34.3 - Medication

Question 1

How does pressure effect needle size

Answer 1

The a larger the syringe, the lower the pressure flow. The smaller a syringe the higher the pressure flow

Question 2

How to use an ampule

Answer 2

• Tap the top to bring down any fluid from the neck and into the lower chamber.
• You can either hold the ampule upside down or set it on a flat surface
• Insert the needle without touching the rim of the ampule
• Aspirate the medication in the syringe by gently pulling back on the plunger
• Keep needle tip under the surface of the liquid, tipping ampule if needed
• If air bubbles aspirated, remove from ampule and hold syringe pointing up
• Tap sides of syringe to cause bubbles to rise to needle
• Draw back slightly and then push plunger to eject air carefully without ejecting fluid
• If there is excess fluid, dispose of some and then check fluid level in syringe again
• Replace needle

Question 3

How to use a vial

Answer 3

• Always clean top of vial with alcohol prior to needle insertion
• Because the vial is a closed system we must inject air equal to the amount of liquid we are removing or there will be a vacuum.
• So if we need to withdraw 2ml of medication, we must push 2ml of air into the vial.
• Vial should be on a flat surface, then insert needle, inject the air (plunger may be forced back by pressure)
• Invert the vial.
• Hold vial between thumb and fingers of nondominant hand
• Hold syringe in dominant hand being sure to counteract the pressure
• Keep needle tip below fluid level and withdraw correct amount.
• Tap syringe to release air bubbles and eject air into vial
• Remove syringe and hold at eye level to ensure correct dose and no air bubbles
• If air bubbles, remove them
• Change needle to one of appropriate guage and length

Question 4

How to Mix medications

Answer 4

• Mixing compatible medications avoids the need to give a patient more than one injection.
• Determine compatibility of the medications (Consult a compatibility chart or a pharmacist for compatible medications.).
• Do not contaminate one medication with another.
• Ensure that the final dose is accurate.
• Maintain aseptic technique.
• Total dose must be within acceptable limits, may reduce the amount of injections.
• Prior to mixing, you need to calculate the final volumes and dosages. Confirm your calculations are accurate

1) Aspirate and Inject volume of air into vial A equal to being withdraw, don’t touch needle to solution
2) Then aspirate and inject volume of air into volume b and then withdraw the correct volume of medication
3) Insert needle back ito vial A and withdraw the correct amount of medication
4) Replace the needle

Question 5

How to give insulin

Answer 5

• Before preparing insulin, gently roll all cloudy insulin preparations (Humulin-N) between the palms of your hands to resuspend the insulin.
• Mixing insulin is the same procedure as mixing medications that we already discussed. Draw up clear before cloudy
• Can mix insulins if taking different types, but ensure they are compatible.
• administered within 5 minutes of preparing as longer acting insulins may bind with the short acting and reduce its action
• Patients choose one anatomical area (e.g., the abdomen) and systematically rotate sites within that region; this maintains consistent insulin absorption from day to day.
• Absorption rates of insulin vary on the basis of injection site. Insulin is most quickly absorbed in the abdomen and most slowly in the thighs.

Question 6

What are some conditions that carry an increased risk for hemorrhage?

Answer 6

Recent childbirth; severe diabetes and renal disease; liver disease; severe trauma; and active ulcers or lesions of the gastrointestinal (GI), genitourinary (GU), or respiratory tract

Question 7

where to give heparin

Answer 7

heparin given in the abdomen at least 5 cm from umbilicus

Question 8

Subcutaneous Injection: angle to use

Answer 8

Rule: if you can grasp 5 cm of tissue, insert the needle at a 90-degree angle; if you can grasp 2.5 cm of tissue, insert the needle at a 45-degree angle

Question 9

Subcutaneous Injection: needle gauge

Answer 9

• 25-27 gauge (10-16mm);
• syringe 1-3ml
• 25-gauge 16-mm needle inserted at a 45-degree angle
• 12-cm needle inserted at a 90-degree angle.
• A child may require only a 12-cm needle
• insulin, needles of 3/16 inch (4 to 5 mm) administered at a 90-degree angle should be used to reduce pain

Question 10

Subcutaneous Injection: sites to use

Answer 10

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

• Choose an injection site that is free of skin lesions, bony prominences, and large underlying muscles or nerves.

Question 11

Administering Continuous Subcutaneous Medications

Answer 11

Use a small-gauge (25 to 27) winged butterfly IV needle or a special commercially prepared Teflon cannula.
Use the same anatomical sites for subcutaneous injections and the upper chest.
Requires a computerized pump with safety features.

Question 12

intramuscular Route: needle gauge

Answer 12

• Use a longer and heavier-gauge needle to pass through subcutaneous tissue and penetrate deep muscle tissue.
• Syringe 2–3 mL for adult, 0.5–1 mL for infants and small children
• Needle, with length corresponding to the site of injection and the age of the patient according to the following guidelines (25-38mm)
• Any site (children):1.6–3.2 cm (depending on the size of the child)
• Vastus lateralis (adults):2.5–3.8 cm
• Deltoid (adults):2.5–3.8 cm
• Ventrogluteal (adults):3.8 cm

Question 13

intramuscular Route: sites to use

Answer 13

• Vastus lateralis
• Ventrogluteal
• Deltoid

Question 14

intramuscular Route: angle to use

Answer 14

• Inject at 90°, dart-like, to the hub of the needle and inject at 1 mL per 10 seconds.
• Wait at least 10 seconds before withdrawing the needle.

Question 15

Intradermal (ID) injections: needle size

Answer 15

• Use a tuberculin (TB) or small syringe with a short 9 mm to 16 mm (⅜- to ⅝-inch), fine-gauge (25 to 27) needle
• Inject only small amounts of medication (0.01 to 0.1 mL) intradermally.

Question 16

Intradermal (ID) injections: angle to use

Answer 16

5-15 degrees angle of insertion with bevel up. Creates a small bleb with insertion (mosquito bite)

Question 17

Sharps Safety for needles

Answer 17

• The most frequent route of exposure to bloodborne disease for health care workers is needle-stick injury.
• Research has shown that most needlestick injuries occur in patient rooms and in the operating room.
• Always dispose of sharp immediately following use
• Never recap needles
• Do not leave sharp devices in your pockets!
• Anything considered a sharp (can break skin) disposed of in sharps container
• one handed scoop to cap an insulin needle before walking to patients room

Question 18

Advantages of volume controlled infusions

Answer 18

• The risk of rapid-dose infusion by IV push is reduced. Medications are diluted and infused over longer time intervals (e.g., 30 to 60 minutes).
• Medications that are stable for only a limited time in solution (e.g., antibiotics) can be administered.
• IV fluid intake can be controlled

Question 19

3 methods of IV administration

Answer 19

Large-volume infusions
Intravenous bolus injection
Volume-controlled infusions

Question 20

Precautions to decrease Intravenous infection

Answer 20

• Assess insertion site and surrounding tissue a minimum of every 4 hours in hospital or daily in community
• Assess for redness, swelling, drainage, or leaking; palpate through an intact dressing for pain, discomfort or cording along the vein
• Ensure dressing is dry and occlusive
• Change needle free connectors a minimum of every 7 days or sooner if indicated
• Use alcohol swab or chlorhexidine to scrub needle free connector prior to each access
• Change administration sets with placement of a new VAD, with possible contamination and according to policy
• Attach a sterile cap on end of intermittent tubing when not in use

Question 21

Documentation of an IV

Answer 21

• Document IV solution, rate of infusion and integrity and patency to employer policy and procedure.
• Document use of any EID or control device and identification number on that device.
• Document solution and tubing change on patient’s record. Use infusion therapy flow sheet, if available.
• Document patient response to therapy and unexpected outcomes.
• At change of shift or when leaving on break, changes of solution, report rate of, and volume left in infusion to nurse in charge or next nurse assigned to care for patient.