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Reference Guide

Nursing II - Reference Guides

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ANAT - Anatomy
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permacharts MT Nursing II 2nd EDITION PREPARATION & ADMINISTRATION OF PARENTERAL MEDICATIONS ITRADERMAL INJECTIONS PREPARATIONS • Intradermal injections are • Cleanse selected skin area with an injected directly into the skin alcohol pad and insert the needle (or dermal tissue) in small at a very shallow angle amounts of 0.5 mL or less (0 to 15°) just under • Used mainly for diagnostic testing the skin surface to determine sensitivity to • Bevel should be medications (or other substances) facing up so that or to check for exposure to medication diseases (e.g., tuberculosis) forms a wheal • The ventral surface of the just under forearms and the scapular the skin surface surfaces are the areas most • Inject the commonly used medication • Other possible sites include the slowly to avoid tissue damage upper arms and upper chest areas • Withdraw needle gently and place a small gauze pad over the injection site to absorb any blood • Areas that should be avoided are sites with any bruising, irritation, • Do not massage the site; this will force the and/or swelling; areas where medication into the tissue clothing brushes up against the • Annotate the injection site so as to note if there are skin; areas that are scarred or any changes; include the time, medication, site, etc. have been altered because of skin • Monitor the patient for any adverse reactions, disorders; and areas that are Note: See Subcutaneous Injections and pigmented or hairy (these areas such as a rash, itching, hives, swelling or breathing may hide or give a false reaction Intramuscular Injections for more difficulties; notify the nurse and/or physician if the to the medication) information patient exhibits any of these signs SUBCUTANEOUS INJECTIONS ASSESSMENT OF EDEMA • Edema is the accumulation of interstitial fluid • Formation may be localized in one or more areas of the body or may be generalized throughout the body • To assess, press on area firmly over a bony surface for 5-10 seconds and then release Rating Description 0 No indentation, no edema +1 Mild pitting, with slight indentation +2 Moderate pitting, but indentation subsides • Subcutaneous injections are • Tissues of the anterior thighs and quickly given into the loose abdomen, the buttocks or upper connective/fatty tissue between back areas can also be used +3 Deep pitting, indentation remains for a the skin and muscle short period of time (area appears swollen) • If required to give frequent +4 Very deep pitting, indentation remains for a • They are commonly administered injections, rotate sites similar to prolonged period of time, and the general in the tissues of the upper arms in that done for diabetic patients region is very swollen volumes of 2 mL or less PREPARATIONS • When a site has been selected, clean skin with alcohol, pinch skin between BREATH ODOR ASSESSMENT your fingers to pull the subcutaneous tissue away from skin, and insert needle at a 45 to 90° angle with bevel up • Angle depends on thickness of skin and amount of subcutaneous tissue Breath Odor Possible Cause available Sweet, fruity breath Diabetic ketoacidosis with (acetone scent) children • Dehydration and • Release the skin; aspirate (pull back on) the plunger to determine if you are in malnutrition a blood vessel (do not aspirate if you are injecting heparin) • If there is blood return, then withdraw the needle, prepare the needle for Ammonia Uremia another injection, and select another site; if no blood appears, then inject the Musty odor Liver disease medication slowly Fetid, foul odor Dental or respiratory infection • When finished, withdraw the needle at the same angle as injected and gently Alcohol odor Alcohol ingestion or chemicals massage the injection site with a gauze pad to speed up absorption Mouselike odor Diphtheria • Monitor the patient for adverse reactions and document your activities 1 NURSING II • 1-55080-735-8 w w © 2002-2012 Mindsource Technologies Inc. permachartsMT INTRAMUSCULAR INJECTIONS • Intramuscular injections are given into V ENTROGLUTEAL SITE M ID DELTOID SITES the deep tissue of large muscle groups for rapid action and absorption of up to 5 mL • If volume is greater than 5 mL, then divide injection and select other sites • Common sites include the Iliac ventrogluteal site (lateral hip area), crest dorsogluteal site (upper, outer buttocks area), quadriceps femoris sites (anterior thigh muscles for adults and infants), and mid deltoid sites (lateral upper arm area) • Of these, the dorsogluteal site presents the greatest risk because of its proximity to the large sciatic nerve and gluteal artery • The preferred site for large volume D ORSOGLUTEAL SITE injections is the ventrogluteal site because it is not located near any major QUADRICEPS FEMORIS SITES nerves or arteries Adult • The quadriceps femoris sites, which include the rectus femoris (mid-anterior thigh) and vastus lateralis (mid-lateral thigh), are also free from nerves and blood vessels; they are preferred for pediatric patients PREPARATIONS • Several techniques can be used to administer an IM injection Basic Technique • First begin by positioning the patient so Infant that he/she is in the most relaxed position; placement of the patient in the PREPARATIONS FOR THE Z-TRACK METHOD prone position with the toes turned • Place patient in a lateral or prone position to expose inward relaxes the gluteal muscles the gluteal muscle • Assess the potential site to ensure that • Cleanse area with alcohol swab; pull the skin and there is no tissue damage; ensure that the muscle is large enough to absorb underlying tissues approximately 1 inch to the side and downward from the site the medication and handle the needle • This retraction changes the relative positions of the you have chosen for the injection skin, subcutaneous tissues, and underlying muscles • Clean the area with alcohol and stretch the skin tight between your thumb and • While maintaining the retraction, insert needle deeply first finger into the muscle tissues • Aspirate; if there is no blood return, then inject the • Insert the needle at a 90° angle with a medication slowly quick, smooth motion • Aspirate to determine if the needle is • Wait approximately 10 seconds before you withdraw positioned in a blood vessel; if not, then the needle • Do not release the tissues until after you have inject the medication slowly and withdrawn the needle and do not massage the site withdraw the needle • Massage the area unless otherwise indicated; encourage patient to walk so PREPARATIONS FOR THE AIR LOCK METHOD as to assist absorption • Aspirate a small air bubble (0.2 to 0.3 cc) into the syringe with the medication • Monitor the patient for adverse • Invert the syringe so that the bubble rises to the plunger end of the barrel reactions and report activities completed • Insert the needle and inject the medication as you would with the basic technique Other Techniques • After you inject the air bubble, wait 10 seconds, and then withdraw the needle slowly and maintain pressure over the area for a few moments • The Z-track method can be combined with the air lock technique; it can also Note: For your protection and the protection of the patient, always dispose of used syringes and be used separately to prevent leakage needles in the proper container in accordance with local policy of medication into the subcutaneous tissues that can irritate or discolor the underlying tissue (e.g., iron preparations) • The air lock technique is used to prevent medication leakage along the needle path and the pain and tissue injury caused by that leakage; it seals the medication in the muscle with a small air bubble 2 NURSING II • 1-55080-735-8 w w w . pe © 2002-2012 Mindsource Technologies Inc. permachartsMT INSULIN TYPES & THEIR ACTIVITY EQUIPMENT • Effect on blood glucose (hours after administration) • Insulin syringes are used and calibrated Type Description Onset Peak Termination to measure a specific Long Acting volume of a specific Regular (crystalline zinc) Clear Immediate 2 to 4 6 to 8 type of insulin (U–40, Semilente (SL)* Cloudy: amorphous zinc insulin 1 4 to 6 12 to 16 U–100 or U–500) suspension, no protamine • The most commonly used are U–100 Intermediate Acting syringes; they hold NPH † Cloudy: crystalline zinc insulin suspension2 to 3 8 to 12 18 to 24 100 units insulin per 50% saturated with protamine cc of medication and Lente Cloudy: mixture 30% SL + 70% UL, 2 to 3 8 to 12 18 to 24 are calibrated in no protamine 2- and 10-unit increments Short Acting • The units may be very PZI† Cloudy: excess protamine 6 14 to 20 24 to 36 close but are not
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