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Medication (generic/trade)General usageUsual dose rangeUsual interval between injectionNeedle gauge to usenotesAripiprazole/Abilify MaintenaAntipsychotic for schizophrenia and bipolar 1300mg-400mg4 weeks21 gauge Supplement with oral abilify for 2 weeks during initiationComplex prefilled syringe. Read directions fully before attempting to mix medication.Do not give sooner than 26days from last dose. If after 4weeks, but before 6weeks, give asap. If after 6 weeks, need to stat another 14days of oral with injectionFluphenazine deconateAntipsychotic for schizophrenia and psychotic symptoms 20mg-40mg2-4 weeks21 gaugeAn oral dose of 20mg fluphenazine hydrochloride is equivalent to 25mg (1ml) fluphenazine deconate every 3 weeksHaloperidol deconate/ Haldol deconateSchizophrenia and tourette syndrome25mg-200mg4 weeks21 gaugeInitiate a lower dose (maximum 100mg) and adjust dose upward as requiredSome providers will load this medication by scheduling doses every week for up to one month.Increased risk of death in elderly patients with dementiaOlanzapine extended release injectable suspension / Zyprexa relprevvschizophrenia300mg-400mg2-4 weeks19 gauge gluteal onlyPost injection delirium/sedation syndrome can occur in 1% of clients so appropriate monitoring is requiredCan only inject in gluteal muscle, no deltoidRisperidone/ Risperdal ConstaSchizophrenia and bipolar25mg-50mg2 weeks21 gaugeSupplement with oral medication for at least 3 weeks during initiationPaliperidone palmitate/ Invega sustennaSchizophrenia and schizoaffective117mg-234mg3-4 weeksDeltoid injection= <200lbs = 23gauge>200lbs= 22gaugeGluteal injection all weights =22 gaugeStarting dose of 234mg followed by dose of 156mg 1 week later, then start monthly regiment. Invega trinzaSchizophrenia and schizoaffective273mg-819mg3 monthsDeltoid injection= <200lbs = 23gauge>200lbs= 22gaugeGluteal injection all weights =22 gaugeCan start this after 4 months of invega sustenna usage.General rules of injections:Length of needle: Deltoid- < 200lbs = 1inch, >200lbs= 1.5 inch. Gluteal <200lbs= 1.5inch >200lbs= 2inchDo not give more than 3cc in any one location, if needed split dose and give in two sitesAs long acting antipsychotics are in oil, pull up needed amount using a 18 gauge needle. This will save you a Ton of time. (you need to switch out the needle before injecting anyway)Always inject the same amount of air into the vial as medication you will be drawing up so as not to create a vacuum inside the vialDo not massage the injection site after as this can cause the medication to seep into the fatty tissue just wipe the area and apply a bandage as neededHave fun bandaids. Even your big “tough” guys will enjoy them. (at least mine always did)How to make injections less painful:Have the client fold their arm across their lap to relax the deltoid muscle. A relaxed muscle is less painful to injectMassage the area for about 10sec Before giving the injectionAlways change out a needle that has been pushed through a vial top as they get crazy dull and don’t go in smoothly. No one wants a dull needleDart the needle into the muscle very quicklyInject the medication very slowly (30sec per cc)Setting up for your injection:Make sure you know how to give this specific injection. If you have never given this medication READ THE INSTRUCTIONS. They tell you all about the medication, what to look out for, and how to mix or administer the medication. If you are still confused, consult YouTube they have videos for everything. Do this before meeting the client so neither of you are nervous about your competency. Make sure you have all your supplies. Do you have your sharps container? Can you reach it easily?Do you have the correct size needle for drawing the medication up if needed and the correct size needles available for your client?Do you have a way to wash or sanitize your hands before you start drawing up and giving the medication?Do you have glovesDo you have alcohol for both the vial and the client’s skin?Do you have a cotton ball to wipe the area after if neededDo you have a band-aid?Community/roadside Injections:Community injections are basically the same as office injections. You need the same list of supplies, but instead of just taking it out of a drawer, you need it in a travel bag (it is nice if it’s a fancy community nursing bag, but a paper bag will do. Just make sure your supplies are concealed for client confidentiality)Always ask your client where they want to meet for the injection. If your client is ok with you giving it in front of a room mate or on a street corner that is their choice. If they want to find a private spot, work with them to find someplace, even if it is just behind a building out of sight of others.Double check you have ALL your supplies before you leave the office. You can not wander around with a needle outside of a sharps bin for instance.Remember that this is not surgery. You do not need a sterile environment. You have hand sanitizer and alcohol wipes for a reason. Its ok to give an injection outside by the train tracks if that is where your client is. If your client is homeless and dirty, bring a few alcohol wipes or even a wet wipe to clean the area before using your alcohol wipe to clean the area for injection. As most antipsychotic injections can be done in the deltoid, you do not have to risk exposing your client while giving a community injection, but if a client prefers gluteal injections or if giving a gluteal only medication, get creative to protect privacy. Beach towels are great options. If you do a lot of community injections ask your team if you can get a community nursing bag. You can order them off supply websites like Hopkins Medical Supply. Having a designated spot for a small sharps container, alcohol wipes, extra needle tops, extra syringes, cotton balls, gloves, hand sanitizer, and bandaids is really helpful. If you can not get one, either create a check list for yourself, or make your own “nursing bag” out of a gym bag or the like. Just make sure you always double check all your supplies are in there before you leave the office. Charting:Make sure you record the medication type, amount, and site given (you will want to switch sides of the body every time you give it)Chart how the client appeared on the visitChart how you will check for possible side effects (this can be making sure the client contacts you if they start to feel any side effects, or if someone will be monitoring the client for side effects)Monitoring side effects:Ideally you should be evaluating side effects every time you give an injection and within a week of a new or increased dose. In my opinion the best way to monitor side effects is to use the Glasgow Antipsychotic Side Effect Scale or GASS. This scale not only assess for side effects, but the questions are broken down into categories that tell you what area the client is experiencing the side effect in (EPS, hormonal, cardiac etc).LUNSERS is another tool but it is a lot longer and appears less concise. AIMS testing is specifically for dyskinesia ................
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