Week 1 and 2 Flashcards
1
Q
Parenteral Routes
A
outside of the GI system
2
Q
List the Parenteral Routes
A
ID, Subcut, IM and IV
3
Q
Intradermal Injections
A
small volume injections
admin skin test
4
Q
What is the syringe size for ID injections
A
1 mL syringe
5
Q
What is the needle gauge for ID injections
A
25-30 guage
6
Q
Subcutaneous Injections
A
nonirritating substances
injected into fatty tissue sites
Insulin and Anticoagulants
7
Q
How much can be administered with a Subcut injection
A
1 mL
8
Q
what is the gauge of the needle for a subcut injection
A
25-30 gauge
9
Q
Intramuscular injections
A
deliver medications for faster absorption
tolerate more concentrated substances
10
Q
How much can be administered via IM
A
up to 3 mL depending on patient skin integrity and muscle size
11
Q
How far away from the umbilicus must you be when giving an injection
A
at least two inches
12
Q
Why is the dorsogluteal are not recommended for injections
A
because of the potential for nerve and vessel damage
13
Q
What is the basis for selecting a needle
A
type of medication
size and condition of patient
are of injection
* larger the gauge the smaller the diameter the needle
14
Q
What is the approximate length for an ID needle
A
3/8-1/2 inch
15
Q
What is the approximate length for subcut needle
A
3/8-5/8 inch
16
Q
what is the approximate length for an IM injection
A
5/8-2 inches
17
Q
What are some examples of diseases that could be contracted because of a needle stick
A
Hepatitis B, C, and HIV
18
Q
What must you do before mixing medications
A
always consult a reference for compatibility or the pharmacist
19
Q
Where must all liquid medications be measured
A
at the meniscus
20
Q
If the vial is multi-dose what must the nurse do
A
must label it with date, time and amount of diluent used and their initials
21
Q
When giving IM injections what must you always do
A
always aspirate
22
Q
What happens if blood is returned while aspirating
A
reject the dose and start over
23
Q
What is the maximum single injection for adults
A
3 mL
24
Q
What should you do before administering antiinfectives
A
check the patients medication history of drug sensitivity
25
Insulin
an aqueous solution
| principal hormone of the pancreas
26
Diabetes mellitus
deficiency of insulin
27
Type 1 DM
occurs before age 30
pancreatic beta cells do not produce insulin
insulin injections must be taken daily
28
Type 2 DM
usually occurs after age 30
pancreas produces some insulin
only 40% take insulin regularly
29
what is the most common complication of insulin therapy
Hypoglycemia
30
what is used to treat hyperglycemia
glucose tablets
glucose gel
and glucagon injections
31
If a patient is over 20 Kg how much glucagon can be injected
1 mL
32
If a patient is under 20 Kg how much glucagon can be injected
0.5 ml
33
What is the preferred area for insulin injections
abdomen
34
what are alternative areas for insulin injections
upper arms, back, or thighs
35
What are the signs of hypoglycemia
```
rapid onset
cold and clammy skin
diaphoretic
nervous
blood glucose below 70mg/dL
```
36
What are the signs of hyper glycemia
```
several hour onset
warm skin
flushed dry skin
lethargic
blood glucose above 300 mg/dL
```
37
Rapid Acting Insulin
Aspart (Novolog)
Lispro (Humalog)
Glulisine (apidra)
38
Aspart characteristics
5-15min, 1-3hr, 3-5hr
39
when do you take rapid acting
15 min before meals
40
what can be mixed with rapid acting
NPH
41
Characteristics of Lispro and Glulisine
15 min, 1-2hr, 3-4 hours
42
Short- Acting Insulin
Regular (novolin R)
| Regular (humulin R)
43
Regular (Novolin R) characteristics
30-60min, 2-5hr, 6-8hr
44
Regular (humilin R) charateristics
40-60min, 2-3hr, 4-6hr
45
What can short-acting insulin mix with
NPH
46
When should you take short-acting insulin
30min before a meal
47
Intermediate actin Insulin
NPH (Novolin N)
| NPH (humulin N)
48
NPH Novolin N
90min, 4-12hr, up to 24 hr ** cloudy
49
NPH Humulin N
2-4hr, 4-10hr, 14-18hr *** Cloudy
50
When should you take intermediate insulin
30min before a meal
51
what can be mixed with intermediate insulin
Regular and rapids
52
Long-acting insulin
Glargine (lantus)
| Detemir (levemir)
53
Glargine (lantus)
3-5hr, peakless, 22-26hr
54
Detemir (Levemir)
2-4 hr, Peakless, 13-20hr
55
When should you take Glargine
bedtime
56
When should you take Detemir
Bedtime or supper time
57
What can you mix with long-acting
NOTHING DO NOT MIX
58
How often are premixed insulins taken
Twice a day
59
Short and intermediate acting 70/30 or 50/50
1-4hr, 2-4hr/6-10hr, 3-4hr/10-16hr, *** cloudy
60
When do you take short and intermediate mix
30min before a meal
61
Rapid and intermediate acting
75/25 and 70/30 Novolog mix
62
75/25 mix-
15min-4hr, 1-2hr/60-10hr, 3-4hr/10-16hr *** cloudy
63
70/30Novolog Mix
15min-4h, 30-90min/ 6-10hr, 4-5hr/10-16hr ***cloudy
64
When do you take the rapid and intermediate acting mix
15min before a meal
65
Why is the combination of NPH and Regular insulin given
give a 24 hour effect
66
What types of syringes are used when giving insulin
1 ml or 0.5mL
67
When giving insulin what must you do before administration
Insulin dosage requires two nurses to double check for accuracy
68
How are insulin dosages drawn up
they are drawn up exactly as ordered
69
In what order do you draw up insulin
Clear to cloudy
70
What do insulin pumps do?
Supply a continuous infusion of insulin
71
What may happen if the insulin is interrupted involving an insulin pump
ketoacidosis
72
What should you do to prevent ketoacidosis when using a pump
have supplemental insulin ready
73
how often should blood sugars be checked when using an insulin pump
before meals and at betime
74
What is the best type of diabetes management
Carbohydrate ratio technique
75
What type of insulin can be given IV
only clear regular insulin
76
Sulfonylureas
stimulate the pancreas to make more insulin
77
Biguanides
decrease the amount of glucose made by the liver
78
Alpha-glucosidase inhibitors
slow the absorption of the starches you eat
79
Thiazolidinediones
make you more sensitive to insulin
80
Meglitinides
stimulate the pancreas to make more insulin
81
D-phenylalanine
help your pancrease make more insulin quickly
82
DPP-IV inhibitors
boost incretin gut hormone production to help lower blood glucose levels
83
Heparin sodium injections
interrupt the clotting process
| affects the ability of blood to coagulate
84
What is Heparin used for
```
to treat deep vein thrombosis
pulmonary embolism
cardiac surgery
during hemodialysis
MI
disseminated intravascular coagulation
```
85
how is heparin administered
IV or subcut
86
What is heparin's half-life
1-6 hours
87
How is heparin titrated
on the basis of Partial thromboplastin time levels (taken every 6 hours)
88
what counteracts heparin
protamine sulfate
89
Lovenox and Framin
are low-molecular-weight anticoagulants
90
Why are lovenox and framin prescribed
for the prevention and treatment of
DVT
PE
and also after knee and hip surgery
91
What is the preferred site of administration for lovenox and framin
in the "love-handles" or anterolateral abdominal wall
92
What must you always do when administering an anticoagulant
always verify dosage with a second nurse for accuracy
93
Where must lovenox and fragmin never be given
in the deltoid
94
why must lovenox and fragmin never be given in the deltoid
because they leave large hematomas
95
Arixtra
non-heparin anticoagulant, not animal origin,
| specific inhibitor of activated factor X
96
what is Arixtra used for
prophylasis of venous thromboembolism, DVT, PE
97
What can be administered in conjunction with Arixtra
Warfarin to treat acute DVT
98
Arixtra is not intended for what?
IM use
99
Why should you not massage the injection sites
because it increases risk of bleeding and hematoma development
100
What should the subcut dose be for Heparin
dosage should not exceed 1mL
101
what is heparin made from
pork and beef, CHECK Patients allergies
102
why are elderly given large doses of heparin
because heparin resistance may occur
103
What are symptoms of overdose in heparin
nosebleed, bleeding gums, tarry stools, petechiae, and easy bruising
104
When intermittent or continuous Heparin IV therapy is used what needs to be done
blood should be drawn for PTT and hematocrit levels to determine course of therapy
105
How are therapeutic anticoagulant dosage regulated
according to PTT results and patients weight
106
Warfarin
used as prophylaxis after an episode of thrombolytic complications and for atrial fibrillation to prevent blood coagulation.
107
What is the action of warfarin
it inhibits the activity of vitamin K- which is required for activation of clotting factors
108
how is the level of warfarin measured in a patient
by International normalized ratio (INR)
109
What is the normal range for an INR
2-3
110
what is the antidote for warfarin
Vitamin K, plasma or whole blood
111
What should a patient taking warfarin avoid
foods rich in vitamin K until INR is stabilized
112
Clopidogrel (plavix)
an antiplatelet agent that blocks the formation of blood clots by preventing the clumping of platelets
113
what is plavix used for
prevention of heart attacks, unstable angina, recent stroke or peripheral vascular disease
114
what is the only PPI safe to use with plavix
Pantoprazole (protonix)
115
Acetylsalic Acid (aspirin)
prevents the formation of blood clots
116
Dosing of Aspirin
can be prescribed concurrent with warfarin
117
at what angle can you give subcut injection
45-90
118
what angle can you give IM injections
90
119
what angle can you give ID
5-15
120
What is the length of the needle for an IM given to the deltoid
1-1.5
121
What is the length of the needle for an IM given to the VL
5/8-1
122
What is the length of the needle for an IM given to the VG
1-1.5
123
What is the most common way to get air into the syringe
by pulling too fast
124
what can dull a needle
puncturing the vial
125
how long do you need to clean surfaces before puncturing them
15 seconds
126
How many rotations must be completed before drawing up insulin
20 rotations
127
how do you use an insulin pen
prime the needle with 2 units and inject at a 90 degree angle
128
What are the IM sites
Ventrogluteal
Deltoid
Vastus Lateralis
129
Ventrogluteal
Good for large volume viscous and irritating medication
130
What are the sites for Ventrogluteal
gluteus medis and minimus, and greater trochanter, anterior superior illiac crest and dorsal crest of illiac spin
131
What is the site for Vastus Lateralis
anterior lateral aspect of thigh, greater trochanter or femur, lateral femoral condyle
132
Deltoid
acromin process
| below 1-2 inches
133
z track method
pull skin to the side of injection with non-dominant hand
insert needle and aspirate
maintain traction for 10 seconds before withdrawing needle
release skin
134
how fast can you inject a person with medication
10seconds/mL
135
how is intermittent medication given
through a saline or heparin lock
136
what things are important for the person administering the IV to know
action of medication, flow rate, adverse reactions and antidotes
137
Types of IV lines
peripheral
peripheral inserted central catheter
central line
138
Describe the Peripheral IV line
is usually used for fluid replacement and temporary intermittent medication administration
given in hand, arm or possible leg
139
describe Peripheral Inserted Central Catheter
longer than a central line,
| usually the vein in the antecubital region of the arm
140
What can the osmolarity be for a PICC line
10% or less osmolarity
141
Describe central line
inserted by MD or DO directly into the jugular or subclavian vein into the superior vena cava
142
What type of syringe should be used when flushing Peripheral IV lines
a 10mL syringe - a smaller syringe creates a greater pressure within the line
143
macrodrops in mL
10 macrodrops in one mL
144
microdrops in mL
60 drops in mL
145
how often should you check the IV bag with a pt
every hour
146
Hypotonic Solution
fluid shifts out of intravascular compartment, hydrating cells
(250 mOsm/L)
147
Isotonic solution
osmolarity equal to that serum
| 250-375 mOsm/L
148
Hypertonic solution
fluid is drawn into the intravascular compartment from the cells
(375 mOsm/L)
149
What must you do to every port before puncture
clean with antiseptic
150
what are patient-controlled analgesia (PCA)
allows a specified amount of narcotic to be available to the patient on demand
151
Total Parenteral Nutrition Device
delivery mode allows the infusion of nutritional elements slowly at the beginning of the administration
this keeps the glucose level from rising too rapidly
152
Pressure- Flow infusion device
the ambulatory infusion device system was developed for ambulatory use
