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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


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


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

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

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


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


The development of fibrous fatty masses and thickening skin at injection site, caused by repeated use of injection site.


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


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°

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