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T1ct
INJECTIILE
TIPUL SCOPUL LOCUL INJECTIEI soLuTrlADMINISTRATE
RESORBTIA
- izotone, ugorresorbabile, cudensitate mici
- foarte lentiINJECTIAINTRA-
DERMICA(i.d.)
EXPLORATOR:- intradermoreacliila tuberculini, ladivergi alergeniTERAPEUTIC:- anestezie locali
desensibi l izareaorganismului incazul alerqiilor
REGIUNI LIPSITE DE FOLIOULI HILU)I.- lata anterioari a antebralului;- {aia externi a bratului 9i a coapsei;- orice regiune, in scop de anestezie
- solulii izotone,nedureroase;- solulii cristaline:insulina, histami-na. cofeina
- incepe la 5-10minute de laadministrare;- dureazd in func-lie de cantitateaadministratA
TNJECTIAsuBcuJA-
NATA(s.c.)
TNJECTIAIII'{TRAMUS-
CULARA(i.m.)
TERAPEUTIC REGIUNI BOGATE IN TESUT CELULAHLAX. EXTENSIBIL:- fata extern6 a bratului;- tita suDeroexternd a coapsei;- taia subra- 9i subspinoasd a omoplatului;- rebiunda subclaviculari;- fla-ncurile peretelui abdominal
TERAPEUTIC MUSCHI VOLUMINOgI, L lPSlTl DETRL'NCHIURI MARI DE VASE $l NERVI:- reoiunea superoexterni a fesei;- tita exterhd a coaPsei, in treimeamiilocie;I tai
"it"rnd a bralului, in mugchiul deltoid
- solufii izotone;- solulii uleioase;- solulii coloidale,cu densitate mare
- incepe imediatdupi adminis-trare;- se termini in3-5 minute;- mai lenti Pentrusolufiile uleioase
- solulii izotone;
- solutii hipertone- instantanee
INJECTIAINTRA.
VENOASAi . - r l
EXPLORATOR:- se administreazdsubstanle de contrastradiologicTEqAPEt-iliic
- venele de la Plica cotului;- venele antebralului;- venele de pe fdla dorsald a mAinii;- venele maleolare interne;- uarplle nnicraniene
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-IE
ffirife.lAiure medicamentelor
Forme deprezentare
Cdi deadministrare
Intervenf iile asistentei medicate.Reguli de respectat.
tablete(ex. penicilina V)
capsuleoperculate
(ex. ampicilind,oxacilind250 mg,
doxicilin6)
pulberiinflacoane
(ex. oxacilind250 mg,
penicilina G400.000 u,
kanamicind 1 g)fiole
orali
parenterald(injeclii i.v., i.m.,intrarahidiene,
perfuziiintravenoase)
AftTrHoncELoR glOI]OTERAPICELOR
lfllUbde suosranleoqri:e, provenite din meta-
,lh*rrr.l oefulelor vii (muce_rSF-. bacterii) sau obfinute]lpe cale sinteticd, care auil propri€tefi bacteriostatice,i batericide sau antimicotice.! Chimioterapicele - substan_i !e chimice cu acliune bacte-I riostatica sau bactericidd.| $trul de activitate:I t irpust (ex. penicilind, strep_I tornicind);i o larg (ex. tetraciclinele,I doramfenicol) |! A4iuni: II r Bactericidd Ii ex. penicilind, cefalosporine, II aminoglicozide, rifampicilind I' I Bacteriostatici II ex. tekaciclind, cloramfenicol, I' eritromicini, sulfamide I
(ex. gentamicine) |
unguente I tegumente 9i(ex. neomicind) I mucoase
- recolteazi produsele biologice sau patologicepentru examenul bacteriologic in' vedereaidentificdrii agentului patogen 9i a determiniriisensibilitdfii lui la antibiotice _ antibiograma.- verilici termenulde valabilitate al irodusului.- administreazi antibioticul prescris,' respectAnd:
I prevenirea reactiilor alergice prin anamnezacorectd pentru depistarea persoanelor cu terenalergic Ai prin testarea sensibilitdlii organismului(testul intradermic sau prin scariiicarJ
", Oilulii
100 u/ml sau 1000 u/ml pentru antibioticelemdsurate in unitdti sau d,001 g/ml, n"^ii, ]antibioticele misurate tn grame; -
IJ dozape 24 de ore 9i doza unicd; se exprimd I
in u.nitili (ex. penicilina) sau in grame (ex. Ilmpicilina, oxacilina, tetraciclina); - '----lf dizolvarea corecti a pulbeiilor de antibiotice I
l^ sqr fiziologic, injectarea fdcAndu_se imediat. Iiano nu sunt la dispozifie flacoane monodozd. Ilzotvarea se face pentru mai multe prize; II concentralia sotutiei oblinuti bentiu peni_ |;ilind poate fide 50.000-200.000 u/mt; I
I evitarea asocierii in aceeagi seringe a mai Ilultor antibiotice sau a antibioticelor cu atte Iredicamente:
@o Definilie.
Acfiunea medicamentelorForme deprezentare
Cii deadministrare
Interventiile asistentei medicale.Regulide respectat.
I Antimicoticd
i "r.griseofulvinAI Efecte adverse:Alergice: eruplii, soc ana-
| filacticj Toxice: hepato-, nefro-,] neuro-, ototoxiceI Biologice: dismicrobism,1 aparitia rezistenlei micro-il biene la antibiotice.
2. ADMTNTSTRAREA IcoRTlzoNULUt I
IGortizonul _ este hormonul I tablete,ryandelor suprarenale secre- | (ex. Prednison)eat de stratul cortical sau Ianalogi de sintezd. i solufii in fioleActiune: j (ex. hemisucci-- antiinflamatorie {inhibi pro- | nat de hidrocorti-cese e rn1l'trannatorii exsuda- I zon)l1*€, *€tr:tfir€E pr-0itf3'3:'re :
oral6
parenterali(injeclii i.m., i.v.,intraarticulare,intrarahidiene)
I ritmul de administrare se respecti pentru amentine concentratia eficientA in sdnge aantibioticului - poate fi de 3-4-6 - t2-24 de ore;
I calea de administrare se respecte, eaputdnd fi orald, intramusculard, intravenoasd,intrarahidiand, perfuzie intravenoasi. Penicilina Vse administreazl pe cale orald, cu 30 de minuteinaintea meselor.- administreazd sulfamidele cu o cantitatesuficienti de apd pentru a asigura o diurezd de1.500 mll24 de ore, evitAnd precipitarea renald.- eviti sensibilizarea sa fati de antibiotice, prinfolosirea mdnugilor de cauciuc in timpul dizolviriigi manipulirii antibioticelor.
- respecte doza 9i ritmul de administrare;- respectd orarul de administrare pe cale orald,prednisonul administrdndu-se dimineala intreorele 6 9i 8, cAnd secrefia corticosuprarenaleieste maximi;- invali pacientul sd-gi administreze pe calerespiratorie doza, fiind reprezentatd de numdrulde ,,puf"-uri;
il
ffilli'
{r
- anildergbeSe administreazl in diferitedectumi: RAA, astm brongic,str arqafifactic, edem glotic,$a; in lhipofunctie cortico_nryaretnalE-;mtryrtl nu vindeci, ci mo_nica €aalitb la agentul cau_a €ht.iatea are un carac_lBl $Fdomatic, paliativ.ftesffi secundare:- scAderea rezistenlei orga_n'mrrufuila infeclii;- cregterea secrefiei gastricede FlCl;- perturbarea metabolismuluisodiului, apei, glucidelor,pmteinelor.
IJ
3" ADMINISTRAREAANTICOAGULANTELOR
Anticoagulantele sunt medi_camente care impiedicd coa_gularea sAngelui, actiondndasupra factorilor plasmatici aieoagulirii.
lnlerverrfiile asistentei medicale.Reguli de respectat.
flacoane(ex. hidrocortizon
acetat, volon)
unguente(ex.
fluometazondpivatat)
flaconpresurizat
(ex. beclomet)
heparina- solulie in fla-
coane de5.000 uiml
- fiole 5.000 u/rn
locali(pe tegumente gi
mucoase)
respiratorieaerosofi
parenteraliinjecfii subcuta-nate, intrave-
noase, pertuzieintravenoasd
preveni infectiile locale: -.' r-
- asigurd regimul alimentar al pacientului, care_"rtg desodat, hipogtucidic, dit;6;;d", cusuplimentare de calciu, potasiu Si tosior;--- supravegheazi 9i noteazd zilnic in'foaia detemperatu16 tensiunea arteriald, gr"rt"t""co19or3]d, raportut ingestie/excrelie; w'-'-^recofteazd sAngele pentru dozareaglicemiei larecomandarea medicurur :- sesizeazi efectele secundare prezentate depacient giinformeazd medicut 0;il;;';are deeufo.rie, anxietate, dureri il,gr;i;;;;;' HTO,cregterea in greutate).
- respectd mdsurile de igiend a tegumentelor11::::::^l.1r^^;1 lenteriei pacienturui,- pentru a
Atenfie: este obligatorie agitarea fiolelor,3:::l^"ll gy :y.g gn;ie thiorocirtilJn' acetat; invederea administrdrii.
-,respectd indicatiile .medicului privind doza,calea 9i ritmulde administrare -'-r'v
- verificd calitatea produselor: termen devalabilitate, aspect, culoare, i"i.giit"t" ; " "'
olrJ , Definitie.
, AdiurnarredicamentelorForme deprezentare
Cii deadministrare
Intervenliile asistentei medicale.Reguli de respectat.
I Tratamentul se face subI control clinic si de laborator
(timpul Howell, Quick, l.N.R.I - International NormalizedI Ratio) pentru a preveniI accidentele hemoragice.
I Heparina are acliunei imediatd, de scurti duratd| (cca 4-8 ore).I Reaclii adverse: alergie,I febra, frison, eruplii cutanate,
i Ooc anafilactic.iI Anticoagulante cumarinice
- trombostop - efectul lor seinstaleazd dupi un timp delatenti. Se folosegte inlratamentul ambulatoriu suboontrolul siptdmAnal allirnptrlui Quick, Howell, careeste de doud ori 9i jumitate
i mai mare decdt normal.
calciparina- seringi preum-
plute 0,2 ml-5.000 u
- fiole de 1 ml -25.000 u
fraxiparine- solutie
9.500 u/ml- seringi pre-
umplutenegradate0,3-{,4 ml
gradate0,6-0,8 ml
trombostop
hepathrombinigel, unguent
injectiisubcutanate
injectiisubcutanate
orali
aplicalii localepe tegumente 9i
mucoase
pregetegte instrumentele 9i materialelenecesare tehnicii de administrare in functie decalea prescrisd de medic, respect6nd misurile deasepsie.Astfel:a) Heparina prin injecfie subcutanati,intravenoasd sau in perfuzie cloruro-sodiciizotoni; injecliile se fac in zonele de elecfiecunoscute Si dupi tehnicile invilate;b) Calciparina gi fraxiparine, prin injectiesubcutanatd. Locul de electie este regiuneaabdominald, anterolateral gi posterolateral,stAnga-dreapta.Tehnica de administrare: se inspecteazi regiu-nea, se dezinfecteazd tegumentele 9i se formea-zi pliul cutanat intre policele gi indexul mAiniistdngi, seringa preumplutd cu acul atagat, seintroduce perpendicular pe pliul cutanat, cu mAnadreaptd. Se verificd pozifia acului 9i apoi se injec-teaz6. in timpul iniectiriise menfine pliul cuta'nat; el se elibereazi dupi scoaterea acului 9idezinfectia locului injecliei.Accidente: durerea in timpul injectdrii impune tra-gerea imediat5 a acului gi injectarea in alti zond.c)Trombostop - se administreazi pe cale oral6.Se line seami de medicamentele care in-fluenfeazi efectul produsului. Cresc efectul: aspi-
fcFn ffiaInterventiile asistentei medicale.
Reguli de respectat.
rina, paracetamol, fenilbutazoni; scad efectul:pansamentele gastrice, cdrbunele medicinal.d) Hepathrombina - aplicd gelul sau unguentulde mai multe ori pe zi pe zone cu c6ntuzii,hematoame, entorse, fdcdnd masaje in sensulcirculatiei venoase.Aplicd unguentul pe o compresd find din tifon 9iapoi pe zonele cu acfiuni venoase inflamatorii.- supraveg.hea{ pacientul 9i sesizeazd apariliaunor complicafii, hemoragii (epistaxis, gingivo_ragii, metroragii, hematoame) qi rap6rteazdmedicului.- recolteazd periodic sdnge pentru monitorizareatimpului Quick, Howell.
Atentie:r bula din seringile preumplute nu se elimini
inainte de injectare.r nu se asociazd heparina in solulie
perfuzabild salind izotond cu alte medicamente.I in timpul tratamentului cu anticoagulante se
eviti injectiile intramusculare, intravenoase, altetraumatisme.
r tratamentul cu anticoagulante incepe cuheparina gi se continui cu trombostop.
r nu se fac masaje cu hepathromUina in cazde tromboze sau tromboflebite.
r nu se aplicd unguentul sau gelul pemucoase sau rdni deschise.
@5 Definilie.
Acliunea medicamentelor
4. ADMINISTRAREAANTIDIABETICELOR
Insulina - este secretatd decelulele beta, ale insulelorLangerhans ale pancreasului.Este singurul hormon hipo-glicemiant cunoscut.Dupi modalitatea de obli-nere:
r insuline provenite de laporcine gi bovine;
r insuline inalt purificate,de tip Monocomponent MC;
r insuline de tip uman HM'cr'iosintetice sau semisinte-
Supd dinamica acfiunii:r insuline rapide (ex.: in-
sufina cristdine, Actrapid MC,Ffilf). Se utilizeazdin urgenle.
r insuline intermediarelex.: Semilenti MC, Mono-ta"d l',4O sr HM. Humulin HM).rmunea LneOe h 4f120 detrflrl]|rilTr!,ltlB^ f,r]/.|fi8E" 1:-e4 * s.e.
I
&Fil,
flacoane5 ml/40u
ex: insulinacristalind,
Actrapid MC, HM
flacoaneSemilentd MC,Monotard MC,
HM, Humulin HM
flacoaneinsulind lentdUltralent MCHuminsulinLong HM
Pen-uricartug de 1,5 ml
(100u/ml);3 ml (100u/ml)
parenteraldinjec!ii
subcutanate,intramusculare,intravenoase
parenteralesubcutanat
parenteralisubcutanat
parenteralisubcutanat
a) Pentru administrarea insulinei:- respecti prescrip!iile medicului privind
doza, calea gi ritmul de administrare;- verificd valabilitatea preparatelor gi aspectul
lor ( insulinele rapide sunt l impezi, celeintermediare au aspect lactescent, dar fdrdflocoane);
- pdstreazd flacoanele cu insulind la frigider(2-8"C); flacoanele din care se administreazd sepot pastra 9i in camerd rdcoroasi la intuneric, lao temperaturd sub 25'C;
- pregdtegte pacientul in vederea admi-nistrdrii (insulinele rapide se administreazA cu15-30 de minute inaintea mesei);
- pregdtegte instrumentele 9i materialele ne-cesare pentru administrarea prin injectiesubcutanatd, intramusculard sau intravenoasd (inurgente). Se utilizeazd seringi de unici folosintd,gradate in unitdti de insulini. Flacoanele cuinsulind intermediard sau lenti se omogenizeaz|prin culcarea flaconului intre palme gi rularea luiblAndd 9i repetati. Aspirarea dozei recomandatedin flacon in seringi se face aplicdnd mdsurile deasepsie 9i evitdnd pitrunderea bulelor de aer inseringi.
r in$illne leflte (ex.:Uitrabnt MC, Lente MC,|,Lmdnsufin Long HM).
en:erae de insutiniFrTrtf --stiburi- (pen-uri)@ fu Fff cartuge.
ry edverse: alergie,Mfiucarfre" cefalee, dureriffirrmab, diaree, balondri.
&rtunklefe antidiabetice :I suffonamide (ex:
-alh;tamid, Glibenclamid).Se dministreazl, pacienfiloreu obezitate.
r biguanide (ex: Meguan,Sillubin). Efecte adverse:dllreri abdominale, balondri.
Intervenf iile asistentei medicale.Regulide respectat.
Inleruenfiile asistentei medicale.Reguli de respectat.
pompd extern5de infuzie a
insulinei
tableteex: Tolbutamid,
Meguan
prin catetersubcutanat,
intraperitoneal
- injectarea insulinei se face Oupe tefrnicile:^111:yp,"te injecfiif or subcutanate, intramuscu_lare sau intravenoaie, respectdnd loculOe elecrie9i regulile de asepsie;
-. .supravegheazi pacientul 9i sesizeazdaparilia unor compticajii generale sa-u-'tocate(hipoglicemia, ateroia-.li irrsrfi"a, nffiistrotiaatroficd sau hipertrofical;recolteazd sAnge,. urind, ir je0ne Sipostprandial, pentru monitorizarea tticlmiei 9iglicozuriei.
Atenfie:r fiecare tip de insulind se administ reazd. cuseringd separatd.r fiecare amestec insulinic se administreazd
cu seringd separati.r dupd dezinfectia dopului de cauciuc cualcoot, al flaconului de insulini-." I'ur""p,aevaporarea alcoolului.r rotatia locurilor de electie ale injecliei
subcutanate este obligatorie pentru a 'preveni
lipodistrofia.la pacientii normoponderali, pentruinjectarea subcutanatd
" 'inrJin"i"
l" nivetabdominal, nu este necesard formarea pliuluicutanat.
Deftnifie.Acf i u nea medicarnentelor
ennrlnqer*zanm weoerdrkiouu @lrtrn pruunryffr
ADMI NISTRAREA INSULINEI
r la pacientii supraponderali, indiferent delocul de eleclie al injecfiei subcutanate cuinsulind, se va forma pliul 9i se vor utiliza ace de12,5-19,5 mm.
- invat6 pacientul cu diabet zaharat, insulino-dependent, sd-gi administreze singur insulina prininjectie subcutanatd, respectdnd zonele deelectie, doza gi misurile de asepsie.b) Pentru administrarea antidiabeticelor orale:
- administreazd antidiabeticele sulfonamide(tolbutamid, glibenclamid) cu 30 de minuteinaintea meselor;
- supravegheazd pacientul 9i sesizeazi apa-ritia unor efecte secundare;
- recolteazd sdnge gi urini pentru monito-rizarea glicemiei 9i glicozu riei.
Zonele de elecliepentru injectia cu
insulindDan@eqnri
ibrutl
F cibhxice asupra celufelor
r.AaGmrnE/rGtrcr^ncELAn
ftcffilce*e (chimioterapicesrr aqlicancetoase) au efec_
- .respecti indicafiile .medicului privind doza,calea gi ritmulde administrare
intravenoasi (pentru Vincristin, i; -intr_un
minut) sau in pertuzialentd aflatd in "ur.,
in tubulperfuzorului.Atenlie:
I substanfa este iritantd gi impune verificareapozifiei acului in vend, inainte gi in timpulinjectArii.
f daci solufia pdtrunde accidental in lesutulperive_nos, se intrerupe injectarea gi se continudin altd vend; local, se injecteaza r.,lJrrJnio"ra,pentru a reduce disconforiul.
- verifici termenuf de valabiliiate a produsutui;- pregitegte instrumentele gi mateiateU nece-sare tehnicii de administrare:- informeazi pacientul privind efectele secun_dare ale tratamentutui (gastroinie.tin"i",Lrlp""i"reversibilS) etc.-, prepari solufia in funcfie de produsuladministrat (ex: Vincristin _ un ir".oni"'2oo rng,11.!izova.in.rp ml apd.distilatd sau gLcJza sz,9au ser fiziologic; dizotvarea se- t"ce t6rit11._?,:'rg, prin alitare puternicd ta temperaturacamerei. Se utilizeazd solufia oOfi[rta lamaximum doud ore de la prepara;.
--'"''- administreazi solulia prin injectare strict
GreU./ri, virsdturi, anorexie,stomatite, diaree, alopeciereversibild, pigmentareaFielii, fenomene neuro_ giototoxice.
urdce in seringa speciali
ou rffierare intensd.fu rffia g celufele normatemum ae mdtiplicd activ.fifiMioete tavorizeazdrFzrdtarea infecfiilor prinqmarea mecanismelor de
ii O"* a organismutui.
; n* adverse:
Interverrliile asistentei medicale.Reguli de respectat.
5tb rEEnEr rne,otcarc.neguli de respectat.
flacoanecu pulbereliofilizatd
EX:Ciclofosfamida
(Endoxan)VincristinVinblastinMetrotexat
tableteex: Metrotexat
parenteraldinjecfii
intravenoase,perfuzii
intravenoasegi intraarteriale,intratumorale,intrapleurale,
intraperitoneale
orald
Intron Asolutie injectabild
injecfiisubcutanate
I nu se administreazd chimioterapiceintravenos, in venele brafului, de partea sAnuluipentru care s-a practicat mastectomie urmat5 saunu de roentgenoterapie.- sesizeazi fenomenele neuro- 9i ototoxice,digestive apirute 9i informeazd medicul;- monitorizeazd functiile vitale 9i recolteazisAnge 9i urind pentru evaluarea functiilor renale,hepatice 9i medulare;- hidrateazi suficient pacientul pentru a avea obund diurezd (ex: la administrarea cisplatinului,hidratarea se face cu 6-8 ore inainle, prinadministrarea de 1-2litri de lichid, 9i provocareadiurezeicu manitol.
- respecti prescripliile medicului privind doza,calea 9i ritmul de administrare;- verifici valabilitatea produsului ;- pregitegte instrumentele 9i materialele nece-sare in condilii de asepsie pentru administrareaprodusului.ex.: pentru Betaferon
- flacon cu solvent (NaCl 0,54%) 2 ml, cucapicel alb
&$tt
6. ADMINISTRAREAINTERFERONULUI
frErferonul- s.fistanfd a organismuluidoGati cu proprietiti anti-virale, anticanceroase Sinrodulatoare ale functieilrnunitare.
I Edfi UGi Gnlr; dehfrrtmri:- A|[a - produs de monocite;- B@ - produs de cdtrelMss*i:- Gffta - produs de cdtrehmffie T.
hmlrfrrcr$ oblinuli prin ingi-illtsme gsrE[ice sunt utilizati in
L tr,ffimentul sarcomului Ka-r p6si (cf,n cadrul SIDA), innegmeb cronice 9i al unor
,sere. Interferonul beta _?r hdamentul sclerozei mul-fle; interferon alfa - in trata-nerlhJl hepatitelor cronice cuvrrnrs C.
i Ebcte adverse:I I sindrom pseudogripal. f tulburdri digestive (ano_1 rexie, greald, diaree)
I tulburdri neurologiceI tulburiri cardiovascularef tulburdri renale (protei-
nurie gi hematurie)
lntervenfiile asistentei medicale.Reguli de respectat.
iltrfe asistentei medicale.Reguli de respectat.
Betaferonflacoane cu
pulbere (cdpdcelalbastru)
injecfiisubcutanate
.. - flacon cu Betaferon pulbere, cu cdpicelalbastru- celelalte materiale pentru injeclia sub_cutanatd
; Prepararea solufiei se face cu o seringd de 2 ml,1. c,afe se aspird 1 ,2 ml solvent ce se iniroduce insticJufa cu pulbere - se agitd "nJarOiriiL"on
_sering6. Se obtine o soTulie timd;; ."r" ,"aspird in seringd 9i apoi se inlecteiza- --- Inrectarea subcutanatd se face dupd tehnicaobignuitd;
__sypravggheazd pacientul pentru a sesizaefectele adverse, informdnd meiticui;- -
- monitorizeaz|TA, menline o bund hidratare apacientului pentru a preveni hipov;lemi;;"-.._ recotteazi . produsele 'biologice
pentruex_amenele de laborator, pentru "monit6rizareGOT, GPT, leucogramd;-Iy"ta pacientuitratat ambulatoriu cu Betaferon:itj lrl"p sotufia si sa_si
-idminislielI' sinsurooza prescrisd.
Atenfie:I Betaferonul se pdstreazi la frigider, se
transportd in containere termoizolante (i O,g.C).I nu se ingheatd.I solufia preparatd se injecteazd imediat.
.l_ dacd la prepararea solutiei apar grunji,solutia nu se va utiliza.
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