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Chapter 35

Administering Intradermal, Subcutaneous, and Intramuscular Injections

QuestionAnswer
Ampules all-glass containers containing medication
Anaphylactic Shock circulatory failure from an allergic reaction
Bevel the slanted part of the needle tip
Bleb bump, visible elevation of the epidermis
Core circular cutout piece
Diluent specified fluid to dissolve the solute
Fibrosis formation of fibrous tissue
Gauge scale of measurement
Gluteal pertaining to the buttocks
Induration quality of being hard
Injection forcing fluid into a part of the body
Intradermal (ID) into the dermis
Intramuscular (IM) into the muscle
Lumen opening or interior diameter
Parenteral not delivered via the gastrointestinal tract
Solute solid material
Subcutaneous beneath the skin layers
Tuberculin Syringe syringe with graduated measurements to 1 mL
Urticaria a reaction characterized by reddened, slightly elevated patches known as wheels
vials small bottles
Viscous thick and sticky
Z-track Technique causing a needle track, or pathway, in the shape of a 'z'
When are parenteral injections used? -patient is NPO -digestive juices counteract oral drugs
What are parenteral injections used for? -hasten the action of the drug -ensure the delivered dose is accurate
What is the appropriate size needle for intradermal injections? 24, 27, 29 gauge
What is the appropriate size needle for subcutaneous injections? 27 gauge 3/8 - 1/2 or 25 gauge, 5/8
What is the appropriate size needle for intramuscular injections? 1-3 inch
What would you do if a 5-year old child refuses his immunizations? demonstrate procedure on a doll, let child look at empty vials/syringes, explain that medicine will help them to stay well
Why is it important to rotate injection sites? it is best to rotate injection sites to promote the best absorption of the medication and to decrease tissue irritation or fibrosis
What information must be on the syringe label? patient's name, name of the drug, and the dose
Select an injection site that is relatively free of: hair, lesions, inflammation, rashes, moles, and freckles -avoid major nerves, blood vessels, & underlying organs
What must the nurse be aware of when administering medications? -purpose of medication -side effects of the drug
How soon after a new medication is given should the nurse assess for side effects? 30 minutes
Epidermis contains cells that produce pigment and protect immune system
Dermis contains nerve endings, oil and sweat glands, and hair follicles
Subcutaneous Tissue made up of fat, connective tissue, and larger blood vessels
Intradermal injection: -medication is deposited into layers of skin -typically TB test, skin tests, allergy testing -small needle; 15-degree angle of insertion -tuberculin syringe -forms skin bleb
Is a 29 gauge needle bigger or smaller than a 24 gauge needle? smaller - the larger the number of the gauge, the smaller the needle
You have issued a tuberculin test intradermally. When should the patient return to assess the injection site? 48-72 hours after the test
Subcutaneous injection: -0.5-1 mL of medication into tissue below dermal layer into subQ fat -usual sites: upper outer portion of arm, anterior surface of thigh, abdomen -insulin or tuberculin syringe -45 or 90 degree angle
Name two medications that can be given subcutaneously: -heparin -insulin -allergy extract
Why is the abdomen a good place to administer certain subcutaneous medications? The abdomen provides the most reliable, steady absorption
How do you give a subcutaneous injection? -gently pinch skin and insert the needle 45 to 90 degree angle -after inserting the needle completely, release grasp on skin -inject all solution by steadily/gently pushing down the plunger
Intramuscular injections: -injected in muscle layer at 90-degree angle -common sites: deltoid, dorsogluteal, ventrogluteal, vastus lateralis, rectus femoris -19-23 gauge, volume up to 3 mL -aspirate for blood prior to injection to avoid blood vessel
Which intramuscular site is the best side for administering medication to infants and the elderly? infants: vastus lateralis elderly: ventrogluteal and vastus lateralis
Which injection site can cause sciatic nerve injury if medication is administered incorrectly? dorsogluteal
How to find the ventrogluteal site? -palm over greater trochanter -index finger on anterior superior iliac spine -middle fingers by posterior iliac creat -injection site in 'V' formation
Z-Track Method IM route: -may be used anytime IM is given -deep IM injections of drugs like iron dextran/Vistaril -reduces pain from drugs leaking into subQ tissue -seals medication in muscular layer
What needle size and length would you use when administering a medication using the Z-track method? What if the patient is morbidly obese? -airlock method should be used with the Z-track method because it prevents medication leakage
What are the two materials used for syringes? -glass - can be sterilized/reused -plastic - disposable -some syringes are refilled with medication
Syringe composition: composed of barrel and plunger with a needle tip made of plastic or glass
3 mL syringe -popular because large enough for subcutaneous and most IM injections
U-100 syringe used with U-100 strength insulin -calibrated in units
Tuberculin syringes -1 mL in size -calibrated to measure as small as 0.01 mL drug doses
Unit-dose cartridge -requires a special holder for the cartridge and needle
Most 3mL syringes have two scales, which are: -tenths of a milliliter (o.1mL) -minim scale
Needle metal tube through which liquid medication flows
Needle gauge/length -standard sizes from 13-30 -larger the number, smaller the needle -consists of hub fitting on end of syringe, hollow shaft (cannula), a bevel
Filter needles: -medications drawn from ampule may have glass in them from breaking of ampule -used when medication is withdrawn from ampule to trap glass particles -filter is discarded & new needle attached to syringe for injecting medication into the patient
Preventing needle sticks: -HIV, Hep B, Hep C -safety syringes prevent needle sticks (used when available) -needle must be disposed of in sharps container -report all needle sticks
What increases your risk of a needle stick injury, and blood borne pathogens? recapping or trying to recap needles
Preparing syringe for use: -aseptic technique -needle, tip, inner barrel, plunger must remain sterile -discard if contaminated
Parenteral solutions: -available in ampules/vials (single dose/multidose) -Mix -O-vials - meds in powder form, diluent present in 2 halves of vial separated by rubber stopper -unit-dose cartridges - carpuject/tubex holders
What type of needle must be used when withdrawing medications from an ampule? filter needle
Name a medication that is supplied in an ampule: digoxin
If you do not use all the medication in an ampule, can the remainder be saved for the next dose? no
Ampules: -made of glass/polyurethane -consist of body, neck, stem - typically single dose -all meds must be in ampule body before neck is broken -before open, meds must be removed from neck/stem -tap/flick stem with finger to free trapped solution
What are two ways to check drug compatibility? -check a compatibility chart -ask the pharmacist
Vials: -single or multidose -1 - 50mL -powder form needing reconstitution (label/package insert with instructions) -check compatibility before mixing
Reconstituting a drug: -drugs that are unstable in liquid form, prepared in powdered form -solute mixed with diluent prior to injection -diluents - sterile water/saline
Compatibility of medications: -reaction occurs when drug combines with an incompatible drug -range from color change, precipitation, clouding to invisible chemical changes making drug inactive -charts often available that outline compatible drugs
When drugs are compatible, you inject what into the vials? -amount of air equal to desired dose of each drug into the respective vials
What are symptoms of anaphylactic shock? -urticaria, bronchiolar constriction, edema, finally circulatory collapse
Things to remember: -check for allergies -know possible/expected side effects -date multidose vials when opened -question order that don't make sense -follow 6 rights/ 5 rules -know landmarks/injection techniques
What is not an appropriate site for an intramuscular injection? Dermal
Darlene is about to give her patient an intramuscular injection. What angle should the injection be given? -90 degrees
Sylvie is going to give her 1 yr old patient an IM injection. What is the preferred IM site? -vastus laeralis
Michael is going to give his patient an injection of iron. To help minimize the pain, what can Michael do? use the z-track method
Created by: ahoyyitbeaddi