Class 5 - Medication Admin and Parenteral Medication Admin

Question 1

define parenteral route

Answer 1

medication that is administered into the body other than through the GI tract.

ex: intravenous (into a vein)
subcutaneous (under the skin)
intramuscular (into muscle)

Question 2

define ampoule

Answer 2

small glass container for individual medication doses

Question 3

define intramuscular

Answer 3

into the muscle

Question 4

define intravenous

Answer 4

into the vein

Question 5

define subcutaneous

Answer 5

beneath the layers of skin

Question 6

define u-100 syringe

Answer 6

specifically designed syringe for insulin injections

Question 7

define vial

Answer 7

a glass medication container with a sealed rubber cap for single or multiple doses

Question 8

what are the parts of the syringe

Answer 8

tip
barrel
plunger

Question 9

what are the parts of a needle

Answer 9

bevel
shaft
hub (the gauge # is on the hub)

Question 10

Identify the parts that must be sterile

Answer 10

syringe - the plunger, tip and inside of barrel

needle - the bevel and the shaft

Question 11

what are the ways in which infection can be prevented when giving injections

Answer 11

• swabbing the injection site with 70% alcohol or a mixture
  of alcohol and cholorohexidine
• don’t contaminate the tip of the syringe
• don’t touch the plunger other the the top part to push
• dont’ touch the needle shaft or bevel

Question 12

apply standard precautions when administering injections by

Answer 12

• doing hand hygiene
• wearing gloves
• doing 3 checks and 10 rights
• using medical aseptic practices btw needle and pt

Question 13

how can i prevent needle stick injuries

Answer 13

• never bend or break needles prior to disposal
• never recap a needle that has ben inserted into a client
• when recapping a needle:
  *use a safety mechanical device that firmly grips the
  needle cap and holds it in place
  *use the scoop method
  *use safety syringes that require no contact

Question 14

where on the body can you use subcutaneous injections

what sites

Answer 14

• abdomen (heparin, insulin)
• back side of the upper arm
• front part of the thigh
• scapular area of upper back
• top part of the buttocks

Question 15

why do we rotate subcutaneous sites

Answer 15

• to minimize tissue damage
• aid in absorption
• to avoid discomfort

Question 16

what are the guidelines for mixing short and intermediate acting insulin in one syringe

Answer 16

• mix insulins from clear to cloudy (cloudy insulins have an
  added protein that cannot contaminate the clear
  insulins)
• when insulins are mixed administer within 5 minutes
• ensure accurate dosing
• only use an insulin syringe to administer insulin!!!

Question 17

where are the injections sites for administering intramuscular injections

Answer 17

• ventrogluteal (top of the buttocks)
• vastus lateralis (middle of the thigh)
• deltoid (shoulder)

Question 18

what are the special considerations for injections whe dealing with infants and children

Answer 18

• infants: vastus lateralis is better b/c there are no major
  blood vessels or nerves, and it is the largest muscle in
  an infant
• children: deltiod is recommended b/c of the smaller
  muscle mass and to minimize discomfort

Question 19

why is the z track method of injection used

Answer 19

• less painful that putting the neddle in straight
• decrease leakage of irritatind and discoloring medications
  into the subcutaneous tissue
• enables the medication to become trapped in the muscle
  for better effectiveness

Question 20

what are the needle size and lengths for subcutaneous injections

Answer 20

generally 13 to 16 mm long; using a #23 to #25 gauge or #28 to #30 for insulin

Question 21

what is the maximum volume of medication that can be administered by subcutaneous injection

Answer 21

doses of 1mL

Question 22

what are the advantages/disadvantages of subcutaneous injections

Answer 22

advantages:

• no large blood vessels to hit
• minimal bleeding
• rapid absorption
• less pain
• lots of sites to choose from
• lower risk of infection from injection

disadvantages:
- only small doses can be done
- more risk of lipoatrophy b/c of site rotation
- increased sensitivity from being close to the surface of
skin

Question 23

what are the advantages/disadvantages of intramuscular injections

Answer 23

advantages:

• large volume for doses of medication
• minimal discomfort

disadvantages:
- greater risk of infections
- potential to hit blood vessels or structures beyond the
muscle

Question 24

what are the needle size and lengths for intramuscular injections

Answer 24

standard is 2.5 or 3.8 cm needle length which equates to #21 to #25 gauge needle

*remember the size of the patient is what dictates the length of the needle used (ex: the larger the persons muscle mass is the longer the needle needs to be)

Question 25

what is the volume of medication that can be administered by intramuscular injection

Answer 25

- usually 1 to 2mL to a max of 3mL in well developed muscles - for deltoids 0.5 to 1mL is the maximum dose - if you have more than 3mL you need to do two needles

Question 26

what are percutaneous routes

Answer 26

``` routes that medications are absorbed through the skin or mucuous membranes ex: inhalers transdermal patches topicals nasal sprays eye/ear drops buccal (cheek) sublingual (under the tongue) vaginal rectal ```

Question 27

primary advantage of percutaneous drugs are

Answer 27

- the action of the drug is localized to the site it is applied and side effects are reducedb/c there is no systemic issues **some exceptions to this though are: some inhalers, patches, sublingual and buccal can produce some systemic effects**

Question 28

what does topical med administration mean

Answer 28

- applied to the skin | ex: creams, ointments, lotions, powders

Question 29

what can topical medications do

Answer 29

- relieve local signs and symptoms - i.e.: itching - reduce inflammation - rehydrate skin - clean and debride wounds

Question 30

the amount of medication absorbed through the skin depends on what

Answer 30

- the size of the area covered by medication - concentration or strenght of the medication - lenght of time the medication remains on the skin - general condition of the skin

Question 31

percutaneous administration of opthalmic (eye drops) means what

Answer 31

to apply medication to the eyes directly

Question 32

why do we apply pressure to the inner canthus when applying eye drops

Answer 32

to prevent a systemic reaction with the medication

Question 33

how long should you hold the inner canthus after applying the medication

Answer 33

1 to 2 minutes

Question 34

what should you do when applying eye drops

Answer 34

- clean eye from inner canthus out prior to administering - wear gloves - tell patient to look up and to not blink - hold the inner canthus with a tissue or gauze immediately after application of meds to reduce systemic reaction

Question 35

what should you NOT do when administering eye drops

Answer 35

- do not clean from outer to iner canthus - do not share eye medication amongst patients - do not touch the tip of the medication bottle to the patients eye

Question 36

what is a transdermal patch

Answer 36

a controlled relaese of medications through a semipermeable membrane for several hours to 3 weeks

Question 37

what are sublingual/buccal administrations of medications

Answer 37

Sublingual: medications administered under the tongue Buccal: medications given btw the cheek and the molars - advise patient not to swallow medication - primary advantage is rapid absorption and onset of the medication - the action of the medication is systemic

Question 38

what do metered dose inhalers (MDIs) do

Answer 38

delivers medication directly to the mucous membranes of the respiratory tract (lungs)

Question 39

what are some things to remember when giving inhaled medications

Answer 39

- if dexterity is an issue use a spacer to deliver medications - wait 30 secs btw inhalations - if using 2 different inhalers always use the bronchodilator (short acting) before the corticosteroid (long acting) *ventolin - dilates bronchioles *flovent - relaxes smooth muscle, decreases inflammation - allow 5 mins for bronchodilator towork before administering a long acting corticosteroid

Question 40

what is the angle of injection for intramuscular and subcutaneous injections

Answer 40

``` intramuscular = 90 degree angle subcutaneous = 30-45 degree angle ```

Question 41

what are intradermal injections

Answer 41

it is an injection of medication into the dermal layer (just below the epidermis, outer most layer of skin)

Question 42

what reason are intradermal injections done

Answer 42

usually for allergy testing and tuberculosis screening

Question 43

where are intradermal injections done

Answer 43

usually on the inside of the forearm (left for TB screening)

Question 44

define lipohypertophy

Answer 44

lump inder the skin caused by an accumulation of extra fat at the site of many subcutaneous injections

Question 45

when do you aspirate a needle

Answer 45

you aspirate everywhere except in the deltoid and if you see any blood in the needle remove the injection and start over this means that you have hit a blood vessel