NUR 336 Final Exam 2022/2023 Graded A+

medication safety in administering injection - ANSWER -3 checks and 6 rights -allergies -multidose vials: facility policy for how long after opening (usually a month) -check expiration date -only NPH insulin should b ...

medication safety in administering injection - ANSWER -3 checks and 6 rights -allergies -multidose vials: facility policy for how long after opening (usually a month) -check expiration date -only NPH insulin should be cloudy -proper withdrawal from vial -know appropriate meds to mix -gloves and hygiene -withdraw needle completely and engage safety -deposit in sharps container (should not be more than 3/4 full) -do not recap! site choices and technique for ID/IM/subcut injections - ANSWER 1. ventrogluteal -palm of opposite hand from hip on greater trochanter of femur -index finger on ant. sup. iliac spine (hip bone) -middle finger extends towards iliac crest -thumb pointed to groin 2. vastus lateralis -football field with hands, one below hip and one above knee -midline of anterior and lateral thigh 3. deltoid -palpate acromoin process -place 3-4 fingers across deltoid -aim for below 4. dorsogluteal -posterior superior iliac spine -locate greater trochanter -imaginary line between -injection is above and lateral -patient prone with toes pointed in -last resort because you can pierce the sciatic nerve or major blood vessels -pinch up skin/muscle or spread skin tightly -inject: quick and firm (dart motion) at 90 degree angle, anchor before injection 1. IM -aspirate for blood (check medication first and facility policy) -if no blood return: inject med -deltoid, ventrogluteal, dorsogluteal, vastus lateralis 2. ID -inner forearm, upper back (allergy testing) -stretch skin at injection using thumb or forefinger of non dominant hand -with needle almost against patient skin, insert needle at 5-15 degree angle with bevel up -make sure bleb appears 3. subcut -abdomen, thigh, upper arm, lower back -pinch up skin -inject quickly at 45 or 90 degree angle -anchor -do not aspirate needle/syringe sizes - ANSWER -intradermal 25-27 G 3/8 - 5/8 in -subcut 25-27 G 3/8 - 5/8 im 20-25 G 1-1.5 in insulin administration - ANSWER -insulin syringe only bc insulin measured in units (U) not mL -if mixing insulin: regular before NPH (RN) -inject air into NPH, then the rest of the air into regular, withdraw regular insulin then NPH -can use sliding scale -typically given in lower abdomen or thigh -rotate sites parenteral route vs nonparenteral route - ANSWER 1. parenteral -im, subcut, intradermal, intravenous, epidural -faster -iv = quickest 2. nonparenteral -oral, sublingual, topical, transdermal, ophthalmic, otic, nasal, rectal, vaginal -oral route = most common first step in med administration - ANSWER -check/verify facility policy assessment of allergies - ANSWER -ask pt if known allergies -ask pt to explain what happens if they ingest allergen -check for allergy wristband med admin performance skills for ID/IM/subcut injections - ANSWER 1. verify facility/unit policy 2. verify orders (check MAR against physician's orders) and verbalize 5 rights A. right patient B. right medication C. right dose D. right route E. right time 3. perform hand hygiene 4. assemble equipment: alcohol wipes, tape, pen, gloves, bandaids, sharps container 5. syringes and needles: select appropriate size syringe and needle length/gauge based on client age, size, type of injection, injection site. verbalize rationale for syringe/needle size selection 6. go to med cart and select correct med and compare label on container with patient MAR to check five rights 7. perform drug dose calculations if needed 8. check vial/med to assure expiration date has not passed and that one date is within appropriate range 9. clean top of vial with alcohol in circular motion for 30 seconds and allow to air dry 10. draw air into the syringe to equal the amount of med being withdrawn (leave needle cap on) 11. remove needle cap (up, up, and away) 12. insert needle through center of rubber stopper of vial 13. inject air into vial then invert and make sure the tip of the needle is in the solution 14. withdraw correct amount of solution examining for and removing air bubbles 15. remove needle from vial and replace needle cap using scoop method and maintaining sterility 16. change needle for injection into client (correct size/gauge based on size and age) when appropriate for IM and subcut meds 17. label syringe with drug name and dose 18. check med with MAR and verify 6 rights (end of second check) 19. introduce self to client 20. provide privacy 21. gel in 22. state purpose of interaction 23. identify client using 2 identifiers 24. discuss drug's purpose, actions possible adverse effects, explain if you'll be administering med as im/id/subcut 24. position client appropriately and maintain safe body mechanics 25. verify client ID band and scan band or do third check if no scanner 26. perform hand hygiene 27. non clean gloves 28. select appropriate injection site by identifying and palpating landmarks for site and position client appropriately 29. cleanse skin at injection site with alcohol wipe using circular motion for 30 seconds and allow to air dry 30. remove needle cap with non dim hand 31. relocate appropriate landmark and either pinch up skin or stretch skin 32. hold syringe between thumb and forefinger of dog hand 33. insert needle 34. anchor needle 35. inject medicine slowly and aspirate for blood if appropriate (IM and only certain medications) 36. withdraw, engage safety, and discard in sharps container (DO NOT RECAP) 37. apply light pressure and apply bandaid if needed 38. remove gloves and perform hand hygiene if needed 39. terminate interaction and document appropriately delegation limits to nurse assistant/CNA for central line dressing - ANSWER -check facility policy -check state policy -CNA can report to nurse but nurse must change technique to take off old dressing (central line) - ANSWER -pull off old dressing towards insertion site working around -use alcohol/adhesive remover -stabilize catheter with one hand -avoid touching skin, catheter, insertion site reason for labeling central line dressing - ANSWER -documentation -to know when it was last changed and by who infection control: when to use clean vs sterile gloves for central line - ANSWER -pt and nurse must wear mask -clean: used to pull off old dressing because you aren't touching line/insertion site -sterile: used to clean site and apply new dressing, must use sterile because you're coming into contact with line and insertion site central line dressing change steps - ANSWER 1. Verify order on patient chart, unit standing orders/protocol and review facility policy 2. Assemble equipment including clean gloves, central line dressing kit, extra barrier masks, alcohol prep pads, bio patch and trash can 3. Provide for privacy 4. Perform hand hygiene and follow standard precautions as appropriate 5. Introduce self to client 6. Identify client with 2 identifiers. Allergies.