27 terms

LAB 2 CHAPTER 11 injections

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subcutaneous injections
-given is the subcutaneous tissue located under the skin-adipose tissue
-medication is absorbed into the blood stream through capillaries in the adipose tissue
-angle of insertion: 45 degrees
-amount of Rx: not more than 1 cc
-needle length: 1/2"-5/8"
-needle gauge: 23g-25g
-sites: upper lateral arm, anterior thigh, upper back, abdomen
sub technique
pucker skin
-aspirate to be sure you are not in blood vessel
sub purpose
epinephrine injection, insulin injection, allergy injection
sub type of injection
aqueous (more water than anything else)
intramuscular injections
-medication in injected into the muscles giving a quick rate of absorption since muscles are very vascular
-angle: 90 degrees
-amount of med: up to 3 cc
-needle length: 1"-3"
-needle gauge: 18g-23g
-sites: vastus lateralis, deltoid, dorsogluteal site
vastus lateralis
desirable for infants and under three whose gluteal muscles are not yet developed. mid anterior thigh. one hand below the greater trochanter of femur and one hand above knee
deltoid
put four fingers across the deltoid muscle with the top finger touching the acromion process. the injection site is three fingers below the acromion process
dorsogluteal site
desirable in adults and children over three. can absorb a large amount of medication. given in the upper outer quadrant of the gluteal area. draw an imaginary line from the greater trochanter of the femur to the posterior iliac spine. injection is given above and outside this area
ventrogluteal
not a common site but growing in acceptability
-technique: taut skin, aspirate
-purpose: oil based meds, large amounts of meds, quickest rate of absorption, used to administer meds irritating to tissues
-types of injection: oil based and aqueous
z track
-a special IM technique
-used for skin staining meds or skin irritating meds
-technique: pull skin and subcutaneous tissue to side before injecting med. once skin is out back into place, the needle track is sealed off so med cant leak upwards
intradermal injections
-given just below the surface of the skin
-angle: 10-15 degrees
-amount of Rx: 0.01-0.2 cc
-needle width: 25-27 g
-needle length: 3/8"-5/8"
-sites: anterior forearm, middle of back
-technique: taut skin, insert needle 1/8" into skin until bevel penetrates, do not aspirate, do not massage, wheal will form
-Purpose: allergy testing, mantoux PPD testing (TB)
-type of injection: aqueous
tuberculin testing
-infectious disease that infects the lungs
-caused by bacteria
-symptoms: fatigue, weakness, weight loss, low grade fever, night sweats, coughs producing mucopurulent sputum, hemoptysis, chest pain
-not highly contagious
-individual infected may not develop disease (inactive or latent TB infection)
-10 % of latent infections turn active usually due to a breakdown of body defenses
purpose of TB testing
to prevent the spread of TB by early detection
TB test reactions
-tuberculin is a purified protein derivative (PPD) extracted from the bacilli that causes TB
-if patient has active or latent TB we will see induration (something has gotten larger and hardened positive reaction)
-if this occurs MD will follow up with chest x-ray and examination of sputum
induration
abnormally hard spot caused by accumulation of small sensitized lymphocytes
TB testing methods
tine test
mantoux test
tine test
-sterile plastic unit consisting of 4 sharp prongs impregnated with tuberculin (rarely used)
-patient inoculated about 1 mm beneath skin
mantoux test
-administered through ID inj
-needle length: 3/8-1/2
gauge: 26-27
dose: 0.01 ml of PPD
-solution is injected into the superficial skin layer to form a wheal
-if injected into SC layer wheal will not form. if injected too shallow, solution will leak out
-must be read 48-72 hours after administration
guidelines for reading results
-induration is the ONLY criteria used to determine a positive reaction. erythema (redness) may be present but would be considered negative
-NEVER record as positive or negative, record size of induration in mm
*if no induration is present, record 0 mm
*induration of 10 mm or more (positive)
*10 mm with no vesiculation (positive with further tests ordered to determine if there is active TB)
*induration of 5 mm to 9 mm is doubtful BUT positive in someone with HIV
*induration of less than 5 mm (negative)
-new hires often need to do a two step PPD: 1 upon hire and then another 3 weeks later
quantiFERON (TB gold)
-a new blood test that identifies people are infected with the bacteria that causes TB
-special collection procedures must be followed by the medical assistant in the office
allergy testing
-the first time an allergen enters the body, it stimulates antibodies (IgE) to the allergen
-antibodies combine with the allergen causing a massive secretion of histamine
-histamine directly affects the respiratory system and skin with the Sx of an allergic reaction
treatment for allergies
1) avoidance of the allergen
2) antihistamine drugs, bronchodilators
3) allergy injections - decreases the sensitivity of the body to the allergen
types of allergy tests
-patch testing
-skin prick testing
-intradermal skin testing
-RAST testing
patch testing
-identifies causes of contact dermatitis
-small piece of gauze impregnated with allergen applied to skin
-Pt to return in 48 hours
-patches removed and read 20 minutes later
-positive: erythema, induration, itching, and vesticulation
skin prick testing
-apply allergen extracts to skin using pin or scrub brush
-maximum reaction occurs 15-20 minutes after pricking skin
-positive reaction: induration and itching. the more induration (+1, +2, = 3) the more severe the allergy
intradermal skin testing
-similar to skin prick testing but allergen extracts are inj under skin with an intradermal inj
-wheal is formed
-positive reaction: induration and itching
rast testing
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