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Nasal Drops Local - moisturizing and anti-inflammatory Systemic - not used widely Nasal Drops: Technique Position with head down (off bed or exam table) to instill drops Breath thru mouth Apply drops 1/2 inch above nostril Remain in position for 5 minutes Nasal Sprays: Technique Gently blow nose Close one nostril with finger Insert nozzle - 1/2 inch into open nostril Breathe out thru mouth, then close mouth Breathe in thru open nostril and spray Breathe in thru nose and out through mouth Respiratory Nebulizer/Metered Dose Inhalers ~Administer SHORT acting BEFORE LONG acting ~Administer bronchodilators BEFORE steroids ~Steroids can irritate mouth and lead to fungal infxs (RINSE AFTER) Vaginal Meds Local - anti-infective, soothing Systemic - contraceptive Lithotomy position Rectal Meds Local - laxatives or hemorrhoidal meds Systemic - antipyretics, antiemetics, analgesics Sims position and lubricant used SQ Route Adipose tissue 1-2 mL syringe (smaller area, smaller volume, smaller syringe) Meds: SQ Route Heparin Insulin Lovenox Arixtra Neupogen SQ Route: Typical Sites Consistently fatty areas 1. Lower Abdomen (1 in from umbilicus) 2. Upper arms 3. Anterior Thigh 4. Upper gluteal areas Scapular areas (not accessible for self-injection) SQ Route: Volume ≤ 1 mL Volumes larger than 1 mL can cause abscesses (painful lumps) or leaking out (tracking) SQ Route: Needle Gauge 25-29 30 for insulin ( ↓ pain and comfort) SQ Route: Needle length 3/8 in - 5/8 in 1 in - 45° ≥ 2 in - 90° IM Route Quicker absorption 2° blood flow 1-3 mL syringe Meds: IM Route Pain medications Antibiotics Vaccines Vitamins Larger mass for ↑ volumes IM Route: Typical Sites Well-developed muscles ~Deltoid (small) ~Vastus Lateralis (preferred for INFANTS) ~Ventrogluteal (preferred for ADULTS; no major nerves or vessels) ~Dorsogluteal (most risky; sciatic nerve) IM Route: Volume 2-3 mL IM Route: Needle Gauge 21-23 Varies for age, site and med solution 22-25 peds 23-25 deltoid 20 for viscous meds IM Route: Needle Length 1 - 1.5 in 1 in - DELTOID 5/8 - 1 inch - Peds Shorter for children and deltoid Longer for OBESE patients Assuring Correct Dose ~Correct math calculation ~Double check label and calculation (concentration, how to mix) ~Inject air into vial to create pressure to withdraw medication effectively ~Withdraw slowly ~Eject air bubbles from syringe (tap or flick forcefully) Preparing Injectable Medications Ampules DO NOT inject air first - causes a loss of fluid since its an open system Use a filter needle to collect the small pieces of glass Needle Gauge Diameter of the lumen LOWER the number = BIGGER the gauge Needle Length Depends on client's size & route of med admin Pinch tissue: no more than 1/2 width of fat fold Basal Insulins Roll because shaking causes bubbles ~Contain preservatives (CLOUDY) ~Peak LATER and last LONGER ~Never given IV; the only insulin that is given IV is REGULAR (short acting) Mixing Insulins Clear BEFORE Cloudy Short BEFORE Long Lipohypertrophy The development of fibrous fatty masses and thickening skin at injection site, caused by repeated use of injection site. Lipoatrophy Breakdown, atrophy or dimpling of subcutaneous fat at the site of repeated insulin injections. Complications of SQ Injections Site Rotation Used for SQ and IM Document site used Air Lock Injecting 0.1 -0.2 mL of air AFTER med; LOCKS the med in the muscle Prevention of Leaking for IM Injections Z-Track Method of pulling the skin taut & tissue pulled to one side to give an IM; Seals the med in the muscle Prevention of Leaking for IM Injections SQ Injections Bunch the skin Needle angle: 45-90 degrees IM Injection: Technique Pull skin taut Needle angle: 90° Aspirate