Administering Injections

Assessment:

Compare medications listed against physician’s orders. Check if drug requires skin testing of if ST has been done, checks for result. Assess psychological and physical status including size and general build, and assess need for assistance. Check for age, weight and height. Check medication available and reference for safe child’s dosage. Determine appropriate needle and syringe to be used. Determine other equipment needed.

Planning:

Plan a method of approaching and restraining a child appropriately. Wash hands observing proper technique. Gather needed equipment.

Implementation:

Rea form charts/kardex the name of drug ordered. Take from shelf/drawer and check label and expiry date of medication. Draw up correct dosage of medication from vial. Clean top of vial and allow to dry. Discard alcohol swab appropriately. Prepare syringe and needle. Draw appropriate volume of air into syringe. Insert needle into vial through rubber stopper. Inject air into vial. Pick up vial nondominant hand, and withdraw required volume of drug. Examine for air bubbles and expel them. Recheck volume of medication for accuracy. Remove needle from vial. Replace needle guard. Change needle appropriate for injection. Observe sterile technique  throughout the procedure. From vials, wash hands and observe other appropriate infection control procedures. Prepare the medication vial for drug withdrawal. Mix the solution, if necessary, by rotating the vial between the palms of the hands, not by shaking. Remove the protective cap or clean the rubber cap of a previously opened vial with an antiseptic wipe by rubbing in a circular motion. Withdraw the medication. Attach a filter needle, as agency practice dictates, to draw up premised liquid medications from multi-dose vials. Ensure that the needle is firmly attached to the syringe. Remove the cap from the needle, then draw up into the syringe the  amount of air equal to the volume of the medication to be withdrawn. Carefully insert the needle into the upright vial through the center of rubber cap, maintaining the sterility of the needle. Inject the air into the vial, keeping the bevel of the needle above the surface of the medication. Withdraw the prescribed amount of medication using either one of the following methods: Hold the vial down, move the needle tip so that it is below the fluid level, and withdraw the medication. Avoid drawing up the last drops of the vial. Invert the vial, ensure the needle tip is below the fluid level. And gradually withdraw the medication. Hold the syringe and vial at eye level to determine that the correct dosage of drug is drawn into the syringe. Eject air remaining at the top of the syringe into the vial. When the correct volume of medication is obtained, withdraw the needle from the vial and replace the cap over the needle using the scoop method, thus maintaining its sterility. If necessary, tap the syringe barrel to dislodge any air bubbles presenting the syringe. Replace the filter needle, if used, with a regular needle and cover of the correct gauge and length before injecting the client.

Evaluation:

The right patient received the right medication in the right dosage by the right route at the right time. The criteria, specified in the plan of care(NCP) established for ascertaining the effectiveness of a specific drug were used. Side effects, if present, were promptly identified and recorded.    Necessary referrals were made.

Documentation:

Record appropriately according to the policy of the facility.

Tracheostomy Care

Assessment:

Assess breathing pattern. Listen to the breath sounds. Observe for infection. Observe for hypoxia. Assess the needs of the patient with a tracheostomy for suctioning and cleaning.

Planning:

Wash your hands. Obtain the necessary equipment, as follows: Tracheostomy tube, mask, sterile gloves, self-inflating breathing bag, sterile water, sterile suction catheter, sterile syringe, normal saline if saline is to be instilled, sterile gauze squares, eye protection, portable suction machine and suction trap, if a spectrum specimen is needed.

Implementation:

Identify the patient. Provide privacy. Explain the procedure. Establish a way communicating with a tracheostomy patient. Test the suction apparatus. Place the patient on supine or in Mid-fowler’s position. Turn the patients head slightly toward you. Place the unconscious patient in the lateral position facing you. Put an eye protection and mask. Prepare 5ml sterile saline in a syringe. Open the sterile suction set, and prepare the equipment. Place the drape from the kit or a clean towel over the patient’s chest. Most kits contain a pocket of solution, sterile gloves, the sterile suction catheter and sterile gauzesquares. If the kit contains all this equipment, first put on gloves. Pour the saline into the basin. Hold the catheter in your dominant hand. And use the non-dominant hand to hold the suction taking to control the suction and to handle any after unsterile object. The non-dominant hand is now contaminated and cannot touch the catheter. The second person attaches the breathing bag to the oxygen source and prepares to ventilate the patient. The second person attaches the breathing bag to the tracheostomy tube and provides three deep breaths coordinated with the patients breathing pattern. Instill the  normal saline into the tracheostomy. Control the suction with your unsterile gloved hand while suctioning with your sterile hand. Insert the catheter 4 to 5 inches into the tracheostomy without occluding the part on the suctioning catheters. Apply the suction by closing the system. This is done placing you thumb over the post or side opening at the base of the catheter. Apply suction for only 10 seconds. Withdraw the catheter, rotating it gently while you continue suctioning. Rinse the catheter with sterile water or normal saline. The second person provides ventilation immediately after the suction catheter is removed. Observe the patient for dyspnea after the suction catheter is removed. If hypoxia occurs, immediately provides additional deep breaths of oxygen. Turn off the suction and listen for clear breath sounds. If breathing is not clear, repeat suctioning method. If breathing sounds clear, uses the breathing bag to provide 3 or 4 deep breaths of oxygen Disconnect the catheter from the suction tubing. Grasp the cuff of the sterile glove, and pull the glove down over the used catheter. Discard all disposable equipment. Wash your hands and provide oral hygiene.

Evaluation:

Evaluate using the following criteria: tracheostomy tube in place, respiratory rate and depth normal, breath sounds clear and patient resting comfortably.

Documentation:

Record the procedure and observation on the patients chart. Amount and description of secretions and patient’s response to the procedure.

Surgical Scrub Procedure: Brush-Stroke Method

A prescribed number of brush strokes, applied lengthwise of the brush or sponge, is used for each surface of the fingers, hands and arms. A short prescrub wash loosen surface debris and transient organisms. Scrub by brush or sponge removes resident flora.

Wet the hands and arms. Wash the hands and arms thoroughly to 2 inches (5cm) above the elbow with an antiseptic agent. With the hands held under running water, clean under the fingernails carefully with a metal or disposable plastic nail cleaner. Discard the cleaner after  use. Rinse the hands and arms thoroughly under running water, keeping the hands up and allowing water to drip from the elbows. Take a sterile brush or sponge from a dispenser or package. Apply an antiseptic agent to the brush or sponge (if not previously impregnated.) scrub the nails of one hand 30 strokes, all side of each finger 20 strokes, the back of the hand 20 strokes, the back of the hand 20 strokes, the arms 20 strokes for each third of the arm, to 2 inches (5cm) above the elbow. Repeat step 6 for the other hand and arm. Rinse the hands and arms thoroughly.

Bag Technique

Planning:

Gather all necessary equipment, as follows: paper lining, extra paper for making bag for waste materials (paper bag), plastic/linen lining, apron, hand towel in plastic bag, soap in soap dish, thermometers in case (one oral and rectal), 2 pairs of scissors (1 surgical and 1 bandage), 2 pairs of forceps (curved and straight), syringes (5ml and 2 ml), Hypodermic needles G. 19, 22, 23, 25, sterile dressings (OS, CB), sterile cord tie, adhesive plaster, dressing (OS, cotton ball), alcohol lamp, Tape measure, Baby’s scale, 1 pair of rubber gloves, 2 test tubes, test tube holder, and Medicines: betadine, 70% alcohol, Ophthalmic ointment, Zephiran solution, hydrogen peroxide, spirit of ammonia, acetic acid, and benedict’s solution.

Implementation:

Upon arriving at the client’s home, place the bag on the table or any flat surface lined with paper lining, clean side out (folded part touching the table). Put bag’s handle or strap beneath the bag. Ask for a basin of water and a glass of water if faucet is not available. Place these outside the work area. Take out hand towel, soap dish and apron and place them at one corner of the work area (within the confines of the linen/plastic lining). Do hand washing. Wipe, dry with towel. Leave the plastic wrappers of the towel in soap dish in the bag. Put on apron right side out and wrong side with crease touching the body, sliding the head into the neck strap. Neatly tie the straps at the back. Put out things most needed for the specific case (e.g. thermometer, kidney basin, cotton ball, waste paper bag) and place at one corner of the work area. Place waste paper bag outside of work area. Close the bag. Proceed to the specific nursing care or treatment. After completing nursing care or treatment, clean and alcoholized the things used. Do hand washing again. Open the bag and put back all articles in their proper places. Remove apron folding away from the body, with soiled side folded inwards, and the clean side out. Place it in the bag. Fold the lien/plastic lining, clean: place it in the bag and close the bag. Make post-visit conference on matters relevant for future visit health care, taking anecdotal notes preparatory to final reporting. Make appointment for the next visit (either home or clinic), taking note of the date, time and purpose.

After care

Before keeping all articles in the bag, clean and alcoholized them. Get the bag from the table, fold the paper lining (and insert), and place in between the flaps and cover the bag.