From Foundations of Nursing by Christensen and Kockrow, Chapter 23, pages 681-736
For adults and children older than 3 years of age, pull earlobe upward and back
For children younger than 3 years of age, turn head with affected side up, pull earlobe downward and back
Irrigating an ear is an independent nursing intervention. No need for an order
Tell patient to remain in same position for 5 to 10 minutes to allow medication to drain into ear by gravity.
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Head forward and upward
Head forward and downward
Head backward and downward
Head backward and upward
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MDI delivers a measured dose
Nasal Sprays are accurate
Both MDI and Nasal Sprays are percutaneous forms of medication
MDI and Nasal sprays are exactly the same.
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Achieved by placing a tablet between the cheek and the teeth
A drug that is administered Buccal can also be administered sublingual
Tablets are the most common form of buccal administration
Rapid onset of drug's active ingredient is due to absorption into the capillaries of the mucous membranes of the cheek
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Vial
Ampule
Canister
Capsule
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Vial
Ampule
Canister
Capsule
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Have patient open lips and place inhaler 1 to 2 inches from mouth with opening towards back of pharynx. Lips will not touch inhaler.
Have patient open lips and place inhaler 1/2 to 1 inch from mouth with opening towards back of pharynx. Lips will not touch inhaler.
Have patient open lips and place inhaler 1 to 2 inches away from the mouth with opening toward back of pharynx. Lips will not touch inhaler.
Have patient exhale, then grasp mouthpiece with teeth and lips while holding inhaler with thumb at mouthpiece and fingers at the top.
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Have patient exhale fully, then grasp mouthpiece with teeth and lips while holding inhaler with thumb at the mouthpiece and fingers at the top
Have patient inhale fully, then grasp mouthpiece with teeth and lips while holding inhaler with thumb at the mouthpiece and fingers at top
Have patient open lips and place inhaler 1/2 to 1 inch from mouth
Have patient open mouth and position inhaler 1 to 2 inches away from the mouth
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Breath in slowly for 3 to 5 seconds and hold breath for 20 seconds
Breath in quickly for 5 to 6 seconds and hold breath for 30 seconds
Breath in quickly for 3 to 4 seconds, and hold breath for 1 minute.
Breath in slowly for 2 to 3 seconds, and hold breath for 10 seconds
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2 to 5 hours
2 to 5 seconds
2 to 5 minutes
10 to 15 minutes
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5 to 10 minutes
5 to 10 seconds
15 to 20 minutes
15 to 20 seconds
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Places the medication under the patient's tongue
Gives the patient a glass of water
Uses 3 identitifiers
Applies six rights
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Dysphagia
Urgent need to provide absorption
Urgent need for immediate onset
Some medications are altered by the GI tracts
Patient dislikes oral medication
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Plunger inside the barrel
Outside of a barrel
Point of a needle
Rubber Stopper
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1 mL
3 mL
5 mL
10 mL
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Achieved by placing medication beneath the tongue until it is dissolved
They bypass the liver which reduces time it takes to produce a drug's desired effect
While tablet is being dissolved in the mouth, it is acceptable for the patient to drink a glass of water.
It is acceptable to squeeze liquid out of a capsule if ordered by sublingual route
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Epidural
Intramuscular
Subcutaneous
Intradermal
Intravenous
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0.5 mL
1 mL
1.5 mL
2 mL
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Small doses of epinephrine
Subcutaneous medication
Electrolytes
Intradermal skin test
Mantoux
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It has the smallest needle
It is calibrated in units
It is the most effective syringe
It was designed for insulin
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U100 syringe holds 100 units of insulin per 1 mL
U100 syringe holds 100 units of insulin per 10 mL
U50 syringe holds 50 units of insulin per 0.5 mL
U30 syringe in 0.3 mL size
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1 mL
3 mL
5 mL
Tuberculin
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SubQ
IM
ID
IV
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Diameter of the lumen determines the gauge
The smaller the gauge, the larger the diameter
A 29-30 gauge needle has a large diameter
The thicker the medication, the smaller the gauge
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Butterfly and over-the-needle catheter are the two types of IV needles
Butterfly needle (scalp or winged needle) is useful for short term IV fluids
Over the counter needles are called Angiocaths, Jelcos, Abbocaths, or Insytes
The catheter should not be used for long term IV because it is flexible
It is possible to use Angiocaths for an indefinite period of time
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Emergency situations and surgery
Immunization and preventive innoculation
TPN and thick IV infusion
Blood and blood products transfusion
Intensive care cases
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Angiocaths and Intracaths are used for the same purpose. A stylet is made of plastic
Angiocaths are longer than Intracaths while a Stylet is used to guide a catheter.
Angiocath is a plastic catheter over a stainless needle. A stylet is a bevel-tipped metal guide used to pierce skin and vein. Intracaths are longer than angiocaths and are used for long term IV
Angiocaths, stylets and intracaths are used for IV and SubQ
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Always shake an insulin
Roll long and intermediate acting insulin between palms
DO not mix long acting insulin glargine (Lantus) with regular insulin (Lantus is acidic and will affect action of regular insulin)
Administer mixtures of insulin within 15 minutes of preparation
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Ventrogluteal
Vastus lateralis
Dorsogluteal
Deltoid
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Dorsogluteal
Ventrogluteal
Vastus lateralis
Deltoid muscle
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Rectus femoris
Deltoid
Vastus lateralis
Intramuscular
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Use your right hand for the patient's right hip, and the left hand for patient's left hip.
Point your thumb toward the patient's groin, point your index finger toward the anterior superior iliac spine, and extend your middle finger back along the iliac crest toward the buttock as far as possible
Injection site is the center of the triangle formed by index and middle finger
Palpate the greater trochanter at the head of the femur and the anterior superior iliac spine
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Injection site is about 1 to 2 inches below the acromion process
Position patient sitting or lying down, exposing upper arm and shoulder.
Use in infants or children who are underweight
Inject no more than 1 mL into the muscle
Landmarks are the acromion process of the scapula and the axillary fold.
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Used to avoid or minimize tissue irritation
IM is the preferred site
Ventrogluteal or dorsogluteal should be avoided
Does not allow staining or tracking of medication into tissue as needle is withdrawn
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When performing an intradermal injection, you have to aspirate to avoid injury
Small volumes such as 0.1 mL are injected to form a small bubble-like wheal just under the skin
Absorption in this location is slow which makes intradermal ideal for allergy sensitivity tests
Use a tuberculin syringe to give intradermal because it holds only a maximum of 1 mL
Use the upper chest, the inner aspect of the lower arm or the scapular area for ID injections
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Up
Down
Left
Right
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Fluids and Electrolytes
TPN and medication
Blood and blood products
Chemotherapy and PCA
Insulin, heparin, Lovenox and Fragmin
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Fentanyl
Dilaudid
Buprenex
Demerol
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Intermittent Venous Access Device is the same as Heparin Lock and Intermittent Infusion is the same as Piggyback
Intermittent Venous Access Device is same as Piggyback. Intermittent Infusion is the same as Saline Lock
The former and the latter are the same
The former and the latter are both subcutaneous
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Provides more pain relief with less medication
Patient is more in control and decreases anxiety
Patient can have as much medication as needed
Patient can have medication as often as needed
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Designed to deliver a measured amount of fluid over a period of time
Designed to deliver any amount of fluid within a period of time
Designed to deliver fluids at any time
Designed to deliver any medication within a specified period of time
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IV tubing box
IV line
IV catheter
IV needle
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Sip water before attempting to swallow medication
Crush medication if needed and mix with apple sauce
Tell the patient to chew the tablet before swallowing
Mix the tablet with alcohol to stimulate a pleasant taste
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Intramuscular injections
Subcutaneous injections
Intradermal injections
Intravenous injections
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Check the patient
Complete an incident report
Call the supervisor
Call the physician
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