Bypassing First-Pass Metabolism with Sublingual Administration

A small, sealed glass drug container that must be broken to withdraw the medication and a special needle with a filter to draw up the medication and then replaced with a normal needle for administration

Metabolism of oral medication by the liver...decreasing the effect of the medication...can be bypassed by using sublingual, buccal, and parenteral routes.

Parenteral route: Includes: intradermal (ID), Subcutaneous (subcut), intramuscular (IM), and intravenous (IV).

Right Task Right Circumstance Right Person Right Direction/Communication Right Supervision

Barrel Tips (slip-tip or luer-lok tip) Plunger

1. Regular Syringe: 3.0, 5.0, or 10 mL IM or subcutaneous 2. TB Syringe: 1.0 mL TB, newborns and infants. 3. Insulin Syringe: ONLY insulin calibrated in units (0.3, 0.5, 1mL) 4. Prefilled Syringe: single dose, ready to use, disposable cartridges

1. Hub: used o attached the needle to the syringe 2. Bevel: slanted tip of the needle to prevent coring and should always face upward 3. Shaft/cannual: denotes needle length-maintain sterility 4. Safety guard: safety for all once med is administrated

The diameter of the needle typically between 14G and 27G. The larger the #, the smaller the gauge

Needles come in different lengths ranging typically from 3/8 to 2-inches.

A glass or plastic container of medication with a rubber stopper that must be punctured with a needle for medication removal.

An injection of a small amount of fluid into the dermis immediately below the epidermis. Given in LVentral forearm with a 20-30G, 1/2 - 5/8 G needle put in at a 15-degree angle to create a "bleb".

Deposits the medication into the subcutaneous layer below the skin. Given in abdomen with a 3/8-7/8 inch; 24-29 G needle at a 45 or 90-degree angle depending on fat in abdomen. Insulin and heparin most common

Injections directly into the muscle at 90 degrees using a 20-22G, 1-1.5 inch needle (adults) - Total of 2-3mL into ventrogluteal sites (gluteus medius and glutewus minimus) - Total of 1-2mL into vastus lateralis and rectus femoris - Total of 0.5-1 mL into deltoid - Total of 0.5mL into children and infants

Provides for closure of the needle track when you release the skin and tissue while an IM injection.

- Use side of hand to pull tissue (1-in) taut - Insert needle at 90* while holding tissue - Aspirate - Wait 10-sec - Withdraw needle - Apply pressure but DO NOT massage

Gluteus medius and gluteus minimus muscles in the hip.

RBC: 4.5-5 WBC: 5-10 HgB: 11-17 INR: 2-3 Platelets: 150-450

Anterior aspect of the thigh.

Upper outer quadrant of the buttocks

- Lipotrophy - breakdown of subcutaneous fat at site - Lipohypertrophy - buildup of sub-fat at site

- A group of serious and chronic disorders affecting metabolism of carbohydrates - Glucose is the primary source of energy for the body - Glucose is transported by the blood; entry into the cells is controlled by insulin

- A hormone secreted by beta cells of the Islets of Langerhans in the pancreas - When an inadequate production of insulin or the body is unable to use the insulin it produces, glucose cannot enter the cells and it accumulates in the blood, increasing hyper-glycemia.

- Glycosuria: glucose in the urine - Polyuria: excessive urination - Polydipsia: excessive thrist - Polyphagia: excessive appetite - Loss of weight, weakness, and fatigue

- Keytones: =end product of rapid or excessive fatty-acid breakdown and made when body breaks down fat for energy; will be present in the urine when the keytones in the blood go above a certain level. - Ketoacidosis: condition in whichacids from keytones accumulate. May lead to diabetic coma, which can result in death. - Blood cells become stiff and rigid - Cause tiny tears along the inside of vessels - Plaque adheres to the tiny tears - Decreased circulation and increased complications - Atherosclerosis: major cause of death in diatetics - Retinopathy: leading cause of blindness - Arterio-scerosis - Kidney disease resulting in dialysis - Neuropathy - Infections; especially in urinary tract

- Unknown - Viruses and obesity may precipitate diabetes

-Prediabetes: precurser to type II - Type I: Insulin Dependent Diabetes Mellitus (IDDM) - Type II: Noninsulin Dependent Diabetes - Gestational: diabetes during pregnancy

- Improper use of insulin by the cells of the body - Fasting blood glucose levels ***>110mg/mL but <126mg/mL - May advance to Type II

- When your body either resists the effects of insulin or doesn't produce enough insulin to maintain a normal glucose level. - Treated with diet, exercise, oral meds

- Diabetes occuring during preganancy - Occurs between 16th - 28th week of pregnancy - Insulin required IF not responsive to diet and exercise - Usually disappears after the infant is born. - Predisposed to diabetes developing after 5-10 years after pregnancy.

- Lipro (Humalog) - Onset: 15-min - Peak: 0.5 to 1.5 hours - Duration: 5 hours

- Regular Humulin R; Novulin R; and Reg Iletin II - Onset: 0.5 to 1 hour - Peak: 2-4 hours - Duration: 6-8 hours

- Humulin U; Humulin N; Novulin N; NPH; Lente Iletin II - Onset: 1-2.5 hours - Peak: 4-15 hours - Duration: 18-25 hours

- Humulin U - Onset: 4-8 hours - Peak: 10-30 hours - Duration: 36-hours

- Reg Humulin N; Humulin 70/30; Humulin 50/50; and are stable and can be administered without conern for time after withdrawal from vial - Onset: 0.5 - 1 hour - Peak: 4-8 hours - Duration: 24 hours - NOTE: When injected within 15-minutes of being combined - they act as if they have bee injected separately.

- May be administered subct and IV - Dosages are usually very small - Nurse does not aspirate -