Summary of Fundamental Clinical Nursing Skills Exam
Fundamental Clinical Nursing Skills Exam: Your Ultimate Guide
Introduction
Parenteral and wound care nursing covers techniques for administering medications and managing different types of wounds. This material focuses on safe injection practices (intravenous, intramuscular, subcutaneous, intradermal), recognition and prevention of complications, basics of wound classification and healing phases, and practical points for dressings and drains.
Definition: Parenteral administration means delivering drugs or fluids by routes other than the digestive tract, commonly via IV, IM, SC, or ID injections.
Injection Routes: Overview
- Intravenous (IV): medication/fluids delivered directly into a vein. Rapid onset and predictable effect.
- Intramuscular (IM): into muscle tissue, used for vaccines and some medications needing faster absorption than SC.
- Subcutaneous (SC): into subcutaneous fat, used for insulin and low-molecular-weight heparins.
- Intradermal (ID): into dermis; used for allergy tests, tuberculin, and sensitivity testing.
Practical steps and angles
- IV: needle/cannula inserted into vein; secure and monitor infusion site for patency and extravasation.
- IM: use a 90-degree angle for deltoid or gluteal injections. For dorsogluteal site, use the upper outer quadrant to avoid sciatic nerve injury.
- SC: typically inserted at 45-degree or 90-degree depending on needle length and patient habitus; for standard subcutaneous heparin inject at 45-degree with no aspiration (do not aspirate) and use the outer arm or abdomen.
- ID: shallow bevel, small volume, used for skin testing; the prick method applies to intradermal administration.
Definition: Extravasation is the leakage of a vesicant or infusion solution from the vein into surrounding tissue; paravenous administration means infusion solution outside the vein.
💡 Věděli jste?Fun fact: Did you know that rotating subcutaneous insulin injection sites reduces the risk of lipodystrophy and helps maintain consistent insulin absorption?
Specific administration details and common practices
- Release of Esmarch tourniquet: For IV injection, once blood appears in the syringe or cannula indicating venous entry, the tourniquet should be released before injection or cannulation is completed to avoid venous congestion.
- Aspiration: For SC heparin injections, do not aspirate; inject at a 45-degree angle and use an appropriate SC needle and syringe.
- Lipodystrophy: A known complication of repeated SC insulin injections at the same site; rotating sites prevents this.
Injection site selection and safety
- Dorsogluteal IM: use the upper outer quadrant to avoid sciatic nerve and major vessels.
- Deltoid IM: commonly used for vaccination; deliver at 90 degrees.
- For SC injections, choose sites with adequate subcutaneous tissue (abdomen, outer arm, anterior thigh), rotate systematically.
Complications of injections and infusions
- IV extravasation/paravenous administration: infusion solution outside the vein. Monitor for pain, swelling, erythema; stop infusion and manage per protocol.
- SC complications: lipodystrophy (lipoatrophy or lipohypertrophy) from repeated insulin injections without rotation; atrophy can occur but lipodystrophy is most common.
- ID complications: induration at site is a possible local reaction.
Infusion solution properties
- Osmotically effective solutions: can increase osmotic diuresis when they remain in the intravascular compartment and draw water into urine-producing pathways.
- Which formulations are suitable for IV: aqueous solutions are appropriate; oily solutions and many emulsions or suspensions are generally not suitable for routine IV administration unless specifically formulated for IV use.
Wound types and healing phases
- Wound etiologies: traumatic and surgical are two primary categories; others include burn, pressure, and pathological (e.g., ischemic) wounds.
Table: Phases of Wound Healing
| Phase | Timing | Main processes |
|---|---|---|
| Hemostasis/Inflammatory | Immediate |
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Parenteral & Wound Care
Klíčové pojmy: Release Esmarch tourniquet after blood appears during IV insertion, Use upper outer quadrant for dorsogluteal IM injections, Administer SC heparin at 45° without aspiration, Rotate SC insulin sites to prevent lipodystrophy, ID injections may cause local induration, Extravasation means infusion solution outside the vein, Second phase of wound healing is proliferative, Drains are classified as open or closed, Elastic lower-limb bandage applied distal to proximal to support flow, Monitor CBC and vital signs during LMWH therapy, Aqueous solutions are appropriate for IV administration, Long-acting basal insulin is given subcutaneously
## Introduction
Parenteral and wound care nursing covers techniques for administering medications and managing different types of wounds. This material focuses on safe injection practices (intravenous, intramuscular, subcutaneous, intradermal), recognition and prevention of complications, basics of wound classification and healing phases, and practical points for dressings and drains.
> Definition: Parenteral administration means delivering drugs or fluids by routes other than the digestive tract, commonly via IV, IM, SC, or ID injections.
## Injection Routes: Overview
- **Intravenous (IV)**: medication/fluids delivered directly into a vein. Rapid onset and predictable effect.
- **Intramuscular (IM)**: into muscle tissue, used for vaccines and some medications needing faster absorption than SC.
- **Subcutaneous (SC)**: into subcutaneous fat, used for insulin and low-molecular-weight heparins.
- **Intradermal (ID)**: into dermis; used for allergy tests, tuberculin, and sensitivity testing.
### Practical steps and angles
- IV: needle/cannula inserted into vein; secure and monitor infusion site for patency and extravasation.
- IM: use a 90-degree angle for deltoid or gluteal injections. For dorsogluteal site, use the upper outer quadrant to avoid sciatic nerve injury.
- SC: typically inserted at 45-degree or 90-degree depending on needle length and patient habitus; for standard subcutaneous heparin inject at 45-degree with no aspiration (do not aspirate) and use the outer arm or abdomen.
- ID: shallow bevel, small volume, used for skin testing; the prick method applies to intradermal administration.
> Definition: Extravasation is the leakage of a vesicant or infusion solution from the vein into surrounding tissue; paravenous administration means infusion solution outside the vein.
Fun fact: Did you know that rotating subcutaneous insulin injection sites reduces the risk of lipodystrophy and helps maintain consistent insulin absorption?
## Specific administration details and common practices
- Release of Esmarch tourniquet: For IV injection, once blood appears in the syringe or cannula indicating venous entry, the tourniquet should be released before injection or cannulation is completed to avoid venous congestion.
- Aspiration: For SC heparin injections, do not aspirate; inject at a 45-degree angle and use an appropriate SC needle and syringe.
- Lipodystrophy: A known complication of repeated SC insulin injections at the same site; rotating sites prevents this.
### Injection site selection and safety
- Dorsogluteal IM: use the upper outer quadrant to avoid sciatic nerve and major vessels.
- Deltoid IM: commonly used for vaccination; deliver at 90 degrees.
- For SC injections, choose sites with adequate subcutaneous tissue (abdomen, outer arm, anterior thigh), rotate systematically.
## Complications of injections and infusions
- IV extravasation/paravenous administration: infusion solution outside the vein. Monitor for pain, swelling, erythema; stop infusion and manage per protocol.
- SC complications: lipodystrophy (lipoatrophy or lipohypertrophy) from repeated insulin injections without rotation; atrophy can occur but lipodystrophy is most common.
- ID complications: induration at site is a possible local reaction.
## Infusion solution properties
- Osmotically effective solutions: can increase osmotic diuresis when they remain in the intravascular compartment and draw water into urine-producing pathways.
- Which formulations are suitable for IV: aqueous solutions are appropriate; oily solutions and many emulsions or suspensions are generally not suitable for routine IV administration unless specifically formulated for IV use.
## Wound types and healing phases
- Wound etiologies: traumatic and surgical are two primary categories; others include burn, pressure, and pathological (e.g., ischemic) wounds.
Table: Phases of Wound Healing
| Phase | Timing | Main processes |
|---|---:|---|
| Hemostasis/Inflammatory | Immediate