unit 4 study guide Flashcards
Describe the steps to prepare and complete an enteral feeding.
hand hygiene- check to make sure medication are correct
open roller clamp-allow administration to fill-clamp off and hang high on pole
keep patient in high fowlers
make sure tube is in correct spot
check gastric volume levels
Describe the steps to prepare and administer enteral medications
CHECK ORDER, ID PATIENT
(NAME/DOB), HAND
HYGIENE, GLOVE
PROVIDE PRIVACY,
POSITION PATIENt
ASPIRATE THE TUBE,
REPLACE THE CONTENT
FLUSH THE TUBE WITH 30
ML OF WATER
DO CHECKS OF
MEDICATION AND GIVE
ONE MEDICATION AT A
TIME
LUSH WITH 15-30 ML
BETWEEN EACH
MEDICATION AND 30 ML
AFTER LAST MEDICATION
Describe the steps to complete medication administration via parenteral and other routes intradermal
With nondominant hand, stretch skin over site with forefinger or thumb.
b. With needle almost against patient’s skin, insert it slowly at 5- to 15-degree angle until resistance is felt. Advance needle through epidermis to approximately 3 mm (1⁄8 inch) below skin surface. You will see bulge of needle tip through skin (see illustration).
c. Inject medication slowly. Normally you feel resistance. If not, needle is too deep; remove and begin again.
With nondominant hand, stretch skin over site with forefinger or thumb.
Needle pierces tight skin more easily.
b. With needle almost against patient’s skin, insert it slowly at 5- to 15-degree angle until resistance is felt. Advance needle through epidermis to approximately 3 mm (1⁄8 inch) below skin surface. You will see bulge of needle tip through skin (see illustration).
Ensures that needle tip is in dermis. You obtain inaccurate results if you do not inject needle at correct angle and depth.
c. Inject medication slowly. Normally you feel resistance. If not, needle is too deep; remove and begin again.
Describe the steps to complete medication administration via parenteral and other routes
IM
Position ulnar side of nondominant hand just below site and pull skin laterally approximately 2.5 to 3.5 cm (1–1½ inches). Hold position while medication is injected. With dominant hand, inject needle quickly at 90-degree angle into muscle
fter needle pierces skin, still pulling on skin with nondominant hand, grasp lower end of syringe barrel with fingers of nondominant hand to stabilize it. Move dominant hand to end of plunger. Avoid moving syringe
Pull back on plunger 5 to 10 seconds. If no blood appears, inject medication slowly at rate of 10 sec/mL.
Once medication is injected, wait 10 seconds, then smoothly and steadily withdraw needle,
Describe the steps to complete medication administration via parenteral and other routes SQ.
a. For average-size patient, hold skin across injection site or pinch skin with nondominant hand.
b. Inject needle quickly and firmly at 45- to 90-degree angle (see illustration). Release skin if pinched. Option: When using injection pen or giving heparin, continue to pinch skin while injecting medicine.
c. For obese patient pinch skin at site and inject needle at 90-degree angle below tissue fold.
After needle enters site, grasp lower end of syringe barrel with nondominant hand to stabilize it. Move dominant hand to end of plunger and slowly inject medication over several seconds
Withdraw needle quickly while placing antiseptic swab or gauze gently over site.
Describe the steps to complete medication administration via parenteral and other routes Eye
Ask patient to look at ceiling. Rest dominant hand on patient’s forehead; hold filled medication eyedropper approximately 1 to 2 cm (1⁄4 to 1⁄2 inch) above conjunctival sac.
Drop prescribed number of drops into lower conjunctival sac (see illustration).
When administering drops that may cause systemic effects, apply gentle pressure to patient’s nasolacrimal duct with clean tissue for 30 to 60
Describe the steps to complete medication administration via parenteral and other routes Topical
Remove previous dose paper. Fold used paper containing any residual medication with used sides together and dispose of it in biohazard trash container. Wipe off residual medication with tissue.
Write date, time, and your initials on new application paper.
Describe the steps to complete medication administration via parenteral and other routes
ear
Straighten ear canal by pulling pinna up and back to 10 o’clock position
Instill prescribed drops holding dropper 1 cm (1⁄2 inch) above ear canal.
Remove cotton after 15 minutes. Help patient to comfortable position after drops are absorbed.
Describe the steps to assessing an IV site,
heck accuracy and completeness of each MAR or computer printout with health care provider’s written medication order
Review medical record to assess patient’s medical and medication history
Assess relevant laboratory result
Review medication reference information for medication action,
determine compatibility of medication with IV fluids and any additives within IV solution.
Assess patency of patient’s existing IV infusion line
Describe the steps to assessing an, flushing a saline lock,
filled with normal saline to prevent clotting when not in use. To use an SL, the cannula is flushed with 3 to 5 ml of normal saline to assess patency.
Describe the steps to assessing an discontinuing an IV
Place the IV clamp to the “off” position (clamped).
Loosen the edges of the transparent dressing and tape in the direction of the IV site.
Place a gauze pad over the IV site and gently pull the IV out parallel to the skin in a slow and steady motion.
Hold pressure on the IV site for 2-3 minutes. If the patient is on anticoagulant medication, you may need to hold for 5-10 minutes.
Inspect the catheter to ensure it is intact and dispose of it in an appropriate container.
Remove the gauze pad once bleeding has stopped and assess for any signs of infection at the site, such as redness, swelling, warmth, tenderness, or purulent drainage.
Describe the steps to setting up a secondary infusion
hang secondary solution bags higher than the primary infusion bag, thus “piggybacking” it on top of the primary IV infusion. This higher position places greater gravitational pressure on the secondary IV solution.
