Flashcards
module 4 practical skills
Flashcards do conjunto (66)
- 1Administering medications by irrigationMedications may be used to irrigate or wash out a body cavity and are delivered in a stream of solution. Irrigation solutions are most commonly sterile water, saline or antiseptic solutions and are used for the eye, ear, throat, vagina and urinary tract. When the cavity to be irrigated is not sterile, as is the case with the ear canal(see Box 27-12) or vagina, a clean technique is acceptable. Irrigations can be used to clean an area, instil a medication or be applied hot or cold to injured tissue
- 2Parenteral administration of medicationsParenteral administration of medications is the administration of medications by a route that bypasses the GItract (e.g. topical or injectable routes). The term `parenteral administration' is often used to refer to injections. This is an invasive procedure that must be performed using aseptic techniques (Box 27-13). After a needle pierces the skin, there is risk of infection.
- 3Insulin syringeThese are available in sizes that hold 0.3-1 mL(Figure 27-13) and are calibrated in units. Insulin syringes that hold 0.3 mL are known as low-dose syringes. Most insulin syringes are U- 100s, designed for use with U-100strength insulin. Each millilitre of solution contains100 units of insulin; 1 mL = 100 unit
- 4NeedlesSome needles arepre-attached to standard-sized syringes. Most needlesare disposable and have three parts: the hub, which fitsonto the tip of a syringe; the shaft, which connects tothe hub; and the bevel or slanted tip. A short-bevelled tip is bestfor intravenous injections because it is not easily occludedagainst the inside of a blood vessel wall. Long-bevelledtips are sharper and narrower; this minimises discomfortwhen entering subcutaneous or intramuscular tissue. The nurse chooses the needle length (Figure 27-15)according to the client's size and weight and the typeof tissue into which the medication is to be injected.A child or slender adult generally requires a shorterneedle. The nurse uses longer needles (25-38 mm) forintramuscular injections and shorter needles (9-16 mm)for subcutaneous injections.
- 5Preparing an injection from a vialA vial is a single-dose or multidose container with a rubber seal at the top(Figure27-16B). A metal or plastic cap protects the seal until it is ready for use. Vials can contain liquid or dry forms of medications; those that are unstable in solution are packaged dry. The vial label or package insert specifies the solvent or diluent used to dissolve the medication and the amount of diluent needed to prepare the desired medication concentration. Normal saline and sterile distilled water are commonly used to dissolve medications. Unlike the ampoule, the vial is a closed system, and air must be injected into it to permit easy withdrawal of the solution. Failure to inject air before drawing up creates a vacuum within the vial that makes withdrawal difficult
- 6Mixing medicationsIf two medications are compatible, it is possible to mix them in one injection as long as the final volume is within accepted limits for the site to be used. A client will then receive just one injection at a time. Most nursing units have charts that list common compatible medications, as do the manufacturers' instructions. If there is any uncertainty about medication compatibility, consult a pharmacist.
- 7preparing injection equipmentEquipment
Medication in an ampoule:
• Syringe and two needles (filter needle optional)
• Small gauze pad or alcohol swab
Medication in a vial:
•Syringe and two needles (filter needle optional)
• Small gauze pad or alcohol swab
• Diluent (e.g.Normal saline or sterile water)
Both:
• Medication administration record(MAR) - 81. Review order, including name and medication name, dose, route of administration and time of administration.Ensures correct administration of medication.
- 92. Review pertinent information related to medication, including action, purpose, side effects and nursing implications.Allows nurse to administer medication properly and to monitor client's response.
- 103. Check date of expiration of medication vial or ampoule.Medication potency may increase or decrease when outdated.
- 114. Assess client's bodybuild, muscle size and weightDetermines type and size of syringe and needles for injection.
- 125. Perform hand hygiene.reduce transmission of microorganisms
- 136. ampule: Tap the top of the ampoule lightly and quickly with your finger until fluid moves from the neck of the ampoule. Place a small gauze pad around the neck of the ampoule. Snap neck of ampoule quickly and firmly away from hands. Draw up medication quickly. Hold ampoule upside down, or set it on a flat surface. Insert syringe or filter needle (see agency policy) into centre of ampoule opening. Do not allow needle tip or shaft to touch rim of ampoule. Aspirate medication into the syringe by gently pulling back on the plunger. To expel excess air bubbles, remove needle from ampoule. Hold syringe with needle pointing up. Tap side of syringe to cause bubbles to rise towards needle. Drawback slightly on plunger, and then push plunger up wards to eject air. If syringe contains excess medication, use sink for disposal. Hold syringe vertically with needle tip up and slanted slightly towards sink. Slowly eject excess medication into sink. Recheck medication level in syringe by holding it vertically. Change needle on syringe.Rationale: Dislodges any fluid that collects above the neck of the ampoule. All solution moves into the lower chamber. drawing up medication quickly prevents airborne contaminants. The broken rim of the ampoule is considered contaminated. When the ampoule is inverted, the solution will dribble out if the needle tip or shaft touches the rim of the ampoule
- 146. Remove cap covering top of unused vial to expose sterile rubber seal, keeping rubber seal sterile. If reusing multi-dose vial, firmly and briskly wipe surface of rubber seal with alcohol swab and allow it to dry. Pick up syringe and remove needle cap. Pull backon plungertodrawamountofairinto syringe equivalent to volume of medication to be aspirated from vial. With vialon flat surface, insert tip of needle with bevelled tip entering first through centre of rubber seal. Inject air into the vial's airspace, holding on to plunger. Hold plunger with firm pressure; plunger may be forced backwards by air pressure within the vial. Keep tip of needle below fluid level. Allow air pressure from the vial to fill syringe gradually with medication. If necessary, pull back slightly on plunger to obtain correct amount of solution. When desired volume has been obtained, position needle into vial's air space; tap side of syringe barrel carefully to dislodge any air bubbles. Eject any air remaining at top of syringe into vial. Remove needle from vial by pulling back on barrel of syringe.Air must first be injected into vial to prevent build-up of negative pressure in vial when aspirating medication. Air must be injected before aspirating fluid. Injecting into vial's air space prevents formation of bubbles and inaccuracy in dose.
- 156. Vial containing a powder (reconstituting medications):Ensures proper dispersal of medication throughout solution.Shaking produces bubbles.
- 16Mixing medications from two vialsOnly one syringe is needed to mix medications from two vials, assuming both medicines are compatible (Figure27-17).The nurse takes an appropriately sized syringe with a needle attached and aspirates the volume of air equivalent to the dose of the first medication (vialA). The nurse injects the air into vial A, making sure the needle does not touch the solution. The nurse withdraws the needle, aspirates air equivalent to the dose of the second medication(vialB), and then injects the volume of air into
vial B. The nurse immediately withdraws the medication
from vial B into the syringe. At this point the medication
from vial A has not contaminated vial B. The nurse applies
a new sterile needle to the syringe and inserts it into vial
A, being careful not to push the plunger and expel the
medication within the syringe into the vial. The nurse then
withdraws the desired amount of medication from vial A into the syringe. - 17mixing medications from one vial and one ampule
- 18insulinThe medication is available in 100 units per mL of solution. When preparing insulin, an insulin 'pen' is most commonly used; however, sometimes in acute care, the insulin may also be administered using an appropriately sized 'nsulin syringe'. A 100-unit scaled syringe is commonly used to prepare 100-unit insulin (see Figure27-13C).
Insulin is classified by rate of action, including rapid, intermediate and long-acting. Each type has a different onset, peak and duration of action. A client with diabetes may require more than one type of insulin. For example, by receiving a rapid-acting(regular)and an intermediate- acting insulin, a client receives more-sustained control of blood glucose over 24 hours. - 19insulinRegular insulin is a clear solution that acts rapidly and can be given either subcutaneously or intravenously. Other types of insulin are also mostly clear, although some older and less commonly used types are cloudy (because of the addition of a protein,which slows absorption).The slower-acting insulin can be given only subcutaneously.
Insulin is ordered by specific dosage at select times, or by a sliding scale. A sliding scale dictates a certain dosage based on the client's blood-glucose level(BGL)
(Box27-14).Only regular insulin is used for sliding scales. Before withdrawing insulin from a vial,the vial should be rotated for at least 1 minute between both hands. This re-suspends the modified insulin preparations and helps to warm the medication. - 20subcutaneousReview prescriber's medication order for client's name, medication name, dose, time and route of administration. Review prescriber's medication order for client's name, medication name, dose, time and route of administration.
Assess for contraindications.
A. For subcutaneous injections Assess for factors such as circulatory shock or
reduced local tissue perfusion. Assess adequacy of client's adipose tissue. Reduced tissue perfusion interferes with medication absorption and distribution. Physiological changes of ageing or client illness may influence the amount of SC tissue a client possesses. The injection site chosen should be free of skin lesions, bony prominences and large underlying muscles or nerves. Prepare correct medication dose from ampoule or vial. Identify client; check identification bracelet with MAR and ask client's name. Close room curtain or door. Wash hands thoroughly; apply disposable gloves. - 21subcutaneousPalpate sites for masses or tenderness.
Avoid these areas. For daily insulin, rotate site daily. Be sure needle is correct size by grasping skinfold at site with thumb and forefinger. Measure fold from top to bottom; needle should be half-length. Have client relax arm, leg or abdomen, depending on site chosen for injection. Clean site with anantiseptic swab. Apply swab at centre of the site and rotate out wards in a circular direction for about 5 cm. Remove needle cap from needle by pulling it straight off. Hold bevel of needle pointing up. Hold as dart, palm down(see illustration) or hold syringe across tops of fingertips. For average-size client, spread skin tightly across injection site or pinch skin with the non-dominant hand. Inject needle quickly and firmly at 45- to a 90-degree angle. Then release skin, if
pinched. For obese client, pinch skin at site and inject needle at 90-degree angle below tissue fold. inject slowly. - 22subcutaneous injection sites
- 23subcutaneous injectionthe injections should be given at least 2.5cm away from the previous site. Rotation of sites with in an anatomical region ensures more consistent absorption times. Repeated injection into the same site causes a natural immunere sponse, resulting in lipodystrophy.
- 24intramuscularReview prescriber's medication order for client's name, medication name, dose, time and route of administration. Review prescriber's medication order for client's name, medication name, dose, time and route of administration.
Assess for contraindications. Assess for factors such as muscle atrophy, reduced blood flow or circulatory shock. Atrophied muscle absorbs medication poorly. Factors interfering with blood flow to muscles impair medication absorption. Prepare correct medication dose from ampoule or vial. Identify client; check identification bracelet with MAR and ask client's name. Close room curtain or door. Wash hands thoroughly; apply disposable gloves. Select appropriate injection site. Note integrity and size of muscle and palpate for tenderness or hardness. Avoid these areas. If injections are given frequently, rotate sites. Have client lie flat, on side or prone, depending on site chosen. use distraction therapy. Position non-dominant hand at proper
anatomical landmarks and pull skin down to
administer in a Z-track. - 25intramuscularPosition non-dominant hand at proper anatomical land marks and pull skin down to administer in a Z -track. If client's muscle mass is small, grasp body of muscle between thumb and fingers.
- 26intramuscularInsert needle quickly at 90-degree angle into muscle. After needle enters site, grasp lower end of syringe barrel with non-dominant hand. Move dominant hand to end of plunger. Avoid moving syringe while slowly pulling back on plunger to aspirate drug (see illustration). If blood appears in syringe, remove needle, discard medication and syringe and repeat procedure. Inject medication slowly.
Smoothly and steadily withdraw needle and release skin. - 27IntramuscularThere
is, however, a risk of inadvertently injecting medications
directly into blood vessels. The nurse uses a longer and
heavier-gauge needle to pass through subcutaneous
tissue and penetrate deep muscle tissue. Bodyweight and
the amount of adipose tissue can influence needle size
selection. For example, an obese client may require a
needle 77 mm long, and a thin client may require a needle
only 12-25 mm long.
The angle of insertion for an intramuscular injection is
90 degrees (Figure 27-20). A normal, well-developed client
can tolerate 3-4 mL of medication into a larger muscle
without severe muscle discomfort. A larger volume of
medication is unlikely to be absorbed properly. Children,
older adults and thin clients can tolerate only 2 mL of
an intramuscular injection, and no more than 1 mL is
recommended for small children and older infants. - 28im sittinghttps://www.youtube.com/watch?v=DBHnd3N-5Ns
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The ventrogluteal muscle is a safe site for all clients, with a
maximum dose of 4 mL
The vastus lateralis muscle is normally used in adult
clients, for volumes up to 5 mL.
The dorsogluteal muscle has been a traditional site for
intramuscular injections for volumes of 1-4 mL.
Although the deltoid muscle is easily accessible, this muscle
is often not well developed and is not recommended for
injection volumes over 2 mL. - 29whether to asperate or notThe study clearly identified that the aspiration of blood does occur. Therefore, recommending elimination of the practice of aspiration during IM injection for all such injections may not be safe practice. Additionally, should an IM injection be administered mistakenly into the vasculature, the route is modified from intramuscular to intravenous (IV). Based on all of the data, it is recommended that nurses assess for the following circumstances regarding the patient scenario prior to deciding whether or not to aspirate: identify whether a medication, dose, administration rate, patient condition, or emergent situation if mistakenly given IV would be harmful for patients. When these instances occur and could pose a threat to patient safety if accidentally given IV rather than IM, then the practice of aspiration during the IM injection procedure should be implemented ([15] ).
- 30whether to asperate or notThe nurse assesses the patient circumstance—there are times when spending the extra time to effectively aspirate could impact patient and nurse safety. Examples of this include: emergency situations, combative patients, and patient safety i.e. unable to stabilise limb with patient actively withdrawing (such as a small child)
The patient circumstance does not pose a threat to safety—continue on the pathway
The patient circumstance poses a threat to the safety of the patient and/or nurse—do not aspirate and abort the aspiration pathway - 31whether to asperate or notThe medication is identified with a dextrose level of > 10% and has an osmolarity of > 900 mOsm/litre—continue on the pathway and prepare for aspiration
The medication is identified with a dextrose level of < 10% but has an osmolarity of > 900 mOsm/litre—continue on the pathway and prepare for aspiration
The medication is identified with a dextrose level of > 10% but has an osmolarity of < 900 mOsm/litre—continue on the pathway and prepare for aspiration
The medication is identified with a dextrose level of < 10% and has an osmolarity of < 900 mOsm/litre—do not aspirate and abort the aspiration pathway
Additional recommendations from the [6] have identified that certain medications are not acceptable at all for IM injection or peripheral intravenous injection. Depending on the dose and concentration, such medications may include: potassium chloride, amiodarone, antibiotics, and any infusate with particulates. Aspiration should be completed over 5 to 10 seconds
All intramuscular injections should be delivered at a slow push and should never exceed 2 ml. - 32intradermalReview prescriber's medication order for client's name, medication name, dose, time and route of administration. Review prescriber's medication order for client's name, medication name, dose, time and route of administration.
Assess for contraindications. Prepare correct medication dose from ampoule or vial. Identify client; check identification bracelet with MAR and ask client's name. Close room curtain or door. Wash hands thoroughly; apply disposable gloves. Select appropriate injection site. lesions or discolouration of forearm. Select site three to four finger widths below antecubital space and a hand width above wrist.
use distraction therapy. locate site using anatomical landmarks. Have client extend elbow and support it and forearm on flat surface. Clean site with anantiseptic swab. Apply swab at centre of the site and rotate out wards in a circular direction for about 5 cm. Remove needle cap from needle by pulling it straight off. Hold bevel of needle pointing up. With non-dominant hand, stretch skin over site with fore finger or thumb. - 33intradermalWith needle almost against client's skin, insert it slowly at a 5-to15-degree angle until resistance is felt. Then advance needle through epidermis to approximately 3 mm below skin surface. Needle tip can be seen through skin. Inject medication slowly. Normally, resistance is felt. If not, needle is too deep; remove and begin again. While injecting medication, notice that small bleb approximately 6 mm resembling mosquito bite appears on skin surface(see illustration). Withdraw needle while applying alcohol swab or gauze gently over site. Support of tissue around injection site minimises discomfort during needle withdrawal. Do not massage site after subcut injection of heparin or insulin or after IM or ID injection. Discard uncapped needle or needle enclosed in safety shield and attached syringe into puncture and leakproof receptacle. Remove disposable gloves and perform hand hygiene.
- 34intradermalThe nurse typically gives intradermal injections for skin
testing, for example, tuberculin screening and allergy
tests. These medications are potent, so they are injected
into the dermis, where blood supply is reduced and
medication absorption occurs slowly. A client may have a severe anaphylactic reaction if the medication enters the
circulation too rapidly.
Skin testing requires the nurse to be able to clearly
see the injection sites for changes in colour and tissue
integrity. Intradermal sites should be lightly pigmented,
free of lesions and relatively hairless. The inner forearm
and upper back are ideal locations.
The nurse uses a small hypodermic syringe for skin
testing. - 35RECORDING AND REPORTING• Chart medication dose, route, site, time and date given in medication record.
• Report any undesirable effects from medication to nurse in charge or medical officer.
• Record client's response to medications in nurses' notes. - 36The nurse may be ableto minimise aclient's discomfort in the following ways:Use topical anaesthetic creams or patches to reduce the sensation of the injection.
Use a sharp-bevelled needle in the smallest suitable length and gauge.
Position the client as comfortably as possible to reduce muscular tension.
Select the proper injection site, using an atomical landmarks.
Divert the client's attention from the injection through conversation.
Insert the needle quickly and smoothly to minimise tissue pulling.
Hold the syringe steady while the needle remains in tissue.
inject slowly and steadily
massage injectionnsite for several seconds. - 37Reducing the risk of anaphylaxisObtain up-to-date medical information and developing a health-care plan.
Staff training in recognition and management of acute allergic reactions.
Awareness that unexpected allergic reactions might occur for the first time outside of home in those not previously identified as being at high risk.
Age appropriate education of children with severe allergies and their peers.
Implementation of practical strategies to reduce the risk of accidental exposure to known allergic triggers.
Consider institutional provision of AAIs for general use. - 38Obtain up-to-date medical information and developing a health-care plan.Documentation should include an ASCIA Action Plan, completed and signed by a registered medical practitioner to include:
Identification of the child (photo), parent/guardian contact details and details of the medical practitioner completing the Action Plan;
Documentation of confirmed allergens, the first aid response and prescribed medication;
Instructions on AAI administration (if prescribed).
For those with food allergy and asthma, asthma management should be optimised. Additional identification of children by medical identification jewellery (e.g. MedicAlert, Emergency ID), badges or special clothing is not considered necessary in young children but may be helpful in some situations (e.g. medication or latex allergy where accidental exposure may occur in the healthcare setting where no other source of information is immediately available). - 39Staff training in recognition and management of acute allergic reactionsRecognition and treatment of allergic reactions (including anaphylaxis) is essential. Training should address:
What is allergy and anaphylaxis?
Common causes of allergic reactions including anaphylaxis.
Signs and symptoms of mild to moderate and severe allergic reactions.
Using ASCIA Action Plans as the emergency guide to manage allergic reactions including anaphylaxis.
Instruction on how to use AAIs including hands-on practice with AAI trainer devices.
Risk minimisation strategies to prevent accidental exposure to allergic triggers.
provided by appropriately qualified professionals (e.g. trained nurse educators, first aid trainers accredited to provide anaphylaxis training) and reinforced every 1–2 years, in conjunction with regular practice using AAI trainer devices. Where access to face-to-face anaphylaxis training is unavailable (or if staff require interim or refresher training), ASCIA anaphylaxis e-training for schools and childcare is freely available from the ASCIA website - 40Staff training in recognition and management of acute allergic reactionsIn responding to an allergic reaction, the following principles should be followed:
ASCIA Action Plans should be used as emergency guides as to whether the person is experiencing a mild to moderate or severe allergic reaction.
Lay child flat; do not allow them to stand or walk. If breathing is difficult, allow them to sit.
If in doubt, administer the AAI first and other medication second.
Adrenaline is the only medication of proven benefit in treating anaphylaxis.
Antihistamines, corticosteroids and asthma medicines are not suitable alternatives for treating anaphylaxis. If in doubt, administer the AAI first and ancillary medication second. - 41Staff training in recognition and management of acute allergic reactionsAfter the AAI is administered the child must be transported to hospital by ambulance (where possible) for further observation.
Anaphylaxis can sometimes present with isolated life-threatening asthma-like symptoms without other signs such as rash or swelling. If someone with a known food or insect allergy has sudden severe breathing difficulty, staff should treat for anaphylaxis first, administer the AAI and follow the ASCIA Action Plan.
Staff should be prepared to administer an AAI in an anaphylaxis emergency, as even older children and adults may be too unwell to self-administer an AAI. No child, teen or adult experiencing anaphylaxis should be expected to be fully responsible for self-administration of an AAI.
Staff should also be trained to administer cardiopulmonary resuscitation if the person is unresponsive and they have shallow breathing or no breathing. - 42how many doses of adrenalineA second dose of adrenaline may be required before an ambulance arrives.
- 43Age appropriate education of children with severe allergies and their peersIt is primarily the responsibility of parents to teach allergic children to care for themselves as they mature. The school, pre-school and childcare service also has a role to implement a health-care plan and reinforce appropriate avoidance and management strategies.
Education is required for:
The child with allergy (to tell others of the nature of their allergy, enquire about the presence of allergic triggers in food and to refrain from accepting food from others);
Other students (about the potentially serious nature of allergy, hand washing after eating, not sharing food with a child with FA, how to help the child having an allergic reaction);
Parents and guardians (about school policies to minimise the risk of anaphylaxis); and
School staff (to consider risks when planning school activities; to communicate with parents/guardians and the student at an age appropriate level; to have policies discouraging swapping of food among children; and to have policies addressing the potential for bullying and teasing of the allergic child). - 44Implementation of practical strategies to reduce the risk of exposure to known allergic triggersWhile skin contact (e.g. touching the allergen, hugging and kissing) may result in localised itching, swelling and discomfort (including eye and facial swelling), oral ingestion is almost always required to trigger anaphylaxis.12 Simple personal and food hygiene measures such as hand washing and bench-top cleaning are considered appropriate measures to reduce skin contact with allergens.19
Banning specific foods will not eliminate the risk of accidental exposure and cannot be enforced. However, food restrictions, with appropriate education and communication, may have a role to play in very young children who have insufficient maturity to protect themselves (e.g. childcare through to early primary school or children with developmental delay). - 45Implementation of practical strategies to reduce the risk of exposure to known allergic triggersYoung children often share toys where cross-contamination with food may result in allergic reactions from oral exposure or greater person-to-person contact. Much of the focus is on accidental peanut or tree nut exposure, as reactions may occur after exposure to tiny amounts, and as these foods are the most common trigger for childhood anaphylaxis. Thus, some childcare services, pre-schools and early years of primary schools may request that nut products are not sent in lunch boxes, to reduce the risk of accidental exposure in very young children. However, it is impractical to restrict cow's milk and other dairy products or other common food allergens such as egg and wheat, in the same way as nut product restrictions in childcare settings that care for babies and toddlers. This situation, however, is not applicable to older children or teenagers, who should have sufficient maturity and education to minimise their exposure, unless language or intellectual disability impairs their ability to do so.
- 46Reducing the risk of allergen exposure in children with food allergyYoung children with FA ideally should only consume food provided by parents/guardians from home.
Bottles, other drinks and lunch boxes provided by the parents for their children with FA should be clearly labelled with the name of the child for whom they are intended. This is of particular importance in infants with cows milk allergy to minimise consumption of incorrect baby formula.
If food is purchased from the school canteen, parents should check the appropriateness of foods by speaking directly to the canteen manager.
Where food is provided in OOHC settings, food preparation personnel should be educated about how to read labels for FA and instructed about measures necessary to prevent cross-contamination during the handling, preparation and serving of food. Examples include preparing food for children with FA first, careful cleaning (using warm soapy water) of food preparation areas after use and cleaning of utensils when preparing allergenic foods. - 47Reducing the risk of allergen exposure in children with food allergyFood should not be given to children with FA in childcare and primary school without parental engagement and permission (e.g. birthday parties, food treats).
Where food needs to be consumed inside the classroom (e.g. lunches consumed inside classrooms on rainy days), the risk of accidental exposure to the allergic child should be minimised. .Implement policies to avoid trading and sharing of food, food utensils or food containers.
Unlabeled food poses a potentially greater risk of allergen exposure than packaged food with precautionary labelling suggesting a risk of contamination with allergen.
Use of food in crafts, cooking classes, science experiments and special events (e.g. fetes, BBQs, assemblies, cultural events) needs to be considered and may need to be restricted depending on the allergies of particular children and their age. - 48Reducing the risk of allergen exposure in children with food allergyIn craft, an appropriate alternative ingredient can be substituted (e.g. wheat-free flour for play dough or cooking) and substitution of non-food containers for egg cartons, particularly in younger children.
When planning for out-of-school activities such as excursions (e.g. restaurants and food processing plants), or school outings or camps, catering requirements of the food allergic child and emergency planning (including access to emergency medication and medical care) should be considered early. - 49available adrenaline pens AustraliaChildren 7.5-20 kg (aged around one to five years):
EpiPen® Junior (150 microgram) or
Anapen® 150 (Jr) (150 microgram)
Adults and children over 20kg (aged around five years or over):
EpiPen® (300 microgram) or
Anapen® 300 (300 microgram)
Adults and children over 50kg (aged around twelve years or over):
New *Anapen® 500 (500 microgram) or
Anapen® 300 (300 microgram) or
EpiPen® (300 microgram). - 50Can a higher dose be given to a young child if no lower dose device is available?Yes. In children 7.5-20kg (around one to five years of age) a device containing 150 micrograms of adrenaline should be used.
However, if only a higher dose device is available (containing 300 micrograms of adrenaline) this should be used in preference to not using one at all. Under-treatment of anaphylaxis is more harmful (and potentially life threatening) than over-treatment of a mild or moderate allergic reaction. - 51how to give an anna pen
- 52when to give second dose of adrenalineUnder-treatment of anaphylaxis is more harmful (and potentially life threatening) than over-treatment of a mild or moderate allergic reaction.
Further adrenaline may be given if there is no response after 5 minutes. - 53Adrenaline injectors can be given by non-medically trained people.Some older children or adults can self administer adrenaline injectors if they are not too unwell or unconscious:
They should lay flat once it has been given, or sit with legs outstretched if breathing is difficult, or in the recovery position if they are vomiting or pregnant.
If a person who knows how to self-administer is too unwell, they will need another person to give the adrenaline injector. - 54If you are unsure if it is asthma or anaphylaxis, when should an adrenaline injector be used?In a person with asthma, who is also at risk of anaphylaxis, the adrenaline injector should be used first, followed by asthma reliever medication, calling an ambulance, continuing asthma first aid and following the ASCIA Action Plan for Anaphylaxis.
If someone with known food or insect allergy suddenly develops severe asthma-like symptoms, give adrenaline injector FIRST, then asthma reliever medication. - 55Before, during and after using adrenaline, how should a person with anaphylaxis be positioned?When a person has anaphylaxis their blood pressure can drop rapidly, which reduces blood flow to the heart. Laying the person flat will help blood flow to the heart which improves blood pressure, whilst standing can make anaphylaxis worse by causing blood pressure to drop.
Therefore it is important to LAY PERSON FLAT - do NOT allow them to stand or walk
If unconscious or pregnant, place in recovery position - on left side if pregnant, as shown below
If breathing is difficult allow them to sit with legs outstretched
Hold young children flat, not upright
The person should NOT stand, walk, or be held upright, even if they appear to have recovered. - 56Can an expired, cloudy or discoloured adrenaline injector be used if it is the only one available?Yes. Adrenaline injectors with discoloured adrenaline or expired adrenaline injectors are not as effective when used for treating anaphylaxis and should therefore not be relied upon to treat anaphylaxis. However, the most recently expired adrenaline injector available should be used if no in-date device is available.
- 57contraindications and considerations for dosing of covid 19 vaxesPrevious systemic allergic reaction to a previous dose of the same vaccine
Previous systemic allergic reaction to any excipients of the vaccine, including PEG (Pfizer and Moderna vaccines only)
Individuals with localised urticarial (itchy) skin reactions (without systemic symptoms) to the first dose, should receive the second dose with prolonged observation (30 minutes) in a setting with full resuscitation facilities
Individuals with previous history of anaphylaxis not related to components of COVID-19 vaccines can be vaccinated
Localised injection site reaction to first dose is not a contraindication to further dosing
Individuals with bleeding disorders can be immunised if this is deemed reasonably safe by a doctor familiar with the person's bleeding risk. - 58Infection prevention and controlAll those attending for vaccination and those delivering vaccination should wear appropriate personal protective equipment (PPE) as described in the infection prevention and control (IPC) advice current at the time of administering the vaccine. Gloves are not necessary for vaccine clinics unless there is a risk of contact with blood or bodily fluids ([16]) but vaccinators should follow PHE guidance for IPC regarding appropriate PPE in their area ([ 1]). Hand hygiene is critical to prevent the spread of infection and hands should be cleaned with alcohol-based gel or soap and water before vaccine preparation, and between patients. Those preparing and administering the vaccine should maintain good hand hygiene throughout and should take care not to touch the vial bung with their fingers ([13]).
- 59give vaccinationsthe vaccine refrigerator displays minimum/maximum temperatures within the +2°C to +8°C range before removing the vaccine from the refrigerator (see National Vaccine Storage Guidelines: Strive for 51
Gently shake the vial, pre-filled syringe or reconstituted vaccine to ensure a homogeneous suspension. Check for particulate matter or colour change in the vaccine. If either is apparent, refer to the vaccine product information. - 60Injectable vaccines that do not need reconstitutionIf the vaccine is in a vial, remove the cap carefully to maintain sterility of the rubber bung. There is generally no need to wipe the rubber bung of single-dose vials with an alcohol swab if it is visibly clean. If there is visible contamination or the rubber bung is inadvertently touched, clean the bung with a single-use swab.
Use a new, sterile, disposable 19 or 21 gauge needle to draw up the recommended dose through the bung (or through the top of the ampoule), if required. - 61Injectable vaccines that need reconstitutionUse a new, sterile, disposable 19 or 21 gauge needle for reconstitution.
Use a separate new, sterile, disposable 22–25 gauge needle that is 25 mm long for most people (see Recommended needle size, length and angle for administering vaccines).
Use only the diluent supplied with the vaccine or recommended in the product information. Do not use sterile water for injection instead of a supplied diluent. Completely mix the diluent and vaccine.5
Check reconstituted vaccines for signs of deterioration, such as a change in colour or clarity.
Give reconstituted vaccines as soon as practicable after reconstituting. This is because reconstituted vaccines may deteriorate rapidly. The vaccine’s product information states the maximum time between reconstitution and administration. - 62Vaccines in multidose vialsMultidose vials are not routinely used in Australia. The exception is BCG (bacille Calmette–Guérin) vaccine (see Tuberculosis). All vaccines on the National Immunisation Program have single-use preparations. If rabies vaccine is given by the intradermal route, the vial of vaccine may be used for multiple people and should be managed as a multidose vial.
- 63vaxcines not given intramuscularlyMost vaccines available in Australia are given intramuscularly. Only a few vaccines are given subcutaneously, orally or intradermally.
Rotavirus vaccines are only available for oral administration and must never be injected.
Immunisation providers need special training for intradermal administration. This is important for 2 vaccines: Q fever and tuberculosis.
Subcutaneous injection
IPV vaccine — IPV (IPOL) is given subcutaneously; combination vaccines containing IPV are given intramuscularly
Haemophilus type b conjugate vaccine (Act-HIB)
VV (varicella vaccine)
Japanese encephalitis vaccine (Imojev)
Q fever vaccine — the vaccine is given subcutaneously, but only specially trained immunisation providers can do intradermal Q fever skin testing
zoster vaccine
Oral
Vaccines administered by the oral route:
rotavirus vaccine
cholera vaccine
oral typhoid vaccine - 64Skin cleaningIf the skin is visibly clean, there is no need to wipe it with an antiseptic (such as an alcohol wipe).4,9
If you use alcohol or other disinfecting agents to clean skin that is visibly dirty, the skin must be allowed to dry before injecting the vaccine. This prevents inactivation of live vaccines and reduces the likelihood of irritation at the injection site. - 65Anaesthetics and vapocoolant spraysTopical anaesthetics, such as EMLA, are not recommended for routine use. They could be considered in a child with excessive fear or dislike of needles. These products need to be applied 30–60 minutes before an injection.17
Coolsense is a topical anaesthetic device that numbs the skin within 10 seconds of application. It can be used before injection.
Vapocoolant sprays are applied 15 seconds before vaccination. These sprays are more effective in adults than children. This is because children can perceive coldness as painful, and applying the spray may also focus the child on the procedure.
Topical lignocaine/prilocaine is not recommended for children <12 months of age because of the risk of methaemoglobinaemia.14
The exception is a specific recommendation to give paracetamol prior to meningococcal B vaccine in infants <2 years of age. - 66Children with congenital limb malformationChildren with congenital limb malformation(s) should receive their vaccines in an unaffected limb if possible. They can also receive vaccines in the ventrogluteal area
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- university Intergrated Nursing Concepts 3 FlashCards sobre module 4 practical skills, criado por Avalon Frost em 10-03-2022.
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- Avalon Frost
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