Parenteral Administration Methods

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Questions and Answers

In the context of parenteral medication administration, which of the following represents the MOST critical factor ensuring patient safety and preventing iatrogenic harm?

  • Prioritization of cost-effectiveness in selecting the least expensive available supplies.
  • Using the largest possible syringe to accommodate potential dosage adjustments during administration.
  • Expeditious administration to minimize patient discomfort and reduce the overall procedure time.
  • Adherence to the prescribed route, meticulously verifying anatomical landmarks to avoid neural or vascular compromise. (correct)

Given the variability in medication viscosity and patient-specific factors (e.g., adipose tissue depth, muscle mass), which of the following scenarios requires the MOST critical reassessment of needle gauge and length BEFORE parenteral administration?

  • Administering a rapid intravenous bolus of a crystalloid solution during a medical emergency.
  • Administering a low-viscosity, aqueous solution to an average-sized adult via the subcutaneous route.
  • Performing an intradermal injection of a purified protein derivative (PPD) for tuberculosis screening.
  • Administering a highly viscous, oil-based medication intramuscularly to an obese patient with significant subcutaneous adipose tissue. (correct)

Considering the inherent limitations of syringe calibration and the potential for medication errors, which approach represents the MOST rigorous method for verifying the accuracy of a prepared parenteral dose, particularly for high-alert medications?

  • Employing a calibrated external measuring device (e.g., microbalance) to confirm the precise weight or volume of the prepared dose. (correct)
  • Cross-checking the prepared dose with a colleague, focusing primarily on the medication name and route of administration.
  • Documenting the preparation process meticulously, without additional verification measures.
  • Relying solely on the visual alignment of the plunger with the syringe's volume markings, assuming manufacturing precision.

In the context of aspiration during intramuscular injections, which of the subsequent statements reflects the MOST nuanced understanding of current best practices and mitigates the risk of inadvertent intravascular administration?

<p>Aspiration should be selectively performed based on anatomical location and medication characteristics, considering the potential for false negatives and tissue trauma. (D)</p> Signup and view all the answers

When comparing Luer Lock and Luer Slip syringe tip designs, what considerations are MOST critical when selecting the appropriate connection type for high-pressure injections or infusions?

<p>Luer Lock is preferred due to its threaded design, which provides a secure, leak-proof connection capable of withstanding high pressures. (A)</p> Signup and view all the answers

In the context of insulin administration, what is the MOST critical implication of utilizing a U-500 insulin concentration compared to a U-100 concentration, particularly concerning potential dosage errors and patient safety?

<p>U-500 insulin requires a fivefold reduction in the administered volume compared to U-100 insulin, necessitating meticulous attention to accurate syringe calibration to avoid potentially fatal overdoses. (C)</p> Signup and view all the answers

Considering the inherent limitations of prefilled syringes, which scenario presents the MOST significant challenge concerning accurate dose customization and patient-specific medication requirements?

<p>Providing a weight-based anticoagulant dose to a neonate using a prefilled syringe that cannot be easily adjusted to the calculated volume. (C)</p> Signup and view all the answers

When selecting parenteral equipment, which of the following represents the MOST consequential consideration for minimizing the risk of medication contamination and ensuring aseptic technique?

<p>Adhering strictly to single-use protocols for all syringes, needles, and vials, and employing meticulous hand hygiene practices. (A)</p> Signup and view all the answers

In the event of a confirmed needlestick injury involving a contaminated needle, what IMMEDIATE action should be prioritized, predicated on current best practices for post-exposure prophylaxis and infection control?

<p>Thoroughly irrigating the wound site with copious amounts of sterile saline, reporting incident, and initiating appropriate post-exposure prophylaxis based on risk assessment. (B)</p> Signup and view all the answers

Regarding the Centers for Disease Control and Prevention statistics for needlestick injuries, which percentage range of injuries is MOST LIKELY preventable through needleless systems in safe health care institutions?

<p>62% to 88% (A)</p> Signup and view all the answers

Given the variable pharmacokinetics associated with different parenteral routes (intradermal, subcutaneous, intramuscular, intravenous), which route is the MOST appropriate for delivering a medication requiring sustained, prolonged absorption and distribution?

<p>Intramuscular or subcutaneous, depending on medication properties and desired absorption rate, as these routes offer more sustained release compared to intravenous. (A)</p> Signup and view all the answers

Considering the relationship between needle gauge and diameter, which numeric gauge designation corresponds to the LARGEST bore size, facilitating the delivery of highly viscous solutions or rapid fluid infusions?

<p>18 (D)</p> Signup and view all the answers

Which of the following needle gauges is generally BEST suited for subcutaneous injection?

<p>25 (C)</p> Signup and view all the answers

When preparing medications from ampules, what is the MOST critical step to prevent patient harm related to glass particulate contamination during medication withdrawal?

<p>Utilizing a filter needle to withdraw medication, discarding the filter needle, and attaching a new sterile needle for administration. (C)</p> Signup and view all the answers

In the context of medication preparation from vials, what is the PRIMARY rationale for injecting a volume of air into the vial equal to the volume of medication to be withdrawn?

<p>To create positive pressure within the vial, facilitating easier medication withdrawal and preventing vacuum formation. (D)</p> Signup and view all the answers

When reconstituting powdered medications, what is the MOST crucial factor for achieving accurate drug concentration and ensuring patient safety during administration:

<p>Adhering strictly to the manufacturer's instructions regarding the type and volume of diluent, as well as proper mixing techniques. (B)</p> Signup and view all the answers

Which type of parenteral medication container system inherently provides the GREATEST accuracy in delivering a precise dose, minimizing the risk of medication errors associated with manual dose preparation?

<p>Mix-O-Vial (D)</p> Signup and view all the answers

When preparing a mixture of rapid-acting and intermediate-acting insulin in a single syringe, what is the MOST critical step to ensure accurate dosing and prevent contamination?

<p>Drawing up the rapid-acting insulin first to prevent contamination of the rapid acting insulin vial. (C)</p> Signup and view all the answers

When administering insulin to a patient, what step MUST the nurse do FIRST?

<p>Check thoroughly for complete drug order information. (B)</p> Signup and view all the answers

In the context of safe parenteral medication administration, which of the following actions constitutes the MOST egregious breach of aseptic technique, potentially leading to severe patient harm?

<p>Touching the plunger of a syringe after removing it from its sterile packaging. (D)</p> Signup and view all the answers

Which of the following statements MOST accurately differentiates between the appropriate use of a tuberculin syringe and a standard syringe in parenteral medication administration?

<p>Tuberculin syringes provide more precise measurement of small medication volumes (e.g., &lt;1 mL), making them ideal for pediatric or neonatal dosing, while standard syringes are suitable for larger, less critical volumes. (B)</p> Signup and view all the answers

If you are administering a subcutaneous injection, at what angle should you administer the medication?

<p>45 degrees (C)</p> Signup and view all the answers

If you are administering an intradermal injection, at what angle should you administer the medication?

<p>10 to 15 degrees (A)</p> Signup and view all the answers

If you are administering an intramuscular injection, at what angle should you administer the medication?

<p>90 degrees (B)</p> Signup and view all the answers

Of the following choices, what is the MOST important reason for using a needleless access device?

<p>They provide an alternative to needles for routine procedures, reducing the risk of needlesticks with contaminated sharps. (B)</p> Signup and view all the answers

Which of the following is NOT an advantage of prefilled syringes?

<p>Additional expense. (B)</p> Signup and view all the answers

Which of the following is NOT required equipment for preparation of parenteral medications?

<p>Patient medical history (C)</p> Signup and view all the answers

If a drug is administered parenterally, it will NOT have which of the following?

<p>Lower cost (C)</p> Signup and view all the answers

How do you ensure that you are reading a syringe with the most accurate measuring of medication?

<p>Always use the plunger ring closest to the tip to read the volume contained in a syringe. (A)</p> Signup and view all the answers

In the context of safe handling and disposal of contaminated sharps, what constitutes THE MOST critical element in preventing needlestick injuries and transmission of bloodborne pathogens?

<p>Immediately discarding used needles and syringes, without re-capping, into designated sharps containers that meet OSHA standards. (A)</p> Signup and view all the answers

Within the multifaceted domain of parenteral medication safety, which of the subsequent elements represents the MOST VALID, evidence-based strategy for mitigating the risk of 'wrong-route' medication errors – a category of adverse events with potentially devastating consequences?

<p>Implementing a robust, multi-tiered verification process that includes independent double-checks of the medication order, label, and intended route, performed at the point of administration. (B)</p> Signup and view all the answers

Considering the diverse physicochemical properties of parenteral medications (e.g., pH, osmolality, solubility), which quality parameter represents the MOST critical determinant of drug compatibility when co-administering multiple agents through a single intravenous line?

<p>Visual inspection for particulate formation, cloudiness, or precipitation, which indicates potential incompatibility and risk of thromboembolism. (B)</p> Signup and view all the answers

Given the complexities inherent in calculating and preparing accurate medication dosages, particularly in pediatric populations, what modality embodies the MOST reliable approach to minimize errors and optimize therapeutic outcomes?

<p>Implementing a comprehensive, weight-based or body surface area-based dosing protocol, coupled with independent double-checks of all calculations and dose preparations. (C)</p> Signup and view all the answers

Flashcards

Parenteral Administration

Drug administration by any route other than the GI tract.

Parenteral Drug Effects

Rapid onset, shorter duration, smaller dosage with higher potency and higher cost of drug administration.

Syringe

Made of plastic, including a barrel, plunger, and tip, used to inject fluids.

Tuberculin syringe

A syringe calibrated in mL that requires a 1-mL syringe.

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Insulin Syringes

Syringes with a special scale for measuring insulin.

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Prefilled Syringes

Syringes that are disposable and have a premeasured amount of medication.

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Needle

Has hub, shaft and beveled tip; gauge refers to the diameter inside.

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Ampules

Glass containers usually containing a single dose.

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Vials

Glass containers that contain one or more doses.

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Drug

Ensure it is sterile and in a sealed container.

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Procedure Protocol Steps

Use hand hygiene and follow the seven rights.

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Preparing Medication from Ampule

Move medication to the bottom, use gauze to break the top, use a filter needle, then a sterile needle.

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Preparing Medication from Reconstituting the vial

Withdraw diluent, tap the vial, cleanse diaphragm, inject diluent, and mix.

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Preparing Medication from Mix-O-Vial

Tap container, remove protector, push plunger, mix solvent, cleanse diaphragm.

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Preparing Two Insulins in One Syringe

Check compatibility, labels, draw rapid then intermediate, cleanse with alcohol.

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Needle Gauge

Diameter of the needle´s bore.

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Intramuscular Injection

Injecting directly into a muscle.

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Subcutaneous Injection

Injecting into the subcutaneous tissue.

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Intravenous Injection

Injecting directly into a vein.

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Intradermal injection

Injecting into the dermal layer of the skin.

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Study Notes

Parenteral Administration

  • Refers to drug administration via any route other than the gastrointestinal (GI) tract

  • Routes include:

    • Intradermal
    • Subcutaneous
    • Intramuscular (IM)
    • Intravenous (IV)
  • Drugs administered parenterally have:

    • Rapid onset, but shorter duration
    • Smaller dosage with higher potency
    • Higher cost

Syringes

  • Typically made of hard plastic with three main parts: the barrel, plunger, and tip
  • Calibrated in milliliters (mL)
  • Tuberculin syringes are available, requiring only a 1mL syringe, and are used to measure small volumes of medication accurately

Insulin Syringes

  • Feature a special scale for measuring insulin
  • In the United States, insulin is manufactured in U-100 concentration
    • A U-100 syringe holds 100 units of insulin per milliliter
    • Low-dose insulin syringes are used for patients receiving 50 units or less of U-100 insulin

Prefilled Syringes

  • Disposable and contain a premeasured amount of medication
    • Advantages: Time saved in preparation, reduced chance of contamination
    • Disadvantages: Additional expense, different holders required for different cartridges, and limited volume of second medication

Needles

  • Needles have three parts: Hub, Shaft, and Beveled Tip
  • Needle gauge refers to the diameter of the hole inside the needle
  • Needle size and injection site selection vary from pediatric (smaller needles) to adult (standard gauges)

Safe Injection Practices

  • A major safety improvement is the development of needleless systems
    • Needleless systems offers an alternative to needles for routine procedures, reducing the risk of needlestick injuries with contaminated sharps
  • Syringes and needles must be sterile
  • Discard used syringes and needles in a sharps container, complying with OSHA standards

Needle Gauge and Length Selection

  • Needle gauge and length depend on the route of administration
  • Volume of medication varies for each route
    • Intradermal
    • Subcutaneous
    • Intramuscular
  • Volume in the syringe is read where the rubber flange is parallel to the calibration scale on the barrel

Parenteral Dose Forms

  • Ampules: Glass containers usually containing a single dose
  • Vials: Glass containers holding one or more doses
  • Mix-O-Vials: Glass containers with one dose, featuring an upper chamber containing the solvent and a lower chamber containing the drug

Preparation of Parenteral Medications

  • Equipment needed includes:
    • Drug in sterile, sealed container
    • Syringe of the correct volume
    • Needle of the correct gauge and length
    • Needleless access device
    • Antiseptic swab
    • MAR (Medication Administration Record) or medication profile

Procedure Protocol

  • Hand hygiene should always be performed
  • Follow the "seven rights" of medication administration
  • Check compatibility chart before mixing medications
  • Check medication calculations
  • Medications need to be prepared in a clean, well-lit area
  • Use an aseptic technique
  • Check the expiration date

Preparing Medication from an Ampule

  • Move medication to the bottom of the ampule by shaking the liquid down out of the top
  • Cover the ampule neck with a sterile gauze pledget or antiseptic swab while breaking off the top
  • Use a filter needle to withdraw medication from the ampule; discard filter needle
  • Attach sterile needle using correct gauge and length to administer medication to the patient

Preparing Medication from a Vial (Reconstitution)

  • Withdraw the measured volume of diluent required for reconstitution
  • Tap the vial of powdered drug to break up caked powder; cleanse the rubber diaphragm with a swab
  • Insert the needle or needleless access device in the vial and inject the diluent in the powder
  • Mix thoroughly to dissolve the powder
  • Attach sterile needle using correct gauge and length to administer medication to the patient

Preparing Medication from a Vial

  • Cleanse the top of the vial of diluent
  • Pull plunger of syringe to fill with an amount of air equal to the volume of the solution to be withdrawn
  • Insert the needle or needleless access device through the diaphragm and inject air into vial
  • Withdraw the measured volume of the drug
  • Attach sterile needle using correct gauge and length to administer medication to the patient

Preparing Medication from a Mix-O-Vial

  • Tap the container a few times to break up the caked powder
  • Remove the plastic lid protector.
  • Push firmly on the diaphragm-plunger
  • Mix thoroughly by shaking gently to dissolve the drug into the solvent
  • Cleanse the rubber diaphragm and remove the drug using a syringe to administer to the patient
  • Attach a sterile needle using correct gauge and length to administer the medication to the patient

Preparing Two Medications in One Syringe

  • Check the compatibility of the two types of insulin
  • Check the labels against the insulin order
  • Check type, concentration, expiration date, appearance, and temperature
  • Draw up the rapid-acting insulin into the syringe first, then add the intermediate-acting insulin
  • Cleanse the top of both vials with separate antiseptic alcohol wipes

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