SubQ Injections

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Outline

Overview

  1. Purpose
    1. Some medications are given under the skin in the subcutaneous layer
    2. Improper administration can make the medication be too shallow (intradermal) or too deep (intramuscular)

Nursing Points

General

  1. Supplies needed
    1. Required medication vial
    2. Appropriate size syringe
      1. Insulin syringe
      2. 1 mL
      3. 3 mL
    3. Appropriate size needle
    4. Alcohol pad
    5. Gauze
  2. Injection sites
    1. Anterolateral thigh
    2. Upper outer tricep
    3. Upper buttocks
    4. Abdomen
  3. Needle size
    1. Length – ½ – ⅝”
    2. Gauge – 26 – 30 g
  4. NOTES
    1. Rotate sites with frequent injections
      1. Especially insulin – risk for maldistribution of fat
    2. Must choose site with good subcutaneous fat layer
    3. With heparin
      1. Do not inject over a bruise
      2. Do NOT press or massage

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Verify provider order
    2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
    3. ALWAYS prepare medications at the patient’s bedside
    4. Gather supplies
    5. Perform hand hygiene
    6. Don clean gloves
    7. Let the patient know what meds they will be receiving
    8. Draw up medication in appropriate syringe
    9. Select appropriate site
      1. Rotate from previous site
    10. Select appropriate needle size and attach needle
    11. Clean the site with alcohol in circles starting at the center and working outward – LET DRY
    12. Pinch the skin up off the muscle so there’s a layer of subcutaneous fat between your fingers
    13. Insert the needle at a 45-90 degree angle
    14. Inject medication slowly
    15. Remove needle
    16. Apply gentle pressure with gauze
      1. Do NOT massage
    17. Activate safety and/or dispose of needle in sharps container
    18. AFTER administration
      1. Document administration and patient’s response
      2. If using barcode medication administration
        1. Scan all meds before preparing
        2. Confirm administration AFTER giving to patient
    19. Discard all used supplies
    20. Remove gloves
    21. Perform hand hygiene
    22. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

  1. Indication and possible side effect(s) of medication(s)
  2. Signs to report to nurse or provider

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Transcript

In this video, we’re going to show you the proper technique for subcutaneous injections. Remember you should always rotate sites, so make sure you know the last place they got their shot. And, of course, always follow your 5 rights.

First, of course, calculate your required dose and draw up the medication in an appropriate syringe and needle size. In this case, we’ve got 15 units of NPH insulin to administer, so we’re using an insulin syringe.
Now, you will choose an appropriate site – in this case, we’re going to give it in the upper outer arm on the patient’s right side.
Open your alcohol pad and cleanse the site in circles from the center outward and let it dry.
Pinch the skin away from the muscle so you have a layer of subcutaneous fat between your fingers.
Insert the needle at a 45-90 degree angle and inject the medication slowly. Then remove the needle.
You can apply gentle pressure with gauze, but do NOT massage the area.
Activate the safety on the needle and/or throw the needle away in the sharps container.

Remember any time you give insulin you should be checking blood sugars before and checking on the patient afterward.

Document your administration and monitor your patient for the effects of the meds! Now, go out and be your best selves today. And, as always, happy nursing!

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Basics of Pharm Study Plan

Concepts Covered:

  • Concepts of Pharmacology
  • Studying
  • Test Taking Strategies
  • Learning Pharmacology
  • Dosage Calculations
  • Medication Administration
  • Intraoperative Nursing
  • Microbiology
  • Disorders of Pancreas
  • Circulatory System
  • Upper GI Disorders
  • Fundamentals of Emergency Nursing
  • Understanding Society
  • Tissues and Glands
  • Adulthood Growth and Development
  • Newborn Care
  • Postoperative Nursing
  • Prenatal Concepts
  • Substance Abuse Disorders
  • Immunological Disorders
  • Adult
  • Emergency Care of the Cardiac Patient
  • Nervous System
  • Vascular Disorders
  • Cardiac Disorders
  • Anxiety Disorders
  • Depressive Disorders
  • Bipolar Disorders
  • Psychotic Disorders
  • Central Nervous System Disorders – Brain
  • Gastrointestinal Disorders
  • Neurological
  • Respiratory Disorders
  • Noninfectious Respiratory Disorder
  • Hematologic Disorders
  • Peripheral Nervous System Disorders
  • Pregnancy Risks
  • Postpartum Complications

Study Plan Lessons

Pharmacology Course Introduction
Pharmacokinetics
Pharmacokinetics Nursing Mnemonic (ADME)
12 Points to Answering Pharmacology Questions
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
The SOCK Method of Pharmacology 1 – Live Tutoring Archive
The SOCK Method of Pharmacology 2 – Live Tutoring Archive
The SOCK Method of Pharmacology 3 – Live Tutoring Archive
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Complex Calculations (Dosage Calculations/Med Math)
Pediatric Dosage Calculations
Struggling with Dimensional Analysis? – Live Tutoring Archive
Medication Errors
6 Rights of Medication Administration
Using Aseptic Technique
Supplies Needed
Needle Safety
Drawing Up Meds
Medications in Ampules
Oral Medications
SubQ Injections
IM Injections
Injectable Medications
Pill Crushing & Cutting
Positioning
Tips & Tricks
Insulin
Insulin Mixing
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin Drips
Glipizide (Glucotrol) Nursing Considerations
IV Insertion Course Introduction
Selecting THE vein
IV Catheter Selection (gauge, color)
IV Insertion Angle
Starting an IV
IV Placement Start To Finish (How to Start an IV)
Bariatric: IV Insertion
Combative: IV Insertion
Dark Skin: IV Insertion
Tattoos IV Insertion
Geriatric: IV Insertion
Tips & Advice for Pediatric IV
Tips & Advice for Newborns (Neonatal IV Insertion)
How to Secure an IV (chevron, transparent dressing)
Maintenance of the IV
How to Remove (discontinue) an IV
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Understanding All The IV Set Ports
Spiking & Priming IV Bags
IV Infusions (Solutions)
Hanging an IV Piggyback
Giving Medication Through An IV Set Port
IV Push Medications
IV Pump Management
IV Drip Administration & Safety Checks
IV Drip Therapy – Medications Used for Drips
Drawing Blood from the IV
NG Tube Medication Administration
NG Tube Med Administration (Nasogastric)
Interactive Practice Drip Calculations
Pain Management Meds – Live Tutoring Archive
Pain Management for the Older Adult – Live Tutoring Archive
Opioid Analgesics in Pregnancy
Patient Controlled Analgesia (PCA)
Codeine (Paveral) Nursing Considerations
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Ketorolac (Toradol) Nursing Considerations
ACLS (Advanced cardiac life support) Drugs
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Atenolol (Tenormin) Nursing Considerations
Hydralazine
Lidocaine (Xylocaine) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
Nitro Compounds
Verapamil (Calan) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
TCAs
MAOIs
Mood Stabilizers
Olanzapine (Zyprexa) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Barbiturates
Sedatives-Hypnotics
Sedatives-Hypnotics
Pentobarbital (Nembutal) Nursing Considerations
Phenobarbital (Luminal) Nursing Considerations
Benztropine (Cogentin) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Anti-Infective – Antifungals
Nystatin (Mycostatin) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Epoetin Alfa
Neostigmine (Prostigmin) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Meds for Postpartum Hemorrhage (PPH)
Methylergonovine (Methergine) Nursing Considerations
Rh Immune Globulin in Pregnancy
Eye Prophylaxis for Newborn
Phytonadione (Vitamin K) for Newborn
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Anesthetic Agents
Propofol (Diprivan) Nursing Considerations
Nalbuphine (Nubain) Nursing Considerations
Interactive Pharmacology Practice