Parenteral Meds + Diabetes

Question 1

What does parenteral mean?

Answer 1

Umbrella term to describe intradermal, subcutaneous, IM, and IV. Uses aseptic technique and its invasive.

Question 2

Advantages and disadvantages of parenteral administration?

Answer 2

A- faster onset, used for NPO, unconscious client, if they have nausea, avoids first past digestion

D- painful, cause damage to nerves/tissues, risk for infection, individuals more anxious

Question 3

Characteristic for subcutaneous injections (angles, length…)

Answer 3

Syringe size 1-3 mL, volume of medium is 0.5-1.5 mL, gauge is 26-31 g, length is 1.3-1.6 cm, angle of insertion is 45-90 degrees. (insert 90 with shorter needle and vice versa)

Question 4

Intramuscular characteristic of needle?

Answer 4

Syringe size is 2-3 mL, volume of medium is 2-5 mL (2 mL max into deltoid), gauge is 19-25 mL, length is 2.5-3.8 cm, and angle of insertion is 90 degrees.

Question 5

Characteristics of ampule/vials?

Answer 5

A- one time use, contains single sterile dose of drug, use blunt filter needle
V- single or multi dose vial, use blunt needle, need to inject air first before withdrawing

Question 6

Characteristics for site selections?

Answer 6

Free of rashes, redness, scar tissue, edema, bruises, choose site 2.5 cm away from previous injection/umbilicus.

Question 7

How do we prepare the skin for injection?

Answer 7

Use chlorhexadine swab.

Question 8

Is medication absorbed slower for subcut?

Answer 8

yes because tissue doesn’t have a good blood supply.

Question 9

How do we pinch/spread skin and how do we choose what angle for subcut injections?

Answer 9

Spread skin if there’s a lot of tissue. Pinch if there is a little tissue. 2.5 cm of less of tissue we use 45 degrees and 2.5 cm or more we use 90 (like in stomach).

Question 10

Sites for subcut injections?

Answer 10

Back of arm, abdomen (between coastal margin and illiac crest), just above buttocks font of upper thigh, top of back.

Question 11

What are intradermal injections usually used for?

Answer 11

Skin testing like allergies or tuberculin.

Question 12

Sites of intradermal injections?

Answer 12

Forearm and back.

Question 13

Needle characteristics for intradermal?

Answer 13

Needle length is 1-1.9 cm, gauge is 26-28 g, angle of insertion is 5-15 degrees, volume of fluid is around 0.1 mL usually.

Question 14

Is medication absorbed quick er for IM?

Answer 14

Yes

Question 15

What is the dorsogluteal site?

Answer 15

Not recommended and its used in emergencies. It could cause paralysis or nerve damage if it hits the sciatic nerve.

Question 16

What is the Z track method?

Answer 16

Used for IM. Mimics local skin irritation by sealing the med into muscle tissue. Pull overlying skin 2.5 to 3.5 cm laterally with non dominant hand and then inject needle. After withdrawing needle you’ll release the skin.

Question 17

What to do in case of needle stick injury?

Answer 17

Allow area to bleed, wash area with soap/water, call SHA incident reporting lien, and report to your instructor.

Question 18

What is diabetes mellitus?

Answer 18

Chronic hyperglycemia from impaired process in glucose regulation (reduced insulin secretion).

Question 19

What is insulin and where is it produced?

Answer 19

Facilitates glucose to move across cell membrane. Glucose in stored as glycogen. Produced in beta cells in the pancreas.

Question 20

What is glucagon?

Answer 20

Releases glucose from storage sites.

Question 21

What are microvascular and macrovascular effects of DM?

Answer 21

Macro- CV disease, cerebrovascualr disease, reduced immunity
Micro- retinopathy, neuropathy, sexual dysfunction, cognitive dysfunction

Question 22

What happens when there is too much glucose in our bloodstream?

Answer 22

Body breaks down fats/energy which release free fatty acids and ketones into blood. Leads to polyuria (excessive urine) and extreme thirst.

Question 23

What is type 1 and 2 for diabetes?

Answer 23

Type 1- auto immune disorder, beta cells destroyed (can’t produce insulin)
Type 2- more common, insulin resistance/defiency

Question 24

Risk factors for diabetes?

Answer 24

Hyperglycaemia, abdominal obesity, hypertension, and hyperlipidemia.

Question 25

What is hemoglobin A1C?

Answer 25

Measures glucose control over long period of time. Need to assess 2-4 times/year for people with diabetes.

Question 26

What is fasting blood sugar?

Answer 26

Taken when person is NPO for at least 8 hrs. Should be greater than or equal to 7.0 mmol/L for them to have diabetes.

Question 27

Regular values for A1C?

Answer 27

Should be less than or equal to 7.0 mmol/L

Question 28

What is oral glucose tolerance test?

Answer 28

Drink a glucose drink (used in pregnancy) and measure after 2hrs. Should be greater than or equal to 11.1 mmol/L to have diabetes.

Question 29

Nutrition to help with diabetes?

Answer 29

Canadas food guide (45-60% of energy carbs, 15-20% protein, 20-35% fat), want a high fibre diet, carbs for women (45-60 g/meal) men (60-75 g/meal).

Question 30

Exercise for diabetics?

Answer 30

150 minutes of aerobic activity over 3 days of the week. Goal is to increase 4 hrs or more/week. Encourage resistance exercise/strength training around 2x/week.

Question 31

What is basal insulin?

Answer 31

Background insulin. Maintains glucose levels when not eating and used for type 2. It prevents unchecked high glucose levels.

Question 32

What is prandial insulin?

Answer 32

Meal time and bolus insulin. Given in anticipation of spiking glucose levels to digestion of carbs when eating.

Question 33

What is correction insulin?

Answer 33

Extra dose when glucose level is above range.

Question 34

How to assess patients with DM in hospital/what to monitor?

Answer 34

Often have elevated blood glucose levels (monitor regularly at least 4x/day), assess fluid/electrolyte balance, kidneys, CV monitoring. Any delayed wound healing, foot injuries, urine retention.

Question 35

How to treat hypoglycemia when BGM is <4 and 2.8?

Answer 35

BGM is <4 mmol/L. Treat with 15-16 g of fast acting carbs, BGM <2.8 then treat with 20 g of fast acting carbs.

Question 36

What is hypoglycemia?

Answer 36

BGM is less than 4.0 mmol/L. Leads to tremors, hunger, pallor, LOC, seizures, coma, death.

Question 37

What to assess Diabetic patients for pertaining to foot?

Answer 37

Hx of previous ulcer/amputation, any abnormal foot conditions, deformities, loose strength, loose protective sensation.

Question 38

Is CKD common in diabetes and what do we do to test for it?

Answer 38

It is common. Urine test for albumin and is albumin is in urine then we control BP/blood glucose/avoid nephrotoxic agents/stop smoking.