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49 Cards in this Set
- Front
- Back
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What are the contraindications for injections?
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1) allergy to the meds
2) coagulopathy 3) occlusive peripheral vascular dz 4) shock 5) impairment of peripheral absorption |
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What are the "5 rights" that help to prevent medication errors when giving injections?
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1) Right DRUG
2) Right DOSE 3) Right PATIENT 4) Right ROUTE 5) Right TIME |
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How many times should the label on a drug be checked before an injection is given, and when?
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3 times
1) when the drug is taken from storage 2) when the amt of drug is removed 3) when the container is returned to storage |
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What are the potential complications associated with injections?
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1) anaphalaxis rxn
2)medication error 3) infection/abscess at site 4) lipodystrophy or atrophy of subQ fat 5) pain |
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What causes lipodystrophy?
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repeat injections at the same injection site
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What is the most common site for intradermal injections?
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ventral forearm
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What sites are used for extensive allergy testing?
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outer aspect of the upper arm & and the area of the back between the scapula
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What are the most common sites for subQ injections?
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1) outer aspects of upper arms
2) anterior thigh 3) loose tissue of lower abdomen 4) upper buttox 5) upper back |
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Where should IM injections be administered?
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1) deltoid
2) dorsogluteal (gluteus medias) 3) ventrogluteal (gluteus medias & minimus) 4) vastus lateralis |
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If you give an IM injection too low or too posterior to the deltoid, which nerves can be damaged?
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radial, ulnar, brachial
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What is the common size for a subQ injection?
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25 gauge
5/8 inch |
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What is the common size for an IM injection?
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18-22 gauge
1.5 inches |
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What is the common size for intradermal injections?
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26-27 gauge
1/2 - 5/8 inch long |
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At what angle would you enter the arm when giving an intradermal injection?
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15 degrees
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If you give an intradermal injection too deeply and a wheal fails to develop, what is your next step?
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withdraw needle and administer another test at least 2 inches from the first site
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At what angle would you enter the arm when giving a subQ injection?
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45 degrees
if a fat fold is >1 inch, the needle may be inserted at 90 degrees |
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What are the preferred insulin injection sites?
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arms, abdomen, thighs & buttocks
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What is the preferred injection site for heparin?
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lower abdominal fat pad, 2 inches beneath the umbillicus, btwn the iliac crests
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What are the follow up instructions for the patient after an injection?
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Report new onset of fever, joint pain, SOB, or rash.
Also report, tenderness, erythema, or ecchymosis at the injection site. |
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Where is the V1 electrode placed?
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4th intercostal space at rt border of sternum
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Where is the V2 lead placed?
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4th intercostal space at lt border of sternum
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Where is the V4 lead placed?
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midclavicular line & inter-space in which the apex is located (5th intercostal if apex not palpable)
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Where is lead V3 placed?
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midway btwn 2 & 4
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Where is lead V5 placed?
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anterior axillary line horizontal with V4
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Where is lead V6 placed?
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midaxillary line horizontal with V4 & V5
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What are the indications for a exercise stress test?
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-Dx, stratify risk, & monitor tx for CAD
-screen asymptomatic pts at risk for CAD or w/occupations that could harm the public -assess exercise capacity -monitor tx for pts w/exercise-related dysrhythmia |
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What are the absolute contraindications of a stress test?
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Acute MI
unstable angina uncontrolled arrhythmia severe aortic stenosis uncontrolled symptomatic HF acute PE or PI acute myocarditis or pericarditis acute aortic dissection |
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What are the relative contraindications of a stress test?
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-Left main coronary stenosis
- Moderate stenotic valvular heart dz - Electrolyte abnormalities -Severe arterial hypertension - Tachyarrhythmias or bradyarrhythmias - Hypertrophic cardiomyopathy - Mental or physical impairment -High-degree AV block |
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Who is most at risk for the ADR of sudden death from a stress test?
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middle-aged & older pts with advanced atherosclerotic CAD
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What is the most reliable indicator of exercise-induced ischemia?
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ST segment depression (stress test)
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What is the most common protocol for a stress test?
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Bruce Protocol: seven stages, each lasting three minutes. In stage 1 the patient walks at 1.7 mph (2.7 km) up a 10% incline. Speed & incline increase with each stage
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What are the prep instructions prior to a stress test for pts taking beta-blockers or digoxin ?
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beta-blockers = disc. day before test
digoxin = disc 1 week before test |
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What are the indications for an endotracheal tube?
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-inability to maintain patent airway
-loosing ability to ventilate adequately -bypass anatomic obstructions & to provide a means for suctioning the lower airways of secretions & foreign materials |
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What is the contraindication for endotracheal tube placement?
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laryngeal disruption
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What are the complications associated with endotracheal intubation procedure?
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-trauma to turbinates, mucosa, adenoids or retropharyngeal tissue
-esophageal & tracheal perforations -c-spine injuries -occular injuries |
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What are the late complications associated with endotracheal intubation?
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-vocal cord paralysis
-aspiration -dysphonia -tracheal stenosis -tracheomalacia -pmx -sinusitis |
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What are the physiological complications associated with endotracheal intubation?
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-hypoxia
-hypercarbia -hyper/hypotension -cardiac dysrhythmias/arrest -intraocular or intracranial HTN -bronchospasm -laryngospasm -post traumatic stress disorder |
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What medications should be given to anesthetize an awake pt prior to endotracheal intubation?
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Glycopyrrolate 0.2mg IV to dry airways (10 minutes)
Topical anesthetics applied to larynx and trachea- cocaine, benzocaine, tetracaine, lidocaine (10-20 minutes) |
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Which nerve must you be careful not to anesthetize/block when performing an endotracheal intubation?
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recurrent laryngeal nerve
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What are the sedatives of choice for patients prior to endotracheal intubation?
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Fentanyl
Midazolam |
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What physical preparation is needed prior to endotracheal intubation?
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-pt in supine position w/head close to practitioner
-pt head should be in the sniffing position - aligns the axes of oropharynx, hypopharynx, & larynx |
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What are the contraindications of PFTs?
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hemoptysis of unknown origin
unstable cardiovascular status thoracic, abd, or cerebral anuerysm eye surgery recent abd or thorax surgery |
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A patient presents with abnormal spirogram findings. What are the possible obstruction dysfunctions that may have lead to this result?
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asthma
emphysema chronic bronchitis neoplasm foreign body tracheal stenosis or malacia vocal cord paralysis |
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A patient presents with abnormal spirogram findings. What are the possible restrictive disorders that may have lead to this result?
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fibrosis
pneumonitis pneumoconiosis granulomatosis pulmonary edema neoplasm atelectasis pleural effusion kyphoscoliosis neuromuscular dz obesity abd distention |
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What would a spirogram show if the pt had an obstructive disorder?
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low FEV1
nl/low forced vital capacity **low FEV1/FVC ratio nl/low vital capacity **high total lung capacity |
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What would a spirogram show if the pt has a restrictive disorder?
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normal FEV1
low forced vital capacity **nl/high FEV1/FVC ratio low vital capacity **low total lung capacity |
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How old must a patient be in order for them to complete a PFT?
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at least 5 years old
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What is the pt prep for PFTs?
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-wait 3 wks after resolution of bronchitis or pmx
-wear loose-fitting clothing -do not eat 1 hr before spirometry -do not smoke 1 hr before spirometry -withhold certain meds |
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What is the minimum and maximum number of maneuvers that should be preformed during a PFT?
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min= 3
max = 8 |
