Medical Procedures and Techniques: Injections, Blood Withdrawal, and Wound Care, Exams of Health sciences

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CPSS Exam 1 Questions With Verified Answers By Expert Small bottle that contains the drug - Ampule Diameter of the needle - Gauge Enlarged base by which a hollow needle may be attached to a device (as a syringe) - Hub Cylindrical container that holds liquids - Barrel A small container, usually with a closure, used especially for liquids - Vial What are the reasons to give an injection? - - if drug is poorly absorbed or degraded by GI system - if pt is uncooperative, unconscious, unable to take PO - used when localized therapy is desired - preferred when rapid & predictable drug response is desired in ER situations What is the needle size used for blood withdrawal? - 18 g What is the needle size used for IM injections? - 22g What is the needle size used for SubQ injections? - 25-27g What needle size is used for ID injections? - 26-27g What type of injection has the fastest rate of absorption? - IV > IM > SQ When are IM injections indicated? - - drugs are not easily absorbed PO - when you want an intermediate rate of onset & duration of action - when parenteral delivery is necessary What are the 3 main sites of IM injections? - - gluteal (upper outter quadrant) - deltoid (lateral & 3-4cm below the acromion) - vastus lateralis (antero-lateral, upper thigh) Which IM site is preferred in infants & kids under 3? - Vastus lateralis (largest muscle in this age group) *painful due to fascia lata *lack of nerves and vessels 0.5-2.0cc Which IM site is preferred in kids over 2? - Gluteus maximus *higher risk of hitting sciatic nerve in kids under 2 NOT recommended for immunization by fatty absorption in butt Which IM site is preferred in adults? - Deltoid *watch for radial nerve in kids <2cc What is an important technique to use when giving an IM injection? - Draw about 0.2ccs of air into syringe (air lock) Hold syringe like a dart at 90 degree angle Max amount injected is 3ccs *DO NOT MASSAGE- will break seal* What are the complications associated with IM injections? - - inject into vessel - inject into nerve - needle breaks off - sterile/septic abscess Which type of injection is used for drugs requiring slower absorption and longer duration of action? - SubQ *drugs must be soluble and potent in small concentrations What are the 3 common sites used for SC injections? - - upper outer arm - anterior thigh - lower abdomen possibly lower back too What are the MC SC injections given? - Heparin & Insulin *refrigerate insulin *Do NOT aspirate or massage heparin injections How is insulin mixed? - Rolled between palms of hands - gently! What technique should be used when giving a SC injection? - Pinch SC tissue into roll with thumb & forefinger of non-dominant hand; inject at 45 degree angle to about 3/4 total length Max amount 2ccs Which type of injection has little systemic affects and is mainly localized? - ID injections - TB & allergy testing What are the C/I to IV therapy? - - venipuncture should be avoided at the *site of an active skin infection* - IV lines should not be inserted distal to any site of thrombophlebitis - LE venipunctures should be avoided in elderly, pts with PVD & venous insufficiency What are the primary kind of IV needles we will use? - Over the catheter needles What type of needle is used for central monitoring and long term medication administration? - Inside the needle catheter Which type of IV fluid has a risk of causing edema, so should be avoided in HTN and CHF patients? - Isotonic - LR, NS Which type of IV fluid is helpful when pt is dehydrated, on dialysis, or in hyperglycemic conditions (DKA)? - Hypotonic- 0.45% NaCl, 2.5% Dextrose Which type of IV fluid is dangerous to use when the pt is dehydrated? - Hypertonic - D5% , 0.45%NaCl, D5% LR, D5%NS, blood products, and albumin Lactate is metabolized by the liver into? - Bicarbonate - buffers the blood if acidosis is present Which type of fluid is indicated for massive hemorrhage and resuscitation? - Lactated Ringer What is the ideal IV site in the hand? - Dorsal metacarpal veins What is the ideal IV site in the forearm? - Cephalic vein (good for large gauge), Accessory Cephalic vein, & Median Cubital vein What is the rate of a micro/macro drip? - Microdrip - 60 drops/mL *good for peds* Macrodrip- 10-15 drops/mL *good for routine/rapid delivery* What is the formula for calculating flow rates? - (Volume mL) x (drip set) / (time in minutes) What are the complications of IV therapy? - Localized: - bruise, cellulitis, infiltration (non-vesicant), extravasation (vesicant), phlebitis Systemic: - sepsis, PE, air embolism, catheter fragment embolism, These complications can happen at insertion of needle if both walls of the vein are penetrated or at a later date if catheter moves and penetrates walls? - Infiltration or Extravasation (blistering) What areas should not be used for venipuncture? - - scars from burns & surgery - UE on the side of previous mastectomy - hematoma - IV/ blood transfusions on same arm - cannula/fistula/heparin lock - edematous extremities What type of antiseptic is used for blood cultures? - Povidone-iodine wipes What is the order of blood draw? - 1- blood culture tube (yellow black) 2- Non additive tube (red or STT) 3- coagulation tube (light blue) - NEVER DRAWN FIRST 4- Additive tubes (Heparin- Dark green; EDTA- lavender; oxalate/fluoride- light gray) What kind of symptoms should be avoided when performing a finger stick? - Avoid puncturing a finger that is cold, cyanotic, swollen, scarred or covered with rash What can be done to prevent a hematoma? - - puncture only top wall of vein - remove tourniquet before removing needle - use major superficial veins - apply pressure to site How many times must a sample be discarded before a specimen can be obtained for analysis using an indwelling catheter? - Discard a sample at least 3 times the volume of the line before a specimen is obtained for analysis What causes hemoconcentration (increased concentration of larger molecules & formed elements in blood)? - - prolonged tourniquet application (+2 mins) - massaging, squeezing, or probing site - long term IV therapy - sclerosed or occluded veins What effect may exercise have on pts blood sample? - increases: - CK - AST - LDH - platelet count What effect does stress have on pts blood sample? - Increases: - WBCs - adrenal hormone values (cortisol, catecholamines) - lactate (seen in hyperventilation/anxiety pts) What is the therapy for a red wound? - Keep site moist, clean and protected What is the therapy for a yellow wound? - Topical antimicrobial & application of prep to lift off pus, fibrin & necrotic tissue What is the therapy for a black wound? - Mechanical, surgical or chemical debridement to dissolve black necrotic tissue What is created when the anatomic integrity of the tissue is disrupted? - Wound What is the process whereby the integrity of the tissue is restored? - Healing How is an arterial ulcer diagnosed? - Noninvasive: ABI, US, transcutaneous oxygen pressure Arteriogram What medications are used to increase circulation to the area in question in arterial ulcers? - Pentoxifylline (Trental) Cilostazol (Pletal) What is the most common type of ulcer affecting the lower extremities? - Venous ulcers *medial malleolus *not too painful What is the treatment for venous ulcers? - Controlling edema Compression- typically 40mmHg (compression dressings, stockings, mechanical pumps) What are the 3 phases of wound healing? - Reaction (injury - 72 hrs) Regeneration (72 hrs - 3 weeks) Remodeling (3 weeks - 2 yrs) What phase consists of inflammation? - Reaction What phase consists of formation of granulation tissue, epithelialization & contraction? - Regeneration What phases consists of scar formation? - Remodeling What groups are high risk for wound healing? - Elderly Disabled Bedridden Head injuries Spinal injuries Nonblanchable erythema of INTACT skin? - Stage 1 pressure ulcer - fill dead space (VAC) -pressure reduction (Clinitron bed) What type of topical dressing is used for activation of wound environment? - Dynamic dressing - biological support (Apligraf) - remove nonvital tissue (Accuzyme) What activates endothelial cells & fibroblasts, stimulates vascular proliferation, migration, and new blood vessel formation & recruits smooth muscle cells and epricytes to stabilize newly formed vessels? - Platelet derived growth factors (pdGF) What modulates protease activity, keeps the growth factor active while bound, delivers growth factor back to wound over time & modifies hostile proteolytic environment of chronic wound? - Oxidized Regenerated Cellulose (ORC)/ Collagen What type of debridement is used for a wound requiring debridement of fibrinous exudate, other necrotic material or slough? - Enzymatic debridement *removes senescent fibroblasts - can't produce cytokines *removes necrotic tissue harboring bacteria Give an example of an enzymatic debridement application? - Accuzyme *apply directly to the wound Panafil What type of dressing is used to decrease bioburden? - Anti-infective dressings (Aquacel Ag) What type of dressing is indicated for venous ulcers or DM ulcers? - Acticoat (nanocrystalline silver coating) Wound with clean granular base; how to treat? - Protect & keep moist Ex- Hydrocolloid, Hydrogel, VAC device, secondary dressing, wet to damp saline Wound with crater; how to treat? - Fill the space with uniform contact Ex- Hydrogel, Alginate, Foam, hydrocolloid, VAC device, wet to damp saline Wound with necrotic/non-viable tissue; how to treat? - Debride and cleanse Ex- enzymatic dressing, hydrogel, calcium alginates, pulse irrigation, VAC device, hypertonic salts, wet to damp saline Wound with exudate; how to treat? - Absorb and contain Ex- Alginate, foam, VAC device, wet to damp saline Wound with sinus, tunnel, undermining; how to treat? - Prevent pre-mature closure, absorb exudate- treat with loose packing Ex- soak gauze w/ hydrogel; calcium alginate if high drainage, VAC device, wet to damp saline Wound with infection; how to treat? - Decrease local bacterial count Ex- pulse irrigation, long acting abx, antimicrobial, VAC device, wet to damp saline Which type of sutures pass through tissue easier & resists bacteria? - Monofilament strands Which type of sutures have greater strength and are easier handling and softer knots? - Multifilament strands List the absorbable synthetic sutures - Vicryl Monocryl PDS II (polydioxanone) Panacryl List the nonabsorbable synthetic sutures - Ethilon & Nurolon (Nylon) Polyester Polypropylene (prolene) List the nonabsorbable organic sutures - Silk (tensile strength 1 yr) List the absorbable organic sutures - Plain gut & chromic gut (collagen) Enzymatic degradation What's the most & least reactive absorbable suture? - Most- Fast gut Least- PDS II What's the most & least reactive non-absorbable suture? - Most- silk Least- prolene What are the stages of healing? - Inflammatory 0-7 - wound strength is minimal Proliferation 7-21 - rapid increase in wound strength Maturation 21+ - further CT remodeling What % of tensile strength is achieved by 2 weeks? - 25% Which type of organic absorbable suture is used for superficial skin closing? - Fast gut (5-7 days) Which type of organic absorbable suture is used for superficial blood vessels? - Plain gut (7-10 days) Which type of organic absorbable suture is used for oral mucosa or tongue? - Chromic gut (10-14 days) What is the most common absorbable suture used? - Coated vicryl Most useful in fascia closure & as buried subcutaneous (ID) suture What is the fastest absorbing synthetic suture that is only used for superficial skin & mucosa? - Coated vicryl rapide What type of suture is used for SC areas with stress (joint surfaces)? - PDS II over joint surfaces: knees, elbows What type of suture is used for extended wound support, *general soft tissue & orthopedics, tendons, ligaments, & used in pts with compromised wound healing*(steroids, CA pts, obesity, malnourished)? - Panacryl What type of suture is used in areas such as the periocular area, lips, & other mucosal surfaces- loses strength when exposed to moisture? - Silk What type of suture is used in abdominal wall closures? - Steel What are the 2 types of needle points? - Taper point - soft, easy to penetrate skin Cutting point- tough, hard to penetrate skin Skin suture used for face, fingers, cosmetics? - 6-0 prolene Skin suture used everywhere, including dorsal of hand? - 5-0 ethilon Skin suture NOT used on face - 4-0 ethilon Most common SC closure, face? - 5-0 Vicryl Strong SC suture? - 4-0 Vicryl or PDS II What suture is used for tight spaces? - 5-0 vicryl What suture is used for intranasal & intraoral? - Intranasal - 5-0 chromic gut Intraoral - 4-0 chromic gut