Intradermal

Beveled 10-15 degrees

SubQ – ex: insulin

2 inches from ambilicus for abd

Rotate areas

45-90degrees

Intramuscular Vastus lateralis upper (infants under 12mo old preferred). Ventrogluteal Lower (preferred site) FASTER absorption than SubQ

 90 degrees

Z-track injection. A, Pull the skin to one side and hold; insert needle. B, Holding skin to side, inject medication. C, Withdraw needle and release skin. (prevents irritation of tissues i.e. iron)

Equipment

•    Proper size safety syringe and needle:

•    Sub-Q: syringe (1 to 3 mL) and needle (27 to 25 gauge, 3/8 to 5/8 inch)

•    Sub-Q U-100 insulin: insulin syringe (0.3, 0.5, or 1 mL) with preattached needle (28 to 31 gauge, 5/16 to ½ inch)

•    IM: syringe 2 to 3 mL for adult, 0.5 to 1 mL for infants and small children
—Needle, length corresponding to site of injection and age of client according to following guidelines:
Children: 5/8 to 1¼ inch (based on size of child)
Vastus lateralis (adults): 1 to 1½ inch
Deltoid (adults): 1 to 1½ inch
Ventrogluteal (adults): 1½ inch

•    ID and Sub-Q U-500 insulin: 1-mL tuberculin syringe with preattached 26- or 27-gauge needle
•    Small gauze pad and/or alcohol swab
•    Vial or ampule of medication or skin test solution
•    Clean gloves
•    MAR or computer printout

1.  Sudden numbness or weakness of the face, arm or leg, especially on one side of the body   
2.  Sudden confusion, trouble speaking or understanding   
3.  Sudden trouble seeing in one or both eyes   
4.  Sudden trouble walking, dizziness, loss of balance or coordination   
5.  Sudden, severe headache with no known cause
6. Possible vomiting, seizures, or fever
   Changes in electrocardiogram (diagnostic assessment)
7. Electrocardiogram- ECG, diagnostic test to assess the electrical conduction of the heart

Non modifiable

Age
Gender
Race
Heredity/family history

Modifiable

Atrial fibrillation
MI
Valve disease
Cocaine abuse
Migraines
Sleep apnea
Obesity
Physical inactivity
Smoking

Early identification of warning signs.
Obtain VS, thorough history, neurological, Glascow Coma Scale (GCS), respiratory, and cardiovascular assessment.
For emergency, maintain patent airway
Position midline
Elevate HOB, supply oxygen.
HTN management, SZ precautions
Avoid activities that may increase ICP.
Anticipate diagnostic tests and pharmacological intervention prn