GENERAL NURSING

SKILLS WORKSHOP
Peripheral IV therapy
• Definition :
Peripheral intravenous (IV) lines, catheters or cannulas are indwelling single-
lumen plastic conduits that allow fluids, medications and other therapies such
as blood products to be introduced directly into a peripheral vein.
• Best veins used are:
• Median cubital
• Accessory cephalic vein
• Median vein of forearm
• Dorsal venous network
Preparation for an IV line:
• Tray
• Iv canula appropriate
gauge
• Gloves proper
• Tourniquet
• Normal saline0.9%/10ml
• Syringe
• Chloroxhidine desinfect 2%
• Sterile gauze
• Transparent tape (canula
dressing)
• Extension set
• Sharp container
Preparation with patient:
• Verification of the physician demand
• Review patient medical record for allergies to:
 Antiseptique agent
 Latex
 Anastatique agent
• Verify that all you need is prepared.
• Introduce yourself to the patient and clarify the patient’s identity. Explain
the procedure to the patient and gain informed consent to continue.
• Identify patient verbaly using three name identifiers and check
MRN
• Assess extremities for appropriate placement of IV insertion. Identify contrindication for an insertion
Including :
 Asses clients previous or precieved experience with IV therapy Dialysis access site
 History of mastectomy
 History of trauma or impaired venous damage to extremity
 Prior history of IV complication
 Frail, fragil vein Poster
• Hang the IV solution or medication
• Place the patient in confortable situation(sitting/leaving the arm in a dependant position to increase
venous fill of the lower arm and hands
• Sanitize your hands using alcohol cleanser.
• Apply the tourniquet and re-check the vein.
• Identify accessible vein for venipuncture and remove the hair if it
necessary (shave)
• Palpate the vein lightly with the index and middle finger of your hand to
assess vein condition. If the vein is easily palpable but not sufficiently
dilated place the extrimity in a depandant position for several second and
instruct the patient to make fist for several times
• Release touniquet: Hand hygiene and Wear gloves
• Reapply touniquet
• Desinfect the iv insertion site with an antiseptic agent Chlorhoxidine 2%
• Insert the iv canula :
• Perior to veinupuncture hold the catheter hub and rotate barrel 360 degree
• Stretch the patient skin taut below the pincture site using the thumb of your non
dominant hand to stabilize the vein
• Perfome the insertion holding the vien puncture catheter 10 to 30 degree angle with
level pointed upward
• Look for the blood return in flashback chamber and advance needle several
millimiters to insure catheter entrance into the vein gentely
• Release the tourniquet, apply pressure to the vein at the tip of the cannula and
remove the needle fully. Remove the cap from the needle and put this on the
end of the cannula.

• Carefully dispose of the needle into the sharps bin.

• Apply the dressing to the cannula to fix it in place and label the iv dressing with
the current date, time, initial
• Advice the patient to avoid getting the iv dressing and insertion site wet during
bathing and hand washing.
• Return the bed to the lowest position
• Discard used suplies in aproppriate place
• Remove and discard your gloves
• Perform hand hygiene
• If reusable equipement was used clean and disinfect it
• document the procedure in nursing note
• Site
• Date
• Time
• Gauge
• Patient response
• Dressing
• Flash
DRUG CALCULATION IN NURSING
Drug Calculation? Why it is important for the nurse? Midwifes? Why
do we need to know basic drug calculation?
1. It makes the nurses more confident of there abilities as a health
care professional.
2. It makes the nurse more committed on her responsibility to her
patient.
3. It is counted as the skills that make the nurses correctly interpret
the written prescription written by the physician.
What are the methods for calculation drug dosages?
• Basic formula:
Ratio and Proportion
Blood sampling
 Venous Blood Collection: Supplies
1. Adult butterfly needle set (1)
2. Vacutainer single-use holder (1)
3. EDTA, purple top vacuum tube (1)
4. Tourniquet (1)
5. Alcohol swab (1)
6. Gauze square (1)
7. Plaster (1)
8. Disposable gloves (2)
9
9. Syringe (1)
 Other Supplies Needed: Venous Blood
Collection
1. Sharps container (1)
1

2. Specimen label (2)

a) A pre-printed barcode label
to affix to the specimen
tube OR
b) An ultra-fine permanent 2a
2b

marker to document the

participant’s unique ID on
the specimen tube
• Steps for blood simpling :

2. Organize supplies.
1. Wash hands thoroughly and put on a
new pair of gloves.

3. Put tourniquet on patient

about 7-10 cm above venipuncture site.
4. Have patient form a fist so veins 5. After palpating the path of veins, clean the
are more prominent. venipuncture site with alcohol using a circular
motion. Dry for 30 seconds.

6. Remove needle sheath from butterfly 7. Assemble needle and vacuum

winged infusion set. tube holder.
 9. Insert the needle, bevel side up into the
8. Use your thumb to pull skin tight,
vein. A “flash” of blood will enter the tubing.
1-2” below venipuncture site.

10. Push the vacutainer tube completely

11. Have participant relax the fist, and
into the needle. Blood should begin to flow
release the tourniquet.
into the tube.
 12. When the tube is 13. After completion 14. Remove the needle,
finished filling, remove of blood collection, then apply pressure to
the tube and gently place dry gauze over the pad. Continue
invert it 8-10 times the venipuncture applying pressure until
before laying it down. site. bleeding stops.
This will prevent the
blood specimen from
clotting.
15. Once bleeding stops, 16. Properly dispose of all
apply a plaster. contaminated supplies.

17. Label your tube per protocol.

18. Send tubes to the laboratory
Medication administration
 Definition
The direct application of a prescribed medication whether by injection,
inhalation, ingestion, or other means to the body of the individual by an
individual legally authorized to do so
 Rights of Medication Administration
• The right patient : check that you have the correct patient
using two patient identifiers (e.g., name and date of birth)
• The right medication (drug): check that you have the
correct medication and that it is appropriate for the
patient in the current context.
• The right dose: check that the dose makes sense for the
age, size, and condition of the patient. Different dosages
may be indicated for different conditions.
• The right route: check that the route is appropriate for the
patient’s current condition.
• The right time: adhere to the prescribed dose and schedule.
• The right reason: check that the patient is receiving the
medication for the appropriate reason.
• The right documentation: always verify any unclear or
inaccurate documentation prior to administering medications.
• The right to refuse: Right to refuse medications: includes staff
responsibilities to encourage compliance, document the
refusal, and report the refusal to the administration, nurse
administrator, and physician.
 Medication administration route(s)
• Taken by mouth (orally)
• Given by injection into a vein (intravenously, IV), into a muscle (intramuscularly, IM), into the space
around the spinal cord (intrathecally), or beneath the skin (subcutaneously, sc)
• Placed under the tongue (sublingually) or between the gums and cheek (buccally)
• Inserted in the rectum (rectally) or vagina (vaginally)
• Placed in the eye (by the ocular route) or the ear (by the otic route)
• Sprayed into the nose and absorbed through the nasal membranes (nasally)
• Breathed into the lungs, usually through the mouth (by inhalation) or mouth and nose (by nebulization)
• Applied to the skin (cutaneously) for a local (topical) or bodywide (systemic) effect
• Delivered through the skin by a patch (transdermally) for a systemic effect
Injections
Intradermal injection
Equipement :
• Prescribed medication
• Steril syringe, usually a tuberculin syringe calibrated in tenth and hundredths,
and needle ¼ to ½ inch or 26 or 27 gauge
• Antimicrobial swab
• Disposable gloves
• Small gauze squar
• PPE as indicated
• Paper bag or kidney tray
Steps :
Verify physician order
Performe hand hygiene
Prepare equipements
Enter room and introduce yourself, explain procedure and the medication, and
allow patient time to ask questions.
Close the door or pull the bedside curtains.
Verify patient identity three name identifiers and check
MRN
 Select appropriate site for administration. Site
should be free from lesions, rashes, and moles.
Selecting the correct site allows for accurate
reading of the test site at the appropriate time.

 Performe hand hygiene and apply non-sterile

gloves.

 Clean the site with an alcohol swab or antiseptic

swab. Use a firm, circular motion. Allow the site
to dry.
Using non-dominant hand, spread the skin taut over the
injection site.

Hold the syringe in the dominant hand between the thumb

and forefinger, with the bevel of the needle up.

Hold syringe at a 5- to 15-degree angle from the site.

Place the needle almost flat against the patient’s skin,
bevel side up, and insert needle into the skin. Insert the
needle only about 1/4 in., with the entire bevel under the
skin.
Once syringe is in place, slowly inject the solution
while watching for a small weal or bleb to appear.

Withdraw the needle at the same angle as insertion,

engage safety shield or needle guard, and discard in a
sharps container.Do not massage area after injection.

If injection is a TB skin test, circle the area around

the injection site to allow for easy identification of
site in three days.

 Discard remaining supplies, remove gloves, and 

perform hand hygiene
Document the procedure and findings according to agency policy: Proper
documentation helps ensure patient safety. Document time, date, location, and
type of medication injected.
Evaluate the patient response to injection within appropriate time frame: The
patient will need to be evaluated for therapeutic and adverse effects of the
medication or solution.
Intramuscular Injection
Equipement:
• Syringe and needle
• Alcohol swab
• Disposable gloves
• Medications tray
• Medication to be administered.
• Band AID
• Antiseptic
• Sharp container
Preparation :
Check physianc’s order
Check 8 rights of medication
Performe hand hygiene
Check equipements prepared
Identify the patient three name identifiers and check MRN
Explain procedure to the patient
Provide privacy
Select appropriate site for
administration. Assist the
patient to the appropriate
position as required
Upper Arm \ deltoid muscle
• To find the injection site, feel for the bone at the top of your arm where
your arm meets your shoulder. The injection site is about two inches
below that spot (or roughly two or three finger widths). Be sure to give
the injection in the center of the muscles where it is thickest
Thigh: vastus lateralis/ rectus femoris
• To find these muscles, imagine lines dividing
the front of your thigh into thirds from the
top to the bottom.
• To inject into the vastus lateralis, the needle
should go into the middle third on the outer
portion of your thigh.
• To inject into the rectus femoris muscle, the
needle should go in the middle third at the
front of your thigh.
Buttock
• The dorsogluteal muscle is the large
muscle located in your buttocks. It is one
of the largest muscles on the body but one
that can be awkward to access on your
own. For this site, you will need a partner.
• To find this site, divide one butt cheek into
fourths from top to bottom and side to
side. Your partner will want to give the
injection in the outer, upper quadrant
toward the hip. This is the part of the
buttocks with the least fatty tissue.
Hip
• Your ventrogluteal muscle is located near your hip. While
it is possible to give yourself a shot there, it may be easier
to do with a partner.
• To find the site, lie on your back and have your partner
stand facing your hips. Have your partner place the heel of
their hand so that their wrist is lined up with your thigh.
• Your partner's thumb should be pointed toward your groin
and their fingers should be pointed toward your head.
They should be able to feel the border of a bony area with
their ring finger and pinkie.
• Next, your partner should spread their pointer finger and
middle finger into a "V" and give the injection between
those fingers.
Check the patient for any allergy or phobia
Performe hand hygiene and wear gloves.
Open your alchool swab and in circular motion clear area in 2 inch diamater at
the site of injection at least 2 time, and more if needed
Let it dry.
Take the needle in dominant hand between the thumb and th index finger
At 90 degree angle , plunge the needle into the skin in a dart like motion
Depending on the site of injection , determine how far the needle is going to
have to go into the skin to be in the muscle
Stabilize the needle with non dominant hand
Use the dominant hand to pull back the plunger and aspirate (If there is a blood
aspirated remove the needle and start from the beginning)
Push the medication at a slow and steady pace, Inject medication over 1-2
seconds.
To take the needle out , quickly pull up at 90 degree
Diaspose of needle in a sharp container
apply some pressure at the site of injection with alchool swab
Cover the site with band AID
Throw gloves in yellow bag, and wash your hands
Observe the patient for signs of any allergic reaction
Ask the patient what he/ she feels?
Documents the procedures
Subcutaneous injection
Equipement:
• Syringe and needle
• Alcohol swab
• Disposable gloves
• Medications tray
• Medication to be administered.
• Antiseptic
• Sharp container
Preparation :
Check physianc’s order
Check 8 rights of medication
Performe hand hygiene
Identify the patient 3 names verified zith the ID band
Introduce your self and Explain procedure to the patient
Provide privacy
Check equipement prepared
choose the sites for subcutaneous injections include the outer lateral aspect
of the upper arm, the abdomen (from below the costal margin to the iliac
crest and more than two inches from the umbilicus), the anterior upper
thighs, the upper back, and the upper ventral gluteal area
Cleans the area with alchool swab
Wait the site to dry
Remove the needle cap
Pinch a 2inch fold of skin between your thumb and index fingers
Hold the syringe the way you would a pencil or dart
Insert the needle at 45° to 90° angle to the pinched up skin (the needle should be completely
covered by skin)
Hold the syringe with one hand .
Push the plunger slowely to inject the medication . Pree the plunger all the way down .
Remove the needle from the skin and gentely hold an alcohol pad on the site of injection . Do
not rub
Put the syringe and needle into sharp container
Remove gloves and wash your hands
Ask the patient what he/she feels?
Document the procedure