Term
| What term means a small bottle that contains a drug (especially a sealed sterile container for injection by needle)? |
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Definition
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Term
| What term means the diameter of a slender object, such as a hypodermic needle? |
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Definition
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Term
| What term means the enlarged base by which a hollow needle may be attached to a device (such as a syringe)? |
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Definition
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Term
| What term means a cylindrical container that holds liquids? |
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Definition
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Term
| What term means a small container usually with a closure used especially for liquids? |
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Definition
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Term
| What are the three methods of delivery for parenteral medication? |
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Definition
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Term
| What gauge needle should be used for a blood withdrawal? |
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Definition
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Term
| What gauge needle should be used for an IM injection? |
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Definition
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Term
| What gauge needle should be used for a sub q injection? |
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Definition
5/8 to 3/4in; 23 - 25 G in adults; 25 - 27 G for infants
Blue Hub-25g 5/8” or Gray 27g |
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Term
| What gauge needle should be used for an intradermal injection? |
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Definition
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Term
| Where should a 4 month old infant be injected for a vaccination? Why? |
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Definition
| anterolateral thigh - not much muscle in buttocks and sciatic nerve might be injured if injected into there |
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Term
| What size needle should be used in a 4 month old infant for a vaccination? |
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Definition
5/8 - 1 inch in length
25 - 27 G |
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Term
| Where should a toddler or older child be injected for a vaccination? |
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Definition
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Term
| What size needle should be used in a toddler and older child for a vaccination? |
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Definition
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Term
| Put the following methods of medication administration in order from the fastest absorption rate to the slowest; SQ, IM, IV? |
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Definition
IV is fastest
SubQ is slowest
IM is in between |
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Term
| What are the indications for IM injections? |
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Definition
Drugs not easily absorbed orally
Intermediate rate of onset & duration of action preferred
When parenteral delivery necessary |
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Term
| What are the contraindications for IM injections? |
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Definition
Site of dermatitis or cellulitis
Allergies to medication |
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Term
| What size needle should be used for an IM injection? |
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Definition
1 to 1.5 in. long
19 to 22 g. |
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Term
| What are the principle sites of injection for IM? |
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Definition
Gluteal
Deltoid
Vastus lateralis |
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Term
| What is the danger of using an IM injection into the deltoid muscle in kids? |
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Definition
| Damage to the Radial Nerve |
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Term
| What is the preferred muscle to give an IM injection in in children < 3y/o? |
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Definition
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Term
| What volume of IM injection can be given to larger kids? |
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Definition
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Term
| In which IM injection site are larger volume injections given? What type of med should NOT be given in this region due to low absorption? |
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Definition
| Gluteal; Should not give immunizations here |
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Term
| Specifically what site should a gluteal injection be given? |
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Definition
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Term
| What are the uses of z-track IM injection? |
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Definition
- used for deep IM
- used for highly irritating meds |
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Term
| The injection method described as using the ulnar side of nondominant hand to pull skin laterally, maintain traction and give injection, withdraw needle and do not massage area is called what? |
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Definition
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Term
| What are the complications of an IM injection? |
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Definition
Injection into vessel - toxic reaction, vessel injury, hematoma
Injection into a nerve - pain, paresthesia and nerve damage
Needle breaking off
Sterile or septic abscess |
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Term
| Which type of injection is given into adipose tissue? |
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Definition
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Term
| What are the indications for a sub Q injection? |
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Definition
| Offers slower absorption rate and longer duration of action |
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Term
| What are the contraindications for a sub Q injection? |
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Definition
dermatitis
cellulitis
allergies to med |
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Term
| What is the max amount of med that can be injected with sub Q injections? |
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Definition
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Term
| What sites can be used in a sub q injection? |
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Definition
upper arm
anterior surface of thigh
lower portion of abdomen
also upper back can be used |
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Term
| What method of injection is used for heparin and insulin? |
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Definition
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Term
| Which color hub is used for IM injections? |
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Definition
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Term
| Which color hub are used for Sub Q injections? |
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Definition
| Blue hub (25 G) or Gray Hub (27 G) |
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Term
| From where on syringe should the medication be measured? |
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Definition
| From the side of the plunger where the med makes contact with it. |
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Term
| What is the appropriate way to store and mix insulin? |
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Definition
Insulin should be refrigerated
Insulin vial should be rolled gently between hands to mix |
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Term
| What is the MC injection site for an intradermal injection? What other site may be used and why? |
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Definition
ventral surface of forearm;
Deltoid area - rabies vaccine
Back - skin allergy testing |
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Term
| What drug types are generally injected using ID injection? |
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Definition
Diagnostic determination
Desensitization
Immunization |
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Term
| What is the maximum volume of med that can be administered in an ID injection? |
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Definition
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Term
| What injection method is used for testing for allergens? |
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Definition
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Term
| What injection method is used for TB sensitivity test? |
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Definition
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Term
| What are the contraindications for an Intradermal injection? |
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Definition
Previous allergic rxtn
Dermatitis
Cellulitis
Previous positive TB skin reaction |
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Term
| What size needle should be used for an Intradermal injection? |
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Definition
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Term
| What are the dangers of an intradermal injection? |
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Definition
| severe local skin reaction in a hypersensitive person |
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Term
| When should a TB skin test be read? |
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Definition
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Term
| How do you properly prepare the skin for an injection? |
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Definition
| With alcohol in a target motion (inner to outer circular motion) |
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Term
| What is the purpose of aspirating with an injection? If blood is aspirated, what should you do? |
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Definition
To ensure that you are not in a blood vessel
If blood is aspirated start over completely |
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Term
| Should you aspirate with Heparin? Should you massage with Heparin? |
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Definition
No aspiration with heparin
No massage with Heparin |
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Term
| Should Z-track injections be massaged? |
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Definition
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|
Term
At what angle should each injection be given at?
IM -
Sub Q -
ID - |
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Definition
IM - 90 degrees
Sub Q - 45 degrees
ID - 10 to 15 degrees |
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Term
| Should you aspirate with an intradermal injection? |
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Definition
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Term
| Should you aspirate with a sub Q injection? |
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Definition
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|
Term
| Should you aspirate with an IM injection? |
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Definition
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Term
| What is a positive TB test? |
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Definition
| Induration and redness > 10 mm |
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Term
| How many inches away from the umbilicus should you be with a sub-Q injection? |
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Definition
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Term
| What is the maximum amount of med that can be injected into a large muscle? What should you do if you need to deliver more than 3 cc? |
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Definition
| 3 cc; Inject in two places if need to give more than 3 cc |
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Term
| What sites should be used for injecting irritating meds? What method should be used? |
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Definition
| Large muscles; hat IM method should be used |
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Term
| What is the max amount of med that can be injected into a small muscle? |
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Definition
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Term
| What is the purpose of drawing in 0.2cc of air? |
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Definition
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Term
| An ampule contains how many doses of medication? |
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Definition
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Term
| Which IM injection site is NOT used for infants? |
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Definition
| Gluteal muscles not used – these develop from walking – and because of risk on injury to sciatic nerve |
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Term
| Which is the preferred site for IM injections in infants? |
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Definition
| The vastus lateralis / anterior thigh |
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Term
| What is the procedure for patients that require frequent injections? |
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Definition
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Term
| What site is used most commonly for intradermal injections? |
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Definition
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Term
| What are the indications for an ABG? (4) |
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Definition
Diagnose dysfunction of CO2/O2 exchange
Diagnose and monitor acid-base disorder
Manage pts post-CPR and pts on ventilators
Determine need for supplemental O2 |
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Term
| What are the absolute contraindications to ABGs? |
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Definition
No pulse
Poor collateral circulation
Cellulitis or local infection
Aneurysm at puncture site
AV fistula or graft above puncture site |
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Term
| What are the relative contraindications to ABG? |
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Definition
Chronic renal disease pt
Presence of arterial disease
Bleeding d/o; anticoagulant Rx |
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Term
| For what reasons is the radial artery the MC site of ABGs? |
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Definition
Close to the skin surface
Carries lowest risk for complications |
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Term
| Where can the radial artery be palpated at the wrist? |
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Definition
along the lateral aspect of the anterior forearm
between the styloid process of the radius and the flexor carpi radialis tendon |
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Term
| What is the proper positioning for the wrist when using the radial artery for ABGs? |
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Definition
volar side up
placed on a firm surface
hyperextended (using small rolled towel) |
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Term
| What are the higher risks associated with using the brachial artery instead of the radial arteries for ABGs? |
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Definition
trauma to the basilic vein or median nerve
greater potential for tissue loss distal to the artery because the collateral circulation is less extensive |
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Term
| What is the proper positioning for the arm when using the brachial artery for ABGs? |
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Definition
| arm should be fully extended and secured to a firm surface, ulnar side up |
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Term
| Where should the brachial artery be accessed for ABGs? |
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Definition
| accessed above the antecubital crease |
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Term
| When should the femoral artery be used for an ABG? |
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Definition
ONLY if radial or brachial artery access is not possible or advisable
- volume depletion/ shock |
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Term
| How should the femoral artery be located? |
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Definition
| NAVEL (nerve, artery, vein, empty space, lymphatics) from lateral to medial in the inguinal crease |
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Term
| What special test should be used to assess the collateral blood flow when doing an ABG? What times are normal? |
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Definition
Allen's
Normal < 5 sec
Delayed 6 - 15 sec
Definitely abnormal > 15 sec |
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Term
| What needle size should be used for an ABG? |
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Definition
21 - 25 G (23 G)
1/2 to 5/8 inch |
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Term
| What must the syringe for an ABG contain? |
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Definition
| heparin either in liquid or lyophilized form |
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Term
| What does too much heparin left in the syringe during an ABG cause in the results? |
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Definition
| It MAY lower the PCO2, bicarb, and pH (due to dilution) |
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Term
| If air is not evacuated from the ABG syringe within 30 sec of blood draw, how may the results be changed? |
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Definition
| PaO2 will be increased; PaCO2 will be decreased |
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Term
| If blood draw sample for an ABG is NOT chilled on ice, what effect does this have on the sample? |
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Definition
| psuedohypoxemia - false lowering of PaO2 |
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Term
| When must a NON chilled ABG specimen be analyzed by? When must a CHILLED ABG specimen be analyzed by? |
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Definition
NON-chilled: 10 - 15 min
CHILLED: Within ONE HOUR |
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Term
| What are the complications of an ABG? |
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Definition
Bruising (30%)
Pain or tenderness (10%)
Hemorrhage or hematoma (5%)
Transient ↓ pulse due to arterial spasm
Trauma to BV
Ischemia or gangrene of hand/fingers
Vasovagal Response
Compression neuropathy
Sepsis |
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Term
| What must be considered with needle size when using the z-track method? What is the general rule? |
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Definition
| make sure the needle you're using is long enough to reach the muscle; 2in long for 200lbs pt, 1 and 1/4 in for a 100lb pt |
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Term
| What should be considered when doing an IM injection into the gluteus maximus? |
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Definition
| size of needle must be chosen based on patient's deposits of fat - if too short, injection will be made into fat |
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Term
| How many cc's should be used in a deltoid injection? |
|
Definition
| < 2cc, non-irritating solutions |
|
|
Term
| Describe the proper placement location for an injection in the deltoid? |
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Definition
| lateral & 3 – 4 cm below acromion |
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Term
| When is the gluteal location of an IM injection NOT Recommended? |
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Definition
| In children < 2; for immunizations |
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|
Term
| What are the complications of an IM injection? |
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Definition
| Injection into vessel or nerve, Needle breaking off, Sterile or septic abscess |
|
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Term
| Which route of parental med administration is the most versatile routes of administration in that it can be used for both short term and very long term therapies? |
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Definition
| Subcutaneous (SC) injections |
|
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Term
| With a repeated need to give subQ injections in the same pt, what is important about the site of injection? |
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Definition
| Site is usually rotated when injections are frequent |
|
|
Term
| What are some examples of common meds that are delivered subQ? |
|
Definition
|
|
Term
| What is the MC site of injection for an ID injection? |
|
Definition
|
|
Term
| When must a TB skin test be read? |
|
Definition
|
|
Term
| What common injection procedures should NOT be done when jnjecting heparin? |
|
Definition
| DO NOT aspirate with HEPARIN and do not massage heparin. |
|
|
Term
| What indicates a positive TB test? |
|
Definition
| induration greater than 10mm. |
|
|
Term
| What locations are not acceptable for giving subQ injections? |
|
Definition
| infected site, site with lesion, scars, over bony prominence |
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|
Term
“Gauge” refers to:
a) Length
b) Hub
c) Diameter
d) Bevel |
|
Definition
|
|
Term
What type of injection is used for skin testing & TB testing?
a) IM
b) SC
c) Intradermal
d) Z-Track |
|
Definition
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|
Term
When performing an IM injection, a 0.2 cc air bubble is drawn into the syringe in order to prevent seepage of medication after injection.
True
False |
|
Definition
|
|
Term
An ampule contains how many doses of medication?
a) 1
b) 2
c) 3
d) 4
e) It depends on the size of ampule |
|
Definition
|
|
Term
| Which IM injection site is NOT used for infants? |
|
Definition
| Gluteal muscles are not used; these develop from walking, and because of risk of injury to sciatic nerve. |
|
|
Term
| Which is the preferred site for IM injections in infants? |
|
Definition
| The vastus lateralis/anterior thigh |
|
|
Term
| Why is the Z-track method used? |
|
Definition
| It is used for medications that stain. The purpose is to prevent seepage of medication back into subcutaneous tissue after injection is given. |
|
|
Term
| What is the procedure/ideal recommendation for patients that require frequent injections? |
|
Definition
|
|
Term
| What site is used most commonly for intradermal injections? |
|
Definition
|
|
Term
| Which conditions may warrant the use of ABGs? |
|
Definition
Severe asthma exacerbations
PE
Coma of unknown cause
Suspected drug overdose
Cardiac arrhythmias (refractory to medical intervention)
COPD
post-CPR
Ventilated Pts |
|
|
Term
| What are the potential complications of ABG? |
|
Definition
Hemorrhage/hematome
Thrombosis (Ischemia, gangrene)
Transient arterial spasm
Nerve damage
Infection (rare) |
|
|
Term
| What site is most frequently used for arterial puncture? |
|
Definition
|
|
Term
| From lateral to medial what is located in the anterior compartment of the groin? |
|
Definition
N=Nerve
A=Artery
V=Vein
E=Empty space
L=Lymphatic |
|
|
Term
| Where does the femoral artery lie btwn? |
|
Definition
| halfway btwn the anterior superior iliac spine & pubic tubercle |
|
|
Term
| What are the contraindications to femoral artery ABG sampling? |
|
Definition
Aortofemoral bypass graft or previous
femoral artery surgery
Ischemia of leg
Aneurysm of femoral artery |
|
|
Term
| Where can the brachial artery be found? |
|
Definition
| The brachial artery lies in medial third of antecubital fossa |
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