Podcast
Questions and Answers
Why might older adults receive prescriptions from multiple providers?
What is an appropriate method to ensure an older adult has swallowed their medication?
How can visual deficits in older adults be addressed when providing medication information?
What should be done if an older adult has difficulty swallowing a pill?
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What risk do older adults face when prescribed the same medication by multiple providers?
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What is the recommended way to administer small amounts of oral medication for accuracy?
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What should be done if oral syringes are not available in a facility?
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What is the primary benefit of conducting medication reconciliation for older adults?
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What is the appropriate needle gauge for an intradermal injection?
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Which angle is used for subcutaneous injections?
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Where is the preferred site for intramuscular injections in children?
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What syringe size is generally used for intramuscular injections?
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When administering high alert medications, what is recommended?
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Which of the following needle gauges is most appropriate for viscous solutions during intramuscular injections?
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What is the angle for administering intradermal injections?
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Which location is the least preferred for subcutaneous injections?
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What should you inform UAP about when a patient is taking medication that may cause dizziness?
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Why is it essential to specifically ask patients about OTC drugs and herbal remedies?
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What is the best approach when giving medication to young children?
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In what position should a patient be when assessing their swallowing ability?
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How often should you ask about medication allergies when administering medication?
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Why is it beneficial to develop a strong relationship with a pharmacist?
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What action should be taken when observing a patient's swallow capability?
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What common misconception might patients have regarding OTC medications and herbal remedies?
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What is the maximum amount of medication that can be safely injected into the mid-deltoid site for adults?
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Which intramuscular injection site is considered the safest for avoiding damage to nerves or blood vessels in adults?
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What position should an adult patient be in to relax the gluteal muscles during an injection?
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Which muscle is the site of choice for intramuscular injections in infants from younger than 12 months to 2 years?
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What is a recommended technique for preparing a child for an injection?
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When giving a deltoid injection to a child, where should the injection be administered?
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What might risk a patient moving during an intramuscular injection procedure?
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Why is it important to place an alcohol swab next to the injection site before administering an intramuscular injection?
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What is the correct technique for inserting the needle during the tuberculin skin test?
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How can a practitioner determine if the needle is in the dermis during the injection?
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What should be done after withdrawing the needle from the skin?
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What indicates a positive reaction to the tuberculin skin test for someone at low risk?
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Within what time frame should the tuberculin skin test results be read?
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What should be done to locate the injection site when reading the tuberculin skin test results?
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What denotes a negative reaction in the tuberculin skin test?
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What is the correct action regarding hand hygiene after performing the injection?
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Study Notes
Medication Administration
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When administering medication to a patient, it is important to consider possible side effects and alert UAP about those that may require assistance.
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Be sure to inquire about current medication use, including over-the-counter drugs, herbs, and illicit substances. Ensure a non-judgmental approach when discussing medication history.
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For pediatric patients, encourage positive reinforcement and avoid comparing medication to candy. Instead, focus on the benefits of the medication and offer simple rewards.
Medication Administration for Older Adults
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When assessing swallowing ability, place the patient in a high Fowler's position and observe throat movements as they swallow.
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Ensure the patient's medication is fully swallowed. Some patients, especially older adults or those with psychiatric conditions, may hold medication within their buccal area.
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For visually impaired older adults, create charts with large, dark letters on white background, label the drugs' name, dose, time, and purpose.
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When older adults have difficulty swallowing pills, encourage them to take a small sip of water. Place the pill towards the back of the tongue. Have them take a large sip of water, place their tongue on the top of their mouth, and tilt their chin slightly downward while swallowing. Additionally, consider crushing or cutting pills (unless contraindicated) or requesting a liquid medication form.
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Be cautious of older adults who see multiple providers. They may have the same medication prescribed with different brand names, leading to double doses. Encourage medication reconciliation to avoid overdosing.
Medication Safety
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Use oral syringes for accurate measurement of small quantities (less than 30 mL) of oral medications.
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The intradermal route (ID) is used for dermal layer injections (e.g., tuberculin tests). The injection angle should be 5 to 15 degrees.
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The subcutaneous route (sub-Q) is used for injections below the dermal layer, commonly in the upper portion of the upper outer arm, anterior surface of the thigh, or abdomen (away from the navel). The angle should be 45 to 90 degrees.
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The intramuscular route (IM) is used for injections in the muscle layer, including the deltoid, ventrogluteal, vastus lateralis (children), and rectus femoris of the thigh. The angle should be 90 degrees.
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Choose syringe and needle size according to the medication, patient’s age, and size. For IM injections, a 3-mL syringe with a 22-gauge, 1 ½-inch needle is generally used.
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Tuberculin or 3-mL syringes with 27-gauge, 3/8 to ½-inch or 25-gauge, 5/8-inch needles are used for subcutaneous injections.
Needle Gauge and Length
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The larger the gauge number, the smaller the needle diameter.
- ID injections: 25, 27, or 29-gauge needles are most suitable.
- Subcutaneous injections: 25-gauge needles are strong enough to penetrate the skin and reach below the dermis.
- IM injections: Heavier-duty 20, 21, 22, and 23-gauge needles are needed.
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Commonly used needle lengths for parenteral injections are 1 or 1 ½ inches.
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For viscous or oil suspension medications, 20 or 21 gauge needles are preferred for adult IM injections.
High Alert Medications
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When administering insulin, heparin, injectable heart medications, or parenteral chemotherapy drugs, double-check the medication and dose with another nurse.
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Tuberculin Skin Test:
- Read the test results between 48 and 72 hours after injection.
- Inspect the injection site for erythema and palpate the margin of induration.
- Measure the transverse diameter of the indurated area with a ruler.
- Induration, not erythema, indicates a positive reaction.
- Positive reaction: swelling greater than 5 mm.
- Negative reaction: induration less than 5 mm.
Intramuscular Injections
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The ventrogluteal area is considered the safest site for intramuscular injections in adults.
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Mark the injection site with an alcohol swab to prevent patient movement during the procedure.
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Relaxed muscles decrease pain during IM injections. Ask the patient to lie in a prone position with toes turned inward or the Sims position to relax the gluteal muscles.
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The vastus lateralis is the preferred site for IM injections for infants younger than 12 months to 2 years of age. The deltoid muscle can be used for children older than 13 months if developed.
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When giving a deltoid injection to a child, ensure it is administered in the thickest part of the muscle and that the needle points at a slight angle toward the shoulder.
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Description
This quiz covers essential guidelines for medication administration focusing on various patient demographics, including pediatric and older adult considerations. It emphasizes the importance of understanding medication history, potential side effects, and effective communication strategies for safe administration.