TB

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6
Q

What can syringes measure medication doses in?

A
  • units
  • decimals (tenths)
  • fractions
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7
Q

What must syringes containing medication be labelled with?

A
  • 2 client identifiers
  • name of medication
  • dose/ volume
  • route
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8
Q

What are needles made of?

A

stainless steel

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9
Q

What do needles consist of?

A
  • hub
  • cannula or shaft
  • bevel
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10
Q

describe the gauge of needles

A
  • diameter of shaft
  • varies from #16-#28
  • larger the gauge the smaller the diameter of shaft
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11
Q

how is the length of the needle chosen?

A

according to the route of the injection and the client

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12
Q

What color are blunt ad filtered blunt needles?

A

blunt - red

blunt filtered - lilac

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13
Q

if an ampules has a dot where should it be located when opening?

A
  • dot located on side furthest away from you

- index finger should be covering it

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14
Q

what sizes do ampules come in?

A

1mL-10mLs or more

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15
Q

Why can’t you touch the sides the ampule while pulling up medication?

A

side of ampule could be contaminated

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16
Q

what does subcut stand for?

A

into the subcutaneous tissue

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17
Q

What is the dose for a subcut?

A

usually <1mL but some institutional policies may state up to 2mL

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18
Q

what syringe/needle size is usually used for subcut?

A

1-3mL with a 25G and 5/8in long needle

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19
Q

What angle should a subcut be administered at?

A

45 degrees if 2.5cm tissue can be grabbed at site

90 degree if 5cm tissue can be grasped at site

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20
Q

Why do subcutaneous injection sites need to be rotated in an orderly fashion?

A
  • minimize tissue damage
  • maintain absorption
  • avoid discomfort
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21
Q

What are some things to consider when injecting heparin?

A
  • injected at least 5cm away from umbilicus
  • low molecular weight heparin comes refilled in syringe
  • administered slowly over 10-20 seconds
  • assess abdomen for trauma prior to selecting injection site
  • swab prior to injecting
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22
Q

Where is the best place to administer heparin? Where else can you administer it?

A

can be administered in arms but abdomen preferred

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23
Q

describe insulin syringes

A

come in variety of sizes

  • 30 units
  • 50 units
  • 100 units
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24
Q

describe insulin needles

A

usually 26-31 gauge and 1/4 to 1/2 in long

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25
Q

where is insulin absorbed more quickly?

A

abdomen then arms then thighs and butt

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26
Q

how are patients supposed to rotate sites when injecting insulin?

A
  • in the same anatomical site approx. 2.5cm apart rather than between anatomical sites
  • limits variations in BG levels
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27
Q

what angel should insulin be injected at?

A

90 degrees

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28
Q

once insulin is injected how long should the needle be held at the site for?

A

10 seconds

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29
Q

What are the steps for setting up at subcutaneous butterfly?

A
  • prepare meds including any if priming line
  • select site for injection(arms, chest, legs)
  • swab area
  • insert device at 45-90 degrees c pebbled side facing client
  • remove needle by securing wings at site/ pull end of device
  • apply tegaderm to cover insertion site
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30
Q

What needs to be on the tegaderm label thats covering the subcutaneous butterfly?

A
  • date
  • name of medication
  • concentration
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31
Q

when assessing a subcutaneous butterfly site what are you looking for?

A
  • redness
  • swelling
  • pain
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32
Q

How long can a subcutaneous butterfly stay in place for?

A

2-7 days

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33
Q

What can subcutaneous butterflies be used for?

A
  • specified medication/ concentration that is on the label

- if concentration changes device must be changed

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34
Q

what do you need to document in regards to subcutaneous butterflies?

A
  1. nursing notes
    - insertion of device
    - where its inserted
    - how client tolerated process
  2. sometimes wanted documented in the Kardex
35
Q

what kind of injection is faster in regards to drug absorption?

A

muscle tissue is faster than subcut or ID

36
Q

describe the onset of drugs once administered via IM

A

faster onset of action

37
Q

What group can accept larger volumes of medication?

A

muscles accept larger volumes of medication vs. subcut or ID

38
Q

what kind of medication can muscles accept?

A

some irritating medications that should not be administered by subcut or ID

39
Q

what do muscle injections lead to?

A

good immune response with vaccines

40
Q

describe the syringe and gauge size needed for IM injections

A

1-3mL syringe

21-23 gauge and 1/2-1 1/2in long

obese clients may need longer needle (up to 3in)

41
Q

When administering an IM injections what do you need to select?

A
  • appropriate length
  • appropriate gauge
  • appropriate site
42
Q

in regards to IM injections how is the gauge determined?

A

by the viscosity of the liquid

43
Q

in regards to IM injections how is the site determined?

A

by the medication and volume

44
Q

in regards to IM injections how is the volume administered determined?

A

by the development and amount of muscle mass

45
Q

in regards to IM injections how is the length determined?

A

by the site/ weight of the client

46
Q

in regards to IM injections needles need to be what?

A

long enough to reach muscle but not long enough to reach blood vessels or bones

47
Q

in regards to IM injections what do you need to assess?

A

clients weight and muscle mass

48
Q

what is the needle length used at the ventrogluteal site for a child?

A

1/2-1in

49
Q

what is the needle length used at the ventrogluteal site for an adult?

A

1 1/2 in

50
Q

what is the needle length used at the vastus lateralis site for a child?

A

5/8-1in

51
Q

what is the needle length used at the vests lateralis site for an adult?

A

5/8-1in

52
Q

what is the needle length used at the deltoid site for a child?

A

1/2-1in

53
Q

what is the needle length used at the deltoid site for an adult

A

1-1 1/2in

54
Q

What is the needle length used for men and women if they weigh <130lb?

A

5/8-1in

55
Q

What is the needle length used for men and women if they weigh 130-152lb?

A

1in

56
Q

What is the needle length used for men and women if they weigh 153-260lb?

A

1-1 1/2in

57
Q

What is the needle length used for men and women if they weigh 260+lb?

A

1-1 1/2 in

58
Q

What is the preferred site for IM injections for adults?

A

ventrogluteal

59
Q

How many mLs can be administered in the ventrogluteal site?

A

up to 3mL

60
Q

What positions can the client be in when administering an injection at the ventrogluteal site?

A
  • side-lying
  • suprine
  • prone
61
Q

What land mark identifiers are used when finding injection site for ventrogluteal?

A
  • greater trochanter
  • iliac crest
  • anterior superior iliac spine
62
Q

Where is the deltoid located?

A

lateral aspect of the arm

63
Q

How many mLs can be injected into the deltoid muscle?

A

small amount <1mL

64
Q

What land mark identifiers are used when finding injection site for deltoid?

A
  • acromion process
  • axilla
  • 3-5cm below the acromion process
65
Q

describe the vastus lateralis

A

thick/ well developed in adult and children

66
Q

What is the preferred site for IM injections in regards to children 1 year and younger?

A

vastus lateralis

67
Q

How many mLs can be administered in the vastus lateralis?

A

up to 3mL

68
Q

What position can the client be in when administering an IM injection into the vastus lateralis?

A
  • back-lying

- sitting

69
Q

What land mark identifiers are used when finding injection site for the vastus lateralis?

A
  • anterior lateral aspect of the thigh into middle third
  • greater trochanter
  • lateral femoral condyle
70
Q

What are the advantages to using the vastus lateralis site for IM injections?

A
  • ease of access
  • no major blood vessels/ significant nerves
  • bulk of muscle non-atrophied reduces chances of injury
71
Q

What can get damaged at the vastus lateralis site when injecting not landmarking properly?

A
  • femoral nerve

- femoral artery

72
Q

where is the rectus femoris located?

A

anterior aspect of the thigh

73
Q

how many mLs can be adminsteredin the rectus femoris?

A
  • up to 3mL
74
Q

What position can the client be in when administering an IM injection into the rectus femoris?

A
  • lying

- sitting

75
Q

What land mark identifiers are used when finding injection site for the rectus femoris?

A
  • anterior aspect of thigh
  • anterior-superior iliac spine
  • patella
76
Q

When a client is administering their own medication IM, what site do they use? (not insulin)

A

rectus femoris

77
Q

What is the disadvantage of using the rectus femoris site for IM injections?

A

may cause considerable discomfort

78
Q

Why is the dorsogluteal site not recommended for IM injections?

A
  • sciatic nerve
  • various amount of subcutaneous tissue
  • gluteal artery
79
Q

What are some risk factors associated with IM injections?

A
  • bleeding
  • abscess
  • cellulitis
  • tissue necrosis
  • granuloma
  • muscle fibrosis
  • contractures
  • hematoma
  • injury to blood vessels, bones, peripheral nerves
  • tendonitis
  • pain
  • infection
80
Q

if you are required to aspirated during an IM injection how long do you need to pull back on the plunger for? What does this ensure?

A
  • 5-10 seconds

- ensures needle is not in low flow blood vessel

81
Q

What do you do if blood is aspirated in syringe during an IM injection?

A
  • needle withdrawn
  • syringe discarded
  • new injection prepared using new equipment
  • administered in different location
82
Q

What are the techniques used for IM injections?

A
  • stretch skin (standard method)

- Z-track

83
Q

What technique is used that results in reduced pain and fewer injection site lesions?

A

Z-track

NRSG 202 (11 decks)

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