Vaccine Exam

After

Documentation should be done ________ the medication has been given

1. name of medication

2. dose

3. site

4. route

5. time

6. manufacturer

7. lot number

8. expiration date

9. name of ordering provider

10. patient response

10 parts of vaccine documentation

1. date of procedure

2. time of procedure

3. number of attempts to start IV

4. site

5. type of catheter used

6. size of catheter used

7. name of solution hung

8. amount of solution hung

9. patency

10. rate of flow

11. appearance of site

12. patient toleration of procedure

steps for documentation of starting an IV

1. time of discontinuance

2. amount of solution administered

3. status of catheter removed

4. appearance of site upon removal of catheter

5. patinent response

Steps to discontinuing an IV

15 minutes

patient condition, status of IV site and patency, and current vital signs are assessed and documented every _______

1. right patient

2. right medication

3. right dose

4. right route

5. right time

6. expiration date of medication

7. right needle size

7 safety checks for administering medications

1000 mg

1 gm =

5 ml or 5 cc

1 tsp =

30 ml

1 oz =

1 Liter

1000 ml =

1 kg

2.2 lb =

diphenhydramine hydrochloride, antihistamine

benadryl =

acetaminophen, anti-pyretic and pain relief

tylenol =

ibuprofen, reduce fever, inflammation, and/or pain

motrin =

ceftriaxone, antibiotic

rocephin

methylprednisolone sodium succinate, anti-inflammatory cortico-steroid

solu-medrol

medroxyprogesterone, contraceptive management

depo-provera

ketorolac, short term treatment for pain

toradol

weight of drug:number of tablets/amount of liquid

what do the ratio for dosing mean

units

drug problems should always be set up with the _______ of measure included with the numbers

D/H x Q = X

Formula for solving dosing

single dose vial, pre-filled syringes, and ampules

use once and then discard

multi-dose vial

number of uses depends on size of vial and dose ordered

28 days from opening

when do multi-use vials expire

filter needle

this is used to remove tiny glass particles that result when glass ampules are opened.

Micromedex/UpToDate

these are. used to check medications being mixed are compatible

two or more vial stoppers or is misconfigured

when should a needle be changed

22-25

gauge needle used for IM injections

20 g

gauge needle used for thicker IM injections

minimum of 1”

separation needed for multiple IM vax in same site

5-10 minutes

onset of medication post IM injection

Iron, vitamin B12, Lupron

shots that use Z-track method

seal

the purpose of a Ztrack method is to give medication deep IM, create a _______ over the entry route, and to minimize tissue irritation

change the needle

to reduce the risk of irritation for a ztrack method, _________ after drawing up medication

90 degrees

Angle the needle is inserted for Ztrack, airlock, and regular IM vax methods.

10 seconds

for ztrack method if giving an irritating medication, wait about _________ to withdraw the needle

do not massage

when using Ztrack method, ____________ as this will displace medication into the SC tissue

0.2 mL to 0.3 mL

when doing air-lock IM method, aspirate around _________ of air in the syringe to clear out medication in the needle

change the needle

_______ for airlock method after aspirating

last

in airlock method, the air that was aspirated should be the ______ to exit the needle

5/8”, 22g-25g, anterolateral thigh muscle

Newborns (1-28 days) IM vax needle length, gauge, and location

1”, 22g-25g, anterolateral thigh muscle

infants (1-12 months) IM vax needle length, gauge, and location

1-1 1/4”, 22g-25g, anterolateral thigh

toddlers/preschoolers (1-3 years) IM vax needle length, gauge, and location

5-8” - 1” or 1” - 1 1/4”, 22-25g, deltoid muscle or anterolateral thigh

Children & Teens 4-18 years IM vax needle length, gauge, and location

5-8” - 1”/1”-1 1/2”/1 1/2”, 22-25g, deltoid muscle of the arm

adults over 19 years (male or female <130 LBS/female 130-200 or male 130-260/female 200+ or male 260+) IM vax needle length, gauge, and location

4 years of age

we begin giving injections to children in the deltoid at _______

3 years of age, walking for one year

for gluteal region IM vax it is at _________ and the child has been _________

Z-track injection

for the dorsogluteal site, you may administer a _________ through this site

23-25 g

gauge needle used for SubQ injections

15 minutes

onset of medication post SC injection is ______________

45 degrees

angle needle is injected in for SubQ injections

90 degrees at ½ inch

angle and length of needle used for Lovenox/Lantus injections

False

Should SubQ injections be massaged.

5/8”, 23-25g, fatty tissue over thigh muscle

SubQ vax for infants (1-12 months) needle length, gauge, and location

5/8”, 23-25g, fatty tissue over thigh muscle

Children >12 months, adolescents, and adults SubQ needle length, gauge, and injection site

0.5 mL

deltoid 4-15 years maximum injection volume/single injection

up to 2 mL

deltoid >15 years to adult maximum injection volume/single injection

up to 1 mL

rectus femoris infant/toddler maximum injection volume/single injection

up to 1.5 mL

rectus femoris preschool age maximum injection volume/single injection

1 mL

ventrogluteal >3 years maximum injection volume/single injection

up to 1.5 mL

ventrogluteal preschool maximum injection volume/single injection

up to 2 mL

ventrogluteal school age maximum injection volume/single injection

up to 2.5 mL

ventrogluteal older child to adult maximum injection volume/single injection

up to 1.5 mL

dorsogluteal 3-6 years maximum injection volume/single injection

up to 2 mL

dorsogluteal 6-15 years maximum injection volume/single injection

2.5 mL

dorsogluteal >15 years to adult maximum injection volume/single injection

0.5 mL

other aspect of upper arm infant > 12 months/toddler maximum injection volume/single injection

up to 1 mL

other aspect of upper arm older child to adult maximum injection volume/single injection

1. tissue ischemia

2. sterile abscess

3. nodules

4. poor or rapid absorption

5. temporary or permanent damage to sciatic nerve

6. punctured superior gluteal artery

7. bone bruising/bruising around injection site

8. bacteria introduction into blood system

9. lipodystrophy

10. poor absorption secondary to musce mass or scarring which can be secondary to repeated injections

incorrect technique outcomes of vaccines

26-27g

gauge needle for intradermal injections

3/8 inch

needle length for intradermal injections

15 degrees

angle needle should be inserted for intradermal injections

bevel up

orientation of needle inserted into skin for intradermal injection

True

true or false: you should not massage intradermal injections

5 (0.1 mL)

a standard dose is _______ Tuberculin units for the PPD test

48-72

PPD test is read _____ after administration

0 mm

if someone does not react to the skin test, what is the result

5 mm or more

a positive result is at ________ when:

• HIV-infected person

• recent contact of a person with TB disease

• persons with fibrotic changes on chest xray consistent with prior TB

• patients with organ transplants and other immune-suppresed patients

10 mm

a positive result is at ________ when:

• recent arrivals (<5 years) from high-prevalance countries

• injection drug users

• residents and employees of high-risk congregated settings

• myobacteriology lab personnel

• persons with clinical conditions that place them at high risk

• children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories

15 mm

a positive result is at ______ when there is a person with no known risk factors for TB

NOT

a BCG vaccination should ____ influence the interpretation of a PPD test.

aspiration

the main precaution when administering medications this way is to protect the patient from ________

30-45 minutes

onset of oral medication action post administration is ___________

immediate

onset of medication post-subligual is ________

5 minutes

amount of time someone should lay down after receiving nasal medication

15 minutes

patient should avoid blowing their nose for _________ after receiving nasal medication

upward and outward

to straighten the the ear canal in adults you pull the auricle __________

down and back

to straighten the ear canal in children you pull the auricle _______

2-3 minutes

the amount of time the patient should remain in the position after receiving ear medication

dorsal recumbent

position patient needs to be in to administer vaginal medication

sims’

position patient needs to be in for rectal medication administration

10 degrees

angle the IV is inserted in

take vital signs

this needs to be done before administering IV medication

lightheadedness, increased heart rate, tremors (shaking), and severe coughing

potential side effects of nebulization therapy

2.5 mg/3mL

standard dose of albuterol sulfate

height and age

peak flow can be obtained pre and post nebulization. Need to have the person’s ____________ for this test.

1. recount the narcotics

2. check the narcotics log for mathematical errors

3. check the narcotic box for loose medications

4. notify supervisor

5. document finding

steps for when an error is noted in the narcotics

0.3 mL

the normal amount of epinephrine given for an adult is ______

3 seconds

the epipen should be held firmly against the thigh for ____________ after injection