CSA Patient 1 PREP May 2024 PDF

CSA Patient 1 11 rights PRP MFE DR RDR 3 checks 1. on collection Right patient 2. on dispensing *** make sure to get independent Right time check for heparin and for i...

CSA Patient 1 11 rights PRP MFE DR RDR 3 checks 1. on collection Right patient 2. on dispensing *** make sure to get independent Right time check for heparin and for injections. Right prescription 3. prior to administration Right medication Right form 4 bedside checks Right expiration date Name, DOB, Right dose URN and Right route Allergies Right to refuse Pt states name, DOB, and allergies, these are checked against arm band and med charts. Right documentation Ask and check allergy band for any allergies, and ask patient about type and severity of reaction. Right response Nonpharmacological pain interventions 1. Asking the pt what might make it better/more PQRST(U) comfortable P – what makes your pain 2. Repositioning – sitting up in semi/high Fowlers better/worse? Moving, breathing etc. 3. Distraction (TV), no heat or cold packs over Q – what does it feel like/can you surgical wounds, recheck any pain 30 mins after describe it? Aching, dull, sharp, intervention (or analgesia med.) stabbing, throbbing, crushing? R – where is the pain/can you point to it? Does it go anywhere else? Digoxin Oral - check HR must be above 60 bpm 250 microg. dose PO S – 0 -10 scale: 0 no pain and 10 the worst you have ever felt (e.g. ‘hands Calc: SR/SS = 250 microg. /250 microg. = 1 tablet into a fire’ if no specific past injuries) Metoclopramide IM – give emesis bag, let it take T – when did it start? What were you effect doing? Is it constant or does it 10 mg dose IMI change/stop and start? Calc: SR/SS x vol. = 10 mg /10 mg x 2mL = 2mL U – have you had pain like this Heparin – Subcut – watch BP, pulse, RR before? Do you know why you might have it? 5000 units dose SC In CSA no score to QADDS Calc: SR/SS x vol. = 5000 u/5000 u x 1mL = 1 mL but put in progress notes  Subcut sites (21 and 23 gauge, 16mm) orange 3mL 1. Abdomen 3-5cm (or 2-3cm) inferior and 10cm lateral of umbilicus 2. Lateral aspect of upper arm 3. Anterior thigh 4. Scapula – fatty tissue under the scapula Check site for marks (past sites), hard masses, wounds, redness, rashes, and cleanliness Rotate sites for regular injections Rest on pt – push only 2/3 in with needle, swap hands to hold near end Do not push or rub site afterwards for SC IM sites (25 gauge, 25mm 30g for insulin) green 1. Vastus lateralis – lateral middle third of thigh between the greater trochanter and lateral femoral condyle 2. Deltoid – 3 finger widths down from the acromion process, make a V with fingers (index and middle) and aim between along midaxillary line 3. Ventrogluteal – palm over greater trochanter, index finger on anterior superior lilac spine, middle finger on iliac crest, aim between 4. Dorsogluteal* – Draw an imaginary line between the greater trochanter and posterior superior iliac spine. Locate the center of the line and find a point ~1 inch superior to it. *This site is not recommended because of the risk of contact with the sciatic nerve and/or superior gluteal artery and poor/unpredictable absorption compared to other intramuscular (IM) sites. However, it may be used in patients who prefer it. The gluteus medius muscle can absorb 1 to 5 mL of medication. position limb so it is relaxed, piece skin at 90 degrees (>70 should reach muscle layer). Anatomical markers used to identify IM injection sites: deltoid injection site: the deltoid is a large rounded triangular shape on the outside of the upper arm, on top of the humerus, the clavicle, and the scapula. The brachial artery and the radial nerve sit behind the deltoid and come down from the muscle. The injection site is 3 fingers widths down from the acromion in a smaller triangle-shaped area, in the middle of the deltoid, above the deltoid tuberosity. vastus lateralis injection site on the anterolateral thigh. The injection site is halfway down the vastus lateralis, which is the muscle on the outside of the thigh. Markers include the greater trochanter, and the lateral femoral condyle – the injections site is about halfway between these two levels. the ventrogluteal injection site landmarks: anterior superior iliac spine, greater trochanter of the femur and iliac crest. Place your palm over the greater trochanter (the uppermost bony prominence of the thigh bone), with the thumb pointing towards the umbilicus. Point your index finger towards the anterior superior iliac spine, and spread your middle finger so it aims at the iliac crest. This creates a ‘V’ outlining the ventrogluteal triangular area. The injection site is at the centre of this area. Dorsogluteal site: draw an imaginary line between the greater trochanter and posterior superior iliac spine. Locate the center of the line and find a point ~1 inch superior to it. Located in the lateral and superior outer quadrant (upper and outer) of the thigh. Historically, commonly used for IM injections. However, due to higher risk of complications (such as nerve injury, infection, and pain), healthcare professionals now prefer other sites like the ventrogluteal site