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Parental Medications

STUDY
PLAY
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