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NURS 290 LAB FINAL Notes.docx

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University of Alberta
Debra Mc Ilwraith

LAB 290 Parenteral Medication Administration Medical Asepsis - Hand hygiene - Wearing gloves SterileAsepsis - Parts of the needless to keep sterile are: • Black plunger • Part of the plunger that goes into the barrel • Needle hilt • Needle • End of the barrel at the needle side Administration - Injection site must be free of bruises, rashes, hardened areas - Look at the health of the individual (IM versus SC) - Choose needle length on the amount of muscle or subcutaneous fat - Needles based of size and weight of patient Length of Needles - Intramuscular injections • 1-3 inch • 2.5-3.8 cm - Subcutaneous injections th • 5/8 - ½ inch • 1-1.6 cm - Intradermal injections • ½ inch • 25-30 gage Intramuscular injections - Ventrogluteal site is preferred for IM injections because it is the soft - If need >3mL injection, need to split up the dosages - Deltoid muscle can only get 1mL injection; all other areas only just to 3mL - ALWAYS aspirate before injecting to see if an artery, vein, and capillary is at administration site. (So poke the needle in all the way, aspirate up by putting up on the syringe. If no blood is present when aspirating, no artery, vein, and capillary is there so you can then inject the medication. Subcutaneous injections - If patient has increased subcutaneous fat, go in at a 90 degrees angle to make sure enough medication will be getting deep enough into the subcutaneous fat - If patient has decreased fat, inject lower at a 45 degrees angle to make sure you still inject in the subcutaneous fat and not the into the muscles Intradermal injections - Always inject at a 15 degrees angle Diabetic Care Type 1 Diabetes: ­ Insulin dependent ­ Destruction of the pancreatic beta cells ­ Acute onset (sudden immune response) ­ Unchecked glucose production from amino acids  cant absorb glucose  builds ketone acid bodies --? Large molecules collect in the blood ­ Can result in diabetic ketoacidosis (abdominal pain, nausea, vomiting, hyperventilation) ­ Signs and Symptoms • Hyperglycemia • Increase appetite • Sudden vision changes (also seen in type 2) • Unexplained frequent urine infections (from the glucose) • Dehydration and polyuria ­ Complications • Retinopathy • Nephropathy • Atherosclerosis • Peripheral and autonomic neuropathy • Delayed wound healing ­ Treatment • Insulin • Nutritional management • Exercise Type 2 Diabetes: ­ Decrease in exercise ­ Increased carbohydrates ­ Increased insulin ­ Increased weight (so you would need more insulin but your body becomes more resistant) ­ Insulin resistance (an impaired tissue sensitivity to insulin) and impaired insulin secretion ­ DO NOT develop DKAbecause enough insulin production/sensitivity to impair fat metabolism ­ Progressive glucose intolerance that may go undetected for many years ­ Same complications as type 1 ­ There are damage to the organs an eyes before it is diagnosed ­ Treatment • Oral anti-diabetic agents to keep blood sugars in normal ranges • Insulin therapy can be added to the orals on a temporary basis during acute physiological stress Gestational Diabetes ­ Adegree of glucose intolerance with onset during pregnancy  secretion of placenta hormones cause insulin resistance ­ Causes the baby to gain weight also ­ Risks to mother  increased hypertensive disorder ­ Risks to baby  increased incidence to congenital abnormalities, excessive growth, respiratory distress ­ Treatment • No oral anti-diabetic during pregnancy • Can give insulin Hypoglycemia ­ Blood glucose < or equal to 3.9mmols with or without symptoms ­ 2.6mmols critical ­ Symptoms • Irritable • Anxious • Shaky • Headaches ­ Treatments • Blood sugars of 3.0-3.9  give 15g of glucose tablet or 3tbs of sugar in water or ¾ cups of juice • Blood sugar of < or equal to 2.9  Give 20g of glucose tablet  Retest in 15 minutes if blood sugar is <4.0, retest in another 15 minutes • Unconscious  Place in recovery position and take blood sugar Hyperglycemia ­ Adult, fasting test: 3.3-6.0mmol/L (normal) ­ Adult, random test: 3.3-11.1mmol/L (normal) ­ Same symptoms as diabetes if over 11.1mmol/L ­ Glucometer reading between 4-7mmol/L before meals. 2 hours after meals between 5-10mmol/L is normal ­ Less than 4.0mmol/L has signs and symptoms of hyperglycemia. If less than 4.1mmmol/L, give a snack ­ If greater than 20mmol/L… call doctor! Diabetic Foot Care ­ Poor circulations because of peripheral vascular disease… so wounds do not heal or will be unnoticed and get progressively worse ­ Reduce risk factors such as smoking and high cholesterol
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