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nurs 220L > Injections and meds > Flashcards

Injections and meds Flashcards

1
Q

SQ injections

A

into loose CT under dermis, slower absorption than IM (less vascular), some discomfort - pain receptors

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2
Q

best SQ sites

A

outer posterior upper arms, abdomen, anterior thighs

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3
Q

alternate SQ sites

A

scapula, upper ventral or dorsal glueteal

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4
Q

SQ sites should be

A

free of lesions, bony prominences and large underlying muscles or nerves

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5
Q

LMWH sites

A

right or left side of abdomen 2 inches from umbilicus (love handles); pinch site, don’t expel air bubble in syringe before inj.

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6
Q

U-100 insulin administered with

A

U-100 insulin syringe with 25-31g needle

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7
Q

U-500 insulin administered with

A

TB syringe

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8
Q

insulin sites

A

upper arm, anterior and lateral thigh, butt and abdomen

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9
Q

intrasite injections

A

rotating within the same body part for better absorption; 1 inch apart (don’t repeat injection site for a month)

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10
Q

absorption of insulin from fastest to slowest

A

abdomen, arm, thigh, butt

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11
Q

volume for SQ injections

A

0.5 to 1.5 mL; water soluble; too much volume = sterile abscess

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12
Q

SQ volume for kids

A

0.5 mL

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13
Q

SQ needle length and angle selection

A

based on weight; normal size: 25 g., 5/8 inch needle, 45 deg. or 1/2 inch 90 deg; obese: pinch, longer needle; thin: upper abdomen, under arm (?)

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14
Q

IM injections

A

faster med absorption than SQ (more vascular), more risks (nerve damage, fibrosis, abscess)

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15
Q

needles for IM injections

A

longer, heavier g.; very obese- up to 3”, thin - 0.5” to 1”

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16
Q

degree for IM injections

A

90

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17
Q

volume for IM

A

2 mL for children, adults and thin; normal adult: 2-5 mL, but larger (4-5mL) unlikely to absorb; children 1 mL, infants 0.5 mL

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18
Q

sites for IM

A

free of infection, necrosis, bruising, abrasions; locate bones, nerves, vessels; vol to be injected

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19
Q

ventrogluteal site (IM)

A

safest, away from major nerves, vessels; preferred, esp. for viscous and irritating meds and for vol. > 2 mL; supine or lateral position

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20
Q

vastus lateralis site (IM)

A

middle third of muscle, often used for vaccines in children

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21
Q

Deltoid site for IM injections

A

not well developed in many adults; more risk- axillary, radial, brachial and ulnar nerves, and brachial artery lie within upper arm under triceps and along humerus; usually for vaccines; stand or lie down; 1-2 inches below acromion process

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22
Q

volume for deltoid IM injections

A

small - 2 mL or less

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23
Q

Z track method for IM

A

minimizes irritation, seals in meds

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24
Q

Intradermal injections

A

for skin testing - TB, allergy; meds are potent so inj. into dermis slows absorption

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25
Q

Intradermal injections risks

A

anaphylaxis if meds enter circulation to quickly

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26
Q

site for intradermal injections

A

visible for color changes and skin integrity; inner forearms and upper back; light pigmented, hairless, no lesions

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27
Q

intradermal injections method

A

use TB or small hypodermic needle; 5-15 deg., bevel up; if no bleb or site bleeds, SQ likely, invalid results

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28
Q

legislation of meds

A

FDA ensures safety

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29
Q

State Nurse Practice Acts (NPAs)

A

most influence, define scope of fn and responsibilities; usu. broad; protect the public

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30
Q

Classification of meds

A

effect of med on body system, symptoms relieved or desired effect

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31
Q

medication form determines

A

route of administration; composition enhances absorption and metabolism

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32
Q

topic meds types

A

ointment, liniment, lotion, paste, transdermal disk or patch

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33
Q

ointment

A

salve or cream, semisolid, 1 + meds

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34
Q

liniment

A

usually with alcohol, oil or soapy emolient

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35
Q

lotion

A

liquid suspension; protects, cools, cleanses

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36
Q

paste

A

thick ointment, slower absorption; usu. to protect skin

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37
Q

transdermal disk or patch

A

absorbed via skin over 24 hr, 1 week

38
Q

parenteral meds

A

solution or powder; sterile

39
Q

meds for instillation into body cavities

A

intraocular disk, suppository

40
Q

intraocular disk

A

small, flexible oval (2 outer layers, 1 mid layer with med), slow release when moistened by ocular fluid

41
Q

suppository

A

solid dosage form mixed with gelatin, pellet shaped, melts when reaches body temp

42
Q

pharmacokinetics

A

study of how meds enter body, reach site of action, metabolize and exit

43
Q

therapeutic effect requires

A

taking into body, absorption, distribution, and alteration of physiological fn

44
Q

pharmacokinetics important for

A

timing of administration, route, pt’s risk for alterations in action and evaluating response

45
Q

absorption

A

passage into blood, influenced by route, dissolvability, blood flow, body surface area, lipid solubility

46
Q

most rapid absorption

A

IV; mucosa also quick, oral slow (GI), skin slow

47
Q

dissolving of meds effect on absorption

A

liquid solutions and suspensions quicker than solid

48
Q

acidic meds absorption

A

quick; pass the GI mucosa rapidly, basic not absorbed until small int.

49
Q

larger surface area

A

faster absorption; majority meds absorbed in small int, not stomach

50
Q

highly lipid soluble meds

A

cross the lipid layer of cell membrane quickly

51
Q

Metabolism

A

biotransformation under the influence of enzymes that detoxify, break down and remove bio active chemicals; occurs mostly in liver; also lungs, kidneys, blood and intestines

52
Q

liver disease affects metabolism how

A

slows down; accumulation of meds

53
Q

excretion

A

after metabolism, exit via kidneys, liver, bowel, lungs and exocrine glands

54
Q

to help eliminate anesthetic gases after surgery

A

deep breathing and coughing

55
Q

gaseous and volatile compounds exit the body

A

via lungs (e.g. alcohol, nitrous oxide)

56
Q

exocrine glands excrete what kind of meds

A

lipid soluble; may cause skin irritation when meds exit via sweat

57
Q

GI tract- effect on metabolism

A

if peristalsis increased (laxatives, enema) faster excretion; inactivity and improper diet prolong meds

58
Q

main organ for excretion

A

kidneys; renal failure= risk of toxicity; inc. fluids promote elimination

59
Q

side effects are

A

predictable; harmless or not

60
Q

adverse effects

A

unintended, unpredictable, severe; report to FDA via MedWatch

61
Q

ear drops should be instilled at room temp to prevent

A

nausea, vertigo, dizziness

62
Q

vaginal instillation forms

A

suppositories, foam, jellies, creams

63
Q

pMDIs

A

pressured metered-dose inhalers

64
Q

BAIs

A

breath-actuated metered dose inhalers; good choice for pt’s who have trouble with pMDIs

65
Q

DPIs

A

dry powder inhalers; required less dexterity; activated with pt’s breath, no need to coordinate puffs with inhalation; risk of clumping (humid climate); some pts can’t breath fast enough to get entire dose of med

66
Q

pMDIs, BAIs and DPIs used for

A

bronchodilation; can cause serious systemic side effects

67
Q

spacer used with pMDIs

A

allows the med to slow down and break into smaller pieces, improves absorption in airway

68
Q

spacers not used with

A

BAIs and DPIs

69
Q

parenteral meds should be administered using what technique?

A

aseptic

70
Q

syringes sizes

A

.5mL to 60 mL; unusual to use larger than 5mL for injection

71
Q

SQ and IM syringe usual size

A

1-3 mL

72
Q

larger syringes used for

A

irrigation of wounds and drainage tubes, administering IV meds

73
Q

TB syringe

A

calibrated in hundredths of a mL; 1 mL total capacity; used for intradermal and SQ injections; also for children

74
Q

Insulin syringe size ranges

A

0.3 mL to 1 mL, calibrated in units; most insulin syringes are U-100s to be used with U-100 strength insulin

75
Q

each mL of U-100 insulin contains

A

100 units of insulin

76
Q

needles vary in length from

A

1/4 to 3 inches; 1-1.5” for IM; 3/8 to 5/8” for SQ

77
Q

U-500 insulin

A

5 times as potent as U-100; only used in rare cases for very insulin resistant pt’s; use TB syringe

78
Q

Insulin is classified by

A

rate of action; rapid, short, intermediate, and long acting; need to know the onset, peak and duration

79
Q

Only this type of insulin can be given by IV

A

regular

80
Q

70/30 insulin

A

70% NPH (intermediate), 30% regular

81
Q

Correction (sliding scale) insulin

A

dose based on blood glucose level; ordered on temporary basis

82
Q

mixing insulin

A

2 types of insulin can be mixed if they are compatible; prepare regular insulin first

83
Q

mixed insulin should be administered within 5 minutes of preparation; why?

A

because rapid or short acting insulin binds with intermediate or long acting insulin, which reduces the action of the faster-acting insulin

84
Q

patient characteristics, not GRV assessment, increase aspiration risk. True or false?

A

true

85
Q

prevent aspiration with NE; evidence based data

A

increase head of bed 30 deg +, prokinetic agents, consider post-pyloric feeding if intolerance persists

86
Q

GRV testing can help with ongoing tube placement verification. true or false?

A

true

87
Q

new methods of verifying NG tube placement

A

bilirubin testing and capnometry (CO2 test)

88
Q

bilirubin test

A

bilirubin normally found in intestinal contents, and sometimes in small amounts in stomach; rare in tracheobronchal or pleural fluid; test not available for bedside use

89
Q

capnometry

A

CO2 measured; CO2 indicates pulmonary placement; test shows some reliability but needs more work

90
Q

AACN (American Association of Critical-Care Nurses) recommendations for NG tubes

A

use several methods to verify placement; watch for signs of respiratory distress, pH testing and visual assessment of aspirate; X ray before meds or feeding (if available); mark tube with marker/ tape; check placement q4h

91
Q

x ray is esp. important with what types of tubes?

A

small bore - often no symptoms; risk of perforation by stylet

nurs 220L (11 decks)

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