SL #8 SG
Discuss Rational for not recapping needles after injection is given See SG Note
Decreases risk of nurse sticking self with contaminated needle/decrease risk of infection with AIDS or hep
Discuss Rational for Injecting air into the vial before aspirating meds See SG Note
Vial is closed container. Injecting air increases pressure inside container making it easier to withdrawal the meds
Identify the specific indications for using Z-track method of IM SG Notes
Z-track method minimizes tissue irritation/discoloration when injecting irritating substances such as iron or Vistaril
Describe/contrast the differences in preparing medication from an ampule and a vial pg 875-877
Ampule= disinfect the ampule neck, snap off the pre-scored tip and use a filter needle to aspirate the fluid Vial=draw air equal to amount of medication you wish to aspirate into the syringe, pierces the rubber seal, push the air into the vial and aspirate the meds out
What measures can the nurse encourage to increase relaxation of muscles during injections? SG Notes
Assist the client to assume a position that reduces strain on the muscle and increases relaxation of the muscle such as flexing the knee, hip or elbow or prone position with toes pointing medially for the dorso-gluteal site
Explain the rational for using the Z-track method of IM
...
Discuss 2 reasons why the IM route is preferred above the SubQ for the injection of some meds pg. 888
...
Describe the Z-track method of IM
...
Rectus Femoris Injections -Location
...
Describe how to withdrawal mixed meds b. from a vial and an ampule pg 880-881
1. Correctly aspirate the Rx dose from the vile 2. Correctly aspirate the Rx dose from the ampule
List 4 ways the nurse can prevent infection during injection? See SG Note
1. DO NOT allow ampule to stand open, Draw up medication quickly 2. DO NOT let needle touch unsterilized/contaminated area. Recap sterile needle carefully after medication has been drawn up. 3. DO NOT touch the length of the plunger or inside of syringe barrel. Cover tip of syringe with needle or cap 4. Wash and dry soiled skin. Use circular motions and friction, antiseptic swab to cleanse skin from center outward in 2' radius
Describe how to withdrawal mixed meds a. from 2 vials pg 880-881
1. Draw up air = to A+B meds 2. Inject the air = to the dose of med A needed in to A (NOT touching the fluid), then inject the remaining air into vial B 3. aspirate the correct Rx dose of meds from vial B 4. Replace needle w/ new sterile needle before going back to aspirate the Rx dose of meds from A. **be careful to only aspirate the correct dose and not to create air bubbles**
Describe how to mix two kinds of insulin in one syringe pg. 881
1. Draw up air = to dose of reg. Insulin + NHP Insulin 2. Inject the air = to the dose of NHP Insulin into the NHP vial (NOT touching the fluid), then inject the remaining air into the reg. insulin 3. aspirate the correct Rx dose of reg. Insulin 4. Put the needle back into the NHP Insulin and aspirate the Rx dose of meds from A. **be careful to only aspirate the correct dose and not to create air bubbles**
Vastus Lateralis IM injections -Location
Divide the area between the greater trochanter of the femur and the lateral femoral condyle into thirds and selecting the middle third
Dorsogluteal IM injections -Advantages and disadvantages
Formerly the the primary site of injection whoever is it too close the the sciatic nerve and superior gluteal nerve and artery. Also the injection could very easily be administered subQ instead of IM
Compare the gauge and length of needles used for; IM, SubQ, and ID pg. 874-875, 882
IM= 20-22 gauge , 1 - 1¹/₂" inches long. Length depends upon the amount of adipose tissue SubQ= 24-26 gauge needle ³/₈ - ⁵/₈" long. Obese clients may require 1" ID= 25-27 gauge needle ¹/₄ - ⁵/₈"
Compare the speed of absorption of; Sub Q, IM, ID, and IV pg. 849
Sub Q= Absorption is slower, advantage for certain drugs (ie. insulin and heparin) IM= Rapidly absorbed ID= Slow, advantage for allergy testing IV= Rapid effect
Rectus Femoris Injections -Advantages and disadvantages
Main reason for not using RF is that it cause discomfort for the client.
Dorsogluteal IM injections -Location
Not reccomended
Deltoid Injections -Advantages and disadvantages
Not used much because it is small and located close to the radial A&N, No more the 1mL
Compare the speed of absorption of; Oral v. Parental pg. 848-850
Oral= Slow sometime uneven absorption Parental= Fast absorption
Ventrogluteal IM Injections -Location
Positions the client on side with knee bent and raised slightly towards the chest. The trochanter will protrude. Place heal of hand on greater trochanter with the fingers pointing toward the clients head. The R hand is used for the L hip and Visa Vera. With the index finger on the clients anterior superior iliac spine, stretch middle finger dorsally, palpating the crest of the ilium and then pressing bellow it. The triangle formed by the crest, index and middle fingers is the injection site
List sites commonly used for SubQ injections pg 882, 884
The outer aspect of the upper arms and the anterior aspect of the thighs. other areas are scapular areas of the upper back, and the upper ventrogluteal and dorsogluteal area
Discuss Rational for Placing padding around neck of ampule and breaking it away from you, if not using an ampule opener to open an ampule pg 878
The padding will protect fingers from broker glass, and any glass fragments will spray away from the nurse
Ventrogluteal IM Injections -Advantages and disadvantages
This is the preferred site for IM; `contains no large nerves or blood vessels `provides the greatest thickness of gluteal muscle consisting of both the gluteus medius and gluteus minimus `is sealed off by bone `Contains consistently less fat than the buttock area, eliminating the need to determine the depth of SubQ fat `safest sight for injections over 1mL in clients older than 7 months.
Discuss Rational for Aspirating by pulling back on plunger of syringe after inserting needle and before injecting for the meds for an IM and as indicated for a SubQ pg 884, 892
To verify that you are not about to inject IV. It will take the blood a few seconds to appear so aspirate for 5-10 sec. If blood appears in needle withdrawal and start over.
Discuss the (a) purpose, (b) method and (c) "reading" of ID injections or skin tests pg. 882-884 (SG Notes)
a) skin testing for TB screening allergy tests and vaccinations. b) Using TB syringe, inject into forearm using small short needle at 5°-15° angle. Inject the drug just under the skin surface to form a small bleb c) Read TB/mantoux skin test w/i 48-72 hrs. + skin test shows redness and induration at site that is 10mm or larger
Select the appropriate syringe type/size for each of the following; a. IM (p. 888) b. Insulin (p. 872) c. Small amounts of strong drug (p. 872)
a. IM= usually a 3-5mL syringe b. Insulin= Insulin syringe is specific to insulin and are calibrated in 100-unit. Often come with irremovable needles c. Small amounts of strong drug= Tuberculin syringe has narrow barrel that is calibrated in 10th and 100th of a milliliter on one scale and 16th of a minim on the other (up to 1 minim and 1 mL)
Discuss whether medical or surgical asepsis should be utilized in each of the following steps of injection admin a. Cleansing the top of a medical vial b. Drawing up the medication into a syringe c. Cleansing the skin d. Administering the injection
a. Medical b. Surgical c. Medical d. Medical
Describe what parts of each of the following must be kept sterile when perparing/administering an injection: a. Needle, b. Syringe, c. Vial/ampule See SG Note
a. Needle: Shaft, bevel and inside of hub b. Syringe: inside of barrel, tip of syringe and all of plunger except top c. Vial/ampule: inside of vial/amuple
Deltoid Injections -Location
place 4 fingers across the deltoid muscle with the first finger on the acromion process. The top of the acilla is the line that marks the lower border landmark. A triangle w/in these boundaries indicates the deltoid muscle about 5 cm below the acromion process. Press on the injection site for 10 sec to reduce sensory output
Vastus Lateralis IM injections -Advantages and disadvantages
usually thick and well developed. Recommended in children < 1year. No major blood vessels or nerves and is ideal for infants because their gluteal areas in underdeveloped
