5: Common Nursing Care Procedures

Part 5 Common Nursing Care Procedures



MEDICATION ADMINISTRATION



Safety Precautions









Intramuscular Administration




Obtain necessary equipment.


Explain procedure to child as developmentally appropriate, and provide atraumatic care.


Follow Safety Precautions for administration of medications (see p. 411).


Select needle and syringe appropriate to the following:





If withdrawing medication from an ampule, use a needle equipped with a filter that removes glass particles; then use a new, nonfilter needle for injection. Replace needle after withdrawing medication from a vial.


Maintain aseptic technique, and follow Standard Precautions.


Provide for sufficient help in restraining the child; children are often uncooperative, and their behavior is usually unpredictable.


Determine the site of injection (see pp. 418-421); make certain that muscle is large enough to accommodate volume and type of medication.






Prepare area for puncture with antiseptic agent, and allow to dry completely.


Administer the medication:













Aspirate for blood.





Remove needle quickly; hold gauze firmly against skin near needle when removing it to avoid pulling on tissue.


Apply firm pressure with dry gauze to the site after injection; massage the site to hasten absorption unless contraindicated (e.g., with iron, dextran).


Clean area of prepping agent with water to decrease absorption of agent in neonate.


PRAISE CHILD FOR COOPERATION.


Discard syringe and needle in puncture-resistant container near site of use. Do not recap needle.


Record the date, time, dose, drug, and site of injection.






Subcutaneous and Intradermal Administration (cont’d.)



Subcutaneous Administration





Intradermal Administration



TABLE 5-2 Intramuscular Injection Sites in Children































SITE VASTUS LATERALIS
image
VENTROGLUTEAL
image
DISCUSSION LOCATION*

LOCATION*

DELTOID
image
LOCATIONS*

DELTOID
 

* Locations of landmarks are indicated by asterisks on illustrations.






Procedure for Inserting and Taping a Peripheral Intravenous Catheter




Obtain necessary equipment.


Explain procedure to child as developmentally appropriate, and provide atraumatic care.


Verify order and confirm patient identity.


Follow manufacturer’s directions for all devices used.


Wash hands, and observe aseptic technique throughout procedure.


Choose catheter insertion site and an alternative site in case the initial attempt is unsuccessful.


Sites are as follows:





For extremity veins, start with the most distal site, especially if irritating or sclerosing agents are to be used.


Apply a topical analgesic such as EMLA or LMX 4 to two sites.


Prepare insertion site by applying with friction an antiseptic solution.


Allow solution to dry completely, but do not blow, blot dry, or fan the area.


Don gloves.


Apply tourniquet when site is ready for catheter insertion.


Stretch the skin taut downward below the point of insertion, upward above the site of insertion, or from underneath level with the point of insertion. This technique helps stabilize veins that roll or move away from the catheter as attempts are made to enter the vein.


Inspect catheter, looking for damage (e.g., bent stylet, shavings on the catheter, frayed catheter tip [follow employer’s policy for reporting defective devices]).


Insert catheter through the skin, bevel up, at a 15- to 30-degree angle, and enter the vein. This direct approach is best for large veins and allows the skin and vein to be entered in one step. The indirect approach for smaller veins enables the catheter to enter the vein from the side at an angle. It is sometimes helpful with short veins to start the catheter below the intended site and advance through the superficial layers of skin so that the advancement of the catheter in the vein is a shorter distance. In infants or children with very small veins, insert the catheter bevel down, which prevents the needle from puncturing the back wall of the vein and provides an earlier flashback of blood as the vein is entered.


Watch for blood return in the flashback chamber. Some 24-gauge catheters provide visualization of the flashback within the catheter, so immediate vein entrance is recognized before the needle punctures the back of the vessel or goes through the other side of the vessel.


Once the flashback is seen, lower the angle between the skin and catheter to 15 degrees. Advance the catheter another 1/16 to 1/8 inch to ensure that both the metal stylet and the catheter are inside the vein. Look closely at the IV catheter before inserting it, and note that the stylet tip is slightly longer than the catheter. It is necessary to have both pieces inside the vein before the catheter is advanced. Holding the stylet steady, push the catheter off the stylet and into the vein until the catheter hub is situated against the skin at the insertion site. Activate safety mechanism if necessary (some safety catheters are passive and activate automatically), remove the stylet, and discard into sharps container. Apply pressure to catheter within the vein to prevent backflow of blood before attachment of tubing.


Collect blood if ordered. Remove the tourniquet. Flush the IV line with NS to check for patency (ease of flushing fluid, lack of resistance while flushing), complaints of pain, or swelling at the site. If line flushes easily, proceed to secure the catheter to the skin.


Connect the T-connector, J-connector, injection cap, or tubing, and reinforce connection with a junction securement device (e.g., Luer-Lok, clasping device, threaded device) to prevent accidental disconnection and subsequent air embolism or blood loss.


Place transparent dressing across catheter hub, up to but not including the junction securement device, and surrounding skin.


Further secure the catheter to the skin using tape or adhesive securement devices (e.g., StatLock). Follow manufacturer’s directions for adhesive anchors.


Place a ¼ to ½-inch strip of clear tape across the width of the transparent dressing and the catheter hub, but avoid the insertion site. This will serve as an anchor tape strip, and all other tape will be affixed to this strip (tape-on-tape method). This strip will not compromise the transparent dressing properties or interfere with visual inspection of the catheter-skin insertion site.


To stabilize the catheter and junction securement device, attach 1 to 1½ inches of clear tape that is ¼ to ½ inch wide, adhesive side up, to the underneath side of the catheter hub and junction securement device at their connection. Wrap the ends of the tape around the connections, and meet on top to form a V shape (sometimes referred to as a chevron); secure the overlapping ends onto the anchor tape strip.


Loop the IV tubing away from the catheter hub and toward the IV fluid source. Secure the looped tubing with a piece of tape on the anchor tape strip. Be certain fingers or toes are visible whenever extremity is used.


Consider use of a commercial protective device (e.g., I.V. House) over the catheter hub and looped tubing. Bending one corner of the tape over and onto itself provides a free tab to lift the tape easily for site visualization.



Nasogastric, Orogastric, or Gastrotomy Tube Administration




Use elixir or suspension preparations of medication (rather than tablets) whenever possible.


Dilute viscous medication or syrup with a small amount of water if possible.


Avoid oily medications because they tend to cling to the sides of the tube.


If administering tablets, crush them to a very fine powder and dissolve drug in a small amount of warm water.


Never crush enteric-coated or sustained-release tablets or capsules.


Do not mix medication with enteral formula unless fluid is restricted. If adding a drug:







Check for correct placement of nasogastric (NG) or orogastric tube.


* Place 5 ml of air in the syringe. Connect the syringe to the tube.




Stay updated, free articles. Join our Telegram channel

Oct 20, 2016 | Posted by in NURSING | Comments Off on 5: Common Nursing Care Procedures

Full access? Get Clinical Tree

Get Clinical Tree app for offline access