ch.29 medications Flashcards
(40 cards)
1
Q
administration of parenteral medications
A
- subcutaneous injection
- intramuscular injection
- intradermal injection
- intravenous injection
- intra-arterial injection
- intracardial injections
- intraperitoneal injection
- intraspinal injection
- intraosseous injection
2
Q
subcutaneous injection
A
subcutaneous tissue
3
Q
intramuscular injection
A
muscle tissue
4
Q
intradermal injection
A
corium (dermis), under epidermis
5
Q
intravenous injection
A
vein
6
Q
intra-arterial injection
A
artery
7
Q
intracardial injection
A
heart tissue
8
Q
intraperitoneal injection
A
peritoneal cavity (membrane that lines the cavity of the abdomen)
9
Q
intraspinal injection
A
spinal canal
10
Q
intraosseous injection
A
bone
11
Q
needle gauge
A
diameter of the needle
18-30
diameter of needle increases the gauge number decreases
12
Q
parts of a needle ad syringe
A
-plunger
-barrel
-threads of luer lock
=needle hub
-needle
-safe guard
13
Q
criteria for choosing equipment for injections
A
- route of administration (longer needle for intramuscular than for intradermal or subcutaneous)
- viscosity of solution (meds more viscous require needle with large lumen smaller gauge)
- quantity to be administered (larger amount of med, larger syringe needed)
- body size (obese need longer needle, thinner older pt shorter needle)
- type of med. (ex.insulin syringe only inject insulin)
14
Q
smaller syringes
A
used as needed for precise dosing bc they provide smaller increments of measurement
never estimate a dose
15
Q
types of syringes
A
- standard syringe
- insulin syringe
- tuberculin syringe
- prefilled syringe
16
Q
standard syringe
A
used for intramuscular or subcutaneous injections
17
Q
insulin syringe
A
only injecting insulin
18
Q
tuberculin syringe
A
for small volumes of meds and tb test
19
Q
prefilled syringe
A
single dose, ready to use
20
Q
preparing meds for injection types
A
- ampules
- vials
- prefilled cartridges or syringes
- mixing med in one syringe
- mising insulins in one syringe
- reconstituting powdered meds
21
Q
removing med from apule
A
a glass flask contains single dose, discard remainder
- place unfiltered needle of appropriate size on syringe b4 giving med
- snapping motion to break top of ampule can use gauze
- invert or place flat on surface to draw the solution with filter needle, dont contaminate needle by touching rim of ampule
22
Q
reconstituting powered meds
A
drug supplied as a powder in a vial, a liquid or diluent must be added to the powder b4 it is administered as a solution
23
Q
insulin syringe
A
- available in multidose vial
- dosages calculated in units
- scale used is U100 = 100 units of insulin contained in 1 mL of solution
24
Q
mixing insulin in 1 syringe
A
short acting (clear) insulin and intermediate acting (cloudy) insulin
- roll and clean
- add air to cloudy insulin
- add air to clear insulin
- withdraw clear insulin FIRST, then cloudy insulin
25
angles of insertion for various injections
intramuscular - 90 degree
subcutaneous - 90 or 45 degree
intradermal - 5-15 degree
26
intradermal injections
- into dermis below epidermis
- longest absorption time of all parenteral routes
- used for sensitivity test, tb tests, local anesthesia
- body's reaction to substance is visible
- sites: inner forearm and upper back under scapula
- 1/4" to 1/2", 25 or 27 gauge needle
- 5 to 15 degree angle
- dosage usually less than 0.5 mL
- spread the skin taut over injection site
27
steps of intradermal injection
- spread skin taut over injection site
- inserting needle flat against the skin
- observe for wheal while injecting med.
28
subcutaneous injections
- into adipose tissue
- sites: outer upper arm, abdomen, anterior aspects of thigh, upper back, upper ventral or dorsogluteal area
- avoid: bruised, tender, hard, swollen, inflamed, or scarred sites
- absorption rates: abdomen most rapid, arms somewhat slowly, thighs more slowly, upper ventral or dorsogluteal slowest
- 25-30 gauge, 3/8" to 1" needle, 3/8 and 5/8 most common
- choose needle length based on amount of subcutaneous tissue, pts body weight and build
29
subcutaneous injection cont.
- no more tha 1 mL solution more solution adds to pts discomfort and predispose to poor absorption
- 45-90 degree angle, 45 only for small pts
- shorter 3/8" needle should be inserted at 90 degrees and longer 5/8" may insert at 45 degree
- pinching skin advised for thinner pts and when longer needle is used
- once needle is in release the skin
- if blood or clear fluid at site apply gentle pressure
- massaging site is avoided, can damage underlying tissue and increase absorption of med
30
intramuscular injections
- muscles have larger and greater number of blood vessels than subcutaneous allowing faster onset
- aspiration may be indicated when administering certain meds (non vaccines)
- consider age of pt, med type and med volume for site
- injections into deltoid limited to 1 mL of solution up to 2 mL depending size of muscle
- 90 degree ange
31
sites for intramuscular injections
-ventrogluteal
-vastus lateralis
-deltoid muscle
(dorsogluteal no longer recommended)
32
IM injection site age group and med type
infants and toddler- vastus lateralis (thigh), biologicals
children- vastus lateralis or deltoid
adults- ventrogluteal or deltoid
child/adults: deltoid for biologicals
meds known to be irritating, viscous or oily: ventragluteal
33
IM injection Z track method
recommended for all im injections to ensure med does not leak back along needle track into subcutaneous tissue
-attach clean needle to syringe after syringe is filled with med
-pull skin down or to one side about 1 inch and hold in this position with non dominant hand
,insert needle, inject med slowly, withdraw needle, and release displaced tissue to normal position
-do not massage site may cause irritation
-gentle pressure may be applied
34
intravenous administration of med
- delivers drug directly into bloodstream, has immediate effect cannot be recalled or slowed
- most often used in emergencies
35
med via intravenous solution
med may be added to pts infusion solution
- receives it slowly over relatively long period
- disadvantage when pt needs drug quickly
- check pt receiving for possible adverse effects at least every hour
36
med via intravenous bolus or push
- single injection of concentrated solution directly into intravenous line
- many drugs administered over a 2 minute time frame
37
med via intermittent intravenous infusion
- drug mixed with small amount of iv solution such as 50 to 100 mL and administered over short period at prescribed interval
- using iv infusion pump also smart pumps nurse program infusion rate
- may be achieved by gravity infusion, drops per minute
38
piggyback delivery systems
- some require intermittent or additive solution to be placed higher than the primary solution
- extension hook provided for easy lowering of the main iv container
- port on primary has back-check valve that stops flow of primary allowing for secondary or piggyback solution to flow
39
backfilling/back priming
- alternate way to prime secondary tubing, keeps infusion system intact, preventing loss of med or intro of both
- attach med bag to secondary tubing
- lower medication bag below main IV solution container and open clamp of secondary, this allows primary to flow up the secondary drip chamber
- close clamp on secondary, hand med higher than primary
40
drug infusion/ saline lock
- aka intermittent peripheral venous access device, saline lock
- used for pts requiring intermittent intravenous med but not a continuous infusion
- catheter connected to short length of extension tubing capped with sealed injection port
