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Parenteral Medications Unit XIII

Parenteral Medications Unit XIII. Keith Rischer, RN, MA, CEN, CCRN. Definitions. Parenteral Intradermal (ID) Subcutaneous Intramuscular (IM) Intravenous (IV). If not done correctly…. A drug response that is too rapid or too slow Nerve injury with associated pain Localized bleeding

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Parenteral Medications Unit XIII

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  1. Parenteral MedicationsUnit XIII Keith Rischer, RN, MA, CEN, CCRN

  2. Definitions • Parenteral • Intradermal (ID) • Subcutaneous • Intramuscular (IM) • Intravenous (IV)

  3. If not done correctly… • A drug response that is too rapid or too slow • Nerve injury with associated pain • Localized bleeding • Tissue necrosis • Sterile abscess • Decreased therapeutic effect

  4. Syringes • Syringe Parts • Tip • Barrel • Flange • Plunger • Safety Shield

  5. Syringes • Risks • Syringe Sizes • Hypodermic • Insulin • TB

  6. Needles • Parts of the Needle • Hub • Shaft • Bevel • Lumen • Sheath

  7. Needles • Length 1/2” to 1 1/2” Intradermal • 25 to 27g • Three eighths to five eighths of an inch Subcutaneous 25 to 27g Three eighths to five eighths of an inch Intramuscular 20 to 25g One half to 1 1/2 inches

  8. Handwashing Gloving Asepsis 6 Rights Allergies Sites Knowledge of Meds Check for Tissue Injury Recapping Needles Sharps Container Needle Sticks Safe Administration

  9. Selection of Injection Site • Amount and character of medication • What is the amount and condition of the muscle mass? • What is the frequency of the injection?

  10. Preparing an Injection • Ampules • Vials • Multi dose vials Carpujects

  11. Reconstituting Medications Make sure correct solution Roll gently If viscous use 18g needle

  12. Site Preparation • Hand hygiene • Prevent contamination • Syringe • Needle • Cleanse site • Alcohol swab • Chloroprep • Apply gloves

  13. Indications Needle Size Syringe Size Angle of insertion Amount Site Inner Forearm Upper Back Intradermal Injection

  14. Advantage Disadvantage Needle Size Syringe Size Angle Amount Subcutaneous Injection

  15. Sub-q Injection Sites • Upper Arm • Anterior Thigh • Upper Back • Lower Back • Abdomen

  16. DO: Abd. only 3/8” 25/26 g. 90 degree angle DO NOT: Inject into an area of ecchymosis Aspirate prior to injection Massage area following injection Sub-q Heparin

  17. Advantage Disadvantage Needle Size Syringe Size Angle Amount Z-Track Intra-Muscular Injection: IM

  18. IM Sites: Ventrogluteal • Site • Location • Risk • Position • Uses

  19. Site Location Risk Position Uses IM Sites: Vastus Lateralis

  20. IM Sites: Deltoid • Site • Location • Risk • Position • Uses

  21. Determining Site & Needle Size • Amount & Characteristic of Medication • Amount & Condition of Muscle Mass • Frequency of Injection • Type of Medication • Age • Recommended Route

  22. Comfortable Injections • Appropriate Needle • Position of Client • Relax muscle • Proper Injection Site • Rotate sites • Insert Needle Quickly • Hold syringe steady • Diversion • Z-Track

  23. Pull skin laterally 1-1.5” Hold taut w/nondominant hand Release skin after needle removed Less pain and more effective delivery IM Injection: Z Track

  24. Complications of IM Injections • Infection • Lipodystrophy • Nerve Damage • Ecchymosis

  25. Insulin is secreted by the Islets of Langerhans (Beta Cells) Insulin lowers blood glucose levels after meals Insulin moves glucose from the blood into the muscle, fat, liver, and cells Types I-IDDM II-NIDDM Diabetes Mellitus: Patho

  26. Diabetes Mellitus • Normal Blood Glucose • 99 mg/dl – upper level of normal • Hemoglobin A1c • Type II Medications • Stimulates the pancreas to release more insulin and to increase sensitivity of body cells to insulin • Given twice daily, before meals • Glyburide (Diabeta) • Glucophage (Metformin) • Rosiglitazone (Avandia)

  27. Insulin: Subcutaneous (35-10, p.743 P&P) • Rapid-acting • (lispro, aspart-Novolog) • Short-acting • (Regular) (CLEAR) • Intermediate-acting • (NPH) (CLOUDY) • Long-acting • Glargine (Lantus)*

  28. Insulin: Nursing Implications • Monitor & assess for hypoglycemia • Anxiety/restlessness • Tremors • Diaphoretic • Cool/pale • Altered LOC • Confusion…lethargy…unconscious • Glucagon • 1mg dose-may repeat in 15” • Give subq or IM if unresponsive

  29. Given 1-4 times daily Room Temperature for 30 Minutes Gently roll, look for flocculation Must use syringe that matches the insulin (U-100) Verify dosages with another Nurse If mixing do not keep in syringe longer than 15 minutes Insulin: Subcutaneous

  30. Done 2-4 times per day if on subq insulin Done 3-4 times per week if on oral hypoglycemic (Oral Diabetic) therapy Sliding Scale Blood Glucose Monitoring

  31. Heparin • Mechanism of action • Low dose • Prevents conversion of prothrombin to thrombin • High dose • Prevents conversion of fibrinogen to fibrin

  32. Heparin 5000 units subcut. For 65 yr old male who weighs 220 lbs Morphine 4 mg IM for 88 yr female who weighs 92 lbs Regular Insulin 10 units for 45 yr male who weighs 160 lbs Ketorolac (Toradol) 60 mg IM for 60 yr male who weighs 310 lbs Mantoux 0.1cc ID for 25 yr female nurse as part of yearly screening 6. Heparin 20,000 units/ml 12,000 units bid…amount? 7. Dilaudid 10 mg/ml 4 mg IM now…amount? 8.Ondansetron 4 mg/ml 6 mg IM now 9. Glucose 354 NPH 20 units with low dose scale… 10. Glucose 266 NPH 15 units with high dose Table Scenarios:

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