Pharmacology Ch 4

What size of needle is used for the deltoid site?

23-25g, 5/8-1.5" long

What angle should the needle for a deltoid injection

90* to the skin or towards the acromion.

What volume of drug is used for deltoid injections??

0.5-1ml, no more than 2ml

How much can you inject IM and what must you never go over?

0.5-3mL for adult, 0.5-1mL for child; never over 3 (Usually 0.5-1.5mL injected) (Text page 43)

How much should be injected for adults and children?

0.5-3ml for adults, 0.5-1ml for children

What length of needle is used foor vgluteal?

1.25-2.5" long (20-23 g)

Where are subQ sites?

Abdomen, upper hips, upper back, lateral upper arms, lateral thigh

What is important to do after using a filter needle?

Change the needle to prevent irritation

What must you not do and tell the patient not to do after a transdermal injection?

Don't rub it!

How do you locate the right placement for dgluteal?

Draw an imaginarry line between post. Illiac spine and greater trochanter. The right spot is midpoint and above this line.

When do you NOT aspirate with subQ injections?

Heparin, LMWH, insulin (jess: "surly pirates have parrots and suck on limes..." SUrly=subQ, asPIRATE=PIRATEs, PARrots=hePARin, suck=inSUlin, limes=LMwh)

What are four examples of subQ injections?

Heparin, insulin, epinephrine and allergy meds (jess remembrance: subq= in epi hell -->insulin, epinepherine heparin, allergy...)

What is the rule when using the deltoid site on infants?

If the amount is very small

What 3 types of drugs are used in IM injections?

Irritating drugs, aqueous suspensions, solutions and oils (FYI: ex includes: codeine, morphine)

Why is subQ injections used over other routes?

It has a sustained effect, is absorbed through the capillaries, it has a slower absorption than IM.

What is dangerous about thee dgluteal?

It is close to nerves and blood vessels

What is an advantage of the deltoid injections?

It is easily accessible and pt can be in any position

What is the deltoid injection not suitable for?

More than one injection a day

The nurse is administering medications to an infant. What intervention is the best technique for the nurse to use?

Move slowly and have a non-threatening approach.

Do you put subQ injections in the same site?

NO!

What is enteral route? (6 things)

Oral, eye drops, ear drops, inhalation, suppositories, topicals (jess: head, shoulders, knees, and toes... Eyes, ears, mouth, and nose.)

When using the airlock technique how do you hold the needle

Perpendicular to the site you are injecting

What must you do to the skin on a subQ injections?

Pinch it

How do you locate the site for vgluteal?

Place hand on greater trochanter of femur, middle finger traces iliac crest -->it is the space between index and middle finger.

How do you insert an IV?

Place tourniquet above the selected vein, insert a needle into vein bevel up and short angle to skin (10--15*), if the needle is inserted properly there should be a backflow (FYI: As an uncertified LPN, you can't without IV therapy class)

What position do you put the patient in for dgluteal?

Prone

How do you inject medication with the Z-track??

Pull the skin, subQ tissues, and fat laterally, while holding the skin put in the needle -->inject the drug, AFTER the drug is injected, withdraw the needle & release the tissue at the same time, this prevents back fllow into the subQ

At what angle should you insert the needle on an vgluteal?

Slightly angled towards the iliac crest (*pg 43 of text)

How fast do you inject subQ injections?

Slowly

How can a drug be given through an IV? (4)

Slowly or rapidly Piggyback into an existing IV bag Into a heparin/saline lock

What types of medications are used for subQ injections?

Small doses of non irritating, water-soluable drugs

What parts of the syringe must remain sterile?

The tip and inside

Why would you chose the vgluteal over the dgluteal?

Thinner layer of subQ, less painful

What is the preferred IM site?

Ventrogluteal

Do you aspirate with subQ injections?

Yes

The nurse is administering oral medications to the client. Which are important considerations? a) Administer irritating drugs with food b) avoid mixing mediations in infant formula c) enteric coated capsules CAN be chewed or crushed d)Oral medications are not given if client is vomiting.

a) Administer irritating drugs with food b) avoid mixing medications in infant formula d)Oral medications are not given if client is vomiting.

The nurse administers iron dextran to the client. What special considerations are associated with this? (select all that apply) a) Gluteal site is preffered, best with different needle to draw up and administer b) Deltoid site is preferred, increased chance of "self sticks" c) Vastus lateralis site is preferred d) Gluteal site is preferred with use of one needle

a) Gluteal site is preffered, best with different needle to draw up and administer

The nurse is teaching the client to use an inhaler. What common teaching points should the nurse remember? a)Handheld nebulizers deliver a large molecule particle spray of medication b) Semi-or high Fowler's position is recommended c) Spacers decrease delivery of medication d) A counter should be used to track the number of inhalations used.

a)Handheld nebulizers deliver a large molecule particle spray of medication d) A counter should be used to track the number of inhalations used. ??? Pg 47 text

The nurse administers a variety of medications to the client. Which comment by the client indicates need for further teaching? a)"I do not drink or eat when I have nitroglycerin in place." b) "I mix all these meds in my dessert and hope I am not too full to finish." c) "I keep the meds in their original labeled containers." d) "I store medications away from children and pets."

b) "I mix all these meds in my dessert and hope I am not too full to finish."

The 3-year-old client has an IM medication ordered. What is the most appropriate approach to gain the child's cooperation? a) Engage in fantasy play b) Give injection to a stuffed toy bear c) Restrain the client's upper extremities d) Ask family members to leave the room

b) Give injection to a stuffed toy bear

Which landmarks does the nurse plan to use when administering an IM injection into the dgluteal region?

c. Anterior to the diagonal line from the greater trochanter to the posterior superior iliac spine. The correct anatomic landmarks for the dgluteal site are found by finding the greater trochanter and the posterior superior iliac crest and drawing a line between the two. The injection is then administered above that line.

What is the parenteral route? Name 8 examples.

Anything given by needle, subQ, IM, IV, intra-dermal, intra-lesional, intra-arterial, intra-cardiac, intra-articular (jess mneumonic: calm davsq)

What are the advantages of the VL injection site?

Area good for many injections, free of major nerves; however, if the needle is too long it will hit the sciatic nerves..

What type of effect does the IM injection cause?

systemic

How much syrum is INJECTED during the intradermal route

usually 0.01-0.1 ml injected -->(Syringe= 1mL calibrated to 0.01 mL increments)

Hoow many attempts can you do to insert an IV

3

What is the vollume of drugs for vastus lateralis for infants and adults?

<0.5 ml forr infannts 1 ml max, 1-1.5 ml ofor adults 2 ml max

How do you cleanse an area for injection?

From inside to out in a circular motion.

What is an advantage of subQ injections?

It is non irritating

What effect does a subQ have on the body?

Systemic effect

Things to remember with Intradermal

-Hold skin taut -insert at 10-15 degree angle -inject slowly as wheal -do not massage the area, tell client not to as well -mark with pen -reassess for allergic reaction in 24-72 hours

Intradermal injection

-Local Effect -Small amount is injected so that volume does not interfere with wheal formation or cause a systemic reaction. -Used for observation of an inflammatory (allergic) reaction to foreign proteins. --Ex:TB, allergy sensitivity, immunotherapy for cancer. Eq: Needle: 25-27 gauge; 3/8-5/8" long -Syringe: 1mL calibrated in 0.01-mL increments (usually 0.01-0.1 mL injected)

Subcutaneous injections

-Systemic effect -Sustained effect; absorbed mainly through capillaries, usually slower in onset than with the IM route -Used for small doses of nonirritating, water-soluble drugs Eq: Needle: 25-27 gauge; 1/2-5/8" long Syringe: 1-3mL (usually 0.5-1.5mL injected) -->Insulin syringe measured in units for use with insulin only

Things to remember with SubQ injections

-pinch the skin -insert at a 45-90 degree angle -Release the skin -Aspirate (except herparin LMWH, and insulin) -Gently massage the area unless contraindicated -Apply bandaid

What are 3 advantages of IM injections?

1) More rapid effect, 2) drugs that are irritating to the subQ can be given IM, 3) larger volumes can be given

How much injection do you use for the dgluteal??

1-3 ml

What syringes are used for IM injections?

1-3 ml

What size of syringe is used for subQ injections and how much is usually injected?

1-3ml; 0.5-1.5ml injected

What size of needle do you use for dlguteal?

18-23g, 1.25-3"

What size of needle is used in IM injections?

20-23 g, (18 g for blood products) usually 1- 1 1/2" long (1-3mL syringe)

What type of needle do you use for subQ injection?

25-27 g, 1/2-5/8" long (Volume= 0.5-1.5mL injected using a 1-3mL syringe)

What equipment is used for intradermal injections? Needle gauge, length of needle, syringe...

25-27 gauge, 3/8-5/8" long, 1ml (tb)

What angle should you put tthe needle in the VL?

45-60* angle to the frontal, sagital, and horizontal planes of the thigh

How do you insert the needle for subQ needles, especially on those with not a lot of subQ??

45-90*, it depends on body size. 45* for thinner patients

What drug is only injected through the dgluteal?

5 gamma globulin

What size of needle is needed for the vastus lateralis site?

5/8-1"

Why is the intradermal used and what tests are they used for?

Absorbs slowly, for sensitivity tests, tb, immunotherapy for cancer and local anesthetic.

What are two disadvantages of subQ injections?

Absored more slowly than IM, and you can't inject more than 1.5 ml of drugs

Why are the locations chosen for IM injections?

Adequate muscle and minimal major nerves and blood vessels

What site is preferred for pediatric younger than 7 months?

Bastia lateralis

Why are subQ sites chosen?

Because of the adequate fat pad sites

How do you insert the needle on the intradermal route?

Bevel up, 10-15* (*=degree), the outline of the needle should be visible beneath the skin and inject slowly

What must you do if (more than) <1 ml of meds are to be injected into the body with subQ injections?

Change needles and sites

Who is vastus lateralis injections mostly used for?

Children

How is the drug inserted into the body and what effects does it have? (IV)

Directly into the blood, action occurs almost immediately

How do you locaate the deltoid injection site?

Draw an imaginary line across the armpit at the level of the axilla and then lower edge of the acromion

What needle do you use to draw up meds from an ampule or glass vial?

Filter needle

What do you do after you inject a SubQ injection, and what are two injections?

Gently massage it: (not with heparin and LMWH) *Another example is insulin. apply gentle pressure to reduce bleeding or ooozing and bruising. You do want pressure after heparin to reduce tissue damage.

Which intervention will the nurse plan when administering a medication subcutaneously?

Insert the needle at a 45-90* angle, depending on client size, to penetrate subcutaneous tissue. The proper technique for subcutaneous injections involves the use of a 5/8" needle, 25-27g, @ a 45-90* angle of insertion, dependent on client size. 1- 1-½ inch needle is used for IM injection. Aspiration is done with all medications EXCEPT anticoagulants and insulin. The landmark for the vastus lateralis is one handbreadth below the greater trochanter and above the knee on the outer aspect of the thigh.

What are the best areas for intradermal injections and examples? Why?

Light pigmented, low keratinized, hairless: ventral forearm, clavicular area of the chest, scapulae are of the back. (Because these are areas that inflammatory action can be observed, pg 41 text)

Intradermal injection sites

Locations are chosen so that an inflammatory reaction can be observed. Preferred areas are lightly pigmented, thinly keratinized, and hairless, such as: -the ventral mid-forearm, -clavicular area of the chest, and -scapular area of the back.

Sub Q Sites

Locations for SubQ sites are chosen for adequate fat-pad size and include: -the abdomen, -upper hips, -upper back, -lateral upper arms, and -lateral thighs (*Sites should be rotated with SubQ injections such as insulin and heparin.

How do you read an intradermal result?

Make sure to tell the patient not to wash off the marker, measure the diameter of the local action (don't include any erythema in measurement) assess the area sighting 24-78 hrs

What must you do before taking out the needle on subQ injections?

Release the skin

What syringe do you use for volumes smaller than 0.5 ml

TB

What are some rules about age with injection sites?

VL is used for people with firm walking development, If they don't have firm walking development then VG is prefered DO NOT USE DG FOR CHILDREN

What are the 4 injection sites for IM?

Ventrogluteal, dorsogluteal, deltoid, vastus laterallis

When can you use the z track?

Vgluteal and dglutteal

What is 1 reason you would choose dgluteal over vgluteal?

Vgluteal is safer (less danger of injury to major nerves and vascular structures) +less painful, -but you can't put in as much volume

What are 2 disadvantages to IM injections?

Volumes over 3 will not be absorbed properly, divide doses if over 3.

Why is the z-track technique used?

When a drug is highly irritating to the subQ tissues or has the ability to permanently stain the skin

When would the nurse plan to use Z-track technique for the administration of an intramuscular injection?

With medications that are known to be irritating, painful, and/or staining to tissues The Z-track method prevents medication from leaking into subcutaneous tissues where it can be irritating and/or painful.

The clinic nurse administers a TB test to the client. Which supplies are best used? a) 21 gauge, 5/8 inch needle b) 27 gauge, 5/8 inch needle, 3 mL syringe c) 25 gauge needle, insulin syringe d) 25 gauge needle, tuberculin syringe

d) 25 gauge needle, tuberculin syringe