Pharm Unit 3

Intracapsular

(intraarticular) - Injected into the capsule of a joint, usually to reduce inflammation, as in bursitis

IV Blood Administration

15-18G - used for

3 Parts of a Syringe

1 - Barrel 2 - Plunger 3 - Tip These are the parts of what?

3 Parts of Needles

1 - Hub 2 - Shaft 3 - Tip These are the 3 parts of what?

Types of Syringes

1 - Standard 2 - Tuberculin 3 - Insulin 4 - Prefilled These are the types of what?

Purposes of Parenteral Administration

1 - The client cannot take oral medications (nausea, vomiting, and unconscious) 2 - Medication must be given quickly (life threatening emergency) 3 - Medication might be destroyed by the gastric enzymes 4 - Medication must be given at a controlled rate (IV drip) 5 - Medication is not available in an enteral form

Longer Needles

1, 1 ½, and 2 inches used for intramuscular injections

Intradermal Injection Steps

1. Cleanse skin with an alcohol wipe. Allow to dry thoroughly, otherwise alcohol might interfere with test results. 2. Hold client's arm in non-dominant hand and stretch skin taut. 3. Hold syringe so that the bevel is up and needle is almost flat against client's arm @ a 15 degree angle. 4. Insert needle only far enough to cover the lumen or opening. Point of needle should be visible through skin. 5. Insert medication very slowly. Bubble should begin forming immediately if not, needle too deep. If solution leaks out, needle not deep enough. 6. After medicine injected, remove needle and apply gentle pressure with alcohol wipe. Do not massage. 7. May be helpful to draw a circle around injection site to identify site later for evaluation. If skin testing is being performed, inspection of the injection sites should be done in good light. Measure the diameter of any induration.

Patient Teaching Intradermal Injections

1. Do not scrub, rub, or scratch area. 2. If sensitivity (PPD) test, provide written instructions on when he is to return for reading. 3. If allergy site becomes reddened, swollen and itchy, may use cool wet compresses. If develops more serious symptoms such as respiratory difficulty, puffiness of face, hives, rashes, notify Dr. or go to the emergency room.

Z Track Method for Intramuscular Injections Steps

1. Draw up medication and add 0.5 mL air so drug will clear the needle. 2. Replace the needle, using the correct size. 3. Place the ulnar side of the nondominant hand just below the site and pull the skin and subcutaneous tissues 1 - 1 ½ inches laterally or down. Position must be held until you are finished. 4. Cleanse skin with alcohol. 5. Insert needle with dart-like motion. 6. Aspirate with the nondominant hand. 7. Inject medication slowly at about 10 seconds per mL. 8. Wait 10 seconds before withdrawing needle. 9. Remove needle and release the skin, which creates a zigzag path that prevents escape of medication from the muscle. 10. Press firmly on site with alcohol wipe. Do not massage. 11. Advise client walking will aid absorption. Avoid vigorous exercise or tight garments which cause pressure on site.

Subcutaneous Injection Steps

1. Draw up the prescribed dose. 2. Using landmarks, select site. Insulin may be given in multiple subcutaneous sites. Heparin is only given within two inches of the umbilical area in the abdomen, and Lovenox (LMWH) is given in the right or left side of the abdomen in the love handles using a prefilled syringe-do not expel the air bubble in the syringe before administration. 3. Cleanse skin with alcohol wipe. 4. Grasp skin into a bunch or pinch the skin and inject at a 45 degree angle to avoid an intramuscular injection. If obese, inject at 90 degrees. 5. Hold syringe like a pencil and insert needle quickly. 6. Do not aspirate if Heparin or Insulin. Inject the medication slowly, pushing the plunger all the way. (Too rapid injection may cause pain). If aspiration is indicated for other meds (Humira, Enbrel) and blood is withdrawn, discard the medication and prepare a new injection. 7. Place alcohol wipe over site, applying gentle pressure as you withdraw the needle.

Intramuscular Injection Steps

1. Prepare the medication according to prescribed amount (ampule, vial, powder form needs mixed, or prefilled). May draw up 0.2 mL air into syringe to clear needle (according to institution policy). 2. Assist the client into a comfortable position. Select site using landmarks. 3. Cleanse skin with alcohol wipe, starting at the injection site and working outward in a circular motion toward the periphery. 4. With nondominant hand, stretch skin taut at injection site. 5. Insert needle at correct angle (90 degrees) and depth for site being used and enough force to penetrate skin and muscle in one smooth motion. Use dart-like motion. 6. Aspirate. If no blood returns, inject medication at slow even rate. Withdraw needle quickly. If blood returns, withdraw needle, discard, and start over. 7. Apply gentle pressure. Massage can increase the pain if the muscle mass is stressed by the amount of medication given. 8. Check for bleeding and apply band-aid if necessary.

IM and IV Injections

20-22G - used for

Needle Used for Intramuscular Injections

22 gauge for most drugs, 20 guage for viscous medication, 1 ½ inch for most adults, 1 inch if thin, 2 inch if obese

Subcutaneous Injection and Pediatric IMs

23-25G - used for

Intradermal Injections

25-27G-used for

Shorter Needles

3/8, 1/2, and 5/8 inches used for subcutaneous injections

Infiltration

A complication of IV therapy when the needle becomes dislodged from the vein, allowing infusion of fluid and medication into the issues.

Erythema

A diffused redness over the skin

Prefilled Syringe

A prefilled amount of medication is contained in a disposal sterile cartridge-needle unit that is loaded into a Tubex or Carpuject system. The cartridge fits into the plastic syringe holder with a Luer-Lok tip. After administration, the syringe is discarded, but the plastic unit may be reused.

Intradermal Injection Technique

A small amount of medication (0.1 to 0.2 mL) is injected so close to the surface that a wheal (bubble, bleb) is formed by the skin expanding

Reconstitution

Addition of a sterile diluting solution (sterile water or saline solution) to a powder form of drug to render an injectable solution

IV Therapy

Administration of fluids directly into the venous bloodstream with immediate action. Advantages include large volumes of fluids are rapidly administered into the vein with less irritation; bypasses all barriers to drug absorption, more comfortable for the client; may be intermittent or continuous.

Equipment for IV Therapy

An Administration Set Drop Chambers Controllers Venous Access Devices These are the equipment for what

Parenteral

Any route of administration not involving the gastrointestinal tract; commonly refers to intradermal, subcutaneous, intramuscular, or intravenous injections

Insulin Syringe

Are available in sizes that hold various amounts calibrated in units. Most insulin syringes are U-100, designed to be used with U-100 strength insulin. Each mL of U-100 insulin contains 100 units (1mL) of medication, whereas U-50 has a 0.5 mL capacity. Note that U-40 syringes and insulin may be available in Europe.

Clean Rubber Stopper

Before use, remove the metal cap and disk if glass bottle or plastic cover of port if plastic bag exposing the rubber stopper._________________________________ insert infusion set into bag or bottle using insertion spike careful not to touch point of entry. Leave distal cap on and close roller clamp. Compress the drip chamber and release. Prime tubing and eliminate air bubbles. Which step is missing from this list?

Pressure

Catheter Removal - Gather supplies, wash hands, and don gloves. The dressing and adhesive tape is loosened; the catheter is removed without pressure, and THIS is immediately applied following removal; a small bandage is secured over the site. The site should be inspected for complications.

10mL

Central lines are flushed with saline using a push and pause method under strict sterile aseptic technique. How much Saline should you use?

BP

Check for mechanical obstruction of tubing and avoid __ or restrainst on the arm with an IV.

Thrombophlebitis

Clot in the vein with inflammation

Dorsogluteal Muscle

Common site for adults, not children less than 3 years of age. Should lie on stomach (prone) with toes inward to relax muscle or on side with upper leg flexed. Landmarks: Imaginary line from posterior superior iliac crest to the greater trochanter of femur. 1st method - Injection given between the imaginary straight line and below the curve of the iliac crest (hipbone). Syringe should be held perpendicular to flat table surface with needle directed on a straight back to front course. 2nd method: an imaginary cross is drawn from anus laterally, and from posterior superior iliac crest down the leg. Injection should be in upper outer quadrant of the cross.

Sites for Intramuscular Injections

Deltoid muscle, Dorsogluteal muscleVentrogluteal muscle, Vastus lateralis muscle

Broken Ampules

Discard ______ _______ and any remaining medication in sharps container, no longer sterile and cannot be reused.

Preparing 2 Medications in the Same Syringe

Do not contaminate one medication with another. Ensure that the final dose is accurate. Maintain aseptic technique. Use only one syringe with a needle or needleless access device attached.

Inspection

Do this of the site for drainage, redness, tenderness, irritation, warmth or cold, and swelling. If it appears infliltrated, and flow is diminished or the alarm is frequent, report it to the team leader and IV team. Document findings.

Anchor Vein

Do this to the vein by placing thumb over it and stretch skin against direction of insertion (1 ½ - 2 inches distal). Warn client of sharp stick. Insert bevel up 10-30 degree angle. Observe for blood return in flashback chamber. Advance catheter, removing the needle and stabilize the catheter with hand. Release tourniquet, and quickly connect to saline lock. Gently flush catheter, and remove syringe. Wipe site and apply dressing according to agency. Label the site, and document procedure properly.

1-3 mL of 0.9% normal saline

IV Initiating-Open sterile packages if adapter is indicated using aseptic technique. Prepare short extension tubing with needless connector using normal saline lock. Prime connector with what?

IV Site

IV Initiating-This is contraindicated if there are signs of infection (red, tender, swollen, warm, exudate), infiltration, or thrombosis. Avoid an extremity with a graft/fistula, mastectomy or stroke history, or compromised circulation. Avoid areas of flexion, and start with the most distal site.

Venous Access Devices VADs

IV Therapy- These are catheters or infusion ports designed for repeat access. Require's a written provider's order along with type of solution, does of medication, rate, and frequency. When selecting a site, consider type of fluid, length of therapy, location and condition of veins, purpose of infusion, client condition, and condition of veins.

Syringe Pumps

IV Therapy- These are prefilled and deliver a specific volume of medicine over time. More commonly used for small volumes (insulin, PCA).

Electronic Controllers

IV Therapy- These monitor the gravity infusion rate and protect the client from fluid overload. Nonvolumetric controllers monitor the gravity infusion rate by counting the drops. Volumetric IV controllers pump solution at a specific rate. The two latter devices have alarms.

Roller or Slide Clamps

IV Therapy-These restricts flow while the nurse counts the number of drops per minute that pass through the drip chamber. If the height changes due to position changes or the fluid remaining is minimal, the infusion will slow down or stop.

8 Hours

IV Tubing is usually flushed every _ _____ with 1-2 mL of saline if peripheral site.

Plebitis

Inflammation of the vein

Intracardiac

Injected directly into the heart.

Intraspinal

Injected into the subarachnoid space which contains cerebrospinal fluid (CSF) and surrounds the spinal cord

Intradermal Injection

Injection made into dermal layer of skin just below the epidermis

Purpose for Subcutaneous Injections

Injection of small amounts of medication with slower absorption and longer drug action (less blood supply). Most frequently given medications are Insulin and Heparin, Lobenox.

Intramuscular Injections

Injections made by penetrating a needle through dermis and subcutaneous tissue, depositing medication deep into the muscle mass.

Subcutaneous Injection

Injections made into loose connective tissue between the dermis and muscle layer. The usual amount injected at one site is 0.5 to 1 mL.

Complications

Inspect Site for these including phlebitis, thrombophlebitis, local infection, infiltration, extravasation, bleeding, or circulatory overload.

Sizes of Needles

Length of shaft - range from 3/8 to 3 inches. Selection is based on the viscosity of solution, delivery to the correct site, and client size. Gauge - the diameter of the shaft or the size of the lumen or hole through the needle. The larger the number of the gauge, the smaller the diameter (hole). Range = 15 to 27guage

Burrs

May use a filter needle if concerned about drawing up bits of rubber. Change the needle before administering medication because it may become dull or have irregular edges. These are called?

Refrigerated

Mix o Vial-After mixing, identify the following information on the label: the date and time of mixing, concentration of medication per mL, expiration date/time, and nurse's initials. Some medications must be ____________ after mixing-see package insert.

Dulled

Mix o Vial-Once mixed, gently roll the container to dissolve powder. Insert a needle through the top plunger diaphragm to withdraw solution. The needle should be changed after drug withdrawn as needle may be ______.

Dissolve the Powder

Mix o Vials-Pressure on the rubber plunger of top compartment forces rubber stopper to fall into bottom compartment, letting solvent in to do this.

Saline Lock

Open supplies and prepare dressing and tape. Place ______ ____ within reach on sterile guaze. Cleanse skin properly; horizontal swab, vertical swab, circular swab. Don't touch area after cleansed.

Wear Clean Gloves

Place a towel under the extremity. Apply a tourniquet over the clothing or may use a BP cuff. ________________________________. Select a well dilated vein (stroke extremity, warmth, dependent position. Palpate the vein for a bouncy feeling. Which step is missing from this list?

Does Not

Preparing 2 Medications in the Same Syringe Aspirate the volume of air equivalent to the dose of the first medication (NPH). Inject air equal to dose needed into the bottle of longer acting insulin (NPH) first, making sure the needle ?does or does not? touch the medication. Do not bubble air through insulin as it may break up insulin particles.

Remove Air Carefully

Preparing 2 Medications in the Same Syringe Cleanse the top of NPH vial and insert the needle of the syringe and aspirate the correct dose. Withdraw the needle. Draw small amount of air into syringe and mix the two medications. What do you do next?

Short Acting

Preparing 2 Medications in the Same Syringe Cleanse top of both vials with alcohol swab. When mixing rapid insulin and intermediate or long acting, which insulin is drawn into the syringe first?

Compatible

Preparing 2 Medications in the Same Syringe Make sure the medications are _______________ with each other. Check the labels of medications against the medication order.

Check Dosage

Preparing 2 Medications in the Same Syringe Withdraw the needle, and aspirate air equivalent to the dose of the second medication (Regular). Inject the volume of air into regular insulin leaving the needle in the vial. Invert the vial and withdraw dosage of short acting insulin. Remove needle from bottle then do this

Never Recap Needles

Remember to discard used materials properly. _____ _____ _______ Use needle protector systems (ports, sheaths). Never administer a drug that is cloudy or has precipitate, mix drugs with blood or products, or if compatibility is not known. Finish one medication completely, before adding another medications.

Sterile Needle

Remove filter needle and replace it with the appropriate size _______ ______ before administration.

Controllers for IV Therapy

Roller or Slide Clamps Electronic Control Syringe Pumps

Equipment for Subcutaneous Injections

Small syringe (Insulin), 1 mL, needle gauge of 25 to 29 and needle length 3/8 - 5/8 inch (if client obese, may need longer needle).

Route of Administration, Syringe Design, and Client Size

Some standard syringes are prepackaged with a needle attached, but the needle may need to be changed based upon what 3 things?

1 mL

Standard syringes are calibrated in mL or cc based upon the metric system (formerly may have been calibrated in minims) 16 m = ?

Plebitis and Thrombophlebitis

Symptoms for these include swelling, tautness, pallor, coolness, and pain.

Infiltration

Symptoms of this are swelling, tautness, pallor, coolness, and pain.

Infection

Symptoms of this include redness, heat, edema, drainage from site

Fluid Overload

Symptoms of this include shortness of breath, crackles in lungs, edema

Onset of Action is Fast

The advantage of parenteral administration of medication is the _____ __ ______ __ ____. Onset of action is fast (15-30 seconds for IV, 3-5 minutes for IM, SQ). The bioavailability of the drug is 100%. Injection may be formulated to last days to months (Depo-Provera-3 months). IV is useful for patients in continuous pain or those who need fluids.

Gauge

The diameter of a needle

Irretrievable

The disadvantage of parenteral administration of medication would be the medication is _____________. Persons cannot self-administer or may fear needles and injections (Belonephobia). Most dangerous route since it bypasses natural defenses, exposing user to infection or undissolved particles or additives/contaminants, or air bolus with risk of allergy or trauma at the site. The cost is higher than oral or other forms.

Flicking

The first step is to move all medicine to the bottom of the ampule by _________ top lightly with fingers.

Purpose of Intramuscular Injections

The most common route; rapid and complete absorption due to rich blood supply in the muscle. Used for antibiotics, analgesics, and pre-op drugs, steroids, and vaccinations (pneumonia, influenza, hepatitis).

Insulin Delivery Aids

These such as nonvisual measurement devices, magnifiers, needle guides, or vial stabilizers are available for people with visual impairments.

Vacuum

The vial is a closed system, so air must be injected into it in order to withdraw the medication easily. Failure to inject air creates this making withdraw difficult.

Central Venous Catheters

These VADs are (Hickman, Broviac, Groshong), and implantable ports (Infus-A-Port, Port-A-Cath) empty into a central vein (subclavian and jugular). Used for large volumes, high concentration, hypertonic solutions, peripheral sites exhausted, long term therapy, or emergency.

Peripheral Catheters

These VADs are for short term use for fluid replacement after surgery, during hospitalization, or for medication administration. Placed in peripheral vein of hand or arm such as metacarpal veins, dorsal veins, cephalic vein, and basilic veins. Devices include wing tipped (butterfly), over-the-needle catheters, and inside the needle catheter. Subsequent sites should be selected above previous ones. Available in various gauges (20 and 22 are common). A larger number indicates a smaller size. When using a VAD over-the-needle, insert the needle and advance the catheter while withdrawing the needle. A safety mechanism is used to cover the needle once the catheter is secured to prevent injury.

Peripherally Inserted Central Catheters

These VADs enter a peripheral arm vein and extend to the superior vena cava. Useful for large volumes, TPN, and irritating medications. Requires the nurse to receive special training.PICC

Syringes

These are usually made of plastic, which is disposable, safe, and convenient with less risk of infection. Glass ones are still available, although they must be cleaned and sterilized. Most of these have safety devices to prevent needle stick injury

Non Luer Lok Syringe

These have needles that slip onto the tip, which is smooth.

Luer Lok Syringe

These have needles that twist onto the threads within the tip and locked in place. This prevents accidental removal of the needle.

Purpose of Intradermal Injections

These include Allergy testing, local anesthetics, and sensitivity testing.

Less Common Complications of IV Therapy

These include septicemia, air embolus, pulmonary edema or embolus, and speed shock.

Shorter Lines

These lines on the insulin syringe represent 2 units, whereas the longer lines represent 10 units. Used only for injection of insulin.

IV Solutions

These may be large or small volume in plastic and glass containers in various concentrations and volumes. Plastic bags are double sealed, and small volumes are administered through piggyback or IV rider.

Sliding Scale Rapid or Short Acting Insulins

These provide medication based upon the blood glucose levels and provider's orders

Rapid, Shorter Acting, and Longer Acting Mixed Insulins

These should be given within 5-15 minutes of preparation. Regular insulin (short-acting) should be given within 30 minutes of a meal, while lispro (rapid-acting) insulin should be given within 15 minutes of a meal.

Isotonic Solutions

These solutions (0.9% sodium chloride, ringers lactate, 5% dextrose/0.2% sodium chloride) have same osmolality as body fluid. Are used for fluid replacement due to bleeding, hypotension, maintenance of hydration and electrolytes, administering medications, or to keep open

Hypotonic Solutions

These solutions have less osmolality than body fluids, which move water into the cells. Hypertonic solutions have greater osmolality than body fluids and pull water out of cells.

Additives

These such as potassium are common in IV solutions but must be administered slowly. Medication must be given slowly (one or more minutes), rapidly (IV push), piggyback (drug mixed in 50-100 mL of compatible fluid) given over 30-60 minutes through primary IV site into an existing IV port, VAD, or added to an IV solution. The medicine hangs in tandem connected to the primary set. Risks include medication overdose or fluid overload. Mixing is done in the pharmacy or by manufacturer, unless emergency.

Viscous

Thick

Colored Ring

This around the neck of the ampule indicates where it may be broken easily or filed

Parenteral Administration

This includes subcutaneous, intramuscular, or intradermal routes. Other routes administered by a physician or advanced practice nurse with special training include intrathecal, intradural, intra-articular, or intra-arterial, IV.

IV Bolus

This introduces a concentrated medicine into the bloodstream leaving little time to check for errors. May be irritating to the vein. Never use an IV site if edematous or flow is sluggish. Sloughing and abscess may occur if medicine is delivered to tissue rather than the vein. Always check the length of time for administration.

Mix-O-Vials

This is a glass container with two compartments. The top compartment contains a sterile solution (diluent), the bottom compartment contains the medication powder. The two areas are separated by a rubber stopper.

Administration Set

This is an apparatus that connects a large volume of solution with the IV access device in the client's vein. All sets have an insertion spike, a drip chamber, plastic tubing with a rate control clamp, a rubber injection portal, a needle adapter, and a protective cap over the needle adapter.

Insulin

This is classified as a hormone to treat diabetes mellitus, and dosages are prescribed in units. Be sure to use only an insulin syringe. Once the syringe is prepared, confirm the drug and dosage with another nurse before administration. It is classified as rapid, short, intermediate, and long acting. Only regular this may be given IV. Premixed this is also available, such as 70/30, which is 70% NPH and 30% Regular, eliminating the need to mix insulins. Lantus may not be mixed with any other medication.

Main IV Solution

This is connected to a primary line, which is connected to the IV catheter. The IV may be connected to an electronic infusion device (IED) using the appropriate tubing (tubing may provide 10, 15, 20, or 60 drops/mL. Electronic controllers monitor the gravity infusion rate and protect from overload. Nonvolumetric controllers monitor the gravity infusion rate by counting the drops. Volumetric IV controllers pump solution at a specific rate, both have alarms. Syringe pumps are prefilled and deliver a specific volume of medicine over time used for medicines (analgesics, insulin). Controllers have roller or slide clamps to restrict flow, and changes in height of solution will affect flow rate if a pump is not used.

Catheter Removal

This is indicated when therapy is no longer needed as evidenced by a provider's written order for discontinuing IV

Infiltration

This is loss of vein access and fluid flows into the subcutaneous tissue

Multiple Dose Vial

This or newly reconstituted powder solution must be clearly labeled when opened (date, time, concentration, expiration time, nurse's initials, type and amount of diluent if used). Refrigerate if needed.

Hub

This part of the needle is the flared end that fits on the tip of the syringe.

Shaft

This part of the needle is the long, hollow tube embedded in the hub through which medications passes.

Tip

This part of the needle is the pointed end with a beloved edge that pierces the skin.

Plunger

This part of the syringe is the inner, solid rod that fits snugly into the barrel used to draw up and eject the solution.

Barrel

This part of the syringe is the outer hollow cylinder that holds medication and contains the calibrations for measuring the quantity of medication.

Tip

This part of the syringe is the portion that holds the needle classified as Luer-Lok or non Luer-Lok based upon the tip design.

Insulin Pen

This type of disposable syringe is a portable device that looks like a pen. When used, the cap is removed, a needle is attached, air is removed, and a dose is dialed prior to administration. It delivers insulin.

EpiPen

This type of disposable syringe is an automatic device prefilled with epinephrine for use in an emergency such as anaphylaxis. When help perpendicularly against the thigh and activated, a needle penetrates the skin into the muscle and a single dose is delivered.

Disposable

This type of prefilled syringe is single-dose prefilled syringes are available in some instances. They look similarly; therfore, double check the drug name, concentration, and volume carefully. No preparation is needed except to expel air or unneeded medication. The syringe is used once and discarded and may be more costly.

Tuberculin Syringe

This type of syringe holds a total capacity for 1 mL (cc). Each of longest lines represents 0.1 (1/10) mL. The intermediate lines equal 0.05 (5/100) mL, and the shortest lines are 0.01 (1/100) mL.

Aspirate

To draw out by means of suction; to aspirate means to pull back slightly on plunger to look for blood

Aspirate

To prepare, first remove the lid and cleanse the rubber top with alcohol. ________ an amount of air equal to amount of solution to be withdrawn. Insert needle bevel up, inject the air, and withdraw the medication

72 Hours

Transparent dressings may be changed every __ ______, but check policy of the agency. Do not use antibiotic ointment at the site

Equipment Needed for Intradermal Injections

Tuberculin syringe; small needle (1/4, 3/8, 1/2 inch), gauge (25, 26, 27 inch).

Solutions and Infusions

Types consist of water with dissolved particles commonly sodium chloride, dextrose, and potassium chloride.

Initiating IVs

Universal precautions must be followed. Organize all equipment including VADs, tourniquet, gloves, dressing, IV solution, IV tubing, and electronic infusion devices or pumps. Select the smallest guage possible. Do not use the hand veins on older or ambulatory persons. Foot veins must be avoided due to thrombus risk.

Sites for Subcutaneous Injections

Upper arms, abdomen, anterior thighs, upper back, and buttocks. It is important to rotate injection sites of insulin to prevent lipohypertrophy or lipoatrophy which slows absorption. Rotate systematically within one area before progressing to a new site

6 Rights

Use these to see if IV solution is prescribed?

Filter Needle

Use this to withdraw medication to prevent aspiration of particulate matter such as glass fragments.

Z Track Method for Intramuscular Injections

Used for medications that are irritating to tissues or cause staining of the skin (iron). Creates a seal in the medication, preventing it from leaking into tissue. Select the site; ventrogluteal is preferred.

Ampules

Usually contain single dose of medication in a liquid available from 1-10 mL or more. It is made of glass with a constricted neck that must be snapped off to allow access to the medication.

Meniscus

Volumes in a plastic syringe are read at the point where the rubber flange of the plunger is parallel to the calibration scale of the barrel. This is the ____________. In contrast, read a glass syringe at the point where the plunger is directly parallel with the calibration on the syringe. (Standard Syringe)

3

What size standard syringe is the most commonly used for subcutaneous and intramuscular injections? Larger sizes are used for IV injections, irrigation of wounds or drainage tubes, or aspiration of fluid from the body.

Standard Syringe

Which type of syringe has sizes of 1, 3, 5, 10, 20 and 50 mL? The size to use is determined by the volume of medication to be administered, degree of accuracy in dosage, and type of medication.

Nurse

Who is responsible for the monitoring client carefully checking for errors, double checking calculations, and adhering to six rights of administration. Antidotes must be available. Monitor infusion rate according to prescribed checking type and rate of flow and when initiated.

Push Plunger

____ _______ until medication appears at the tip of needle or measure the amount of air to included to clear needle.

Grasp

_______ above ringed area of ampule with plastic cover, alcohol wipe, or gauze pad and pull down sharply on glass top.

Calibrations

_____________ provide the greatest degree of accuracy. The tuberculin syringe is useful when preparing small, precise doses for infants and children, intradermal injections (allergy testing, TB testing), and subcutaneous anticoagulants (heparin sodium). (tuberculin Syringe)

Total Parenteral Solutions

contain electrolytes, dextrose, amino acids, fatty acids. Solutions may be hypotonic, hypertonic, or isotonic in nature. Solutions may be large volume or small volume containers (piggyback).

Microdrip Chambers

deliver 60 drops/mL and are useful for small volumes of fluid or accuracy as in pediatrics or fluid volume problems. IV Fluids

Purpose of IV Therapy

fluid replacement, electrolyte and nutrient replacement, blood or blood products, emergency use, highly irritating medicines, maintain constant therapeutic blood level of medicine.

Ventrogluteal Muscle

involves the gluteus medius located away from major nerves and blood vessels. Preferred site; safest for adults and children especially for viscous and irritation medication. Not recommend in children less than 2 years old Place in prone, supine, or side lying position flexing the knee and hip. Landmarks: place palm of hand on the greater trochanter with the examiner's hand perpendicular to the femur. Use the right hand for the left hip and vice versa. Point the thumb toward the anterior superior iliac crest and index finger on the crest; extend the middle finger back along the crest toward the buttock. Injection is made into center of the V formed between the middle and index fingers.

Vials

is a single-dose or multiple dose plastic or glass container with a rubber seal on top. It may have liquid or dry forms of medicine. A metal cap protects the rubber seal until ready to be used.

Vastus Lateralis Muscle

is thick and well-developed. Preferred site for adults and children but muscle mass shrinks in elderly, emaciated, very ill, or non-ambulatory client. Often used for infants, toddlers, and children receiving biologicals (vaccines, toxoids, IG). Located on the anterior lateral thigh; client may lie flat with the knee slightly flexed or sit in order to relax the muscle. Landmarks: measure one handbreadth above the knee and one handbreadth below the greater trochanter. Use the middle third of the muscle for injection. The width extends from the midline of the thigh to the midline of the outer side of the thigh. Grasp the body of the muscle if client is cachectic.

Iv Therapy

know institutional guidelines. Requires a written doctor's order with the type of solution, dose of medication, rate, and frequency. May be delegated within the scope of practice to an LPN depending on institutional policy. Many hospitals use infusion teams.

Sites for IV Therapy

may be peripheral or central IV line depending on access device used

Deltoid Muscle for Intramuscular Injections

not well developed in some adults and several nerves and the brachial artery are nearby. Used for small volumes of non-irritating medications (May give up to 2 mL should be given in one site, but 1 mL is common. Use 1 inch needle. Do not roll up a tight-fitting sleeve. Client should relax the arm at the side and flex the elbow sitting, standing, or lying. Landmarks: Draw an imaginary line across armpit at level of axillae and the lower edge of the acromion process. Two imaginary vertical lines, 1/3 and 2/3 of the way around outer aspect of arm creates small rectangle in which medication can be safely given. Option: create a small triangle which includes an imaginary line across the armpit at the axilla, and the lower edge of the acromion process.

Macrodrip Chambers

provide 10, 15, or 20 drops/mL. IV Fluids

Dry Forms

require reconstitution, and the label specifies type and amount of diluent such as normal saline or sterile water. Tap on the vial to break up the powder, and fill the syringe with air equal to the volume of diluent to be withdrawn. Cleanse the rubber stopper of the diluent and inject air into the diluent vial. Aspirate the correct amount and withdraw. Cleanse the rubber stopper of medication, insert the needle, and inject diluent into the powder. Remove the needle, gently roll the vial to mix the contents, and withdraw the dose needed.

Sites for Intradermal Injections

should be hairless and receive little friction from clothing. Usual sites upper chest, scapular areas of back, and inner aspect of forearms. If allergy testing, emergency equipment should be available.

Syringe Used for Intramuscular Injections

standard size. In adults, generally 0.5 to 2 mL is injected, not to exceed 3 mL in one site. If more than 3 mL is to be given, it should be given in divided doses. In infants or small children, should not exceed ½ to 1 mL.