module 3- (subcutaneous injetions/subcutaneous butterfly/intradermal)

Question 1

subcutaneous injections involve=

Answer 1

depositing medications into the loose connective tissue underlying the dermis

Question 2

there are less blood vessels in subq than in muscles, so..

Answer 2

the medications are absorbed more slowly than with IM injections

Question 3

what increases the rate of drug absorption?

Answer 3

-physical exercise or application of hot or cold compresses

Question 4

any conditions that _________ is a contraindication for subcutan injections

Answer 4

impairs blood flow

Question 5

doses for subcutaneous?

Answer 5

small doses of less than 2ml

Question 6

describe the solutions of subq

Answer 6

isotonic, irritating, non-viscous, watersoluble

Question 7

infants and children amount?

Answer 7

0.5ml one site

Question 8

examples of subq injections?

Answer 8

epinephrine, insulin, allergy medications, opioids

Question 9

best subq sites?

Answer 9

outer aspect of upper arm, abdomen from below costal margins to iliac crests, anterior aspects of the thighs

Question 10

key aspects for a good subq site?

Answer 10

• large enough to allow rotating multiple injections within each anatomic location
• easy accessible

Question 11

injection site should be:

Answer 11

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

Question 12

what affects the depth of subq layer?

Answer 12

patients weight and amt of adipose tissue

Question 13

what effects the needle length and angle of needle insertion?

Answer 13

the patients weight and estimate of subq tissue

Question 14

generally, what is the needle size and angle?

Answer 14

25 gauge 5/8 inch needle at 45 degree OR
1/2 inch needle at 90 degree
for normal patient

Question 15

if patient is obese what do you do for needle/insertion of subq?

Answer 15

-pinch the tissue and use a needle long enough to insert through the fatty tissue at the base of the skinfold

Question 16

sometimes thin patients have insufficient tissue for injections, so where is the best site?

Answer 16

upper abdomen

Question 17

special considerations: administration of insulin

Answer 17

• type 1 diabetes managed with injections

- not necessary to rotate anatomic site, one area is chosen and systematically rotated within that region

Question 18

where is insulin most quickly absorbed?

Answer 18

abdomen

Question 19

where is insulin slowest absorbed?

Answer 19

thighs

Question 20

timing of injections is critical to insulin admin, what is it?

Answer 20

based on blood glucose levels and when a pt will eat

-must know peak and duration of insulin for effective diabetes plan

Question 21

special considerations: administration of heprain

Answer 21

• therapeutic anticoagulation to reduce risk of thrombus formation
• thus, patients are at risk for bleeding
• before admin assess for pre-existing conditions that contraindicate its use (cerebral aneurysm, CV hemmorrhage, hypertension)
• assess meds that interact with heparin
• administer heparin subq or IV

Question 22

where is lowmolec heparin given?

Answer 22

to minimize pain and bruising, given subq on right or left side of abdomen at least 5cm from umbillicus
-do not expel the air bubble in syringe before giving the med

Question 23

how can you decrease patients perception of pain?

Answer 23

applying ice to site for 1 min

Question 24

administering subq injection steps?

Answer 24

• clean site with antiseptic swab (centre and rotate outward in circular direction for 5cm)
• remove cap
• hold skin across injection site or pinch skin with nondominant hand
• inject needle firmly at 45 or 90 degree, release skin if pinched
• after needle enters: grasp lower end of syringe barrel with non-dominant hand to stabilize it and move dominant hand to end of plunger and slowly inject med over several seconds
• apply pressure for several seconds

Question 25

indications for subq butterfly?

Answer 25

- circumstances that preclude or compromise oral admin - pain or symptom crisis - poor or variable compliance (dementia, delirium, agitated)

Question 26

benefits of subq butterfly?

Answer 26

- avoids multiple injections - avoids turning and repositioning patient - allows better rest during night - absorbs effectively - simple and inexpensive - if pts at home, family can be taught to give via butterfly

Question 27

how much extra med is taken when admin of subq saf t intima?

Answer 27

0.4 ml of med more is taken to prime the saf-t-intima tubing and needless connecter

Question 28

possible complications of subq

Answer 28

- skin irritation - infection - pain at site - bleeding, bruising, swelling

Question 29

change a butterfly..

Answer 29

weekly at least and at first site of inflammation, erythema, leakage, bruising or swelling

Question 30

what are intradermal injections typically given for?

Answer 30

-skin testing (eg TB or allergy tests)

Question 31

because meds of intradermal are potent, they are injected into dermis where...

Answer 31

blood supply is reduced, drug absorption occurs slowly

Question 32

what could happen if intradermal meds enter circulation too fast?

Answer 32

-anaphylactic reaction

Question 33

ideal locations for intradermal?

Answer 33

inner forearm (lower mid arm) and upper back

Question 34

what needle/syringe for intradermal?

Answer 34

tuberculin or small syringe with a short (3/8 to 5/8 inch fine gauge (25-27) needle

Question 35

angle of insertion for intradermal?

Answer 35

5 to 15 degrees

Question 36

amount of medication injected for intradermal?

Answer 36

small! 0.01-0.1ml

Question 37

why is bleb important for intradermal?

Answer 37

if bleb does not appear or if site bleeds after needle withdrawal, med may have entered subq tissue

Question 38

what do you tell pt when giving intradermal injection?

Answer 38

may cause slight burning or sting

Question 39

where is the ideal spot exactly for intradermal?

Answer 39

three to four finger widths below antecubital space and one hand width above wrist

Question 40

administration of intradermal med?

Answer 40

- with nondominant hand stretch skin over site with forefinger or thumb - with needle almost against patients skin, insert slowly at 5-15 degree angle until resistance is felt - advance needle through to epidermis approx 3mm below skin surface (you will see bulge of needle tip through skin) - insert med slowly, note resistance - note the bleb (approx 6mm) - after withdrawing needle, apply alcohol swab or gauze gently over site

Question 41

evaluation of intradermal?

Answer 41

return to room in 15-30 mins ask about acute pain, burning, numbness, tingling

Question 42

when do you read the TB test site?

Answer 42

48 to 72 hours | -look for induration (hard, dense, raised area) of skin around injection site

Question 43

patients with no known risk for TB?

Answer 43

15 mm or more

Question 44

recent immigrants, injection drug users, residents and employees of high risk settings?

Answer 44

10mm or more

Question 45

HIV positive, fibrotic changes on chest x-ray or immunosuppresed?

Answer 45

5 mm or more

Question 46

what size needle for a saf-t intima subq?

Answer 46

24 gauge 19 mm

Question 47

max intradermal amount?

Answer 47

-0.1 ml

Question 48

most critical potential situation from a nurse administering a injection?

Answer 48

anaphylactic reaction which is seen through wheezing, SOB, flushing, nausea or dizziness

Question 49

in selecting an appropriate site for subq the nurse must consider?

Answer 49

- patients age (elderly and pediatric specifically!) - condition of skin - location of bony prominences

Question 50

implementation of administering a subq butterfly?

Answer 50

- rotate white safety device 360 degrees, ensure bevel is up - pinch yellow wings together with dominant hand (textured side down!), pinching skin with non-dominant hand and insert needle at 30-45 degree angle - securing wings with nondominant hand, pull back on white safety shield to remove needle - apply transparent dressing - attach needless syringe and deliver prime (0.4ml) and med if required