Medication/Documentation/Skin Integrity
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| Intradermal (ID) injection (Max mL, Sites, types of testing, needle size, Degree, how to administer) | MAX 0.1mL
Sites- forearms, scapula, anterior chest
Testing- Tb skin test and allergy testing
Needle size- #25-#27 gauge; 1/4 to 5/8 inch
5-15 degrees
Spread flat with fingers
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| Subcutaneous (SubQ) injection (Max mL, Sites, types of testing, needle size, Degree, how to administer) | MAX 1mL
Sites- abdomen, below scapula, outer aspect of upper arms, anterior aspect of thighs
Testing- vaccines, insulin, and heparin
Needle size- #25 gauge, 5/8-inch for 45 degrees (ADULT); 3/8-inch for 90 degrees (CHILD)
Pinch an inch = 90 degrees
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| Intramuscular (IM) injection (Max mL, Sites, types of testing, needle size, Degree, how to administer) | MAX 1mL (Deltoid); 3mL
Sites- ventrogluteal, Vastus lateralis, dorsogluteal, rectus femoris, deltoid
Needle size- #23 to #25, 1 inch for deltoid; #20 for more viscous solutions; 2 inches for obese clients; 1 inch for emaciated clients
Z-track; Aspirate
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| Who regulates the production, prescription, distribution, and administration of drugs? | Federal drug legislation
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| Generic name (of drug) | given before a drug officially becomes an approved medication; generally used throughout the drug's lifetime
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| Trade name (of drug) | name of drug given by the drug manufacturer; also known as the brand name
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| Who defines limits on the nurse's responsibilities regarding medications? | Nursing practice acts
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| Therapeutic effect | the primary effect effect intended of a drug; reason the drug is prescribed, also known as desired effect
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| Side effect | the secondary effect of a drug that is unintended; usually predictable and may be either harmless or potentially harmful
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| Adverse effect | more severe side effects that may justify the discontinuation of a drug
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| Drug toxicity | the quality of a drug that exerts a deleterious effect on an organism or tissue
ex: overdosage, ingestion of drug intended for external use, or cumulative effect
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| Cumulative effect | buildup of the drug in the blood because of impaired metabolism or excretion
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| Drug allergy | an immunologic reaction to a drug
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| Anaphylactic reaction | a severe allergic reaction that usually occurs immediately after the administration of a drug
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| Drug tolerance | a condition in which successive increases in the dosage of a drug are required to maintain a given therapeutic effect
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| Idiosyncratic effect | a different, unexpected, or individual effect from the normal one usually expected from a medication; the occurrence of unpredictable and unexplainable symptoms
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| Drug interactions | the beneficial or harmful interaction of one drug with another drug
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| Potentiating effect | the increased effect of one or more drugs
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| Inhibiting effect | the decreased effect of one or more drugs
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| Additive effect | when two of the same types of drugs increase the actions of each other
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| Synergistic effect | when two different drugs increase the action of one or another drug
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| Onset of action | the time after administration when the body initially responds to the drug
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| Peak plasma level | the highest plasma level achieved by a single dose when the elimination rate of a drug equals the absorption rate
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| Drug half-life | the time required for the elimination process to reduce the concentration of the drug to one-half what it was at initial administration
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| Plateau | a maintained concentration of a drug in the plasma during a series of scheduled doses
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| Medication orders include: | Client’s full name; date and time the order is written; name of the medication; dosage, frequency, and route of administration; and signature of the ordering PCP or nurse
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| Stat order | The medication is to be given immediately and only once
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| Single order | Medication to be given once; also known as one-time order
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| Standing order | An order that may be carried out indefinitely until another order is written to cancel it, or that may be carried out for a specified number of days
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| PRN order | “as needed order”; permits the nurse to give a medication when, in the nurse’s judgment, the client requires it
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| Three important areas for medication reconciliation to occur are? | on admission; during shift reports, transfers, and with new medication administration records; and at discharge
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| Preferred IM site for infant 1 year and younger? | Vastus Lateralis
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| Preferred IM site for clients older than 7 months? | Ventrogluteal
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| percutaneous | through the skin
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| intentional body wounds | trauma occurs during therapy
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| unintentional body wounds | wounds are accidental; i.e. automobile collision
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| pressure ulcers | injury to the skin and/or underlying tissue, usually over a body prominence, as a result of force alone or in combination with movement
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| friction | a force acting parallel to the skin surface
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| shearing force | a combination of friction and pressure
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| skin maceration | tissue softened by prolonged wetting or soaking
i.e. moisture from incontinence
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| skin excoriation | area of loss of the superficial layers of the skin; also known as denuded area
i.e. from feces, gastric tube drainage, and urea in urine
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| The Braden Scale for Predicting Pressure Sore Risk | sensory perception, moisture, activity, mobility, nutrition, and friction and shear
23 total points; below 18 points is considered at risk
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| Norton's Pressure Area Risk Assessment Form Scale | general physical condition, mental state, activity, mobility, and incontinence, and medications
24 total points; Scores of 15 and 16 are at risk
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| primary intention healing | occurs where the tissue surfaces have been approximated (closed) and there is minimal or no tissue loss; it is characterized by the formation of minimal granulation tissue and scarring
i.e. closed surgical incision
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| secondary intention healing | a wond that is extensive and involves considerable tissue loss, and in which the edges cannot or should not be approximated
i.e. pressure ulcer
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| tertiary intention | wounds that are left open for 3 to 5 days to allow edema or infection to resolve or exudate to drain and are then closed with sutures, staples, or adhesive skin closures
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| inflammatory phase | initiated immediately after injury and lasts 3 to 6 days.
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| hemostasis | the cessation of bleeding
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| phagocytosis | macrophages engulf microorganisms and cellular debris
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| proliferative phase | extends from day 3 or 4 to about day 21 post injury
fibroblasts begin to form collagen; epithelial cells proliferate over connective tissue or dried plasma cells and dead cells form
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| maturation phase | begins on about day 21 and can extend 1 or 2 years after the injury
collagen fibers reorganize themselves , the wound is remodeled and contracted, and the scar becomes stronger
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| exudate | fluid and cells that has escaped from blood vessels during the inflammatory process and is deposited in tissue or on tissue surfaces
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| serous | consists of serum (the clear portion of blood)
i.e. blister from a burn
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| purulent | presence of pus, which consists of leukocytes, liquefied dead tissue debris, and dead and living bacteria
vary in color such as blue, green, or yellow
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| sanguineous | consists of large amounts of red blood cells, indicating damage to capillaries
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| serosanguineous | consisting of clear and blood-tinged drainage; commonly seen in surgical incisions
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| purosanguineous | consisting of blood and pus; often seen in a new wound that is infected
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| suppuration | process of pus formation
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| hemorrhage | massive bleeding
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| hematoma | a localized collection of blood underneath the skin that may appear as reddish blue swelling (bruise)
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| infection | microorganisms colonizing the wound multiply excessively or invade tissues; may cause fever and elevated WBC count
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| dehiscence | the partial or total rupturing of a sutured wound; i.e. an abdominal wound in which the layers below the skin also separate
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| evisceration | protrusion of the internal viscera through an incision
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| RYB color code | protect (cover) red, cleanse yellow, and debride black
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| rebound phenomenon | occurs at the time the maximum therapeutic effect of the hot or cold application is achieved and the opposite effect begins
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| range of motions | the maximum movement that is possible for that joint
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| proprioception | describes awareness of posture, movement, and changes in equilibrium and the knowledge of position, weight, and resistance of objects in relation to the body
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| cerebral cortex | initiates voluntary motor activity; directs arm to pick up coffee; coordinates moves not muscles
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| cerebellum | coordinates the motor activities of movement; blends and coordinates the muscles involved in voluntary movement
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| basal ganglia | maintains posture
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| degrees of head movement | 45 degrees MAX
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| degrees of shoulder movement | 50 degrees (adduction, hyperextension)
180 degrees (abduction, extension, flexion)
360 degrees (circumduction)
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| degrees of elbow | 150 degrees (flexion, extension)
90 degrees (rotation for supination, rotation for pronation)
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| degrees of wrist | 90 degrees (flexion, extension, hyperextension)
0-20 degrees (radial flexion) abduction
30-50 degrees (ulnar flexion) adduction
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| degrees of hand and fingers | 90 degrees (flexion, extension)
30 degrees (hyperextension)
20 degrees (abduction, adduction)
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| degrees of thumb | 90 degrees (flexion, extension)
30 degrees (adduction, abduction)
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| degrees of hip | 90-120 degrees (flexion, extension)
30-50 degrees (hyperextension, abduction)
20-30 degrees (adduction)
360 degrees (circumduction)
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| degrees of knee | 120 degrees (flexion, extension)
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| degrees of ankle | 20 degrees (extension)
45-50 degrees (flexion)
5 degrees (eversion, inversion)
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| degrees of toes | 35-60 degrees (flexion, extension)
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| degrees of trunk | 70-90 degrees (flexion)
20-30 degrees (hyperextension)
35 degrees (lateral flexion)
30-45 degrees (rotation)
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| Parts of body with pivot joint | neck
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| Parts of body with ball-and-socket joint | shoulder, hip
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| Parts of body with hinge joint | elbow, knee, ankle, toes
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| Parts of body with condyloid joint | wrist
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| Parts of body with saddle joint | thumb
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| Parts of body with gliding joint | trunk
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