Nursing Fundamentals: Medication Administration, Documentation, Mobility, Education, and Safety

Comprehensive practice flashcards in vocabulary format covering medication administration (injection techniques, needle parameters, insulin types), healthcare documentation and clinical judgment, mobility and immobility management, patient education frameworks, and clinical patient safety protocols based on lecture materials.

Filter Needle

A specialized needle used when preparing medication from a glass ampule to aspirate the solution and prevent glass particles from entering the syringe; it must be replaced with an appropriate size needle or needleless device before administration.

Ampule Medication Preparation

The procedure of opening a single-dose glass container by wrapping the neck in a paper towel, snapping the neck off, holding the ampule upside down to aspirate medication with a filter needle, and changing the needle prior to injection.

Vial Medication Preparation

The technique of withdrawing medication from a rubber-stoppered vial by first injecting a volume of air equal to the desired dose, reconstituting powder with diluent (sterile water or normal saline) if needed, and labeling multidose vials with date, time, and initials.

Parenteral Injection Angles

The precise angular insertions used for needle administration: Intramuscular ($90^\circ$), Subcutaneous ($45^\circ$ and $90^\circ$), and Intradermal ($15^\circ$).

Needle Safety and Sharps Disposal

Safety mandates requiring immediate disposal of sharps into marked, puncture- and leak-proof containers without forcing; used needles must never be placed in wastebaskets, pockets, or patient trays, and needlesticks require immediate reporting and blood draws.

Rapid-Acting Insulin

Insulin formulations (NovoLog, Humalog, Apidra) administered SUBQ or IV that exhibit an onset of $5\text{--}15\text{ min}$, peak action within $30\text{--}120\text{ min}$, and a duration of approximately $3\text{--}5\text{ hours}$.

Short-Acting Insulin (Regular / R)

Insulin administered SUBQ or IV with an onset of $30\text{ min}$. The U-100 formulation peaks in $2\text{--}4\text{ hours}$ with a duration of $5\text{--}8\text{ hours}$, whereas U-500 peaks in $4\text{--}8\text{ hours}$ with a duration of $14\text{--}15\text{ hours}$.

Intermediate-Acting Insulin (NPH)

Insulin (Humulin N, Novolin N) administered strictly via the subcutaneous (SUBQ) route, with an onset of $2\text{--}4\text{ hours}$, a peak of $4\text{--}10\text{ hours}$, and a duration of $10\text{--}18\text{ hours}$.

Long-Acting Insulin

Basal insulin formulations (Levemir, Lantus, Toujeo) administered SUBQ only, having an onset of $1\text{--}4\text{ hours}$, no peak (or $6\text{--}8\text{ hours}$ for Levemir), a duration of up to $24\text{ hours}$, and which must never be mixed with other insulins.

Insulin Mixing Sequence

The multi-step process for combining insulins in one syringe: inject air into intermediate/cloudy vial (A), inject air into regular/clear vial (B), withdraw clear insulin (B), and finally invert and withdraw cloudy insulin (A) to prevent contaminating the regular vial.

Sample Sliding Scale (SSS)

A protocol for administering Humulin R U-100 based on pre-meal and bedtime fingerstick glucose: $0\text{--}180\text{ mg/dL}$ receives no coverage, $181\text{--}240\text{ mg/dL}$ receives $2\text{ units}$, $241\text{--}300\text{ mg/dL}$ receives $4\text{ units}$, $341\text{--}400\text{ mg/dL}$ receives $6\text{ units}$, and $>400\text{ mg/dL}$ receives $8\text{ units}$ with HCP notification.

Intramuscular (IM) Needle Sizing

Needle dimensions for deep muscle injections: Adults use $18\text{--}25\text{ G}$ ($1\text{--}1.5\text{ inches}$); children use $22\text{--}25\text{ G}$ ($0.5\text{--}1\text{ inch}$); deltoid injections specifically require a $25\text{ G}$, $1\text{-inch}$ needle.

Ventrogluteal Site (V Method)

An IM landmarking technique targeting the gluteus medius: place the palm heel on the greater trochanter with the thumb toward the groin and index finger on the anterior superior iliac spine, spreading the middle finger toward the iliac crest to form a injection triangle.

Ventrogluteal Site (G Method)

An alternative IM landmarking method established by drawing lines connecting the greater trochanter to the iliac crest, extending to the anterior superior iliac spine, and returning back down to the greater trochanter.

Vastus Lateralis Injection Site

An intramuscular injection site located on the anterior lateral aspect of the thigh in the middle third between the greater trochanter and the patella, preferred for infants, toddlers, and children, and also utilized for adults.

Deltoid IM Injection Site

An IM injection site located $1\text{--}2\text{ inches}$ below the lower edge of the acromion process in the center of an inverted triangle; because the muscle is small, adult doses must be restricted to no more than $2\text{ mL}$.

Z-Track Method

An IM administration technique where the skin and tissue are pulled laterally before insertion, the needle is held in place for $10\text{ seconds}$ after injection, and the skin is released upon withdrawal to create a zigzag path sealing medication within the muscle.

Subcutaneous (SUBQ) Injections

Medication delivery into adipose tissue using a $24\text{--}27\text{ G}$ needle ($\frac{1}{8}\text{--}\frac{5}{8}\text{ inch}$ at $45^\circ$ or $\frac{1}{2}\text{ inch}$ at $90^\circ$), given in the abdomen, upper outer arm, anterior thigh, or dorsogluteal area.

Intradermal (ID) Injection

A superficial injection delivered at a $15^\circ$ angle into the dermis using a fine-gauge needle (such as $30\text{ G}$) to produce a bleb (wheal), commonly used for Tuberculin PPD testing read within $48\text{--}72\text{ hours}$.

Indications for IV Therapy

Clinical purposes for intravenous line placement including access for medication administration, emergency therapies, fluid hydration, parenteral nutrition, blood transfusions, venous blood sampling, and keeping veins open (KVO/saline locks).

HCP-Only Parenteral Routes

Physician-restricted injection routes targeting specialized anatomical cavities: Epidural (epidural space), Intrathecal (subarachnoid space/brain ventricles), Intraosseous (bone marrow), Intra-peritoneal, Intra-pleural, Intra-arterial, Intra cardial, and Intra-articular (joints).

Electronic Health Record (EHR)

A comprehensive, longitudinal digital record encompassing an individual's lifetime health and healthcare history across multiple encounters and settings.

Electronic Medical Record (EMR)

A digital record created and maintained within a single healthcare facility detailing clinical care and data for an individual healthcare visit.

ARRA and HITECH Acts

Federal legislative drivers (American Recovery and Reinvestment Act & Health Information Technology for Economic and Clinical Health Act) that mandated and financially incentivized healthcare organizations to adopt electronic records.

Purposes of a Health Care Record

Core operational functions of clinical documentation: facilitating interprofessional communication, providing a legal record of care, justifying financial reimbursement, supporting quality improvement, and providing educational and research data.

Standards for Quality Nursing Documentation

Six professional principles required for clinical charting: factual (objective, clear), accurate (exact measurements), appropriate use of abbreviations, current (timely at point of care), organized (logical sequence), and complete.

Military Time

A $24\text{-hour}$ clock format running continuously from $00:00$ to $24:00$ used in healthcare to document events accurately and prevent errors associated with AM/PM designations.

Charting by Exception (CBE)

A documentation methodology where only significant abnormalities, deviations from defined institutional norms, or unique findings are recorded in narrative notes.

SBAR Documentation

A standardized interprofessional communication framework structured into four concise components: Situation, Background, Assessment, and Recommendation.

Patient Acuity Rating System

A standardized scoring tool used to classify patients into four risk categories (Level 1: Stable, Level 2: Moderate-risk, Level 3: Complex, Level 4: High-risk) to determine staffing needs and care hours every shift or $24\text{ hours}$.

Home Care Documentation Data Sets

Standardized assessment systems—specifically the Outcome and Assessment Information Set (OASIS) and the Omaha System—used by home health nurses to establish eligibility and justify Medicare/Medicaid reimbursement.

Minimum Data Set (MDS)

A federally mandated, comprehensive clinical assessment and screening tool used in long-term care facilities to evaluate resident functional capabilities and create individual care plans.

Six Functions of Clinical Judgment

The sequential cognitive process mapped to the nursing process: Recognize Cues (Assessment), Analyze Cues (Analysis), Prioritize Hypotheses (Analysis/Planning), Generate Solutions (Planning), Take Action (Implementation), and Evaluate Outcomes (Evaluation).

Physical Activity Guidelines

Health promotion standards recommending adults engage in at least $150\text{ minutes/week}$ of moderate-intensity aerobic physical activity along with muscle-strengthening activities at least $2\text{ times}$ per week.

Isotonic Exercise

Dynamic physical activity that involves active muscle contraction and joint movement, such as walking, jogging, swimming, bicycling, or active range-of-motion arm lifts.

Isometric Exercise

Static physical activity involving muscle contraction and increased tension without joint movement or change in muscle length, such as planks, quadriceps tightening, or hip lifting.

Bedside Mobility Assessment Tool (BMAT)

A four-step progressive patient mobility evaluation assessing: Level 1 (core stability/sit and shake hands), Level 2 (lower extremity strength/stretch and point), Level 3 (standing strength), and Level 4 (standing balance and step test).

Timed Up and Go (TUG) Test

A clinical functional test measuring the time it takes a patient to stand from a $17\text{-inch}$ chair, walk $3\text{ meters}$ ($10\text{ feet}$), turn, return, and sit back down; taking $>12\text{ seconds}$ indicates high fall risk.

Pressure Points of Immobility

Bony prominences vulnerable to skin breakdown during prolonged positioning: lateral (ear, shoulder, trochanter, malleolus), supine (occiput, dorsal thoracic, elbows, sacrum/coccyx, heels), and seated (scapulae, sacrum, ischial tuberosities).

Katz Index of ADLs

A validated functional tool evaluating independence or dependence across six basic activities of daily living: bathing, dressing, toileting, transferring, continence, and feeding.

Lawton-Brody IADLs Scale

An assessment instrument measuring independence in eight complex instrumental daily activities: telephone use, food preparation, housekeeping, laundry, transportation, medication management, and handling finances.

Range of Motion (ROM): Active vs. Passive

Therapeutic joint mobility exercises; Active ROM is performed independently by the patient, whereas Passive ROM is manually performed by the nurse or therapist to prevent contractures without patient effort.

Braden Scale

An evidence-based clinical assessment evaluating pressure injury risk across six subscales: Sensory Perception, Moisture, Activity, Mobility, Nutrition, and Friction & Shear.

Integumentary Immobility Interventions

Preventative nursing protocols requiring turning and repositioning bed-bound patients every $2\text{ hours}$, shifting wheelchair weight every $15\text{ minutes}$, and utilizing low-air-loss specialized mattresses.

Orthostatic Hypotension

A drop in blood pressure accompanied by an increased heart rate upon moving from supine to upright, caused by cardiovascular deconditioning from immobility; managed via progressive position changes and leg exercises prior to standing.

Safe Patient Handling (SPH) Interprofessional Roles

Collaborative roles including the RN (assessments, plans, directing protocols), PT (gait and equipment evaluation), RNA (restorative walking/exercise), and UNA (delegated repositioning and transfers under RN supervision).

Bloom's Taxonomy (Revised)

A hierarchical framework categorizing cognitive learning domains from foundational to complex: Remembering, Understanding, Applying, Analyzing, Evaluating, and Creating.

Affective Learning Domain

A category of learning that deals with changes or growth in attitudes, values, emotional acceptance, and expressions of feeling regarding health and illness.

Psychomotor Learning Domain

A category of learning focused on hands-on physical movements, motor skill coordination, and bodily integration required to perform clinical or self-care procedures.

VARK Learning Styles

A model defining sensory learning preferences: Visual (diagrams/images), Auditory (verbal explanations/listening), Reading/Writing (text/lists), and Kinesthetic (hands-on practice/touch).

ABCD Model for Learning Objectives

A four-part structure for crafting patient education goals: Audience (learner: 'The patient will…'), Behavior (observable action), Condition (under what circumstances), and Degree (measurable performance standard/accuracy).

Teach-Back Method

A closed-loop patient education technique in which the nurse asks the patient to explain or demonstrate the taught concepts in their own words to confirm comprehension and identify gaps.

Never Events

Severe, largely preventable healthcare-acquired adverse conditions categorized by CMS/NQF that should never occur, such as CAUTIs, CLABSIs, surgical site foreign bodies, and serious fall injuries.

STEADI Fall Risk Assessment

A CDC fall-prevention screening algorithm for community-dwelling adults aged $65\text{ and older}$ evaluating prior fall history, balance, gait aid reliance, medications, and fear of falling.

Single Leg Stance Test

A timed physical balance assessment where a patient's inability to stand unsupported on one leg for at least $5\text{ seconds}$ during a $30\text{-second}$ window indicates a significantly increased risk for injurious falls.

30-Second Sit to Stand Test

A functional leg-strength test measuring chair-stand repetitions completed in $30\text{ seconds}$; achieving $<12\text{ reps}$ for women or $<14\text{ reps}$ for men (ages $60\text{--}64$) indicates lower-extremity weakness.

RACE Protocol

The standard hospital fire safety emergency sequence: Rescue and remove patients in danger, Alarm (activate fire pull box), Confine fire (close doors and windows), and Extinguish or Evacuate.

PASS Protocol

The four sequential steps for proper fire extinguisher operation: Pull the locking pin, Aim the nozzle at the base of the fire, Squeeze the handle levers, and Sweep from side to side.

Restraint Monitoring Standards

Strict safety regulations requiring face-to-face observation every $15\text{ minutes}$ for violent patients, evaluation every $2\text{ hours}$ for nonviolent patients, and physical release of the restraint at least every $2\text{ hours}$ for skin and neurovascular checks.

Restraint Alternatives

Proactive clinical strategies implemented before physical or chemical restraints: frequent reorientation, 1:1 sitters, unrecorded video monitoring (AvaSys), camouflage of IV lines/tubes, diversional activities, and addressing unmet toileting or pain needs.