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53 Cards in this Set
- Front
- Back
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What are the types of parenteral administration? |
- intradermal - subcutaneous - intramuscular - intravenous - epidural - inter-arterial - intra-osseous - intrapleural - intrathecal - intraperitoneal |
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Why are parenteral routes used? |
- Fast acting - Drug does not pass through the gastric tract. - Absorbed directly through the tissues into the bloodstream and onto the affected areas. - Used when oral administration is not an option. - Used when the drug being injected can be destroyed by digestion, e.g. Heparin & Insulin. |
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When choosing the site for administration what are some of the things to consider? |
1. Patientsmuscle mass 2. Patientsskin 3. BMI 4. Access tosite 5. Type ofdrug 6. Regularityof the drug order 7. Patient preference 8.. Nursescompetence and confidence. |
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What is the needle length of a subcutaneous injection? |
1-2.5cm |
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what is the needle length of an intramuscular injection? |
2.5 - 3cm |
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What is the needle gauge of a subcutaneous injection? |
25-27 gauge |
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What is the needle gauge of an intramuscular injection? |
21-23 gauge |
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What is the syringe size of an intramuscular injection? |
5mL (max) |
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What is the syringe size of a subcutaneous injection? |
100 units (<1mL) |
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What angle is a subcutaneous injection usually injected at? |
45 degrees |
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What angle is an intradermal injection usually injected at? |
15 degrees |
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What angle is an intramuscular injection usually injected at? |
90 degrees |
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Is it necessary to aspirate an intramuscular injection? |
Yes |
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What are four commonly used IM sites? |
- Dorsogluteal - Ventrogluteal - Deltoid - VastusLateralis |
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What is the Z track method used for? |
This technique is used to alleviate leakage ofthe drug from the site which could cause irritation or staining of the skin. |
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What percentage of the adults body weight is water? |
About 60% |
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Why is it vital to maintain a healthy fluid balance? |
1. Medium for metabolic reactions in cells 2. Transporter of nutrients, waste products and other substances 3. Lubrication Insulator and shock absorber 4. One means of regulating and maintaining body temperature |
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Movement of Body Fluids andElectrolytes occurs which four ways? |
• Osmosis • Diffusion• Filtration• Active transport |
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Substances dissolved in a liquid and may be what two things? |
Crystalloids - Salts that dissolve readily into true solutions Colloids - Substances such as large protein molecules that do not readilydissolve into true solutions |
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What are isotonic solutions? |
The same osmolality as body fluids (e.g. normalsaline) |
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What are hypertonic solutions? |
Have a higher osmolality than body fluids(e.g. 3% sodium chloride) |
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What are hypotonic solutions? |
– Have a lower osmolality than body fluids (e.g.0.45% sodium chloride) |
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What are the four routes of fluid output: |
- Urine - Insensible loss through the skin as perspiration and through the lungs aswater vapour in the expired air - Noticeable loss through the skin - Loss through the intestines in faeces |
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What are some factors affecting Body Fluid, Electrolytes and Acid-Base Balance? |
•Age •Gender •Body size •Environmental temperature •Lifestyle - Illness - Trauma - Surgery - Medications - Renal disease |
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How do you assess for odema? |
Press down on the skin - if an indent stays there 2mm dent = 1+ = barely noticeable 4mm - 6mm dent = 2+ 6mm -7mm dent = 3+ 7mm + dent = 4+ |
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How are cues collected when assessing for fluid balance? |
- Nursing history including - Physical assessment of the person - Clinical measurements - Review of laboratory test results |
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What does the nursing history include when collecting cues related to fluid balance? |
- Current and past medical history - Medications prescribed to treat chronic or acute conditions - Functional, developmental and socioeconomic factors - Food and fluid intake - Fluid output - Presence of signs or symptoms suggested of altered fluid balance |
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What does the physical assessment include when collecting cues related to fluid balance? |
- Skin - Oral cavity and mucous membranes - Eyes - Cardiovascular and respiratory systems - Neurologic and muscular status - Daily weights - Vital signs - Fluid intake and output |
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What are vital signs that are indicators of fluid imbalance? |
- Elevated body temperature = Dehydration or a cause of increased body fluid losses - Tachycardia is an early sign of hypovolaemia - Irregular pulse rates = Electrolyte imbalances - Changes in respiratory rate and depth = Respiratory acid–base imbalances ora compensatory mechanism in metabolic acidosis or alkalosis - Decreased BP = fluid volume deficit - INcreased BP = fluid volume excess |
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What are examples of goals for fluid balance? |
- Maintain or restore normal fluid balance - Maintain or restore normal balance of electrolytes - Maintain or restore pulmonary ventilation and oxygenation - Prevent associated risks • Tissue breakdown, decreased cardiac output, confusion, otherneurological signs |
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Which are the most common veins for IVC? |
- metacarpal - basilic - cephalic |
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If an IVC is required less than seven days what catheter or cannula should one use? |
peripheral IV access |
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If an IVC is required up to 14 days what catheter or cannula should one use? |
Peripheral long line (PICC) |
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If an IVC is required for more than what catheter or cannula should one use? |
PICC or CVC |
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If an IVC is required for more than 30 days what catheter or cannula should one use? |
Surgical line (Hickman or portacath) |
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What are peripheral IVC complications? |
• Phlebitis • Infiltration • Haematomas • Cannulae dislodgement • bacteraemia |
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How frequently should the IVC be changed? |
every 72 hours |
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How often should the 'giving set' be changed? |
regularly in line with facility policy (48hrs) |
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How often should the fluid on an IVC be changed? |
(every 24 hrs) |
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Are crystalloids hypertonic, isotonic, or hypotonic? |
Can be all |
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Are colloids hypertonic, isotonic, or hypotonic? |
always hypertonic |
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What are isotonic crystalloid solutions? |
- Contain the SAME concentration of osmotically active particlesas the extracellular fluid - The fluid does not shift between the extracellular and theintracellular areas |
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What are two examples of isotonic crystalloid solutions? |
Hartman's, Normal Saline |
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What are isotonic crystalloid solutions used for? |
- These are the most common of all IV fluids - Used in replacing fluid from diarrhoea and vomiting or toreplace fluid loss post surgery |
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What are hypotonic crystalloid solutions? |
• Are less concentrated than extracellular fluid, therefore theymove from the bloodstream into the cell, causing the cell toswell • Eg 0.45% NaCl |
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What are hypertonic crystalloid solutions and what is it used for? |
- Draw fluid from the intracellular space causing cells to shrinkand the extracellular space to expand - Uses include hypovolemic shock or when you don’t have access to a colloid solution |
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When is an example of a hypertonic crystalloid solution? |
5% Dextrose |
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What are colloids? |
- Always hypertonic - Sometimes referred to as a plasma expander - Colloids pull fluid into the bloodstream (thus expanding thevolume) - Patients receiving colloids require close monitoring |
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What are things to watch out for when someone is receiving a colloid solution? |
• Increased BP• Dyspnoea• Boundingpulse• (all signs of hypervolaemia) |
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What are some examples of colloids? |
• Dextran • Albumin• Gelofusine• Haemacel |
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If neither crystalloids nor colloids are effective, the patientmay require what? |
a blood transfusion |
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What is a continuous subcutaneous infusion (CSCI) used for? |
- Used for pain poorly controlled by oral medications - When the client is experiencing dysphagia or gastrointestinalobstruction - When there is a need for prolonged use of parenteral narcotics |
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What does a PCA stand for? |
Patient controlled analgesia |
