Chapter 014


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  • What are parenteral dosages, and why are some medications given parenterally? Parenteral refers to regions outside of the gastrointestinal tract. Parenteral medications are given when the medications cannot be taken by mouth or when rapid action is necessary. How are parenteral medications administered? Parenteral medications are administered by subcutaneous injection (beneath the skin), by intramuscular injection (within the muscle), by intradermal injection (within the skin), or intravenously (within the vein).
  • One advantage to intravenous (IV) administration of parenteral medications is that the patient does not have to endure the discomfort of multiple injections. How can parenteral medications be administered intravenously? Parenteral medications can be administered intravenously by themselves when they are diluted, in conjunction with existing IV fluids, or in addition to IV fluids.
  • An ampule is a single-dose container that must be broken at the neck to withdraw the drug. A vial is a glass or plastic container that is sealed with a rubber stopper. Vials generally contain more than one dose of medication. A Mix-O-Vial is used to package unstable drugs and allows the components to be combined just before administration. Pressure is applied to the top of the vial to release the stopper between the compartments and allow the drug to be mixed. A prefilled disposable syringe can be used to supply parenteral medications.
  • What are the three parts of a syringe? The three parts of a syringe are the tip, barrel, and plunger. What are the three types of syringes? The three types of syringes are hypodermic, tuberculin, and insulin syringes.
  • Hypodermic syringes are identified by the amount of fluid they can measure. One of the most commonly used sizes is the 3-mL syringe. What is the smallest division that can be read in milliliters on this syringe? The smallest division that can be read on the syringe is 0.10 mL. Therefore, when reading this syringe, it is important to remember that each shorter line represents another 0.1 mL.
  • A tuberculin syringe is a 1-mL syringe that has markings for milliliters and minims. In what situations are tuberculin syringes used? Tuberculin syringes are commonly used in pediatrics and to measure medications administered in very small amounts. What is the smallest division that can be read in millimeters on this syringe? The smallest division that can be read on the syringe is 0.01 mL. Each shorter line represents 0.01 mL, and each longer line represents 0.5 mL.
  • Why has the Occupational Safety and Health Administration (OSHA) recommended the administration of parenteral medications with the use of a needleless system? This recommendation helps protect both the patient and the nurse from needlesticks because the needleless system provides a shield that covers the needle device.
  • The physician’s order and the available drug must be in the same system of measurement before you can write a proportion for the actual amount of medication to be administered. Convert measures into the same system before writing the proportion problem. 1 gr = 60 mg 1 gr : 60 mg :: 0.01 gr : x mg x = 0.6 mg
  • How many milliliters of heparin will be administered? 10,000 units : 1 mL :: 5000 units : x mL 10,000 x = 5000 x = 5000 ÷ 10,000 x = 0.5 mL The nurse will administer 0.5 mL.
  • How many milliliters will the nurse administer? First, convert grains to milligrams. 1 gr = 60 mg Then apply the alternative formula. [(30 mg)/(60 mg)] × (5 mL) = x x = 2.5 mL The nurse will administer 2.5 mL.
  • How many milliliters of KCl will be added to the 500 mL of D 5 W? 40 mEq : 20 mL :: 20 mEq : x mL 40 x = 400 x = 400 ÷ 40 x = 10 mL The nurse will add 10 mL of KCl to the 500 mL of D 5 W.
  • Chapter 014

    1. 1. Chapter 14 & 15 Parenteral and Units Dosages
    2. 2. Parenteral Dosages FIGURE 14-1 Intramuscular, subcutaneous, and intradermal injections, with comparison of the angles of insertion. (From Potter PA, Perry AG: Fundamentals of nursing, ed 7, St Louis, 2009, Mosby.)
    3. 3. Parenteral Dosages (cont’d) <ul><ul><li>May be diluted and administered by themselves </li></ul></ul><ul><ul><li>May be administered in conjunction with existing IV fluids </li></ul></ul><ul><ul><li>May be administered in addition to IV fluids </li></ul></ul>
    4. 4. Parenteral Dosages (cont’d) <ul><ul><li>Packaging of parenteral medications: </li></ul></ul><ul><ul><ul><ul><ul><li>Ampules </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Vials </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Mix-O-Vials </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Syringes </li></ul></ul></ul></ul></ul>
    5. 5. Syringes
    6. 6. Syringes FIGURE 14-8 Parts of a syringe. (From Potter P, Perry A: Fundamentals of nursing , ed 7, St Louis, 2009, Mosby.)
    7. 7. Hypodermic Syringes FIGURE 14-9 Calibrations on a 3-mL syringe. ( From Clayton BD, Stock YN, Cooper S: Basic pharmacology for nurses , ed 15, St Louis, 2010. )
    8. 8. Tuberculin Syringes FIGURE 14-10 BD tuberculin syringes. (From Becton, Dickinson and Company, Franklin Lakes, NJ.) 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00 mL 4 8 12 16
    9. 9. Needleless System FIGURE 14-14 A, Needleless infusion system. B, Connection into an injection port. (From Elkin MK, Perry AG, Potter PA: Nursing interventions and clinical skills, ed 4, St Louis, 2007, Mosby.) A B
    10. 10. <ul><ul><ul><li>Example: </li></ul></ul></ul><ul><ul><ul><li>A physician orders atropine gr 0.01 IM stat. Atropine 0.4 mg/mL is available. Convert the physician’s order to milligrams. </li></ul></ul></ul>
    11. 11. <ul><ul><ul><li>Example: </li></ul></ul></ul><ul><ul><ul><li>The physician orders heparin 5000 units subcutaneous stat. Heparin 10,000 units/mL is available. How many milliliters of heparin will be administered? </li></ul></ul></ul>
    12. 12. <ul><ul><ul><li>Example: </li></ul></ul></ul><ul><ul><ul><li>The physician orders morphine 30 mg IM q4 h prn for pain. Morphine gr 1/0.5 mL is available. How many milliliters will the nurse administer? </li></ul></ul></ul>
    13. 13. <ul><ul><ul><li>Example: </li></ul></ul></ul><ul><ul><ul><li>The order states D 5 W 500 mL plus KCl 20 mEq at 42 mL/h IV. KCl is supplied in a 20-mL ampule containing 40 mEq. How many milliliters of KCl will be added to the 500 mL of D 5 W? </li></ul></ul></ul>
    14. 14. Insulin and Units Brenda Holmes MSN/Ed RN
    15. 15. Insulin and Units <ul><li>Medications: </li></ul><ul><ul><li>Insulin (see handout on a few types) </li></ul></ul><ul><ul><li>Penicillin </li></ul></ul><ul><ul><li>Epogen </li></ul></ul><ul><ul><li>Heparin </li></ul></ul>
    16. 16. Each line represent 1 unit
    17. 18. <ul><ul><ul><li>Example: </li></ul></ul></ul><ul><ul><ul><li>Physician orders Humulin L Lente U-100 insulin 46 units plus regular Humulin R U-100 20 units subcutaneous every morning. You have 100 units/mL of Humulin L Lente insulin and 100 units/mL of regular Humulin R insulin. A U-100 insulin syringe is available. Draw vertical lines through the syringe to indicate the correct doses. </li></ul></ul></ul>
    18. 19. Asking: Units Ordered: Humulin Lente 46 units Humulin R 20 units Available: 100 units/mL
    19. 20. Lente 46 units Regular 20 units