Exam 1; Week 3 CLINICAL CONCEPT Flashcards
(133 cards)
1
Q
What is the single most consistent factor associated with complications and injury with injections?
A
site selection
2
Q
Where are IM injections administered?
A
into muscle tissue below the dermis and subcutaneous tissue
3
Q
At what degree is an IM injection given?
A
90 degrees
4
Q
What does an IM injection promote?
A
rapid injection
5
Q
What do you want to do if amount of fluid to be administered is MORE THAN the max amount allowed by site?
A
divide into 2 injections
6
Q
How many cm apart should injections be if giving more than 1 injection is going into the same site?
A
2.5 cm
7
Q
What kind of needle do you use if drawing a med from a glass ampule?
A
filter needle
8
Q
What do you ALWAYS want to do before actually pressing the med in when giving an IM injection?
A
ASPIRATE
9
Q
What happens if there is blood when you aspirate?
A
- remove the needle
- apply pressure to injection site until bleeding stops
- prepare new injection and choose a different site
10
Q
How much of the needle do you want to insert when doing an IM injection?
A
3/4 at 90 degrees and inject slowly
11
Q
What is the safest and least painful site?
A
ventrogluteal injection site
12
Q
What is the ventrogluteal site free of? What is there less of a distribution of?
A
a. major blood vessels and nerves
b. fatty tissue
13
Q
When do you want to recommend a ventrogluteal injection?
A
for volumes greater than 2 mL and for more irritating meds/solutions
14
Q
What is a good range of needle gauges for adults for ventrogluteal site?
A
20-23
15
Q
What is a good range of needle gauges for infants and children for ventrogluteal site?
A
22-25
16
Q
What size needle should be used in infants and children for ventrogluteal site?
A
1/2-1
17
Q
What size needle should be used in adolescents and adults for ventrogluteal site?
A
1-1 1/2
18
Q
What may you need to use in obese and bariatric patients at ventrogluteal site?
A
a longer needle length
19
Q
What is the max volume for adults in the ventroglutealn injection site?
A
2-5 mL - poor absorption for >3 mL
20
Q
What is the max volume for older/larger children in the ventroglutealn injection site?
A
2 mL
21
Q
What is the max volume for smaller children in the ventroglutealn injection site?
A
1 mL
22
Q
What is the max volume for infants (greater than 18 months) in the ventroglutealn injection site?
A
0.5 mL
23
Q
How do you want to position people for a ventrogluteal injection?
A
in side-lying or supine position
24
Q
Where is this site located?
A
with palm of opposite hand at trochanter
25
What injection site is the preferred/most used site for infants and toddlers?
vastus lateralis (only acceptable site for children <7 months old)
26
What muscle is the vastus laterals prefferred over?
rectus femoris muscle
27
What is a good range of needle gauges for adults for vastus lateralis site?
20-23 gauge
28
What is a good range of needle gauges for infants and children for vastus lateralis site?
22-25 gauge
29
What is a good needle length for neonates in vastus laterals site?
5/8 inch
30
What is a good needle length for infants (1-12 months) in vastus laterals site?
1 inch
31
What is a good needle length for toddlers and children in vastus laterals site?
1 - 1 1/4 inch
32
What is a good needle length for adolescents and adults in vastus laterals site?
1 - 1 1/2 inch
33
What is max volume for vastus lateralis site in adults?
2 - 3 mL
34
What is max volume for vastus lateralis site in older/larger children?
2 mL
35
What is max volume for vastus lateralis site in smaller children?
1 mL
36
What is max volume for vastus lateralis site in infants?
0.5 mL
37
What position is a patient in for a vastus lateralis injection?
place patient in supine position with thigh exposed and knee slightly flexed.
38
What injection site can be used in children 3 years and older?
deltoid injection site
39
How young can a child be to use the deltoid site?
12-18 months
40
What can be done at the deltoid injection site? What can't be done at this site?
a. immunizations/biologicals
| b. no antibiotics unless no other available sites
41
How many fingerbreadths below the acromion process is the deltoid injection site?
2-3 finger breadths
42
What is the max volume for deltoid injection in infants/children?
0.5-1 mL
43
What is the max volume for deltoid injection in adults?
2 mL
44
What is the gauge range for deltoid injection site?
22-25 gauge
45
What is the length of the needles for deltoid injections for children?
1/2 - 1 inch
46
What is the length of the needles for deltoid injections for adults?
1 - 1 1/2 inch
47
What is a method for injecting medication into a large muscle?
Z-track injections
48
What kind of solutions are used with z-track injections?
irritating solutions
49
What kind of injections are administered into the fatty connective tissue below the dermis and above the muscle?
SQ injections
50
true or false: SQ have a slower absorption rate than IM
true
51
What do you never want to do when you are giving your SQ injections?
ASPIRATE
52
What gauge sizes are SQ injections?
25-30 gauge
53
What size needle are SQ injections?
5/8 inch
54
Finish the sentence: only ( ) volumes of water-soluble meds can be given via the SQ route.
small - 0.5-1.5 mL
55
If volume of medication for SQ injection is larger than 1.5 what do you need to do?
need to divide medication into separate injections
56
What are the primary sites for SQ injections on infants?
anterior thigh
57
What are the primary sites for SQ injections on older children and adults?
dorsum of the upper arm, abdomen, anterior thigh
58
How do you avoid reaching the muscle in SQ injections?
pinch up the fatty tissue
59
What angle should insert an SQ injection if you are only able to grab 2 inches?
90 degrees
60
What angle should you insert an SQ injection if you are only able to grab 1 inch of tissue?
45 degrees
61
What 5 areas can insulin (SQ injection) be administered?
1. Lateral/posterior aspects of upper arm
2. Fatty tissue of lower abdomen
3. Lateral aspect of thigh
4. Scapular area of upper back
5. Flank (upper ventrodorsal gluteal areas)
62
How many finger breadths from the umbilicus should a heparin or insulin injection be if it is in the abdomen?
2
63
What are intradermal injections used for?
1. tuberculin screening
| 2. allergy tests
64
What should the skin be free of when giving an intradermal injection?
1. visible veins
2. lesions
3. excessive hair
65
What is the gauge range for intradermal injections?
25-27
66
What is the size of the needle for intradermal injections?
1/2 - 5/8 inch
67
What should be visible when giving an ID injection?
the needle point
68
Do you aspirate with ID injections?
NO
69
What is the volume range for ID injections?
0.01-0.1 mL
70
What are the 3 structures in the upper respiratory tract?
1. oronasopharynx
2. pharynx
3. larynx
71
What are the 5 structures in the lower respiratory tract?
1. trachea
2. bronchi
3. bronchioles
4. alveolar duct
5. alveoli
72
What 2 structures are affected in Croup syndromes?
1. epiglottis
| 2. larynx
73
What are 5 things to look at when doing a respiratory assessment?
1. rate
2. depth
3. ease
4. labored breathing
5. rhythm,
74
What are examples of nursing interventions for children with respiratory problems?
1. Ease Respiratory Effort
2. Promote Rest
3. Promote Comfort
4. Prevent Spread of Infection
5. Reduce Temperature
6. Promote Hydration
7. Provide Nutrition
8. Provide Family Support and 9. Home Care Instructions
75
What is acute viral nasopharyngitis?
common cold
76
What is the cause of nasopharyngitis?
viruses
77
How is acute viral nasopharyngitis diagnosed?
nasopharyngeal swab
78
What are symptoms of acute viral nasopharyngitis?
1. Fever
2. Poor feeding
3. Vomiting
4. Diarrhea
5. Abdominal pain
6. Nasal blockage/discharge
7. Cough
8. Respiratory sounds
9. Sore throat
10. Headache
11. Neck pain
79
What is 3 forms of nursing care for acute viral nasopharyngitis?
1. Prevention and protection (isolation/PPE)
2. Comfort, symptom management, hydration, managing secretions
3. Family support
80
What is the cause of influenza or the flu?
orthomyxoviruses
81
how is the flu diagnosed?
nasopharyngeal swab
82
What are the symptoms of flu?
1. Dry throat
2. hoarseness
3. lack of energy
4. sudden onset of fever and chills
83
What are 2 complications of flu?
1. viral pneumonia
| 2. bacterial infections
84
What nursing care is important for the flu?
1. prevention (PPE)/isolation
2. flu vaccine
3. symptom management
4. family support
85
What is the cause of Croup syndromes?
viruses like parainfluenza, human metapneumovirus, influenza A and B, adenovirus and measles
86
How is croup syndrome diagnosed?
inflammation of larynx, trachea, and bronchi
87
What are symptoms of croup syndromes?
- Epiglottis, laryngitis, laryngothracheobronchitis (LTB), and tracheitis (severe effects on the voice and breathing)
- Hoarseness, brass, barky cough, inspiratory stridor, respiratory distress
88
1 nursing intervention for croup syndromes:
airway protection
89
Acute epiglottis is considered what??
MEDICAL EMERGENCY
90
What is acute epiglottis?
serious obstructive inflammatory process
91
What can acute epiglottis progress to?
severe respiratory distress --> absence of cough, drooling, agitation - anxiety increases as respiratory. distress increases
92
What causes acute epiglottis caused by?
H. Influenza B.
93
4 nursing interventions for acute epiglottis:
1. Maintain airway, administer IV antibiotics, Corticosteroids
2. Positioning, comfort, Possible intubation, reduce anxiety
3. Family support
4. HIB Vaccine
94
what is the most common croup syndrome?
acute laryngotracheobronchitis
95
What causes acute laryngotracheobronchitis?
viruses, rarely bacterial
96
What proceeds acute laryngotracheobronchitis?
a URI which descends to other structures
97
What are symptoms of acute laryngotracheobronchitis?
1. Barky cough
2. retractions
3. nasal flaring
4. stridor
98
What are nursing interventions for acute laryngotracheobronchitis?
1. Maintain airway
2. manage secretions
3. cool mist
4. vigilant observation and respiratory assessment
5. Family support
99
What is a complication of acute laryngotracheobronchitis?
bacterial tracheitis
100
What is bronchitis also called?
tracheobronchitis
101
What is bronchitis?
inflammation of the large airways frequently associated with URI.
102
What causes bronchitis?
1. viruses
| 2. M. pneumonia in children older than 6 years
103
What are symptoms of bronchitis?
Dry hacking non-productive cough (worsens at night)
104
What are nursing interventions for bronchitis?
1. humidity
2. analgesics
3. antipyretics
105
What is the most frequent cause of hospitalization in children younger than 1 yr, and a rare occurrence after 2 years?
respiratory syncytial virus
106
What is RSV?
a respiratory infection of the bronchioles; it is contagious
107
How does someone get RSV?
exposure from contaminated secretions
108
What are symptoms of RSV?
1. sneezing
2. wheezing
3. tachypnea
4. apnea
5. poor air exchange
6. coughing
7. pharyngitis
8. rhinorrhea
9. cyanosis
109
What are nursing interventions for RSV?
1. Suctioning
2. isolation (PPE)
3. oxygen therapy
4. family support
110
How is RSV prevented?
monoclonal antibody - IM injection that is given monthly for high risk patients
111
What is the best way to prevent the spread of RSV?
washing hands
112
Diagnoses of RSV is accomplished through what?
nasal aspiration
113
What is inflammation of lobes of lungs?
pneumonia
114
Viral pneumonia is associated with what?
a URI
115
Bacterial pneumonia comes on?
abruptly
116
What is the 3rd etiology of pneumonia?
1. viral
2. bacterial
3. aspiration
117
What causes pneumonia?
Agent inhaled directly into the lungs or comes from the bloodstream and varies according to child’s age
118
What are symptoms of pneumonia?
1. Fever
2. malaise
3. non-productive to productive cough
4. chest pain
119
What are nursing interventions for pneumonia?
Supplemental oxygen, antibiotics, fluids, rest
| Prevention?
120
What is the most common chronic disease of childhood?
asthma
121
define asthma
A chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and the epithelial cells.
122
What are 4 categories of asthma?
1. intermittent
2. mild
3. moderate
4. severe
123
What influences the persistence and the severity of asthma?
allergies
124
What are symptoms of acute asthma?
1. Prolonged expiratory phase
2. Wheezing, chest tightness, cough
3. Tachypnea, accessory muscle use, retractions, nasal flaring
4. Agitation or altered mental state
5. Hyperinflation, increased AP diameter
125
What are symptoms of chronic asthma?
1. Chronic cough, especially at night
2. Prolonged cough with colds and triggers
3. Allergic symptoms and/or rhinitis
4. With or without increased AP diameter
5. Wheeze though it may only be evident during acute episodes or with activity
6. Atopic dermatitis
7. Recurrent pneumonia and/or 8. sinusitis
9. Shortness of breath on exercise
10. Seasonal pattern
11. Response to beta agonist therapy
126
What are nursing care options for asthma
- Close observation, working with RT, education, symptom management
- Lab values (eosinophils)
- Family support—school action plan
- Medications: MDI- Albuterol, inhaled corticosteroids (Pulmicort, Flovent)
Prednisolone
- Breathing techniques, Yoga, Acupuncture, Diet, Herbal remedies
127
What is a dysfunction of the exocrine glands where thick tenacious mucous is produced?
cystic fibrosis
128
Is cystic fibrosis genetic?
hereditary; autosomal recessive trait
129
What causes cystic fibrosis?
1. Thick mucous obstructs the respiratory passages, causing trapped air and over inflation of the lungs
2. Thick mucous obstructs the secretory ducts of the pancreas, liver and reproductive organs
130
How is cystic fibrosis diagnosed?
1. Elevation of Sweat Electrolytes
2. Sodium and chloride are affected with abnormal
3. Chloride movement
4. Family history
5. Stool analysis
131
What are symptoms of cystic fibrosis?
1. Nutritional deficiencies
- -> Absence of pancreatic enzymes
2. Chronic Respiratory problems
- Wheezing
- Clubbing of fingers and toes
- Thick tenacious secretions
3. Fatty and foul smelling stools
4. Taste salty when kissed
132
What are treatment options for cystic fibrosis?
1. Treat Respiratory Infection with antibiotics
2. Pulmonary hygiene – CPT
3. Pancreatic enzymes with all meals and snacks
4. Fat soluble vitamins A, D, E, &K,
5. High calorie diet
133
What are nursing care options for cystic fibrosis?
1. Comprehensive assessment of all affected systems with special focus on pulmonary and gastrointestinal systems
2. Patients require hospitalization only for pulmonary infections, uncontrolled diabetes or coexisting morbidities – meet emotional needs of child & family
3. Typically managed at home
Anticipatory guidance and education crucial
