module 3- part C (intramuscular) Flashcards
IM meds are deposited into?
deep muscle tissue which has rich blood supply, so medication absorbs faster than by subcutanoues
increased risk for drugs injecting directly into?
blood vessels using IM route
what influences the needle size selection for IM?
-viscosity of med, injection site, patients weight, amount of adipose tissue
a longer heavier gauge needle is used?
to pass through subcutaneous tissue and penetrate deep into the tissue
many needles available are not?
long enough to reach muscle
what degree insertion is IM?
90-degree angle insertion
normal well developed adult tolerates how much med into a larger muscle w/o severe discomfort?
2-5ml
4-5ml are unlikely to be?
absorbed properly
children or older adults max can tolerate?
2ml
do not give more than how much to small children?
1ml
do not give more than how much to small infant?
0.5ml
rotate IM injection site to decrease risk of?
hypertrophy
emaciated or atrophied muscle absorb?
medication poorly
what method is recommended for IM injections?
z track method!
once med is injected, wait..
10 seconds then smoothly and steadily withdraw needle, apply gentle pressure
what are IM injections usually giving?
steroids, immunizations, naloxone
IM syringe for adult?
2-3ml
IM syringe for infants and small children?
0.5-1ml
in aqueous solution what gauge needle?
20-25 gauge needle,
in oil 18-21
it depends on length of needle
why is the dorso-gluteal muscle not recommended for site of injection?
sciatic nerve location!! always consider underlying nerves, bones, blood vessels and volume of med
observe site and ensure that it is?
free of pain, infection, necrosis, bruising, abrasions
ventrogluteal site for IM?
- gluteus medius, situated deep away from major nerves
- easily identified by prominent bony landmarks
- preferred site for all adults, children, and infants, especially larger volumes
- less painful than vastus lateralis
- 5 ml max
vastus lateralis muscle for IM?
- another injection site in adults
- prefer admin for immunizations in infants, toddlers, children
- 2.2ml max
- to relax muscle, have pt lie flat with knee slightly flexed and foot externally rotated
deltoid muscle for IM?
- not well developed in many adults
- faster absorption rate
- potential for injury because of nerves within upper arm
- use site for small med volumes
how to locate deltoid muscle?
palpate acromion process, place four fingers across deltoid muscle with top finger along acromion process
= injection site is three finger widths below
pediatric considerations for IM?
- may be very anxious or fearful
- help with positioning and holding child sometimes
- distraction such as blowing bubbles and pressure at site before may help
elderly considerations?
-decrease muscle mass which decreases absorption of IM
for volumes less than 1ml use which syringe?
the tuberculin syringe
preferred site for children of all ages
ventrogluteal
-as young as neborns
deltoid muscle can be used for small?
small volumes in children
advantages: less pain, fewer adverse effects
because children often jerk away, nurse should carry
an extra needle to exchange for contaminated one
straighter the path of needle and a 90 degree angle, the…
less displacement and shear to tissue and possibly less discomfort
IM injection is chosen when 2 things are required?
prolonged action, rapid systemic uptake (15-20 mins usually)
a thin 82 year old pt requires an IM injection, what site, needle length and gauge should you pick?
ventrogluteal, 1 inch, 23 gauge
although muscles can absorb medication well, what is the usual recommended maximum amt for med for adult?
3 mL
why is it necessary to rotate sites for intramuscular injections?
- client is getting multiple injections
- client has a tenderness or hardness at the site
- client has bruising at the site
- client has scarring at the site
what is the MOST important reason to check client 15-30 mins after injection?
to ensure they are not having difficulty breathing, wheezing, hives, or itchiness
=allergic reaction that could require intervention
anaphylaxis usually occurs within minutes on second exposure to med
why is the needle kept inserted for 10 seconds after a intramuscular injection?
to allow the medication to disperse evenly
preferred site for infants up to 12 months of age?
vastus lateralis
preferred site for children 18 months or older?
-deltoid
literature has clearly identified what site to be the best for IM?
ventrogluteal
