rle finals (2)

• Parenteral medication

  Medication that enters the body by injection through the tissue and circulatory system
• Parenteral medications

  • Absorbed more quickly
  • Used with patients who are nauseated, vomiting, restricted from taking oral fluids, or unable to swallow
• Medications given in this route is irretrievable once injected, the nurse must prepare & administer them ACCURATELY and CAREFULLY
• ASEPTIC TECHNIQUE MUST BE USED since injections are highly invasive procedures
• Syringe

  3 parts: tip, barrel, plunger
• Parts of the syringe that must be sterile

  • Tip
  • Inside of the barrel
  • Shaft of the plunger
• Kinds of syringes

  • Tuberculin Syringe
  • Hypodermic Syringe
  • Insulin Syringe
• Variations on the tip of the syringe

  • Luer lock
  • Non Luer lock (Luer slip)
  • Pre-filled Syringe
• Needle

  Parts: Hub, Cannula or shaft, Bevel
• 3 variable characteristics of a needle

  • Slant or Length of Needle
  • Length of Shaft
  • Gauge (or diameter) of the shaft
• Longer bevels

  • Provide the sharpest needles and cause less discomfort, commonly used for subcutaneous or intramuscular injections
• Short bevels

  • Used for intradermal and intravenous injections because a long bevel can become occluded if it rests against the side of a blood vessel
• Needle stick injuries are wounds caused by needles that accidentally puncture the skin and present a major risk for infection with hepatitis B virus, HIV, and many other pathogens
• Preventing needle stick injury

  1. Use appropriate puncture-proof disposal containers for sharps

  2. When recapping: Do "SCOOP METHOD" or "Fish hook Technique"
• Ampule

  A glass container usually designed to hold a single dose of a drug
• Vial

  A small glass bottle with a sealed rubber cap, can come in single dose or multi-dose

  
• Preparing medications from ampules

  1. Breaking the neck of an ampule

  2. Withdrawing a medication from an ampule
• Preparing medications from vials

  1. Before inserting the needle to the vial, draw the plunger of the syringe back

  2. Injecting air into a vial

  3. Withdrawing a medication from a vial that is held with the base down
• Routes of administering parenteral medication

  • Intradermal Injections (ID)
  • Subcutaneous Injections (SC or SQ)
• Intradermal Injections (ID)

  Administration of drug into the dermal layer of the skin just beneath the epidermis

  
• Intradermal Injections

  • Will not reach subcutaneous tissue
  • Used for skin testing, TB screening & BCG (Bacillus Calmette-Guerin) vaccinations

  
• Common sites for intradermal injections

  • Inner lower arm
  • Upper chest
  • Back beneath the scapula
  • Deltoid
• Skin test

  1. A small bleb will be created on the patient's skin as a test control

  2. Borders will be marked with a pen

  3. Reaction is checked after 30 min

  
• Intradermal route

  The bevel is only introduced, to create the bleb
• Reassessment after intradermal injection

  1. Tuberculin skin testing (for TB)

  2. Reading is 48-72hrs

  3. Look for induration (localized hardening of tissue)

  4. Measure the induration to indicate the presence of TB exposure

  
• Subcutaneous Injections (SC or SQ)

  Administration of drugs into the subcutaneous layer
• Subcutaneous Injections

  • Insulin shots are usually on the abdomen site, 2 inches away from umbilicus
  • Each injection needs to be rotated to prevent lipodystrophy
• Common sites for subcutaneous injections

  • Outer aspect of the upper arms
  • Anterior aspect of the thighs
  • Abdomen (insulin shots)
  • Scapular areas of the upper back
  • Upper ventrogluteal site and dorsogluteal site
• Indications for subcutaneous injections

  • Vaccines
  • Pre-operative Medications
  • Narcotics
  • Insulin
  • Heparin (Anti-coagulant, for blood clotting)
• When it is insulin we do not need to aspirate, for the needles are small and blood vessels cannot be hit
• In the case of heparin we do not aspirate
• Subcutaneous Injections (SC or SQ)

  • Indications: Vaccines (Anti-measles, Measles, Mumps, Rubella (MMR)), Pre-operative Medications, Narcotics, Insulin, Heparin (Anti-coagulant, for blood clotting)
  • For insulin, we do not need to aspirate as the needles are small and blood vessels cannot be hit
  • For heparin, we do not aspirate as it may result in bruising and damaging the tissue
• Advantages of Subcutaneous Injections

  • Drug is almost completely absorbed from the tissue, thus the amount of drug absorbed is predictable
  • Drug generally acts in 30 minutes
  • We do not give insulin intramuscularly as its absorption is faster. When administered subcutaneously it takes 30 min for the medicine to take effect, preventing the patient form hyperglycemia (High blood glucose)
• Example of Subcutaneous Insulin Injection

  • Upon checking the patients' blood glucose levels, it is high so insulin is given before meals. Which helps the blood absorb the glucose from the meal.
• Needle Size and Length for Subcutaneous Injections

  • Pinch tissue, length of the needle is half the width of the skin fold
  • 45º angle, 1 inch of tissue can be grasped
  • 90º angle, 2 inches of tissue can be grasped
• Intramuscular Injections (IM)

  • Introduction of the medication into the muscle tissue
  • Deep intramuscular needles are size 5/8, and the bevel needs to be 1 ½ inches
  • Needle size depends on the muscle, type of solution, amount of adipose tissue covering the muscle, and age of the client
  • Indications: rapid absorption of drugs, to administer greater volume of fluid (up to 3ml), medications that are irritating
  • Angle: 90-degree angle always
• Common Sites for Intramuscular Injections

  • Ventrogluteal site
  • Vastus Lateralis site
  • Dorsgluteal Site
  • Deltoid
  • Rectus Femoris
• 1. track Technique

  • Used for Parenteral iron preparation (to seal the drug deep into the muscle & prevent staining of the skin)
  • Retract skin laterally (use the ulnar side of the non-dominant hand to pull skin appx. 1 inch to the side)
  • Don't massage injection site
  • Pull or push the skin 2-3cm away from the injection site with the non-dominant hand
  • Pierce the skin at 90° and depress the plunger slowly. If resistance occur, pause then resume depressing the plunger.
• Oral Administration of Drugs

  • Generally the safest, most convenient, and the least expensive
  • Drugs for oral administration are available in many different forms: tablets, enteric coated tablets, capsules, syrups, emulsion, elixirs, oils, suspensions, powders, and granules
  • Oral drugs are sometimes prescribed in higher dosage than their parenteral equivalents because after absorption through the gastrointestinal system, they are immediately broken down by the liver before they reach the systemic circulation
  • Nausea, vomiting, inability to swallow and unconsciousness may contraindicate oral administration
• Procedure for Oral Administration of Drugs

  1. Locate the corresponding medication ticket due for the shift and compare it with the doctor's order

  2. Check for history of allergies. Fill up the medication booklet

  3. Arrange the ticket/s automatically either by the location of the patients or by some other factors

  4. Wash your hands

  5. Bring requisites to preparation area. Check the medicine glass to ensure that the rim is not broken