1
Q
Where do we do a capillary glucose measurement?
A
On the side of the finger; less nerve endings
2
Q
Why do we wipe away the first drop of blood?
A
- to avoid contamination by alcohol
- it might be mixed w/ interstitial fluid
3
Q
What is DKA?
A
- diabetic ketoacidosis
- caused by insulin deficiency
- body can’t absorb sugar so it begins to break down fats leading to excess ketones
- characterized by fruity breath, excessive thirst and frequent urination
4
Q
What order do you draw up Insulin R and Insulin NPH?
A
- ISSI
- air into I, air into S, draw up S, draw up I
5
Q
What sites are used for a subcutaneous injection?
A
- posterior aspects/lateral outer of arms
- lower abdomen at least 2 in away from umbilicus
- anterior aspects of thighs
- upper ventral gluteal area
6
Q
What angle is used for subcutaneous injections?
A
- average-sized pt: 45-90 degrees
- obese pt: 90 degrees
- always “pinch an inch”
7
Q
What is heparin? What are the contraindications for heparin?
A
- anticoagulant AKA blood thinner
- contraindications:
- active bleeding
- uncontrolled hypertension
- thrombocytopenia
- NSAIDs
8
Q
What is the correct size of subcutaneous syringe?
A
- use a tuberculin syringe
- syringe calibrated in sixteenths of a minim and in hundreths of a mm
- capacity of 1 mL
9
Q
What is the maximum volume for subcutaneous injection?
A
- 1.5 mL
- can go up in certain cases
10
Q
Why do we do a TB test?
A
- test for tuberculosis
- TB is very contagious w/ high mortality rate
11
Q
Where is the correct spot for a TB test?
A
- 3-4 finger widths below antecubital space and hand width above the wrist
- if necessary, sites for subcu injections can be used
12
Q
What is the angle of insertion of intradermal injections?
A
- 15 degrees
13
Q
How do we read a TB test?
A
- 48 hrs after injection
- inspect injection site
- in healthy person: 15 mm or more of swelling and/or blisters indicates positive
- in unhealthy person: greater than 5 mm of swelling
- those who received BGG vaccine will be positive
- measure the BUMP not the redness
14
Q
What other things might be given intradermally?
A
- allergy tests
- lidocaine
15
Q
What is the difference between a blunt fill and filter needle?
A
- blunt fill: used when drawing up from vials to prevent contamination or damage to the needle, also mitigates risk of needle-stick injuries
- filter needle: used when drawing up medication from an ampule to filter out particles and glass
16
Q
What are some differences between a vial and an ampule?
A
- vial: usually multi-dose, req. air injection to displace pressure, fill needle, inverted
- ampule: single-dose, no air injection req., req. use of filter needle, usually kept upright
17
Q
Name the different parts of the syringe:
A
- barrel: where the medication is stored
- plunger: used to inject medication
- tip: where the needle is screwed into
18
Q
Do you draw up from vial or ampule first?
A
- vial
19
Q
Name the different parts of the needle:
A
- hub: where it connects to the syringe
- shaft: length of the needle
- bevel: angled exit portal of needle (always inject bevel up!)
20
Q
What is the formula for desired dose?
A
desired dose/dose on hand x amount
21
Q
What syringe size do we use for IM?
A
3 mLs
22
Q
Four sites for IM:
A
- deltoid:
- ventrogluteal: preferred site
- dorsogluteal: often preferred by pts but not my nurses b/c of risk of hitting sciatic nerve, contraindicated in children
- vastus lateralis: lacks major nerves and vessels, facilitates rapid absorption, used in infants and children
23
Q
Landmarking deltoid:
A
find acromion process, 2 fingers down, triangle
24
Q
Landmarking ventrogluteal:
A
find greater trochanter, point index finger towards anterior aspect of iliac crest, spread second finger making a V, inject in between knuckles
25
Landmarking dorsogluteal:
find greater trochanter, find posterior aspect of iliac crest, draw imaginary line over two bones, top outer corner of X
26
Landmarking vastus lateralis:
- outer middle third of anterior aspect of thig
27
What is the max vol. for each IM site?
- 3 mLs everywhere except deltoid
- deltoid = 2 mLs
28
Preferred IM site for children vs adults:
- children: vastus lateralis
- adults: ventrogluteal
29
What are signs of UTI?
- chills
- fever
- back pain
- dysuria
- urgency
- delirium in older adults
30
What does polyuria mean?
- excessive urination
31
dysuria
painful voiding
32
oliguria
decreased output
33
anuria
no output
34
neurogenic bladder
lack of nerve supply to bladder
person can't feel when baldder is full
must use catheter to voif
35
What is the purpose of a bladder scanner?
- to screen post-void residual and the amount
36
What is a fecal occult blood test?
- tests for hidden blood in stool
37
What is the advantage of condom catheter?
- more comfortable
- less invasive/less damage
- lower risk of infection
- simpler and non-sterile procedure
38
What is C+S?
- culture and sensitivity test
- cultures to determine type of organism
- sensitivity to test antibiotic effectiveness
39
What is surgical asepsis?
- sterile technique: eliminates all microorganisms
40
What is a nosocomial infection?
hospital acquired infection
41
Common examples of nosocomial infections:
c diff, mrsa
42
3 types of precautions in the hospital and examples:
1. contact: MRSA, C. diff, major wound infections
2. airborne: measles, chickenpox, TB
3. droplet: diptheria, rubella, flu, pertussis, mumps, sepsis
43
What kind of equipment do you need for contact precautions?
- gown and gloves
44
What kind of equipment do you need for droplet precautions
- mask and eye shield worn w/i 2 m of pt
- gown and gloves
45
What kind of equipment do you need for airborne precautions?
- n95 mask
- gown and gloves
46
What is the order of donning?
gown, mask, goggles, gloves
47
What is the order of doffing?
gloves, goggles, gown, mask, hand hygiene b/t each step
48
What is the chain of infection?
infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
49
What are the three elements to pronounce death?
1. no response to noxious stimuli
2. absence of apical/carotid pulse and respirations for one minute
3. no pupillary reaction
50
Under what circumstances can the RPN pronounce?
- by DRs orders
- needs 2 nurses
51
What is rigor mortis?
- stiffening of the body after death
- peaks at 8 hours
- goes away after 12 hours
52
What is algor mortis?
- cooling of the body
- cools for about 1 hr until reaches room temp
53
What is livor mortis?
- settling of the blood
- causes area to turn purple
54
What is the advantage of a subcutaneous butterfly?
- allows for medication to be administered regularly without re injecting the client
- usually analgesics and anticholinergic medications to reduce respiratory secretions
55
What are the sites for subcutaneous butterflies? Angle of insertion?
- upper arm, thigh, abdomen
- 30 degree angle, aspirate
56
What is the otic route?
ear
57
opthalmic
eye
58
What instructions do we give pts when taking SL meds?
- hold under tongue, don't swallow
- refrain from drinking water, eating, or smoking until the med is dissolved
59
What position for rectal medications?
- SIMs
- laying on left side with right hip and knee bent
60
How do transdermal medications work?
- slowly penetrates the layers of the skin and is circulated by bloodstream
61
Buccal vs SL:
- buccal: cheek
- SL: under tongue
cp 2
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