Med Administration Pt. 2 Exam 1

Combinations of Reg/NPH

70/30 (Humulin or Novolin) (70% NPH [intermediate] and 30% regular) Humulin 50/5

Needle

Attached or packaged separately Disposable Some needles come with filters for preparation of medications. Never use filters when administering a medication. Three parts Usual gauges: 18 to 26 Needle length: 3/8 to 2 inches Color coded for ease of selection

Ampules

Glass top must be snapped off Require a filter

Special Considerations for Insulin

Insulin is the hormone used to treat diabetes It is administered by injection because the GI tract breaks down and destroys an oral form of insulin Absorption rates of insulin vary on the basis of the injection site Insulin is absorbed most consistently in the abdomen Patients choose one anatomic area and rotate sites within that region Timing of injections is critical for correct insulin administration

Insulin Syringe

Insulin syringes come with preattached needles and are calibrated in units Insulin is measured in units, and insulin dosage CANNOT be calculated in milliliters. Typically 100 units = 1 ml Also available in low-dose, 30 unit= 1/2ml

Administering Subcutaneous Injections

Medication is placed in loose connective tissue under the dermis Absorption is slow Subcutaneous tissue contains pain receptors! If the patient is obese, pinch the tissue and use a needle long enough to insert through fatty tissue at the base of the skinfold If you can grasp 1 inch of tissue = use a 45-degree angle ► If you can grasp 2 inches of tissue = use a 90-degree angle ► Thin patients often do not have sufficient tissue for subcutaneous injections

Mixing Parenteral Medications in One Syringe

Mixing compatible medications avoids the need to give a patient more than one injection Consult a compatibility chart or a pharmacist for compatible medications The volume of the mixed medications cannot exceed acceptable limits.

Special Considerations for Administration of Heparin

Patients are at risk for bleeding Assess for contraindications and medication interactions Administer subcutaneously or intravenously What is the preferred site of administration? SQ- Bottom of arm, ABDOMEN, thighs -2 inches from belly button

Parenteral Medication Preparation

Preparations of injectable drugs may be packaged in a solvent or powdered form Medication may be in a prefilled syringe, multi-dose vial or ampule

Preparing Medications: Vial

Remove cap covering top of unused vial to expose rubber seal- Wipe surface of rubber with alcohol- Scrub the HUB Pull back on plunger to draw in air amount equivalent to volume of med Place vial on flat surface; insert tip of needle through center of rubber seal Inject air into vial, holding on to plunger Invert vial while keeping firm hold on syringe and plunger Grasp end of syringe barrel and plunger with thumb & forefinger Keep tip of needle in the fluid while withdrawing medication Allow air pressure in vial to fill up syringe gradually Remove needle; eject any air If med going into tissue, change needle If multidose, date & time

Vials

Rubber seal Single-dose or multidose

The Syringe

Single-use Disposable Luer-Lok Non-Luer-Lok

Preparing Medications: Ampules

Tap top of ampule lightly Place small gauze pad or unopened alcohol swab around neck of ampule Snap neck quickly & firmly away from hands Attach filter needle on syringe Set ampule on flat surface or invert ampule Insert filter needle into center of ampule opening without allowing the needle tip to touch rim of ampule Aspirate med into syringe by gently pulling back on plunger Keep needle tip under surface of liquid; tip ampule to reach all fluid Expel excess air bubbles Replace needle

Needlestick Prevention

The implementation of safe needle devices can prevent needlestick injuries Sharps with engineered sharps injury protection (SESIP) Sharps disposal containers May be used one-handed Colored red or labeled with biohazard symbol

Insulin pen injectors

The purpose of the insulin pen is to deliver an insulin dose more accurately than the traditional units 100 syringe and vial When the insulin pen is used, the amount of insulin that is desired is obtained by turning the dial to the number of insulin units needed Many patients report less injection pain than with the traditional insulin syringe Disposable Attach needle, dial in a dose, press button Administer in ½ units up to 80u Do not mix If on two types of insulin, will get two injections

IM Injection: Ventrogluteal

Use for large volumes 2.5 to 5 mL ► Includes the gluteus medius and gluteus minimus Needle Size ½ to 2 inch Landmark: Place heel of hand over trochanter, fingers up Point thumb towards pt's groin, index finger to ant superior iliac crest, middle finger towards buttock (make a "V"); site at center Lie on side or back

Intramuscular Injection Sites: Deltoid

Use small volumes of med (<2ml) Do not use the deltoid site for infants or young toddlers Landmarks: 1-2 inches or three fingerbreadths below acromion Allow pt to sit, lie or stand; have relax arm

Administering Intradermal Injections

Used for skin testing (TB, allergies)-potent meds Slow absorption from dermis, blood supply is reduced Use a tuberculin (TB) or small syringe with a short (⅜- to ⅝-inch) fine-gauge (25 to 28) needle Inject only small amounts of medication (0.01 to 0.1 mL) intradermally Angle of insertion is 5 to 15 degrees with bevel up. A small bleb will form as you inject; if it does not form, it is likely the medication is in subcutaneous tissue, and the results will be invalid

Mixing Insulins

Verify doses with MAR and label Wipe off top of both insulin vials with alcohol prep. Roll the bottles in palms if cloudy (DO NOT SHAKE) Regular to NPH; R to N; Clear to cloudy Inject air into the insulin vial Withdraw number of units Administer the two insulin's immediately after mixing. Do not allow the insulin mixture to stand.

How do you decide which needle to use?

-Where the med is going -size of the pt -type of med (thickness)

Long acting basal insulin

1-2 hrs/ lasts 19-24 hrs GlaD for long term control. Glargine, Detemer

Rapid acting insulin

15/30 min lasts 3-6 hrs Humalog (Lispro) Novolog (Aspart) Apidra (Glulisine)

Intermediate acting insulin

2-4 hrs lasts 10-58 hrs NPH (Humulin or Novolin)

ALL

Before injecting a medication, which of the following factors must be considered by the nurse? A. the volume of the medication to be given B. the viscosity of the medication C. the size of the muscle of the patient D. the amount of adipose and subcutaneous tissue of the patient E. preference of the patient for site/location F. the correct size needle and syringe

measurement

Before use, carefully examine the syringe to determine the ______________ scale and ensure that you use the correct syringe for preparing the ordered medication

viscosity

Choose gauge based on ____________ of medication to be given: ► 20-25 G for aqueous solutions ► 18-21 G for oil-based solutions

size, weight, tissue

Choose needle length according to the patient's _____ and _______ and the type of _______ into which the medication is to be injected ► Subcutaneous: 3/8 to 5/8 inch ► Intradermal:½ to 5/8 inch ► IM: ½ - 1 ½ inch

Administering Injections

Each injection route differs based on the types of tissues the medication enters Before injecting, know: -The volume of medication to administer -The characteristics and viscosity of the medication -The location of anatomical structures underlying the injection site If a nurse does not administer injections correctly, negative patient outcomes may result.

injury

Failure to inject a medication correctly results in _________.

Bone

Failure to select an injection site in relation to anatomical landmarks results in nerve or ________ damage during needle insertion

Intramuscular

Faster absorption than subcutaneous route as muscle has many blood vessels Angle: 90 degrees Amounts Adults: 2 to 5 mL can be absorbed Large-volume injections (>3 mL) are not frequently administered Children, older adults, thin patients: up to 2 mL Small children and older infants: up to 1 mL Smaller infants: up to 0.5 mL ► Properly identify the site by palpating bony landmarks. Can lead to tissue, bone or nerve damage ► Minimize discomfort : Have patient assume a position that helps relax muscle/reduce strain Use distraction Apply pressure to the IM site

c

How will the nurse mix medication that has been diluted in a vial? A. Shake the vial vigorously. B. Turn the vial upside down. C. Roll the vial in the palms. D. Stir the contents with the needle

stability

Inability to maintain _________ of the needle and syringe unit can result in pain and tissue damage

large

Injecting too ________ a volume of medication for the site selected causes extreme pain and results in local tissue damage

injection

Medications administered by the parenteral route enter body tissues and the circulatory system by _________.

larger, smaller

Needle size is determined by gauge and by length. The _________ the gauge number, the smaller the diameter of the lumen and the less pain or bruising experienced by the patient The ___________ the gauge number, the larger the diameter of the lumen, the stronger the needle and the less chance of bending or breaking

intravenously

Only Regular insulin can be given _____________

needle

Overall, the site you use, the age and size of the patient, and the medication you administer all determine the maximum volume of the injection and the gauge and length of the _________

Injectable Preparations

Pre-filled Drug Cartridge and Syringe The disposable cartridge is placed into a reusable metal or plastic holder. In keeping with the amount of drug to be administered, the excess solution must be expelled before administration.

tenths

The 3 mL syringe is calibrated in what?

D

The nurse performing an intradermal (ID) injection feels resistance when inserting the medication. What should the nurse do next? A. Remove the needle. B. Dilute the medication. C. Advance the needle. D. Inject the medication.

Minimizing Patient Discomfort for Injections

Use a sharp-beveled needle in the smallest suitable length and gauge. Select the proper injection site, using anatomical landmarks. Apply a vapocoolant spray or topical anesthetic to the injection site before giving the medication, when possible. Divert the patient's attention from the injection through conversation using open-ended questioning. Insert the needle quickly and smoothly to minimize tissue pulling. Hold the syringe steady while the needle remains in tissues. Inject the medication slowly and steadily

IV, IM, SQ, ID

What are the four routes of parenteral medication administration?

smallest

When you select a syringe, choose the _____________ syringe size possible to improve accuracy of medication preparation

Insulin

_________ is administered at a 45 or 90- degree angle into subcutaneous tissue. The angle for administering insulin depends on the amount of fatty tissue in the patient. When a 90-degree angle is used, the skin should be pinched upward so the insulin is deposited into the subcutaneous tissue For a very thin person, what angle is suggested? smaller angle

Insulin

is classified by rate of action: Rapid, short, intermediate, and long-acting Know the onset, peak, and duration for each of your patients' ordered insulin doses. Use the correct syringe: 100-Unit insulin syringe or an insulin pen to prepare U-100 insulin U-500 also available The insulin syringe may be marked in even units on one side and in odd units on the other side. Timing of injections is critical for correct insulin administration

The continuous subcutaneous infusion (CSQI or CSCI)

is used for selected medications e.g. opioids for pain, insulin for diabetes, terbutaline in preterm labor Fewer risks and less expense than IV administration Easy to operate in the home care setting Use a small-gauge (25 to 27) winged butterfly IV needle or a special commercially prepared Teflon cannula Use the same anatomic sites for subcutaneous injections and the upper chest Requires a computerized pump with safety features

Tuberculin syringe

► Calibrated in tenths (0.1 ml) hundredths (0.01ml) and minims ► Usually a 1-ml syringe (also available in a ½-ml syringe) ► Use tuberculin (TB) syringes to prepare small amounts of medications (<1 ml) for ID and subcutaneous injections ► Also useful when small, precise doses are prepared for infants or young children

5-ml syringe

► Calibrated in twentieths (0.2ml) ► Usually used for volume > 2.5ml ► Frequently used to reconstitute a dry drug

IM Injection Sites: Vastus lateralis

► Recommended for vaccinations in pediatric patients ► Use for larger volumes (Up to 5 ml in adults) ► Use: 3-5 ml syringe, 1/2 -2 inch needle, gauge depends on viscosity of medication (18-25G) Location: Muscle in anterior lateral thigh Landmarks: Handbreadth above knee to handbreadth below trochanter; use middle 1/3 of muscle Relax muscle by sitting or lying flat with knee flexed

Low-molecular-weight heparins (LMWHs)

► The anticoagulant effects are more predictable than heparin ► LMWHs have a longer half-life and require less laboratory monitoring but are expensive. ► To minimize the pain and bruising associated with LMWH, it is given subcutaneously on the right or left side of the abdomen, at least 2 inches away from the umbilicus (the patient's "love handles"). ► Administer LMWH in its prefilled syringe with the attached needle and do not expel the air bubble in the syringe before giving the medication ► There is some new evidence to support a slower injection rate of 30 second to reduce bruising and pain. ► Wait for 10 seconds after injection before withdrawing the needle ► Apply gentle pressure for 30-60 seconds ► Do not massage the site

Two types of syringes used for subcutaneous injections

►Tuberculin syringe (1 ml) ►3-ml syringe Typical Needle Size: ►25-gauge, 5/8-inch needle inserted at a 45- degree angle OR ►25-gauge, 1/2-inch needle inserted at a 90- degree angle Inject small doses of water-soluble medication ► <0.5 ml in children ►0.5 to 1.5 mL in adult