RDT 108 Chapter 8 Questions
Explain the procedure for starting an IV.
1.Wash your hands thoroughly 2.Introduce yourself and thoroughly check the patient's identification 3.Explain the procedure. Make sure the patient understands. Obtains feedback 4.Prepare the drug and all required supplies for administration 5.Put on disposable gloves 6.Determine the most appropriate site for venipuncture, and cleanse it with an alcohol swab using a circular motion while moving from the injection site outward. Cleansing a second time may be warranted 7.Apply a tourniquet 3 to 4 inches above the site of injection. The patient may open and clench the fist to make the veins more identifiable 8.To stabilize the vein and to keep it from rolling, place your thumb directly below the injection site and gently pull the skin toward the fingers of the patient 9.Hold the needle with the bevel facing upward. If using a butterfly set, pinching the wings together assists in stability 10.Insert the needle as a 15-20 degree angle through the skin. Gently advance it into the vein. You will feel a subtle "pop" as the needle enters the vein, and you should see a backflow of blood into the tubing 11.Release the tourniquet and inject the drug. Taping the needle in place during injection will keep it from dislodging. 12.Remove the needle quickly, and apply gentle pressure to the injection site with an alcohol swab 13.Dispose of the syringe and needle in a labeled "sharps" container 14.Chart all pertinent information
What is an aqueous solution and give 2 disadvantages for using them.
A solution of oil; two disadvantages are that the patient may be sensitive to oil and the oil may not be absorbed
List the major advantages and disadvantages of Topical Administration
Advantages: Can bypass the GI tract; can be fast acting with thinner skin Disadvantages: Can be irritating, wash off, or take longer to absorb through different types of skin
List the major advantages and disadvantages of Parenteral Administration.
Advantages: Fastest and most efficient Disadvantages: Most dangerous; drugs are irretrievable once injected.
List the major advantages and disadvantages of Oral Administration.
Advantages: Most convenient; most economical; safest; allows for the easiest retrieval of a drug in overdose situations. Until a drug is dissolved and absorbed, it may be retrieved by lavage or catharsis or may be absorbed to block absorption. Disadvantages: Slower and less efficient than parenterally administered drugs; They may have an objectionable odor or taste or may be bulky to swallow. They may harm or discolor the teeth. They may irritate the gastric mucosa, causing nausea or vomiting. They may be aspirated by a seriously ill or uncooperative individual. They may be destroyed by digestive enzymes. They may be inappropriate for some patients, such as NPO.
List the major advantages and disadvantages of Rectal Administration
Advantages: Rectal administration of certain preparations can be used advantageously when the stomach is non-retentive or traumatized, when the medicine has an objectionable taste or odor or when it can be changed by digestive enzymes. Use of the rectal route avoids irritation of the upper GI tract and may promote higher bloodstream drug titers because venous blood from the lower part of the rectum does not traverse the liver. The suppository drug vehicle is often superior to the retention enema vehicle because the drug is released at a slow but steady rate to ensure a prolonged effect. Disadvantages: Unpredictable retention of drug, or possibility of fluid passing above the lower rectum to be absorbed into the portal circulation, where metabolism can be extensive
List the major advantages and disadvantages of Sublingual Administration
Advantages: The drugs administered by this route will gain access to the general circulation without traversing the liver or being affected by the gastric and intestinal enzymes. Thus, the drug potency may be enhanced. Disadvantages: It is unclear, in some cases, whether a drug is absorbed under the tongue or actually swallowed and absorbed in the intestinal tract
Parenteral administration requires 3 things at the injection site. List them and explain what can happen to the patient if they are not done properly.
Aseptic technique, accurate drug dosage, and proper technique and rate of injection If not followed, lipodystrophy, abscesses, necrosis, skin sloughing, nerve injuries, prolonged pain, and periostitis may occur
What supplies are necessary for the IV injection?
Butterfly needle and an over-needle catheter
Name a common area of injection, region of injection, and example of a drug injected with Subcutaneous Injections
Common Area: Beneath the skin Region: lateral upper arms; thighs; abdominal fat pad (except for area around umbilicus and tissue over bone); upper back; upper hips Example: Epinephrine (non-oily), insulin, some narcotics, tetanus toxoid, vaccines
Name a common area of injection, region of injection, and example of a drug injected with Intravenous Injections.
Common Area: Cephalic and basilic veins Region: dorsum of hand and forearm; antecubital fossa Example: Antibiotics, vitamins, fluids and electrolytes
Name a common area of injection, region of injection, and example of a drug injected with Intradermal Injections.
Common Area: Skin Region: Inner aspect of the mid-forearm or scapula Example: Tuberculin, allergens, local anesthetics
Name a common area of injection, region of injection, and example of a drug injected with Intramuscular Injections
Common Area: gluteus medius, gluteus minimus, vastus lateralis, and deltoid Region: Dorsogluteal, ventrogluteal, anterolateral mid-thigh, upper arm below shoulder Example: most intramuscular and Z-track injections; all intramuscular medications; vaccines, absorbed tetanus; epinephrine
What is the criteria for selection of a save IM injection site?
Distance from large, vulnerable nerves, bones and blood vessels; and from bruised, scarred, or swollen previous injections or infusion sites
What would happen to the patient of a subcutaneous injection became an intravenous or interarterial injection?
If you inject a drug like this wrongly, it can be extremely dangerous to the patient (air embolism, hematoma, extravasation)
What is the disadvantage of using the vastus lateralis IM injection site?
Injection here may be more painful than in the buttocks
What are the 4 most common methods drugs are administered parenterally?
Intradermal, Subcutaneous, Intramuscular, Intravenous
Drug effects are slower and less efficient for which route?
Oral
What type of needle is used for an intramuscular injection (include length and gauge)?
Usually 1-1.5 inches in length and 21-23 gauge
What should the technologist watch for when performing an IV injection?
The tech should watch for drug and blood leakage into the tissues surrounding the vein
What type of patient is the rectal route generally used?
Those whose stomach is non-retentive or traumatized
Why should the fleshy part of the buttock not be used for intramuscular injections?
Underneath the fleshy part of the buttock is the Sciatic nerve, which, if damaged, can result in permanent leg paralysis
When is the intradermal method used and what type of needle is best used? (Include Gauge)
Used for testing allergic reactions, or for giving small amounts of local anesthetic 26-27 gauge and a small barrel syringe such as a tuberculin syringe
How can you prevent subcutaneous injections from becoming intravenous or interarterial injections?
You must slightly draw back the plunger of the syringe to see if a red streak shows up. If so, you have most likely hit a blood vessel and must immediately stop
What is the general angle of insertion used for the SC (subcutaneous) method, and what type of needle is used?
usually between 45-60 degrees; 25 gauge
List the 6 effects (and explain) for medications applied directly to the skin.
• Astringent: resulting in vasoconstriction, tissue contraction, and decreased secretions and sensitivity, thereby counteracting inflammatory effects • Antiseptic or bacteriostatic: to inhibit growth and development of microorganisms • Emollient: for a soothing and softening effect to overcome dryness and hardness • Cleansing: for the removal of dirt, debris, secretions, or crusts • Anesthetic: to remove the sensation of pain • Antihistamine: for manifestations caused by allergic reactions
Explain when the IV method is used and give the injection sites.
• IV method is used when "immediate" effects of a drug or fluid are desired • Basilic or cephalic veins on the back of the hand, the basilic vein on the medial, anterior forearm and elbow or the cephalic vein on the lateral, anterior forearm and elbow.
What information should be included in the chart?
• Name of drug • Dose of drug • Route of drug administration • Date of administration • Time of administration • Injection site (if administered parenterally)
Name the 5 Routes of Drug Administration and give an example of each.
• Right Patient: "May I verify your name and date of birth with your wrist band?" • Right Drug: When setting up a sterile tray, be sure to label all of the medicine that you draw as you draw them. Such as Lidocaine. • Right Amount: An example would be if you were setting up a sterile tray and if the required amount of ccs of Lidocaine was 5cc then you must do 5cc to be safe • Right Time: For example, "At 6:00" • Right Route: Either oral, sublingual, topical, rectal, or parenteral
What are 6 reasons for pain to occur from injections? How can you reduce discomfort?
• Stretching of tissue, irritation from the drug itself; from unsteadiness in the injector's technique, which results in jiggling of the needle during overly slow insertions, during aspiration, while the injector is reaching of the antiseptic swab at completion, or from wet antiseptic on the skin during insertion • You can reduce discomfort by applying firm pressure to the needle-tissue juncture with an antiseptic swab as the needle is withdrawn as well as massaging the site
What are the common sites for CV catheters and where should the catheter be placed?
• Sub-clavian vein is the most common, but it can also be inserted in the internal jugular and femoral veins • Correct placement would be in the superior vena cava, 2-3 cm above the right atrial junction
Give a brief description of Endotracheal tubes, Central Venous Lines, and Pulmonary Arterial Lines
•Endotracheal (ET) tubes are used primarily to assist the patient through a number or respiratory problems. •Central venous (CV) lines, also known as central venous catheters and venous access devices, are catheters inserted into a large vein to: • Administer drugs • Manage fluid volume • Transfuse and analyze blood • Monitor pressures within the heart Used in both short-term and long-term patient care •Pulmonary arterial (PA) lines are commonly called Swan-Ganz catheters o Specialized CV lines that incorporate a small electrode at the distal end used to monitor pulmonary arterial pressures. o Used to estimate left ventricular end-diastolic pressure (LVEDP) o Because catheter placement in the left ventricle creates major physiologic consequences, the safest way to assess left-sided heart pressure is to estimate its value by monitoring right-sided heart and pulmonary pressures
Name the 5 Rights of Drug Administration and give a brief explanation of each
•Right Patient: Verify that you have the right patient with their wrist band and requisition •Right Drug: Check the drug name carefully •Right Amount: inaccurate measurements can lead to significant toxicity •Right Time: Usually indicated by physician or practitioner responsible •Right Route: Must be administered by the right route for proper drug effects
Where is the mid-deltoid IM injection site and when it is used?
•The mid deltoid IM injection site is in the arm, formed by the rectangle bounded on the top by the edge of the shoulder and on the bottom by the beginning of the axilla. It is used for many small-volume medications
Where is the vastus lateralis IM injection site and when is it used?
•The vastus lateralis site is a muscular area in the upper leg. It is used because it can accommodate volumes of medication the same size as the gluteus medius and is distant form any major blood vessels or nerves.
What is the ventrogluteal site and how is it located?
•The ventrogluteal site is an injection site used in either children or adults and could be used more often. The tech must palpate for the left greater trochanter with the right palm, point the right index finger to the anterior superior iliac spine, and extend the middle finger toward the iliac crest. The injection should be made into the center of the V formed between the index and middle fingers
How can a technologist locate the dorsogluteal site and what is it?
•You can locate the dorsogluteal site by looking at the diagonal line from the area of the greater trochanter of the femur to the posterior iliac spine oIt is anterior to the gluteus medius
