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Concepts II
Chapter 37
| Question | Answer |
|---|---|
| To reduce irritation of the tissue along the path the needle made through the skins subcutaneous layer and muscle is called | air lock |
| A small, sealed glass drug container that must be broken to withdraw the medication is an | ampule |
| What is first-pass metabolism? | When the drug enters the liver for metabolizing first then liver disperses remainder to the body (drug is weakened) |
| The diameter of the needle is the | gauge |
| Insulin syringes are prepackaged. | True |
| Intradermal medications are administered where? | between the epidermis and the dermis layers of the skin |
| Intramuscular medications are administered where? | into the largest portion of the muscle (the body of the muscle) |
| Prefilled syringes are single-dose, ready-to-use, disposable syringe cartridges, some with an attached needle and some to which you must attach a needle, that contain | specific dosages of specific medications |
| Subcutaneous medications are administered where? | between the dermis and fatty tissue layers |
| Tuberculin syringe medications are administered where? | usually into the deltoid muscle |
| A glass or plastic container of medication with a rubber stopper that must be punctured with a needle for medication removal is a | vial |
| What method prevents irritating and dark-colored medications, such as iron dextran, from leaking out of the injection site into sensitive tissues or subcutaneous tissues that may stain? | the z-track method |
| Injections are administered through what route? | Parenteral route |
| Parenteral routes include what sites? | Subcutaneous intradermal intramuscular intravenous (can also be intrathecal, intraarterial, intraarticular) |
| Administering medications by injection bypasses what? | gastrointestinal tract (to avoid gastrointestinal irritation) |
| Oral route is the slowest route. | True |
| Injection routes of medications are rapid and absorbed better than oral routes. | True |
| Parenteral administration carries risk of what? | infection and nerve injury |
| Supplies needed when injecting a medication are | syringe alcohol prep pads dry cotton ball or gauze pad needle disposal container examination gloves |
| A syringe is used to hold and introduce the medication into the | needle |
| Which syringes are typically disposal and made of plastic? | medical syringes |
| Which syringes are more prevalent in research settings? | glass syringes |
| Syringes are available in sizes ranging from | 0.3 to 60 ml |
| Most syringe common sizes are | 1ml and 3ml |
| Each syringe has calibrations marked on them in what, indicating the volume of medication administered? | milliliters or units (depending on the type of syringe and medication being administered) |
| Name 3 parts of the syringe | barrel plunger (with flange on the end) tip (connects to the needle) |
| 1ml tuberculin syringe marked in 0.01ml is what as a fraction of a milliliter? | 1/100th of a milliliter |
| U-100 marked syringe is how many milliliters? | 1ml |
| 16 minims equal how many milliliters? | 1ml |
| 3ml standard syringe is marked in | whole milliliters |
| 0.1 ml equals what in a fraction of milliliters? | 1/10th of a milliliter |
| 5ml standard syringe marked in | whole milliliters |
| 10mml standard syringe is marked in | whole milliliters |
| 0.2 ml equals what in a fraction of milliliters? | 2/10th of a milliliters |
| Avoid touching what part of the syringe | plunger |
| The hub connects to what? | the tip |
| The bevel (slanted tip of needle) is up or down when injecting medication into the body? | Up |
| Where is the gauge number located? | the hub |
| What is kept sterile? | the shaft and bevel of the needle |
| The barrel is the hollow cylinder that holds what? | the medication |
| The plunger is inserted into where? | the barrel |
| What has threaded grooves that screw onto the needle hub and lock it in place? | Luer-Lok tip |
| A smooth slightly tapered tip that inserts into the needle hub requiring a slight twist of the syringe or needle to securely snug the needle and syringe together is a | slip-tip |
| The plunger draws up medication or pushes it out | True |
| What is the rubber tip of the plunger for? | To provide traction against the barrel |
| The flange of the plunger allows for grip to pull plunger back when drawing up medications | True |
| What are the four types of syringes? (hint PRIT) | Prefilled, Regular, Insulin, and Tuberculin |
| Total volume of a tb syringe is | 1ml |
| Regular (standard) syringe is most frequently used for what injections? | Intramuscular or subcutaneous injections |
| Standard syringes are available in what milliliter sizes? | 1,3,5,10,20 and 60 milliliters |
| Standard syringe milliliter sizes used the most for injections are? | 1,3,5 milliliters |
| When a needle punctures out a piece of a rubber stopper (like on a vial) this is called | coring |
| The bevel allows for a gradual | increase in the size of the opening made in the skin |
| The higher the gauge number the | smaller the diameter of the needle |
| The smaller the gauge number the | larger the diameter of the needle |
| The needle gauge depends on 3 things | viscosity of the medication, route of administering, and the size of the patient and muscle mass |
| Viscous means | thick |
| A smaller gauge from 4G (2.1mm) to 20G (0.90mm) has a larger diameter required for what viscosity of medications? | thick (high viscosity) medications = slow moviing |
| Larger gauges from 21G (0.8mm) to 30G (0.3mm) have smaller diameters and are used for what viscosity of medications? | thinner (low viscosity) medications = fast moving |
| Needles with gauges from 29G (0.34mm) to 30G (0.3mm) are so tiny that they can be easily | bent (must be extremely careful when drawing up medications to avoid bending) |
| Percutaneous injuries are commonly referred to as | needle stick injuries |
| percutaneous or needle stick injuries provide the perfect mode of transmission for (hint 3 H's) | bloodborne infectious diseases (HIV, Hepatitis B, and Hepatitis C) |
| Never recap used needles | True |
| Use one-handed scoop technique to recap unused clean needle | True |
| If a needle stick occurs do what first? | wash the punctured area with soap and water |
| Does a needlestick injury require an incident or variance report? | YES |
| Can an injected medication be retrieved after administered? | NO |
| How can an orally administered drug be potentially retrieved after administered? | limited partial retrieval or an entire dose by using the gastric lavage or emetic medications to induce vomiting |
| How can a topical administered drug be potentially retrieved after administered? | can be at least partially removed with soap and water if caught quickly |
| Injectable medications can also come in the form of a liquid or a | powder |
| The powder form injectable medication is used for medications that are not stable for very long once they are in what? | the solution |
| The process of dissolving powered drugs using a liquid or diluent such as sterile normal saline or sterile water is known as | reconstitution |
| Some vial labels may indicate rubber stopper is designed for use with needless systems if so, what may be used? | a needleless piercing device may be used in the place of a needle |
| Using nonsharps to pierce rubber stoppers that are not designed for such use allows the device to core the rubber, this is when a round piece of | the stopper is punched out and is now either in the medication or aspirated into the needle or syringe |
| What does ALL multiple dose vials contain? | bacteriostatic preservatives (reduce the risk of microorganism growth) |
| Single dose vials do not contain bacteriostatic preservatives | True |
| Before opening a multiple-dose vial medication write | date, time, and your initials on the label |
| After reconstitution, some multiple-dose vial medications may need to be | refrigerated |
| Some multiple-dose vial medications may only be good for | 24 hours |
| What bacteriostatic preservative alcohol has been known to be toxic to neonates? | Benzyl |
| Benzyl alcohol 0.9% and sodium chloride 0.9% (multiple-dose vial) is contraindicated for use in | newborns |
| After breaking an ampule, a filtered needle is used to filter | debris such as glass from ampules or rubber cores from vials when drawing the medication up |
| After drawing up the medication with the filtered needle you must do what next | change the filtered needle to a regular needle before administering the medication |
| An unwanted reaction that occurs between the drug and the solution, container, or another drug is | incompatibility |
| What are the 3 types of incompatibilities of mixing medications that can occur? | physical, chemical, and therapeutic |
| Physical incompatibilities of mixing medications can produce what affects? | color changes, cloudiness, haze, precipitate and gas formation |
| Chemical incompatibilities of mixing medications can involve what affects? | degradation of the drug resulting from a chemical reaction |
| A therapeutic incompatibility of mixing medications that occur within the patient is the result of two... | concurrently administered drugs that interact. |
| What is the largest organ of the body? | the skin |
| Which layer of the skin is the connected tissue layer of the skin? | the dermis |
| Which layer of the skin is the outermost layer of the skin? | the epidermis |
| The dermis is located below which layer of the skin? | epidermis |
| The dermis is composed of (hint REC) | reticular fibers, elastic tissue, and collagen |
| The dermis is attached to an underlying (hint hy) | hypodermis |
| The hypodermis is commonly called the (hint sub-) | subcutaneous connective tissue |
| What does the subcutaneous tissue store? (hint BAN) | blood vessels (large), adipose tissue, and nerves |
| What layer is beneath the subcutaneous layer and is the deepest? | the muscular tissue layer |
| Are ALL drugs compatible with the layers of the skin? | NO |
| Any break in the skin can have a risk for infection. | True |
| What does PPD stand for? | (tuberculin) purified protein derivate |
| An allergy testing is performed at these sites | left or right ventral forearm, upper chest, and upper back over the scapular |
| Tuberculin (PPD) testing is performed at what sites? | left or right ventral forearm |
| The length of the ID needle for injections should be | 1/4 to 5/8inch |
| What does a bleb look like? | a small, raised, fluid filled blister |
| After 48 to 72 hours of a TB test, a hardened PPD site and/or blisters indicates a positive result | True |
| If blistering is present after the time period, measure the size, 15mm is considered a positive reading | True |
| The back of the arms, the abdomen, anterior thigh, area of the back (below scapula) and the upper buttocks are site for what injection? | Subcutaneous |
| When slow and continuous absorption is needed this injection site is used | Subcutaneous |
| Administering a subcutaneous injection on an obese person, you will need a needle between 3/8 and 7/8inch and 24 to 29gauge and administer at what angle degree? | 90 |
| Administering a subcutaneous injection on a small person, you will need a needle between 3/8 and 5/8 inch and administer at what angle degree? | 45 |
| Do not aspirate before injecting medication | True |
| Do not massage the injection site after injecting insulin or heparin | True |
| Insulin and heparin are two medication that are injected how? | subcutaneous and intravenous |
| Insulin is a hormone that is necessary for transporting glucose from the blood into each | cell of all tissues in the body |
| Blood levels elevate when insulin is not | present to transport glucose from the blood |
| Dangerously low glucose levels are known as | hypoglycemia (insulin shock) |
| Dangerously high levels of blood glucose are known as | hyperglycemia |
| What is a sliding scale dependent on? | results of FSBS |
| Insulin and heparin are verified by 2 to 3 nurses before administering | True |
| Before administering heparin you should assess lab results of what? | PT, PTT, and INR |
| After administering insulin monitor for signs and symptoms of | hypoglycemia and hyperglycemia |
| After administering heparin monitor for signs and symptoms of | bleeding gums, blood in stool, red blood cells in urine, and excessive bruising |
| A patient should wear a bracelet or necklace that indicates that they are diabetic | True |
| Pale, cool, clammy skin, tremors, hunger, nausea, increased irritability, fatigue, difficulty concentrating, headache, dizziness, drowsiness, palpatations, or restless are symptoms of | Hypoglycemia |
| If a patients FSBS is <90 and able to swallow, to maintain glucose levels, give the patient.... | a small glass of orange juice or other simple carbohydrate, followed by a protein source and complex carbohydrate such as peanut butter on wheat bread, cheese and crackers, or a glass of milk and a sandwich. |
| Hot, dry, flushed skin, thirst, fatigue, weakness, sleepiness, sweet or acetone odor to breath are symptoms of | Hyperglycemia |
| If glucose is >200 mg/dL and there are no health-care provider orders specifying whether or not to administer insulin at this level of elevation, | notify the health-care provider. |
| Long-acting insulins, such as glargine (Lantus), are never mixed with other insulins. | True |
| Do not shake insulin instead gently | roll the vial between both hands for approximately 1 minute to resuspend and warm the medication. |
| When mixing insulin remember clear insulin before cloudy | True |
| Rotate insulin injection sites using the | clock method on the abdomen |
| The breakdown of subcutaneous fat from repeated insulin injection is known as | lipo-atrophy |
| The buildup of subcutaneous fat at the site of repeated insulin injections is known as | lipo-hypertrophy |
| An amount of medication given all at once is known as | bolus |
| The minimum requirements, when the body is at rest and no additional demands are being made refers to | basal |
| This system works somewhat like an insulin pump, but the insulin is injected rather than delivered by a pump. | basal/bolus system, or MDI (multiple daily injection) system. |
| Basal/bolus system or MDI systems closely resemble the way the body | delivers insulin to the bloodstream |
| INR is determined by dividing the patient’s | protime result by the normal patient average. |
| The goal for INR is to have the patient’s level between 2 and 3. | True |
| Heparin interferes with the intrinsic clotting process by inactivating prothrombin for several hours after administration of drug. | True |
| PT: Normal range: 60 to 70 seconds Therapeutic range: 90 to 175 seconds | True |
| aPTT: Normal range: 30 to 40 seconds Therapeutic range: 45 to 100 seconds | True |
| 2 to 3 mL is used for injecting a "LARGE" | ventrogluteal site |
| 1 to 2 mL is used for injecting a (hint "Standard") | ventrogluteal site |
| 0.5 to 1 mL is used for small muscles in what patients? | infants and small children |
| 0.5 to 1 mL is used for the deltoid muscle in | small children and up through older adults |
| Cayenne, Feverfew, Ginkgo biloba, Ginseng, Omega-3 fatty acids, St. John’s wort, Vitamins A and C, Antiplatelet drugs, Black Cohosh are herbal supplements that may cause increased (hint It's Red) | bleeding |
| Z-track closes off the needle track pathway and seals the medication within the | body of the muscle |
| The dorsogluteal site is no longer recommended because of the risk of damaging the extremely large | sciatic nerve that extends across the buttock and travels down the posterior aspect of the leg |
| The safest and most comfortable IM injection site for all patients older than 7 months is | the ventrogluteal site |
| The dorsogluteal site should only be used if all other sites are not accessible. | True |
| The ventrogluteal site is not close to any major blood vessels, including arteries, veins, and nerves however there is little subcutaneous tissue overlying the gluteus medius and gluteus minimus muscles. | True |
| The most common site for injection of small volumes such as 0.5 or 1 mL is the | deltoid muscle on the superior aspect of the upper arm. |
| The vastus lateralis on the lateral aspect of the thigh is the second-choice site for injections greater | than 1 mL if the ventrogluteal site cannot be accessed |
| Vastus lateralis is the number 1 choice for what patients? | newborns, infants, and toddler |
| The rectus femoris is located in the longitudinal midline of the | anterior thigh |
| The rectus femoris site is not used in infants and children. | True |
| The dorsogluteal site is no longer a site of choice and is considered a last | resort site option |
| Needle size for infant use is | 5/8-inch needle in a 23 to 27G |
| Needle size for children, older adults, or thin adults use a | 5/8- to 1-inch needle length in a 22- to 23-G needle. |
Created by:
Daarina Jones