ATI Medication 3- Reconstitution of powder to liquid



hi it's a net over house coming to you live from the nursing skills lab at Northwest State Community College and Dennis laughing at me she's filming this is again ATI medication number three and this is reconstitution of a powder to a liquid and in the form of an antibiotic and subsequently giving the intramuscular injection that goes along with it so first we will do our reconstitution you're going to need a vial of practice outter which in this case simulates the powdered antibiotic before it's been reconstituted and the Dilli went that goes along with it you notice these have cap covers those do not ascertain sterility you still need to cover excuse me you still need to cleanse the top of the vial these are just dust covers so let's go ahead and you're gonna get your M AR and see what the dose is in this case your patients receiving Rocephin 500 milligrams and I'm gonna rotate the back of the vial and look at it and I see that if I want to reconstitute for 500 milligrams per milliliter that I will need to add five point six milliliters of diluent it also gives the recipe if you will for four hundred milligrams per ml and 300 milligrams per ml and the amount of gel you went you would need to add for those two we're gonna do five hundred so my vial says remember uses a multi-dose vial 500 milligrams per milliliter I'm adding five point six milliliters of dill you went and in the end I'll have six milliliters which means at 500 milligrams per ml I'll have six doses right 500 milligrams per ml six milliliters there's six doses okay so we're going to clean the tops because as I told you before those are just dust covers they do not insure sterility you need to do a 15 second scrub and allow it to dry you're going to need a needle and a 10 or 12 ml syringe did you say a 3 ml syringe but you'd have to insert it twice into your gently girdle you went because we remember we need a total of 526 fun fact in a question if I was reconstituting for 400 milligrams per milliliter I would need 7.1 milliliters of diluent and in that case I could not use the 10 ml syringe because it's marked off in even increments and you can't just eyeball it she's somewhere between 7 & 7 point 2 and hope the kidneys don't mind in that case you need a more precise measurement that you would get with a smaller syringe so I'm just holding my needle in the wrapper and I'm going to attach my 10 ml syringe I'm going to let her lock that on gonna pull the cover straight off I'm going to pull back 5.6 milliliters of air and I'm going to insert the air into my vial keep your thumb firmly down on there invert getting some air in my syringe but that's okay because we can eliminate that all right how do we get rid of that air you can take a pen and tap it or bandage scissors or you can flick it with your finger one system that I learned what that was some really great as you grip it and slap it and that really makes the air there it's gone now when you see it's not here on the top of your syringe anymore that mean doesn't mean it just disappeared into outer space it's just up here at the top you still have to expel it back into your vial or out into the atmosphere and make sure that the needle is below in the low the waterline and you're just gonna pull back more air into your syringe okay two four six there we go I have 0.6 milliliters and I'm going to inject that now into my powder there's going to be a lot of pressure here the glass vial is a closed system and there was one ml of powder in here already and 10 mils of air excuse me nine mils of air and now I just added five and a half milliliters of fluid so as you can imagine there's a lot of pressure in there I'm going to just ease up on my syringe and let some of that air there we go that should help equalize the pressure now we're gonna mix we do not shake just gently roll it or you can invert it I'll roll it myself and then you need to look at the bottom to make sure that you've mixed it all up as you can see – not quite mixed so I've got to do a little more mix eat – Dixie you can say whatever you want mixing stubborn today real antibiotics when you reconstitute them mix a little more readily a little more easily than these practice powders do okay there we go we're ready I'm going to get rid of this big syringe that I used and put it right in my sharks I'm going to clean my powder again for 15 seconds and now I need my three mil syringe three milliliter syringe I'm gonna pull the wrapper back I'm going to take my syringe out I'm going to twist off my needle off the syringe or on lower lock it it's kind of a mouthful I'm gonna pick up a filter needle twist the cap off and I'm going to lock my filter needle on to my three ml syringe take your cover off dropped one milliliter of air because remember your dose was 500 milligrams per ml your to give 1 ml so I need 1 ml I'm going to inject the air into the vial invert and drop 1 milliliter of medication with my filter needle the filter needle is the filter right here in the hub it helps filter out the tiny little particles of medication that did not mix that you cannot see readily with the naked eye I'm going to scoop to cover my filter needle tighten it down and I'm going to twist it off put it on I'm gonna go back to the plastic tray where I've kept my three milliliter needles sterile little lever lock that back on and now my medication is ready to go down to my patients room and give them their injection this package says that this is a 22 gauge one and a half inch long needle and that's a great size for an intramuscular injection and in this case we're giving an antibiotic when you go to your patients rooms you are going to identify your patient after you have already confirmed the order I like to map out their skin site first and then cleanse it with alcohol and then put my gloves on so for this example we are going to show you how to do a z-trek injection years and years ago in nursing school the only medication that was given as a z-trek was iron and that is because it stained the skin so that was the only reason that medication was given using a z-trek method it was simply for the aesthetics of it all now we understand and it's considered a best practice to give all intramuscular injections as as e-track because it seals the medication down into the muscle and prevents it from tracking back out through the needle line there is a really good illustration of that concept in your Koecher so I encourage you to take a look at that illustration so that you kind of get that in your mind so what you do after you identify your site is that you you know I think I better just put my clothes on first so I will because I don't want to contaminate my site what was going on Danis got the best of me I'm going to loosen my needle cover I didn't walk them off very easily so I had to take it off all the way and just gently put it back on all right so gloves are on I'm going to identify my site the concept booth is a trek is that we're pulling on with a top layer of skin and subcutaneous tissue so we're pulling that over about an inch to an inch and a half and then you're going to clean the skin and now we have to wait for this to dry because if you're not gonna let it dry you might as well just lick it it has to dry in order for exam time my acrylic antimicrobial effect to take place if I had which I was gonna do the first time and I caught my mistake I was going to clean it and then put my gloves on but I did I'd have to still go across what I cleaned with my blog hand as I slid it over so then that would negate all the cleaning I did so we're just gonna hold the patient's skin and I I know it seems a little awkward standing there their skin pulled over while you're not doing anything but I think if you explain to your patient that it's for their safety and from the sterility of it they will be appreciative so now my skin is dry and I'm going to slide my cover off and with my bevel up I'm just going to make a simple little arch right down into the skin now sometimes I see students who have played baseball or softball they're like think of this is all or darts at the bar this is all from the shoulder it is not from the shoulder it's a simple little elbow and wrist thing tuck your elbow in just see straight little pretty little arch and it's like driving a car you remember when you first learned to drive a car and you didn't look ahead of you your car goes where your eyes go and I loved how to drive a car I was always watching the middle blind instead of what was ahead of me this is gonna go where you're gonna go where your eyes go so just keep your eyes on the skin and your needle will go there you're not gonna stick yourself so don't want your me watch your patients skin I always warn my patients if they're gonna feel a little poke you're gonna feel poke and then my little habit is I say 1 2 3 you don't have to do that you can make your own little habit but that's my habit ok 1 2 3 just darted in it's really cruel to your patient if you give it slowly the needle gotta give the medication slowly just don't dare at the needle and slowly we do not aspirate that is not considered a best practice anymore you may see nurses doing that in clinical but that is no longer considered a standard of practice it is not current so no aspiration and you're just going to inject this slowly one milliliter over 10 seconds that gives the muscle time to absorb it so over 10 seconds and then the secret to the z-trek is that we pull the needle out at the same time we lift our hands so that subcutaneous tissue can slide back over and cover the needle track so here we go – it's a little more real with a patient than it is with this pad but you get the idea and your dirty needle goes from right into the sharps and then you might need a band-aid take off your gloves put them in the trash clean up your supplies and document see me if you have questions

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