Week 6 (Admin Injections) & Week 7 (Dressings) Flashcards
Describe how to landmark for the ventrogluteal IM site?
- Have patient lie on lateral or supine position
- Place heel of hand over greater trochanter of the patient’s hip (with the wrist almost perpendicular to the femur)
- Use right hand for left hip and left hand for right hip
- Point thumb towards patient’s groin, point index finger to anterior superior iliac spine, extend middle finger back along iliac crest towards buttocks
- Index and middle fingers along with iliac crest form a triangle
- IM site is at center of triangle
Describe how to landmark for the vastus lateralis IM site?
- Hand breadth above the knee, hand breadth below the greater trochanter of the femur
- Use middle third of muscle for injection
- Anterior lateral aspect
- Vastus Lateralis IM site
Describe how to landmark for the deltoid IM site?
- Find the acromion process on the clavicle
- Three fingers down
- Deltoid IM site
What are the three sites for intramuscular injections?
- Ventrogluteal
- Vastus lateralis
- Deltoid
Which injection do you aspirate on? Why?
Intramuscular injection
- to make sure that you are not injecting into a blood vessel
In what circumstance would you NOT aspirate on an IM injection?
When your hospital policy says not to
What is the purpose of rotating injection site?
To avoid damaging the tissues from repeated injections
- patients may experience hypertrophy from too many injections in one area
Is it appropriate to rotate SC insulin sites?
You do not need to rotate anatomical sites, but you should rotate within the site
(Intrasite rotation)
- helps maintain absorption consistency
Which injections do you NOT aspirate?
SC
Intradermal
What is the MOST important safety precaution you must perform when giving injections?
Do not recap needles
- clean or dirty
Which IM site is no longer recommended? Why?
Dorsogluteal muscle
- risk of hitting the sciatic nerve
When should you wear gloves when giving injections?
All the time
- any injection!
- all injections pose a risk for exposure to blood
Why is the Z track method used for giving IM injections?
Used to ensure the medication administered remains in the deep muscle to avoid irritation to the subcut tissues
What are the five sites where a subcutaneous injection could be safely given?
- Abdomen
- Upper anterior arms
- Outer thighs
- Upper back
- Lower back
What are the three landmarks used to locate the ventrogluteal intramuscular site?
- Greater trochanter
- Anterior superior iliac spine
- Iliac crest
How quickly do you inject medication from a syringe?
Rate of 1 ml per 10 secs
True or False:
Massaging the site after an injection is best practice
False
- do not massage
What should you do if you aspirate blood when giving an IM injection?
Withdraw the needle and syringe, discard needle in the sharps container and redraw the medication
Doctor’s orders: 0.3mg of drug
Available as: 0.4 mg per mL. How many mL do you draw up?
0.75 mL
Doctor’s orders: 5 mg of drug
Available as: 10 mg per 2 mL.
How many mL do you draw up?
1 mL
Doctor’s orders: 0.75 g of drug
Available as: 400 mg per mL.
How many mL do you draw up?
1.9 mL
Keflin is available as 1 g in 4.4 mL IM solution. Prepare a 500 mg injection.
How many mL do you draw up?
2.2 mL
Cimetidine for injection has a dosage strength of 300 mg per 2 mL. Prepare a 0.25 g dosage. How many mL would you draw up?
1.7 mL
Prepare an IM solution of streptomycin sulfate from the powdered drug by adding 9 mL of diluent to a 5 g vial. The reconstituted solution has a strength of 400 mg/mL. The order is for 0.75 g IM. How many mL would you draw up?
1.9 mL
Prepare a 30,000 u dosage of IM bacitracin from a 50,000 u per 2 mL solution. How many mL would you draw up?
1.2 mL
Calcimar is available as a 200 u per mL. parenteral solution. Prepare a 125 u dosage for s.c. injection. How many mL would you draw up?
0.6 mL
Prepare an 80 mg IM injection of Solu-Cortef from a vial labelled 100 mg per 2 mL. How many mL would you draw up?
1.6 mL
A vial of bacitracin contains 50,000 u per 2 mL. How may mL will you need to administer 10,000 units?
0.4 mL
Administer a 0.45 g dosage of Nafcillin Sodium I.M. Reconstitution directions for this powdered drug are to add 6.6 mL of diluent to the vial to prepare a dosage strength of 250 mg/mL. How much will you give in mL?
1.8 mL
What is the benefit of using an injection over other routes of medications?
- acts fast and rapidly absorbed
- faster onset
What are some complications of using injections?
- nerve injury w/associated pain
- localized bleeding
- tissue necrosis
- sterile abscess
- bruising, soreness
- infection
How can we minimize pain when giving injections?
- medication at room temp
- remove all air bubbles
- wait until topical alcohol has dried
- keep muscle relaxes
- pressure
- don’t change angle of needle (in or out)
- break through skin quickly
- try distraction methods
What are intadermal injections used for?
- TB screening
- Allergy tests
What do you have to make sure of when administering an intradermal injection?
Bevel of the needle is UP!
- to form the “bleb”
What are some signs that an allergic reactions is occurring after an intradermal injection?
Rash, itchiness, dizzy, difficulty breathing, discomfort, tightness in chest, wheezing
What part of the skin layer are subcutaneous injections injected into?
Into loose connective tissue under the dermis
What volume of medication is administered via SC?
Small amounts = 1 mL
What do we need to be careful of when administering SC injections into the abdomen?
No injections within 2 inches of the naval (belly button)
What do you need to keep in mind when administering a SC injection into an obese patient?
Must use a needle long enough to insert through the fatty tissue at the base of the skin fold
- Preferred needle length is one half the width of the skin fold
What is the best SC injection site for an extremely lean patient?
Abdomen
What is the action of Heparin?
To provide anticoagulant therapy to decresae risk of thrombus formation
- suppresses clot formation
How many mL can an IM injection administer?
Up to 5 mLs
For oil based medications, what gauge and length of needle do you use? (for intramuscular injections)
18 - 25 gauge needle
1 - 1.5 inch length
What is the most preferred site for IM injections?
Ventrogluteal
How many mLs can you use for an IM injection into the deltoid muscle?
0.5 - 1 mL
How long do you leave the needle in the patient if you administering an IM injection with the Z track method?
10 seconds
At what point do you let the skin go if you are using the Z track method?
After you’ve removed the needle
What stages of classifications of wounds?
Stages I - IV
What is a Stage I wound?
Non-blanching erythema or redness that remains visible for more than 30 mins
What is a Stage II wound?
Partial thickness; loss of the epidermal skin layer, possible loss of dermis but not through the dermis
What is a Stage III wound?
Full thickness; loss through dermis and into the hypodermis but not through the hypodermis
What is a Stage IV wound?
Tissue loss through the hypodermis
What are the 3 stages of wound healing?
- Inflammatory phase
- Proliferative phase
- Remodeling phase
What are the 3 types of wound healing?
- Primary intention
- Secondary intention
- Tertiary intention
Describe serous drainage.
Clear or yellow tinged plasma like fluid
Describe serous sanguineous drainage.
Thin watery red drainage
Describe sanguineous drainage
Bright red blood
Describe purulent drainage
Green or yellow drainage
What are some factors that influence the healing of an incision?
- Age
- Nutrition
- Circulation
- Blood counts (CBC)
- Smoking
- Chronic illness
- Drug therapy
- Steroids
- Cortisone
- Chemotherapy
- Infection
- Environment
How do steroids slow the healing of an incision?
Slow collagen synthesis
How does cortisone slow the healing of an incision?
Depresses fibroblast activity and capillary growth
How does chemotherapy slow the healing of an incision?
Depresses bone marrow production of WBCs and impairs immune function
What are some complications of wound healing?
- Hemorrhage
- Hematoma
- Infection
- Dehiscence
- Evisceration
- Fistula formation
What should you do prior to a dressing change?
Offer pain medication
When cleaning a dressing, what do you clean first?
- Incision
- Sides of incision
- Drains
Where should you stand (on what side of the patient) when cleaning a dressing?
On the drain side
What is primary intention?
A process that closes the edges of a wound with little or no inflammatory reaction (little or no scar)
What is secondary intention?
Healing by granulation or indirect union
- granulation tissue is formed to fill the gap between the edges of the wound with a thin layer of fibrinous exudate
What is tertiary intention?
Delayed wound healing
- occurs in the base of ulcerated or cavitary wound
- especially after infection
- wound fills very slowly with granulation tissue and often forms a large scar
What is a hematoma?
A solid swelling of clotted blood within the tissues
What is dehiscence?
Wound ruptures along a surgical incision
What is evisceration?
Protrusion of the internal organs through an incision
What is a fistula formation?
An abnormal tube-like passage from a normal cavity or tube to a free surface or to another cavity
What is a partial-thickness wound?
Shallow and involve the loss of the epidermis and partial loss of the dermis
What is a full thickness wound?
Extend into the dermis and heal by scar formation
If you had to clean an incision site, a penrose drain, and a nephrostomy tube, what order would you clean them in?
- Incision site
- Nephrostomy tube
- Penrose drain
What is a Penrose drain?
A Penrose drain is a surgical device, placed in a wound to drain fluid.
- It consists of a soft rubber tube placed in a wound area, to prevent the build up of fluid
Once you open a bottle of sterile saline (for wound cleaning), how long is it good for?
24 hours
What is a hemovac drain?
A drain placed under your skin during surgery
- removes any blood or other fluids that might build up in the surgical area
What is a T tube used for?
To drain bile, while the bile duct is healing
- tube drains into a bag that is attached to your body
What is a nephrostomy tube used for?
Drains urine from your kidney (through your skin) into a collecting bag outside your body
- you many need one for each kidney
