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Pharmacology- ch12 Parenteral administration (ID, IM,subcut, IV)

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Parenteral administration
-Define?
- Administration by any other route than the GI tract.
What are the 4 parenteral routes?
1) Intradermal (ID)
2) Subcutaneous (sub-cut)
3) Intramuscular (IM)
4) Intravenous (IV)
Name one quipment used in parenteral administration?
- syringe
Three parts of syringe?
1) barrel
2) Plunger
3) Tip
Syringes are calibrated in 3 units

- Which one is not used routinely?
1) minims
2) milliliters
3) cubic centimers (cc)

-minims-
Tuberculin syringes are used to measure?
-example?
- small volumes of medication accuretaly

(0.5 mL)
Glass vs plastic syringes? (differentiate)

1) Glass? (Advantage & disadvantage)
2) Plastic ? (Advantage & disadvantage)

Which one do we use more? (nowadays)
1) - economic, can be re sterilized
- Easy to break, time consuming, plungers can become loosen easily.

2) Various sizes, disposable
- More expensive, some have unclear calibration (Can't be read)

- Plastic-
milliliter scale
- shorter lines represents?
- longer lines represents?

syringes- what are male & female tapered end (look at ppt)
- 0.1 mL
- 0.5 mL
Insulin syringes
- which scale do you use?
U-100

(hundred units)
Lower dose insulin syringes are used for patients receiving ___units or fewer than 100 units .
-50
Tuberculin syringe
- is the most _____ of doses ___ mL or less.
- accurate
- 1mL
Prefilled syringes
- are they disposable?
- does it already have medication inside?

- advantage (3) & disadvantage?
- yes
- yes

adv ( safe preparation time, less chance of contamination and medication errror)

dis ( cost more, volume of second medication limited. )
The needle has 3 parts?
1) Hub
2) shaft
3) Beveled tip
Gauge refers to the ____ (define)?
diameter of the hole inside the needle.
Use different needles for adult and ____ patients.
pediatric (Smaller gauges)
Needle gauge & length depends on the ___.
route of administration.
Syringes and needles must be___
Sterile
Dispose used syringes and needles in ____.

This comply with ___ standards.
-sharp containers

-OSHA
Parenteral dose has 3 containers?
1) Ampules
2) Vials
3) Mix o vials
Ampules
Glass containers containing a single dose
Vials
glass containers containing one or more doses
Mix o vials

upper and lower (differentiate, what do they contain?)
Glass containers with one dose

Upper chamber containing solvent
A lower chamber containing drug.
Equipments needed for parenteral administration? (5)
1) Drug in sterile sealed container
2) Correct syringe
3) Correct needle length & gauge
4) Antiseptic swab
5) MAR (Medication administration Record)
Procedure protocol? (6)
1) Hand hygiene
2) Seven rights
3) Check compatibility of drugs before mixing
4) Prepare drug in clean, well lit area
5) Use asepsis
6) Check expiration date
How to prepare a medication from an ampule? (6)
1) Shake the ampule (friction)
2) Cover ampule neck with sterile gauze or antiseptic swab
3) Break the neck
4) Use a filter needle to withdraw medication
5) Attach sterile needle using correct gauge
6) Administer
How to prepare a medication from a vial?
1) Cleanse the top of the vial
2) Pull plunger of syringe to fill with amount of air equal to the volume of the solution to be withdrawn (ex. insulin administration)
How to prepare a reconstituting (powder) medicaton from a vial? (5)
1) Withdraw measured volume diluent according to order required to diluent the powder.

2) Tap the vial to break up caked powder

3) Clean the rubber diaphragm with alcohol swab

4) Insert needle and inject diluent.

5) Mix throughly to dissolve poweder
How to prepare a medication from a mix- o- vial? (5)
1) tap the container a few times to break up the cake powder
2) Remove plastic lid protector
3) Push firmly on the diaphragm plunger
4) Mix gently by shaking gently
5) clean the rubber diaphragm and remove drug using syringe
Before injecting, make sure u have the right (4)
1) medication
2) Dose
3) Gauge size
4) needle length
Intradermal route

-Preffered sites? (3)
1) Upper chest
2) Inner forearm
3) Scapular back area
Intradermal route
- Usually used for?
- administer ___ degree
- Allergy testing (tuberculin)

- 15 degrees
Two types of allergy testing using Intradermal route?
- Injection method
-Skin prick test (SPT)
What normally occur during an intradermal injection?
- A bleb
- A wheal
Subcutaneous route
- where is the medication deposited?
(between which layers?)
- Loose connective tissue between dermis and muscle layer
- FAT
Subcutaneous route- common drugs injected subcut (3):
1) Heparin
2) Insulin
3) Enoxaparin
Heparin (treatment for?)
- How does it work?
- Prevent blood clotting for patients who have medical conditions that will trigger blood clotting.

- Stops the growth of clots.
Enoxaparin (treatment for?)
-examples?
Prevent blood clot in patients who are bed rested.

- surgery
- rehabilitation or restoration of injured parts of the body.
Subcutaneous sites? (3)
- administer ___ degree?
1) upper arm
2) Anterior thighs
3) Abdomen

-45 degree
Intramuscular route (IM)
- Sites? (5)
1) Vastus lateralis
2) Rectus femoris
3) VENTROGLUTEAL
4) Dorsogluteal
5) Deltoid muscle
What factors to consider when giving IM injections? (2)
- Administer __ degree?
Age & muscle mass
- 90 degree
Locate iliac crest
anterior, superior iliac spine, gluteus, greater trochanter.
------
Sciatic nerve could also be found between ____ ___ & ___ ___ muscle, aside from the buttocks.
Between greater trochanter and rectus femoris muscle
What is the typical volume of medication usually used for IM injections? ___to __mL

1 mL or less is usually used in ___ patients.
0.5 to 2mL

- pediatrics
Needles used? (IM
gauge size?
one to one and a half inch
20 to 22
Site commonly used in infants (IM)
Vastus lateralis
Sites commonly used in adults? (IM) (3)

(point where they are~!)
1) Gluteal area
2) deltoid
3) Vastus lateralis
IM route

- While administering in the deltoid muscle, do not exceed ___mL in volume.
1mL
Landmark for deltoid include the ___ and ___.

"practice on ur forearm!"
acromion process and axilla .
Z track method
- which type of injection?
- why is it performed? (2)

- do you want blood to come out? why?
- IM
- For patients who needs multiple injections
- so that medication wouldnt leak!

- yes, to make sure that we hit the muscle!
Define IV therapy?
Injection into the vein.
IV route is more effective when? (2)
- Large volume of fluid must be quickly administered.
- Medication must be absorbed faster.
IV theraphy requires a written order from the __
Primary care provider /physician
The physician's order for IV must include (5)
1) Date
2) type of solution/medication
3) dosage
4) rate
5) frequency
Drugs can be administered continuous through infusion through two lines :
Peripheral and central IV line.
Advantages of IV therapy? (3)
1) Drugs can be administered directly from syringe injection into the vein.

2) Drugs can be administered continuous through infusion through two lines : Peripheral and central IV line.

3) More comfortable than IM , subcut injections! (painful)
Disadvantages of IV therapy?
1) Requires extended time to administer.
2) Requires a skilled health care provider to administer
3) Decrease patient's mobility
4) Increase of infection
5) Increase the possibility of severe adverse drug reaction
(allergic) ---> FASTER REACTION
Intravascular compartments (4)
1) Blood vessels 2) arteries 3) veins 4) Capillaries
Intracellular compartment (define)
Inside the cell
Interstitial compartment?
- Between the cells
Extracellular compartment ? (define)
- outside the cell
Intercellular compartment makes up _/_ of the total body water.

Intravascular and interstitial has ___ water.
2/3

LESS!
Equipment used for IV therapy? (6)
1) IV bag
2) IV access device to enter the vein
3) Spikes
4) drip chambers
5) tubing with control clamps
6) Needle adapters
Two kinds of drip chambers?
1) Macrodrip
2) Microdrip
Sizes of macrodrip?
10, 15, 20 drops per mL
Size of microdrip?
60 drops per mL
Formula for drops/ minute?
mL of solution drops/mL (Drip factor)
______________ x _________________= drops/ min
Hours of administ. 1 hour/60 min
Types of infusion control devices?
1) controllers ( it is controlled by___)
2) Pumps (two types)
3) Syringe pumps
1) Gravity
2) nonvolumetric & volumetric
All devices used for administration of IV fluids and drugs have safety features. Name them! (3)
1) Alarm systems
2) Automatic stop capability
3) Programmability
Types of IV access devices? (5)
1) Peripheral devices
2) Midline catheters
3) Central devices
4) Implantable venous infusion ports
5) Saline, heparin or Medlock
Nurses must be familiar with ___ protocols recommended for these devices.
FLUSHING~
Can be used for how long?

1) Peripheral devices
2) Midline catheters
3) Central devices ( name the two types)
4) Implantable venous infusion ports (two types)
1) Short term
2) 2-4 weeks
3) PICC and tunneled
4) Infus-a-port / port-a -cath
Central access devices
- Sites? (3)
- Subclavian, jugular, femoral veins.
Central access devices
Tunneled central venous catheters:
- How is it placed?
- Where does it exits?
- Surgically placed
- Chest
Central access devices
Implantable infusion ports:
- How long?
- Where?
- For 4 things

How is it accessed? (what degree? what needle?)
- Long term therapy
- in central vein for:

IV fluids, medications, TPN and chemotherapy.

-90 degree, huber needle.
How does a hubber needle look like?
Like an "L" rotated
IV solutions
1) consist of__ containing 1 or more ___ particles (solutes)

2) Concentration of dissolved particles is known as ___.
1) water, dissolved
2) Osmolality
IV solution is given to replace body loss of ___ and ___/
water and electrolytes
Name the 3 most important electrolytes?
1) Na (sodium)
2) Cl (chloride)
3) K (Potassium)
Name the four types of solutions?
1) Isotonic
2) Hypotonic
3) Hypertonic
4) Total parenteral solution
Describe function of each:
1) isotonic
2) Hypotonic
3) Hypertonic
4) Total parenteral solution
1) Fluid replacement (add volume)
2) Cellular dehydration- subtract from extracellular and interstitial
3) absorbed fluid from extracellular into blood vessels
4) Has all the electrolytes!
What else does a parenteral solution has? (3)
1) amino acid
2) carbohydrates (dextrose_
3) fatty acids
Large volume solution:
- How much does one bag of solution usually contains? (mL)
100 to 2000mL
Principles of IV medication administration? (6)
1) know the purpose of the drug
2) know the 7 rights
3) Check compatibility of drugs
4) Use aseptic techniques
5) SASH method
6) Calculate drip rates properly.
SASH method?
-define?
- abbreviation
- Flushing method

- Saline antibiotic - saline heparin
Nursing responsibilities?
1) care of ___ and ___ __
2) Change __
3) Flushing___
4) Discontinuing ___ infusion
5) Know which medication can be __
6) Carefully check drug order for __
7) Recommend rate of infusion for all ___ medications.
1) Care of sites and implanted ports
2) Dressings
3) Catheters
4) IV
5) infused
6) dose
7)IV
Type of catheters used?
Midline access catheters
Advantage of "Midline access catheters "?
- where is it inserted? (two choices of vein) at ___fossa
- Where is it placed?

- Lower rates of ___
-Less ___than central venous catheters.
Flexible

- cephalic or basilic vein at the antecubital fossa.
- Distal subclavian vein
- Phlebitis
- expensive
Monitoring IV therapy? (3 steps)
1) Assessment of site insertion
2) Procedures- flushing and administering meds
3) nursing intervention- discontinuing IV when it is needed.
Complications of IV therapy?
1) Phlebitis
2) thrombophleibitis
3) Infection
4) Septicemia
5) Infiltration/ extravasation
6) Air in tubing/ embolus
7) Circulatory overload
8) Pulmonary edema
9) Pulmonary embolism
10) Speed shock
Differ phlebitis and thrombophleibitis?
- Phlebitis (inflammation of the vein)
doesn't have to be necessarily be blood. When it is clot with blood it is called a thrombus--> lead to pulmonary edema.

- Thrombopheibitis ( blood clot)
Differ infection and septicemia?
Septicemia is infection inside the blood (Sepsis shock)

-systemic infection!

An infection only could be generalized in one area.
Define air tubing or embolus?
(why is it dangerous?)
A mass, such as an air bubble, detached blood clot, or foreign body, that travels in the bloodstream.

- clogs the circulation
Differ pulmonary edema and pulmonary embolism?
Edema- abnormal collection of fluid
Embolism- clot of blood which clogs the circulatory system.
Define speed shock?
a sudden adverse physiologic reaction to IV medications or drugs that are administered too quickly.
Signs of speed shock (6 in order)
1) Flushed face
2) Headache
3) tight feeling in chest
4) Irregular pulse
5) loss of conciousness
6) Cardiac arrest