skills lecture 7 Flashcards
1
Q
to safely and accurately administer medications, you need knowledge related to what
A
-legal aspects of health care
-pharmacology/pharmacokinetics
-life sciences
-pathophysiology
-human anatomy
-mathematics
2
Q
legal aspects of health care in regards to medication administration
A
scope of practice
controlled substance regulations
3
Q
pharmacology/pharmacokinetics in regards to medication administration
A
how the medication works
4
Q
life sciences in regards to medication administration
A
how medications work in the body
how underlying issues have an impact on medications
5
Q
pathophysiology in regards to medication administration
A
how medications work in the body
how underlying issues have an impact on medications
6
Q
human anatomy in regards to medication administration
A
how to safely give a medication
7
Q
mathematics in regards to medication administration
A
how to calculate doses
8
Q
what are the three types of drug names
A
-chemical
-trade
-generic
9
Q
provides the exact description of medications composition that is rarely used in nursing
A
chemical name
10
Q
the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. pharmacopeia
A
generic name
11
Q
also known as brand or proprietary name this is the name under which a manufacturer markets the medication
A
trade name
12
Q
Effect of medication on body system, Symptoms the medication relieves, Medication’s desired effect are examples of what
A
classification of a medication
13
Q
what is the classification for lisinopril?
A
treatment for htn
14
Q
what is a combination medication
A
a medication that includes two or more active ingredients combined in a single dosage form
15
Q
how are combination drug names listed on medications packs?
A
list the trade name followed by the generic name of each drug
16
Q
how is the dosage listed for a combination medication
A
in order of the generic names listed
17
Q
norco
A
hydrocodone-acetaminophen
18
Q
percocet
A
oxycodone/acetaminophen
19
Q
the passage of medication molecules into the blood from the site of administration
A
absorption
20
Q
factors that influence absorption
A
-route of administration
-ability of a medication to dissolve
-blood flow to the site of administration
-body surface area
21
Q
exercise and heat can increase blood flow to a site, speeding up and increasing what
A
medication absorption
22
Q
why does parenteral medications absorb quicker than oral medication
A
because it goes in the blood and not in the stomach
23
Q
what is pharmacokinetics
A
a drugs journey through the body
24
Q
what are the pharmacokinetics of medication actions
A
-absorption
-distribution
-metabolism
-excretion
25
how medication is moved through the body
distribution
circulation
26
medications are _________ into a less-potent or an inactive form
metabolized
27
what organ is important in medication metabolism
liver
28
if there is decreased liver function medication will not be metabolized and can cause what
toxic affects
29
excretion of medications occurs through what?
kidney and bowels
30
if kidneys are not filtering out the medication what happens to it?
it stays in the blood
31
what tests can be ran to determine if the kidneys are filtering out medications
egfr
32
how does age affect drug-receptor interaction
brain receptors become more sensitive making psychoactive drugs very potent
33
how does age affect circulation of medication
vascular nerve control is less stable
34
how does age affect metabolism of medication
liver mass shrinks, hepatic blood flow and enzyme activity decline.
metabolism drops to one-half to two-thirds the rate of young adults
enzymes lose ability to process some drugs thus prolonging drug half-life
35
how does age affect absorption of medication
gastric emptying rate and gastrointestinal motility slows. absorption capacity of cells and active transport mechanism decline
36
how does age effect excretion of medication
in kidneys, renal blood flow, glomerular filtration rate, renal tubular secretion and reabsorption and number of functional nephrons decline. blood flow and waste removal slow. age-related changes lengthen half-life for renally excreted drugs. antidiabetic drugs, among others stay in the body longer
37
how does age affect distribution of medication
lean body mass falls. adipose stores increase. total body water declines, raising the concentration of water-soluble drugs, such as digoxin, which can cause heart dysfunction. plasma protein diminishes reducing sites available for protein bound drugs and raising blood levels of free drugs
38
types of medication actions (9)
-therapeutic effect
-adverse effect
-side effect
-toxic effect
-allergic reaction
-medication interactions
-medication tolerance
-medication dependence
-psychological dependence
39
what do we expect the medication to do, expected or predictable outcome
therapeutic effect
40
unpredicted outcome or undesired outcome
adverse effect
41
predictable secondary undesirable response
side effects
42
accumulation of the medication in the blood stream, undesirable affect
toxic effect
43
adverse effects that cannot be explained by the known mechanisms of action of the drug, do not occur in most patients, and develop mostly unpredictably in susceptible individuals only
idiosyncratic reaction
44
who is at risk for toxic effects of medication and why?
older adults because everything slows down
45
unpredictable medication reaction
allergic reaction
46
one medication modifies the action of another
medication interactions
47
more medication is required to achieve the same therapeutic effect
medication tolerance
48
the body needs it
medication dependence
49
the body thinks you need the medication
psychological dependence
50
if a patient has an allergic reaction to a medication what does the nurse need to do
-assess
-assess respiratory
-document
-notify provider
51
A postoperative patient is receiving morphine sulfate via patient-controlled analgesia (PCA). The nurse assesses that the patient’s respirations are depressed. The effects of the morphine sulfate can be classified as:
A. allergic.
B. idiosyncratic. SPECIFIC GROUP OF PEOPLE
C. therapeutic.
D. toxic. BECAUES THE PT IS GETTING TOO MUCH AND IT IS DEPRESSING THE RESPIRATORY
d toxic
52
polypharmacy
-takes two or more medications to treat the same illness
-takes two or more medications from the same chemical class
-uses two or more medications with the same or similar actions to treat several disorders simultaneously
-mixes nutritional supplements or herbal products with medications
53
who determines the medication the patient needs, places the order for the medication
provider
54
what info does the provider need to include on an order
-patients name
-order date
-medication name
-dosage
-route
-time of administration
-drug indication
-prescriber's signature
55
types of orders
-standing or routine
-prn
-single
-stat
-now
-prescriptions
56
administered until the dosage is changed or another medication is prescribed
standing or routine
57
given when the patient requires it
prn
58
given one time only for a specific reason
single one time dose
59
given immediately in an emergency
stat
60
when a medication is needed right away but not stat
now
61
medication to be taken outside of the hospital
prescriptions
62
who prepares and distributes medication
pharmacists
63
what are a nurses role for medications
-determines medications ordered are correct
-ensure medication to be administer is correct
-determines medication timing
-administers medications correctly
-closely monitors effects
-provides patient teaching
64
can you delegate medication administration to assistive personnel?
no
65
can you hand medication to patient then leave the room?
no
66
who can you delegate medication pass to?
another RN
67
if you think it is not safe to give a medication what should you do?
hold medication and contact dr
68
when medications are given more than once a day, it is important they are what?
spaced out evenly
69
scheduled medications are to be given what times?
at specific times
70
what is the time window medications can be given?
one hour before and one hour after it is scheduled
71
use critical thinking and organization skills to group medication administration ________ if possible
together
72
medications that can be given so many times a day, that is dependent on the order and can be found on the mar
prn medications
73
when preparing to administer a prn medication it is important to determine what?
when the last time it was given
74
any preventable event that may cause inappropriate medication use or jeopardize patient safety
medication error
75
when a med error occurs what do you need to do
-first asses the patients condition, then notify the health care provider
-when the patient is stable, report the incident
-prepare and file an occurrence or incident report
76
do you need to report near misses and incidents that cause no harm?
yes
77
examples of medication errors
-wrong dose
-wrong patient
-wrong time
-wrong medication
-expired medication
-wrong preparation
-wrong route
-forgetting to sign off correctly
-signing off before the patient takes the medication
-signature without credentials
-not verifying the controlled substance count on the correct log
-not signing out the controlled substance on the correct log
78
if a nurse experiences a problem reading a physicians medication order, the most appropriate action will be to
call the physician to verify the order
79
seven rights of medication administration
-medication
-dose/amount
-patient
-route
-time
-documentation
-indication/reason
80
what are the patients rights of medication administration
-to be informed about a medication
-to refuse a medication
-to have a medication history
-to be properly advised about experimental nature of medication
-to receive labeled medications safely
-to receive appropriate supportive therapy
-to not receive unnecessary medications
-to be informed if medications are part of research study
81
if a patient refused a medication what are the next steps
-ask why and find out the problem and see if there is a way to fix it, educate, document
82
Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following?
A. Medication before administering it.
B. Medication after administering it.
C. Rationale for administering it.
D. Prescriber rationale for prescribing it.
b medication after adminstering it
83
control substances scheduled
schedule I
schedule II
schedule III
schedule IV
schedule V
84
examples of schedule I drugs
heroin
marijuana
ecstasy
85
examples of schedule II drugs
vicodin
cocaine
methamphetamine
methadone
dilaudid
oxycontin
fentanyl
adderall
ritalin
86
examples of schedule III drugs
tylenol with codeine
87
examples of schedule IV drugs
ativan
ambien
tramadol
88
examples of schedule V drugs
lyrica
89
medications that have the potential for abuse and have a high safety concern when adminstering
controlled substances
90
what are the controlled substances that will be on med pass that we need to know
-tramadol
-hydrocodone
-oxycodone
-ativan (lorazepam)
-norco (hydrocodone with acetaminophen)
-percocet (oxycodone with acetaminophen)
91
lorazepam
ativan
92
hydrocodone with acetaminophen
norco
93
oxycodone with acetaminophen
percocet
94
as soon as you access a controlled substance for a patient you must verify what
the count
95
what do you document on the controlled substance log
current count
amount popped
date
time
initials
96
when do you document on the controlled substance log?
when you pop the medication
97
when documenting on the controlled substance log what are you indicating?
that you have pulled and dispensed a controlled substance
98
documenting on the controlled substance log does not indicate what?
that the patient took the medication
99
if you have to waste a controlled substance what must occur
another nurse must witness and sign off on it
100
rules on wasting medications will depend on what
the facilities procedure
101
do not leave medication cart before you ________ it is the correct medication
verify
102
when comparing the controlled substance log with the medication in hand what must the nurse look at to ensure accuracy?
-patients name
-patients dob
-medication name
-medication dose
-medication route
103
you do not perform _______ with the controlled substance log
tramped
104
common over the counter medications found in nursing homes
community medications
105
if you place a community medication cap of a bottle face down what does this cause
asepsis issues
106
medications that cannot be crushed
-extended release
-sustained release
-delayed release
-enteric coated
-timed release
-controlled release
107
why should you not crush time released medications
they are designed to slowly release medication and crushing them can be harmful
108
what do you do if some medications can be crushed and some cannot?
a consult to see if medication can be changed to a liquid
109
how can you administer medications that cannot be crushed in a way the patient can easily take them?
put it in pudding or applesauce to see if they can swallow it or see if it comes in liquid
110
when preparing a patients medication what should you ask them?
their preference on how they like their medications
111
what is a reason pills will be split?
medication dose is lower than medication strength
112
whats the smallest you should split a medication?
in quarters
113
acronym followed to ensure the seven rights of medication administration are covered each and every time a medication is passed
tramped
114
what are you comparing when doing the tramped process
the mar and the medication pack
115
how many times is the tramped process performed
3 times
116
what is apart of a medication order but not apart of the tramped process
frequency and allergies
117
when the medication is a scheduled medication there is not need to mention the ________
frequency
118
when is frequency of a medication vital to discuss?
when giving a prn medication
119
medication administration steps
-before administering medications always assess the patient first
-make sure the patient is awake and alert, and ready for their medication
-get a set of vitals and an overall general survey
-go to the nurses station to prepare for medication pass
-check orders/mar before getting medication
-collect appropriate medications for the time
-collect all appropriate supplies
-perform tramped process twice by yourself
-get instructor for third tramped
-perform tramped for the last time with the instructor present
120
in a long-term care setting if it is time for mr bobs morning medications what would you ideally do?
get him up and out of bed for medications
121
what supplies might you need for medication administration
-cup
-straw
-medication cup
-water
-spoon
-applesauce
-pudding
-crusher
-pill splitter
122
why do we want to do full set of vitals and head to toe or general survey before giving meds
to determine what medications are appropriate to give for the patients current condition
123
after medications are prepared what are your next steps in the medication administration process
-after 3 tramped process prep the med
-once all meds are prepper and ready to go clean the area
-gather necessary supplies and go to patient
-ask name, date of birth and allergies before medication administration
-verify with mar
-educate patient on what you are giving them
-administer medications
-document administration
124
never leave medications __________
unattended
125
document on mar _________ after patient takes med
immediately
126
when will you document on narrative charting?
when a patient refuses medication or you have to hold a medication due to a finding during vitals or assessment
-if giving a prn medication
127
how do you document a PRN medication
on narrative charting with DAR
-what lead up to pt getting prn med
-when prn med was given
-the results of the prn medication
128
how do you document a refusal of medication on the mar
initial spot on mar, circle it
129
when you are paper charting on MAR what are things to remember
-it is a legal piece of documentation
-no erasable pens
-must be legible and correct
-initial box for correct date/time
-ensure full name, credentials and initials are on the mar signature box
130
how would you document a prn med being given on the MAR?
-initial in box for correct date and prn frequency administered
-include time administered
131
if an error is made on a MAR how should you correct it?
cross it out, initial and then write the correct info next to the error
132
never use ______ on a mar to correct a mistake
white out
133
select medications for administration at a certain time
scheduled medications
134
how do you document a scheduled medication on electronic MAR
-select medication for administration, ensure correct date/time
-click option for "administer"
*this will be different for all systems
135
how do you document prn medications on electronic mar
-select medication for administration, ensure correct date/time
-select reason why medication is being given
136
because you are using your personal login for electronic MAR your name and credentials is
already included with your username attached
137
never use _______ ________ log on to sign off medications
another individuals
138
if you notice a trend with your resident and medication refusal what should you do
ask your resident if they will take their medications before you go prep them all
139
if a patient with dementia initially refuses medications what shoudl you do
try a different approach
walk away and come back
140
if a resident with dementia doesnt know their name dob or allergies what should you do
still ask them
then verify with instructor or staff member
141
5 keys to medication accuracy
-avoid
-administer
-document
-use
-check
142
explain avoid of keys to medication accuarcy
avoid distractions and follow the same routine
143
explain administer of keys to medication accuracy
administer only medications you prepare and never leave prepared medications unattended
144
explain document of keys to medication accuracy
document medications immediately after administration
145
explain use of keys to medication accuracy
use clinical judgement in determining the nest time to administer prn medications
146
explain check of keys to medication accuracy
when preparing medications check the medication container label against the medication administration record three times
147
what order should you tramp medications in?
the order of the mar
148
routes of medication administration
-by mouth
-sublingual
-buccal
-topical
-nasal inhalation
-oral inhalation
-ophthalmic
-suppository
-intramuscular
-intravenous
-subcutaneous
149
what is the easiest and most desired route of medication administration
oral
150
when would oral medication administration be avoided?
-GI issues
-pt cant swallow
-pt unconscious
151
food can sometimes affect medication ________ when taken orally
absorption
152
when giving oral medications what position should patient be in
high fowlers
153
types of oral meds
-solids/pills
-liquids
154
medications that are delivered orally but not swallowed
-sublingual
-buccal
155
sublingual and buccal medications are absorbed where
directly into the blood through the oral tissue
156
where does a sublingual medication go
under the tongue
157
where does a buccal medication go
in the cheek
158
medications that are applied to the skin providing local effect and absorbs slowly
topical
159
types of topical medications
-ointments
-lotions
-paste
-transdermal patch
160
what should you do before applying a topical medication
clean and dry skin
161
how to apply a transdermal patch
-assess skin
-when applying a transdermal patient ask the patient if they have an existing patch on
-apply gloves before old patch removal and new patch application
-remove old patch before applying new patch
-cleanse old area and new area
-apply new patch in a different location
-document the location of the new patch
-date time and initial the new patch
162
topical medication should not be put on skin that has what
compromised integrity
163
medication inhaled through nostrils for local effect
nasal inhalation
164
what are nasal inhalation medications administered for
-nasal congestion
-allergies
-sinus issues
165
nasal inhalation medications do not have any effect on the ________ and _______
lungs and bronchioles
166
how to administer nasal inhalation medications
-help pt into upright position with head tilted slightly forward
-instruct or assist pt to insert tip of nasal spray into appropriate nares and occlude other nostril with finger
-point spray tip toward side and away from center of nose
-have patient spray medication into nose while inhaling through nose
-help patient remove nozzle from nose and instruct to breathe out through the mouth
-offer facial tissue to blot runny nose but caution patient against blowing nose for several minutes
167
medication route inhaled through mouth for medication to enter lung tissue
oral inhalation
168
types of inhalers
-metered dose inhalers
-dry powder inhalers
169
the use of metered-dose inhalers requires hand ______ and ________ coordination
-strength
-hand-breath
170
if a patient does not rinse their mouth out after using inhaler what can it cause
thrush
171
how long does a nebulized mist treatment take
10-15 minutes
172
what to remember when giving ophthalmic medications
-avoid the cornea
-avoid touching eye or eyelid with droppers or tubes
-avoid placing drops to inner or outer corners of the eye
173
where should you administer ophthalmic medication
in the conjunctival sac
174
how do you administer ophthalmic medications
-hand hygiene
-don gloves
-tilt patients head back
-pull down lower lid
-administer drops in the conjunctival sac
175
medications that exert local effects when administered
suppositories
176
two places suppositories' can be inserted where
-vaginal
-rectal
177
what position does patient need to be in for vaginal suppository insertion
dorsal recumbent position
178
what position does patient need to be in for rectal suppository insertion
lateral sims
179
enema administration steps
-explain the procedure, positioning, precautions to avoid discomfort and length of time necessary to retain the solution before defecation
-position patient in left sims
-insert tip
-administer slowly
180
a patient will most likely experience ________ when getting an enema
cramping
181
a blood glucose level should be done before adminstering what
insulin
182
what is a normal blood glucose level?
74-106
183
what is a critically high blood glucose level
450
184
what is a critically low blood glucose level
40
185
necessary equipment needed to obtain a blood glucose level
-gauze - at least two
-alcohol prep pad
-lancet
-glucometer
-test strip
186
steps to take a blood glucose level
-clean hands
-choose site to puncture
-clean site and let it dry
-instruct pt not to move
-insert test strip in glucometer
-don gloves
-hold area to be punctured in dependent position
-stick site with lancet
-lightly squeeze around puncture site until drop of blood is formed
-wipe first drop with gauze
-lightly squeeze around puncture site again until blood has formed
-collect blood using test strip
-interpret appropriately
-place lancet in sharps and throw trash
187
when should you document blood glucose level in the patients chart and why
immediately so you can verify why you gave the amount of insulin you did
188
distribution of medication directly into systematic circulation
parenteral
189
when is parenteral route used over other routes
-when oral routes are contraindicated
-more rapid absorption is needed
190
parenteral medical asepsis techniques
-hand hygiene
-gloves during administration
-clean skin with alcohol prep in a circular motion
191
how should you clean the area of skin you are injecting into?
start at the center of the injection site and rotate outward in a circular direction for approximately 2 inches
192
reasons you should use oral route instead of parenteral route
-least invasive
-less infection rate
-cheaper
193
four major sites of injection
-subcutaneous
-intramuscular
-intradermal
-intravenous
194
if a patient is injected routinely the sites must be rotated why
-maintain appropriate skin and tissue integrity
-decrease infection risk
195
ways to make sure different injection sites are being used
-ask patient where last shot was
-check the mar for where it was given
-alternate the sites
196
if you do an injection in the same spot every time what can it cause
tissue atrophy
197
place the four major injection sites in order of fasted to slowest absorption rate
-intravenous
-intramuscular
-subcutaneous
-intradermal
198
equipment required for an injection
syringe
blunt needle
injection needle
alcohol pad
gauze
bandaid
199
types of syringes
-luer-lok
-non-luer-lok
200
parts of a needle
-hub
-shaft
-bevel
201
which part of a syringe is considered sterile and what should you not do to it
plunger and do not touch it with bare hands
202
what length of needle is used for subcutaneous and intradermal injections
3/8 to 5/8 inches
203
what length of needle is used for intramuscular injections
-1 inch to 1 1/2 inches
204
once the injection is complete, the priority is to activate the safety with ______
one hand
205
what needle should be used to draw medication out of ampules
blunt filter needle
206
to place a needle in the sharps container put it in using _________ only with needle facing ______ or _______
one hand
down
away from you
207
how are facilities charged for removal of sharps
by weight
208
always use _____ when analyzing volume in a syringe never use _____
decimals
fractions
209
each injection route differs based on the types of what
tissues the medication enters
210
before injecting know:
-the volume of medication to be administered
-the characteristics and viscosity of the medication
-the location of anatomical structures underlying the injection site
211
how can you minimize patient discomfort during an injection
-use a sharp-beveled needle in the smallest suitable length and gauge
-position patient comfortably as possible to reduce muscular tension
-select the proper injection site using anatomical landmarks
-divert the patients attention from the infection through conversation using open-ended questions
-insert the needle quickly and smoothly to minimize tissue pulling
-hold the syringe steady while the needle remains in tissues
-inject the medication slowly and steadily
212
if you do not administer injections correctly, what occurs
negative patient outcomes
213
failure to select an injection site in relation to anatomical landmarks results in what during needle insertion
nerve or bone damage
214
inability to maintain stability of the needle and syringe unit can result in what
-pain
-tissue damage
215
injecting too large a volume of medication for the site selected causes what
-extreme pain
-local tissue damage
216
steps in preparing an injection from a vial using blunt needle
-perform hand hygiene
-check expiration date
-remove cap from vial
-connect blunt needle to syringe
-draw up air
-remove cap correctly
-with vial on hard surface insert the needle into the top of the vial
-inject air from syringe into the vial
-turn vial and needle upside down and bring to eye level and draw meds up
-verify amount with instructor
-place vial on hard surface and carefully pull syringe from the vial
-slide needle into cap using swoop method
-twist off blunt needle place in sharps
-replace blunt needle with an appropriate size needle for injection
217
controlled substances are meds that have a potential for ____ and have a high ________ when administered
abuse
safety concern
218
preparing an injection from a vial without changing the needle
-perform hand hygiene and gather supples
-check expiration date
-remove cap from vial or clean it
-draw up same amount of air as volume you will draw up
-remove needle cap correctly
-with vial on a hand surface, insert the needle into the top of the vial
-inject air from syringe into the vial
-turn vial and needle upside down bring vial and needle to eye level
-draw up med
-verify amount with instructor
-place vial onn hard surface carefully pull syringe from the vial
-slide needle into cap using swoop method
-administer injection
219
a glass container with medication in it
ampule
220
how many doses are in an ampule
single dose
221
if you dont use all medication in an ampule what do you do with it
discard it
222
some medications are placed in ampules because they cannot come in to contact with what
rubber stopper on vials
223
where do you discard of an ampule vial
sharps container
224
when preparing an injection from an ampule vial how does it differ from a regular vial
you do not need to inject air because the ampule is open to air already
225
degree that you give intramuscular injection
90 degrees
226
degree that you give subcutaneous injections
45 degrees or 90 degrees
227
degree that you give intradermal injections
15 degrees
228
before doing an injection you must always do what
perform hand hygiene and don gloves
229
when doing an injection you must _______ the location on patient
stabilize
230
what do you need to do after you stabilize locationon patient but before you perform injection
clean site thoroughly
231
injection that occurs in the fatty layer of skin below the dermis and above the muscle
subcutaneous
232
needle length used for a subcutaneous injection
3/8 to 5/8
233
needle gauge for subcutaneous injection
25 or 27 gauge
234
if you can grab _____ inches of tissue you can use 90 degree angle for subcutaneous
2
235
medications administered subcutaneously
insulin
heparin
lovenox (enoxaparin)
236
subcutaneous injection sites
-upper arms
-lower back
-upper back
-lower abdomen
-upper legs
237
when performing a subcutaneous injection do not stop what
squeezing the fatty area until the injection is completed after you cleaned the area
238
subcutaneous injection must be given two inches away from the ________
umbilicus
239
subcutaneous injection pens things to know
-every patient receives their own pen
-twist on a new needle with each administration
-dial in correct amount of medication vs drawing up
240
using a subcutaneous injection pen reduces what
risk of error
241
when injecting subcutaneous injection with pen how do you inject it
inject slowly and steadily and after hearing the click count to 5 to deliver the full dose
242
enoxaparin
lovenox
243
which route is lovenox given
subcutaneous
244
where is lovenox administered on the body
the abdomen only
245
when injecting lovenox subcutaneously you must inject what so it forces the medication deeper into the tissue
air bubble
246
when you have given a lovenox injection you remove needle from patient and then what
turn it away from the patient and point need at the wall then push the plunger hard to activate the safety
247
common intramuscular injections
-vaccines
-antibiotics
-sedatives
-steroids
248
volume amount for injection depends on ______ and _______used
patient
site
249
gauge size for intramuscular injections
21 to 25 gauge
250
performed with large muscle groups to prevent leakage of medication into sensitive tissues
z-track method
251
when is z-track method used
when a patient tells you they have irriation with medications
252
what medication is given im vastus lateralis in adults
epinephrine
253
what does the z track method do to the muscle
seals medication in the muscle and minimizes irritation
254
how many inches do you pull the skin over for z track method
1 to 1 1/2 inches
255
IM injection sites
-deltoid
-vastus lateralis
-ventrogluteal
256
where is deltoid injection given on the body
arm
257
where is the vastus lateralis injection given on the body
leg
258
here is the ventrogluteal injection given on the body
buttocks
259
when selecting an IM injection site consider the following
-is the area free of infection or necrosis
-are there local areas of bruising or abrasions
-what is the location of underlying bones, nerves and major blood vessels
-what volume of medication is to be administered
260
pros for using the deltoid muscle
easily accessible
261
cons for using deltoid muscle for injection
not well developed in adults
risk for coming in to contact with nerves and arteries
262
volume that can be given in the deloid injection
less than 2ml
263
what landmark do you go off of for a deltoid injection
acromion process
264
injection point of a deltoid is ______ below acromion process
1 to 2 inches
265
where is the ventrogluteal injection given
gluteal medius muscle
266
pros of using ventrogluteal injection site
-deep miscle, away from major nerves and blood vessels
-preferred and safest site for all adults childen and infants
267
cons of using vventrolgluteal injection site
-can be difficult to access
-patient may be hesitant
268
hat volume can be administered with a ventrogluteal injection
5 ml
269
index and ring finger will form a v shaped triangle with what body landmark
iliac crest
270
vastus lateralis injection technique
-fully expose the patients leg
-to help relax the muscle, ask the patient to lie flat with the knee slightly flexed and foot externally rotated or to assume a sitting position
-anterolateral aspect of thigh
-hand breadth above the knee to a hand breadth below the greater trochanter of the femur
-use the middle third of available area to inject
271
these injections are used for skin testing
intradermal
272
what skin testing is done using intradermal route
tb
allergies
273
skin testing requires the nurse to be able to clearly see the injection site for _______
changes
274
location of intradermal injections
choose skin testing site that allows you to easily access for changes in color and tissue integrity
-need to be lightly pigmented free of lesions and relatively hairless
-inner forearm and upper back are ideal locations
275
what size gauge do you need to use for intradermal injecion
25 or 27
276
what length of needle is used for an intradermal injection
3/8 to 5/8 inch
277
bevel should be facing which way when giving an intradermal injection
up
278
what do you need to do after you administer medication
follow up and assess
279
how long after giving an oral med do you need to reassess patient
30 minutes to an hour
280
how long after giving a parenteral medication should you reassess
within 30 minutes
