FOPS2

Question 1

What are the steps of ABG?

Answer 1

• Confirm patient identity
• Performs Allens test to check the patients hand is adequately perfused
• Cleans site
• Prepares needle and syringe
• Punctures radial artery and collect blood
• Remove needle from syringe and dispose into sharps bin
• Apply pressure at puncture site for 5 minutes
• Rolles and/or inverts syringe
• Apply dressing and document procedure

Question 2

What would a high CO2 in ABG indicate?

Answer 2

Respiratory acidosis

Question 3

What would a low CO2 in ABG indicate?

Answer 3

Respiratory alkalosis

Question 4

What would a low HCO3- in ABG indicate?

Answer 4

Metabolic acidosis

Question 5

What would a high HCO3- in ABG indicate?

Answer 5

Metabolic alkalosis

Question 6

What equipment is needed for ABG?

Answer 6

• Needle
• Syringe
• Gloves
• Alcohol wipe
• Cotton wool
• Dressing

Question 7

What are the steps of IM injection?

Answer 7

• Confirm identity and check for allergies
• Wash hands and don gloves
• Draw up injection using a needle into a syringe. Expel any air and then place new needle on syringe.
• Use Z technique, insert needle at 90 degrees, leaving 1/3 of needle out of skin
• For DG site only, pull back plunger to check that blood isnt being drawn back
• Inject site
• Safe disposal
• Aftercare advice

Question 8

Where can IM injections be done?

Answer 8

• Deltoid
• Dorsolateral glute
• Vastus lateralis
• Gluteus medius

Question 9

What colour needle is used for IM injections?

Answer 9

23 G (Blue)

Question 10

What are the steps of Sub cut injection?

Answer 10

• Confirm identity and check for allergies
• Wash hands and don gloves
• Draw up medication
• Pinch skin 2cm, and insert needle at 45 degrees
• Inject site
• Safe disposal
• Aftercare advice
• Documentation

Question 11

What equipment is used for IM injection?

Answer 11

• The patient’s drug chart and wrist label
• A clean receptacle in which to place the equipment.
• Alcohol handwash.
• Non-sterile gloves and apron.
• The drug (and diluent if required).
• An appropriate sized syringe.
• Two hypodermic needles of an appropriate size and length.
• 70% isopropyl alcohol swab to clean the skin.
• A sharps disposal bin

Question 12

What are the risks and complications associated with IM injections?

Answer 12

• Pain
• Bleeding (increased risk if patient is receiving anticoagulant therapy or has a clotting disorder)
• Infection
• Abscess formation
• Nerve damage
• Vessel damage
• Inadvertent subcutaneous injection
• Repeated injections at the same site may result in local fibrosis

Question 13

How can you determine where to inject in the gluteus medius?

Answer 13

Place hand over greater trochanter, with thumb facing towards the anterior of the patient. The anterior superior iliac crest should lie above the fingers. The injection point should be between the 2nd and 3rd fingers.

Question 14

What are the absolute and relative contraindications to IM injection?

Answer 14

• Patient refusal
• Infection, inflammation, lesions or broken skin at the injection site
• Vascular insufficiency, poor blood supply, or oedema to the injection site
• Relevant drug allergy (check!!!!)

Question 15

List some medications given by Sub cut injection?

Answer 15

• Low molecular weight heparin
• Insulin
• Opioids such as morphine
• Anti-allergy medication

Question 16

What is the maximum volume of fluid given by sub cut injection?

Answer 16

2ml

Question 17

What are the sites for Subcutaneous Injections?

Answer 17

• Lateral or posterior aspect of the lower part of the upper arm
• Thighs
• Abdomen (umbilical region)

Question 18

What equipment is needed for subcut injection?

Answer 18

• The patient’s drug chart and wrist label.
• A clean receptacle to put the equipment in.
• Alcohol handwash.
• Non-sterile gloves and apron.
• The drug (and diluent if required).An appropriate sized syringe.
• Two hypodermic needles of an appropriate size.
• A sharps bin

Question 19

What needle size is needed for subcut injection?

Answer 19

25 G (Orange)

Question 20

What is important in reducing the possibility of drug error?

Answer 20

Signing drug prescription chart or e-prescription after administration
Ensuring that you are aware of any drug allergies
Checking patient’s details against drug prescription

Question 21

What are the steps of IV infusion ?

Answer 21

• Introduce self, confirm identity, Check for allergies
• Check patients drug chart
• Collect fluid and check expiry date
• Wash hands and don gloves
• Remove seal on infusion bag entry port ANNT
• Open IV administration set aseptically, closing roller clamp and ‘spikes’ infusion bag entry port
• Half fill drip chamber
• Open roller clamp and prime the line expelling bubbles
• Replace cover on distal end of giving set to maintain asepsis
• Clean bung and ensure patency of cannula with flush
• Connect giving set to cannula and commence infusion

Question 22

What equipment is needed for IV infusion?

Answer 22

• Patient’s fluid prescription chart
• 500ml bag of Sodium chloride 0.9%
• Intravenous infusion set “giving set”
• Drip stand
• Antiseptic wipe
• Non sterile gloves and a disposable plastic apron.
• 0.9% sodium chloride ampoule for flush.
• 5 ml syringe.
• Infusion rate calculation sheet

Question 23

What equipment is needed to draw up drugs?

Answer 23

• Patient’s drug prescription chart.
• Sterile needle.
• Appropriate sized syringes
• 0.9% sodium chloride ampoule x 2 for flushes
• Water for injection ampoule for drug reconstitution
• ‘Prescribed’ medication (placebo)
• Antiseptic swab x 2
• Non sterile gloves
• Sharps container.
• IV cannula.

Question 24

What are the steps of drug preperation?

Answer 24

1. Don gloves and wash harms
2. Collect drug and check it against prescription chart. Check everything is in date.
3. Take top off medication and clean it
4. Use an appropriate sized syringe and draw up the diluent
5. Attach an appropriate needle to the syringe
6. Inject the diluent into the vial
7. Whilst keeping the needle in the vial and attached to syringe, release the plunger to allow the air from the vial to enter into the syringe.
8. Gently mix the powder and the diluent
9. Once all the powder has dissolved, inject the air in the syringe back into the vial
10. Invert the syringe keeping the vial uppermost
11. Release the plunger, keeping the bevel of the needle within the solution. Allow the syringe to fill.
12. Remove syringe from the vial. Remove the needle and discard
13. Prepare two 0.9% sodium chloride flushes
14. Wipe the injectable bung with an antiseptic wipe and allow it to dry naturally. Flush the cannula with a 0.9% saline flush.
15. Inject the drug via the cannula. Observe the patient whilst injecting drug
16. Flush cannula again
17. Document procedure