Chapter 63 pages 854-859. Finished set
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Terms | Definitions |
|---|---|
 Using the ___ method ("zig-zag" method) is recommended for administering certain medications, such as iron preparations and steroids, or any other medication that irritates skin and other body tissues. | Z-track. These medications must be injected deeply into the muscle tissue. |
| Slow induction of fluids (not blood) into a vein is called what? | infusion |
| When the IV solution infuses into tissues instead of the vein this is called ____. | infiltration |
| ___ is the injection of blood or blood components or substitutes into a person's circulation. | transfusion |
| When an IV catheter is inserted into a vein and left in place for intermittent administration of medicine or as an open line in case of emergencies this is called ___ ____. | heparin lock (hep) |
| DRF- | drip rate factor |
| TPN- | total parenteral nutrition |
| PICC- | percutaneous intravenous central catheter |
| NS- | normal saline or 0.9% sodium chloride |
| NaCL- | sodium chloride |
| D5NS | dextrose in normal saline (0.9% NaCL) |
| D5 1/2 NS- | dextrose in half-normal saline (0.45% NS) |
| D5W- | dextrose in sterile water |
| IVPB- | intravenous piggyback |
| TPA- | total parenteral alimentation |
| Do not administer an intramuscular injection with the client ___. | standing. rationale: clear identification of the area is difficult, and the muscles will be tenser while standing. In addition, the client may experience a vasovagal reaction and faint, sustaining injury as he or she falls. Explain to the client who is reluctant to lie down that this will be the safest and most comfortable position. |
| It is very important to select the ____ site carefully. | dorsogluteal. rationale: this site is very close to the sciatic nerve. hitting this nerve can cause permanent damage. |
| You should NOT use the dorsogluteal site for infants and children younger then ___ years. | 3 years. rationale: their muscles in this area are not yet developed and are not of sufficient mass. |
| The preffered site for injection in the hip area is the ____ site. | ventrogluteal. |
| The ventrogluteal site can be used if the client is in what positions? | side-lying, prone, or supine position. |
| The ventrogluteal site is safer and less painful for IM injections than the ___ site. | dorsogluteal. (through which the sciatic nerve runs) |
| The fat layer is ___ in the ventrogluteal area, and the gluteal muscle is ___, even in very thin clients. | thinner in the ventrogluteal area, and the gluteal muscle is thicker, even in very thin clients |
| One disadvantage of the ventrogluteal site is that the client may have never recieved an IM injection in theis area, which may cause ___. | anxiety. another disadvantage is that the client can see what the nurse is doing and this may cause even more anxiety |
| When giving an injection in the ventrogluteal site, the client will be most comfortable in the ___ position. | side-lying |
| Although the ___ muscle may be used for IM injections, it is large enough only for small amounts of medication. | deltoid |
| In most cases when giving injections in the deltoid muscle, __ mL is the maximum amount of medication that can be given in this site. | 1 mL |
| What risks exist when using the deltoid muscle to give an injection? | a risk of brachial artery and nerve damage exists with this site. |
| The deltoid muscle site for injections is not used on who? | infants and toddlers |
| When using the deltoid route of injection, use this route only in children only if they are older than __ and only if the medication to be administered is not irritating to the tissues, the volume is very small, and the medication will be absorbed quickly. | 4 |
| The deltoid muscle is located on the lateral aspect of the upper arm, _ to _ inches below the acromion process. | 1 to 2 inches. identify the injection site by placing the index and middle fingers over the acromion process. the injection site is 1 1/2 to 2 inches below the middle finger. |
| What are two examples of medications given in the deltoid muscle? | hepatitis b vaccine and tetanus toxoid |
| The ___ ____ is a thick muscle located on the anterior, lateral area of the thigh. | vastus lateralis |
| The vastus lateralis may be used for IM injections in infants and children younger than __ years because its the largest muscle mass in this age group. | 3 years |
| What site of injection poses little risks of injury because no large nerves or arteries surround the area? | vastus lateralis site |
| How would you locate the vastus lateralis site? | Locate the site by placing the palm of one hand over the greater trochanter and the palm of the other hand over the knee; identify the injection site anteriorly and laterally, halfway between these two points. |
| The ___ ___ site lies medially to the vastus lateralis. Identify the injection site in the same manner as that for the vastus lateralis. | rectus femoris site |
| The ___ ___ site is often used in infants and toddlers. | rectus femoris |
| Many ___ clients find the rectus femoris site uncomfortable; it is often used in this group only when other sites are contraindicated. | adult. rationale: disadvantages of this site are that the sciatic nerve and numerous blood vessels run very close to it. should contact with the sciatic nerve be made while administering the injection, nerve damage- resulting in permanent damage or paralysis-- may occur. |
| IM injections must be given into ___ muscle tissue for proper absorption to accur. | healthy. |
| If a client requires frequent IM injections, what should you do? | rotate the sites and note on the clients MAR or a "site rotation map" which site was used each time. |
| Rotating insulin injection sites is particularly important because insulin can ___ tissue (lipodystrophy) with repeated injection in the same site. | atrophy |
| The ___ ___ method helps prevent medication from leaking back on the skin. | Z-track method |
| Use the Z-track method only in __ muscles. | gluteal |
| Do not ___ the injection site when using the Z-track administration method. | massage |
| How do you administer a medication by Z-track? | Pull the skin of the injection site to one side. Insert the needle, and aspirate and inject the medication. Keep the skin taut and pulled to one side; wait a few seconds before withdrawing the needle. Allow the skin to return to its normal position slowly, while removing the needle. As the tissues slide past each other, they close the needle track. |
| ___ injections and ___ allow the introduction of medications directly into the bloodstream. | IV intravenous and infusions |
| Medications are absorbed more rapidly through the __ route more than any other commony used route. | IV |
| Large quanities of a solution may be given IV by way of an ____. | infusion |
| What are some examples of when IV infusions are commonly given? | For fluid replacement caused by dehydration or excessive blood loss, electrolyte placement, antibiotic therapy, chemotherapy, or nutrition. |
| If blood or blood products are administered IV, the procedure is reffered to as a ____. | transfusion |
| Medications for IV administration are available in many forms, including what forms? | ampules, vials, and prefilled syringes. Take care to ensure that the label of the medication to be infused states that it is safe for IV administration. |
| A medication given IV, even though it may be the correct medication and in an IV form, must also be given in the correct ___. | dosage. For example: an oral dosage given IV will most likely be too large and can rapidly be fatal |
| Healthcare facilities, including home care agencies and clinics, commonly use __ ____. | IV infusions |
| Although the LPN/LVN most likely will not be responsible for initiating an IV infusion, he or she may be responsible for what? | monitoring it |
| What should you monitor an IV site for? | patency, inflammation, infection, or infiltration |
| When monitoring the IV site what should you note/chart? | rate of administration and the type of fluid being administered. |
| Many facilities use a ___ sheet on which nurses enter hourly documentation concerning site condition, infusion rate, and specific medications or fluids being given. | flow sheet |
| Over-the-needle and inside-the-needle catheters are nearly always used to initiate ___ infusions. | IV infusions. An IV site may also be started in the hand. |
| Veins located ober bony prominences or ___ are poor insertion choices because these sites often cause occlusion of the vein, interfering with the infusions delivery. | joints |
| How do you insert an IV infusion? | After the needle has been inserted into the vein and the catheter is placed, the needle is withdrawn and discarded, leaving only a flexible plastic catheter in the vein. A length of IV tubing is attatched to the catheter hub, which is in turn attatched to the plastic bag that contains the prescribed solution. A clamp on the tubing or a mechanical controller regulates the flow rate, or if the clamp is turned off, the flow is occluded or stops completely. |
| ___ infusion devices can control the rate and amount of IV fluid, automatically regulating IV infusions and alerting nurses through an alarm system when what 3 things occur? | Electronic infusion devices. Alerts nurses through an alarm system when air is in the tubing, when the bag or bottle is empty, or when flow is obstructed. |
| ___ pumps incorporate the use of positive pressure to deliver a preset fluid volume. | Infusion |
| What is the disadvantage of infusion pumps? | The disadvantage of these pumps is that they continue to pump fluids even though the catheter may have been displaced from the vein. It is important that the nurse watch for adverse reactions. |
| One such problem of infusion pumps is ___, in which the IV solution infuses into tissues instead of the vein. | infiltration. |
| ____ controllers use gravity to maintain the flow of the IV fluids at a present rate. | Infusion. The height of the IV bag must be sufficient to allow for the force of gravity. |
| ___ sense the # of drops infusing. | controllers |
| ____ are less likely to allow infiltration than are infusion pumps. | controllers |
| Programming an infusion pump or controller varies with the ____; however, both units can be programmed to deliver a preset fluid amount at a preset infusion rate. | manufacturer |
| The nurse must recieve special ___ before working with IVs. | training |
| When a client is recieving fluids using an infusion pump or controller, instruction is ___. | vital |
| Signs of infiltration include ___, ____, and ___at the insertion site. The area may feel warm and hard. | redness, swelling, and pain at the insertion site. Rationale: These symptoms indicate that the IV fluid is flowing not into the vein, but into the surrounding tissues. |
| A nurse may encounter an IV in a long term care setting or in a clients home. In this case, a ____ setuo may be used. | microdrip |
| The ___ setup allows solution to be administered in very small "mini" dropsthat carefully regulate the amount given. | microdrip |
| The microdrip has a (DRF) drip rate factor of ___ drops per milliliter of fluid. | 60. (compare this rate with the more commonly used system, which has a DRF of 10 to 15 drops per milliliter, depending on the tubings manufacturer). |
| Because the microdrip setup delivers fluid in small drops, it can be used in situations in which careful flow rate regulation is necessary to prevent overload and a pump or controller is not feasible or available. What are some examples of this? | in children and confused adults, or for clients in long-term care settings. |
| If an infusion pump or controller is not used, what influences the infusion rate? | the size of the catheter, the height of the solution bag or bottle, and the position of insertion sight |
| A catheter with a larger inner diameter (bore) allows solution to flow ___. | faster. The higher the bottle or bag the faster the solution will flow. |
| Calculation of drip rates is the function of the ____ ___ or ____. | registered nurse or pharmacist. |
| In the healthcare facility, the ___ ___ will specify the volume of fluid to be infused per hour, and the electronic IV pump or controller will be programmed to deliver that volume. | primary provider. |
| If the insertions site requires a great deal of movement (eg, the arm), and the IV is inserted into the anticubital area (inner aspect of the elbow), the solution can flow freely if the client ____s the arm. | extends. However, should the client bend the arm at the antecubital area, the IV flow will be obstructed. |
| A slower rate of infusion is usually necessary for what people? | older adults, small children, clients with kidney or heart disease, or clients with a head injury. A rapid infusion rate may cause circulatory overload or increased intracranial pressure in these clients. |
| A faster rate of infusion is usually desired for what persons? | for persons who have lost large amounts of body fluids and are severly dehydrated |
| When a nurse recieves an order to ___ an infusion, he or she will clamp the IV tubing and withdraw the catheter from the vein. Pressure is applied over the IV site for a short period and a bandage, such as a bandaid, is applied over the puncture site. | discontinue |
| During discontinuation of an infusion, as with any procedure in which a chance exists of contact with blood or other body fluids, ____ precautions are followed during this procedure. | standard |
| After IV removal, the catheter tip is checked to make sure it is ___. | intact. Although such an occurence is uncommon, a small potion of the catheter tip could break apart from the catheters main stem, enter the general circulation, and form and embolism. Should this occur, it must be reported immediately! |
| IV discontinuation is ___. | documented |
| When IV discontinuation is done, what should you document? | if the catheters tip was intact, a description of the site of the discontinued IV, the sites appearance at discontinuation, and the total amount of fluid infused. |
| The ___ catheter is an example of an intravascular device that is inserted into the superior vena cava. This type of IV infusion is used for the client who requires IV or TPN infusion for a prolonged period. | hickman catheter. |
| The hickman catheters main advantage is that it lowers the risk of ___ because of its deep placement into the superior vena cava. | infiltration |
| ____ can be administered only by way of a large central venous catheter. | TPN- total parenteral nutrition |
| Infuse-a-port and port-a-cath (also known as portacath) are examples of implanted devices that give access to a vein for frequent infusion of ____. | medications |
| Catheters used in the infuse-a-port and port-a-cath systems are usually placed in the ____ ____ ____. | superior vena cava |
| The infuse-a-port and port-a-cath systems are often used for cancer ____. | chemotherapy |
| A catheter that is inserted at the antecubital site and threaded up through a vein to a large central vein is called what? | (PICC) percutaneous intravenous central catheter. |
| The PICC catheters length is determined how? | by measuring the clients arm to the central location. the length may be well over 12 to 16 inches. |
| The PICC line can remain in place for ___ or ___. | weeks or months |
| The use of the PICC line restricts the client of use of his or her ___ into which it is inserted | arm |
| What are the most commonly used IV solutions? | normal saline-NS 0.9% or 0.9% NaCL, 5% dextrose in normal saline-D5NS, or 5% dextros in sterile water-D5W, and 5% dextrose in 0.45% normal saline (half-normal saline; D51/2NS). |
| The ___ is responsible for ordering the type of IV solution to use, in addition to the rate at which to infuse the solution. | physician |
| Always observe the ____ of administration and sterile technique very carefully. | "six rights" |
| Many drugs, including ___, ____, and ___, are commonly added to IV infusions. | antibiotics, electrolytes, and vitamins. |
| In most facilties, the ___ adds drugs ordered by the physician to the IV solution. | the pharmacist |
| In the case of commonly added medications or electrolytes, the premixed bags are often supplied by the ____. | manufacturer |
| To decrease the risk of contamination, medications are added to IV solutions in a ____ flow hood. | laminar |
| Frequently, medications are given at scheduled intervals (eg, twice daily) using seperate premixed IV bag and additional IV tubing connected to an existing IV infusion. This method of administration is referred to as what? | IV piggyback (IVPB) |
| Following the physicians order and using a second infusion bottle or bag, the pharmacist adds medication to a predetermined volume of a compatible IV solution usually _ or ___ mL. | 50 or 100 mL. This smaller infusion, which contains medication, commonly an antibiotic, is referred to as the "secondary" infusion or IVPB. It is administered over a period of 20 to 30 minutes or as ordered by the physician |
| The __ or ___ can be programmed to deliver the vloume contained in the secondary bag. | controller or pump. when the total contents of the secondary bag have been administered to the client, the controller or pump automatically switches back to the primary infusion bag. |
| The secondary bag must be hung ___ than the primary bag to allow a greater force of gravity to act on the secondary solution | higher |
| Be sure to monitor the client who is receiving IV therapy for ___ infusion reaction | adverse |
| When a client is receiving IV therapy, check the site for signs of ___ or ___ caused by the infusion. | infiltration or irritation |
| Where should you document the findings of the client receiving IV therapy? | On an IV flow sheet or the nurses notes |
| A ___ lock (formerly called a heparin lock), sometimes referred to as a hep lock, intravenous infusion port, or an intermittent infusion device (IID), is an IV catheter inserted into a vein and left in place, either for intermittent administration of medication or as an open line in case of an emergency. | saline |
| Approximately _ mL of heparin, an anticoagulant, may be injected initially upon starting the hep lock. | 2mL |
| To reduce the possibility of clotting, the lock may be flushed with __ to __ mL of saline (or heparin) every 8 hours. | 2 to 3 mL. Some locks are not flushed; follow the primary providers orders. Nearly all of these locks are flushed with saline today, if they are to be flushed. |
| The __ provides continuous peripheral IV access without continuous infusion. | (PSL) peripheral saline locks |
| Central lines, such as PICC lines, are generally flushed with ___. | heparin |
| The main advantage of a lock is the ___ it provides. | freedom. Because the client is no longer attatched to a IV line and controller or pump. |
| Many times clients are sent home with a ___ in place. | lock |
| A ___ order is necessary to convert an IV to a lock or to discontinue a lock. | physicians order. The physician prescribes which type of lock to be used. |
| ___ or ___ (formerly known as hyperalimentation) is a method by which large quanities of fluids and nutrients are administered to a client. | TPN-total parenteral nutrition, TPA-total parenteral alimentation formerly known as hyperalimentation. |
| ___ can help maintain adequate levels of carbohydrates, proteins, fats, vitamins, minerals, water, and electrolytes for clients who are unable to recieve adequate nourishment by mouth. | TPN. |
| Infusion of TPN requires insertion of an IV line in a large blood vessel, such as the ___ vein. | subclavian. rationale: the nutritive solution is concentrated and could cause irritation, clots, or swelling if administered into a smaller vessel. |
| Insertion of a central line should be performed only by ___ working under antiseptic conditions. | physicians. rationale: the insertion of a catheter into the subclavian vein requires great skill because of the veins proximity to the lung. |
| When caring for a central line, ___ is always a main concern because the high concentration of dextrose contained in TPN provides an excellent medium for bacterial growth. | infection. |
| Although LPNs usually do not change central line dressings, they do care for the client and should be aware of what? | should be aware of the possible complications the clients may experience. |
| Strict ___ technique is important while changing bottles containing the TPN solution, tubing, filters, and dressings. | aseptic. rationale: because the catheter is in a major blood vessel, any infection would spread rapidly throughout the body. |
| Dressings at the insertion site are kept ___. | clean. rationale: this helps to prevent bacteremia (presence of bacteria in the blood) |
| Transparent dressings over the catheter insertion site facilitate ___. | observation. this dressing is changed every 4 to 7 days or more often as needed. follow the protocol of your facility |
| The facility may use ____ or ___ syringes and tubing to help ensure that connections are secure and that air cannot enter the tubing, causing an embolus. | "click-lock" or Luer-Lok |
| An __ embolus in the general circulation is a potentially life threatening comlication. | air |
| Because TPN solutions contain a high concentration of glucose, the clients blood glucose level is checked how many times a day? | several |
| The rate of infusion for TPN must be ___, to prevent episodes of hypoglycemia or hyperglycemia. | constant |
| An ___ infusion pump is used to regulate the rate of infusion for a central line | electronic. |
| Document all medications ___ administering them. | after |
| Systemic effects means what? | that a medication s effects spread throughout the body |
| Topical medications often have __ effects. | local |
| Local effects of a medication are restricted to the area in which they are ___. | administered. |
| Bedtime medications are to be given in the ___ to help clients sleep. | evening |
| PRN meds are to be given as ___. | needed |
| STAT medications are to be given ____. | immediately! |
| Enteral administration means through the ___ system | gastrointestinal |
| Dressings over hickman catheters are usually changed every ___ hours. | 72 |
| Age group appropriate for the deltoid injection (upper arm) and amount of solution with one injection? | children age 4-15 y- amount of solution to be used 0.5mL. children over 15 and adults get 0.5-2.0mL of solution in one injection |
| Age group appropriate for the rectus femoris (anterior thigh) injection and how much solution used in each injection? | infants and toddlers-0.5mL-1.0mL, preschoolers-up to 1.5mL |
| Age group appropriate for the ventrogluteal injection (side hip) and the amount of solution administered in one injection? | toddlers over three yrs-1.0mL, preschoolers-up to 1.5 mL, school-age children-up to 2.0mL, older children and adults-up to 2.5 mL |
| Appropriate age group and amount of solution in one injection for the dorsogluteal injection (back of hip)? | children 3-6yr-up to 1.5 mL, 6-15yrs-up to 2.0mL, 15 y and older-2.0-2.5mL |
| Appropriate age group and amount of solution in one injection for the vastus lateralis injection (side thigh)? | infants and toddlers-up to 2.0mL, adults-up to 3.0mL |
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