pod 2 Flashcards
What are some therapeutic rationales for administration of medications via the intramuscular route?
IM route provides faster medication absorption than subc because muscles greater vascularity
What are some advantages IM
Faster absorption (more blood supply compared to subc)
Helpful in emergency situations
Can inject volumes of medications (3mL in healthy adult, 2mL in deltoid)
Recommended for some meds like vitamin B12, viscous meds need to be given into deep muscles causing less irritation
Long-acting duration of effect (longer onset of action than IV)
What are some disadvantages IM
Greater risk of damage to blood vessels & nerves (accurate landmarking important)
Depending on size of needle the absorption can be erratic
Needle phobia
Contraindicated in pts on anticoagulants
What is the maximum volume of fluid that can be injected into an adult with well-developed muscles?
3mL
What is the recommended volume of fluid that can be injected into the deltoid muscle?
2mL
What kinds of medications are given via the intramuscular route?
Antibiotics, vaccines, psychotropic long-acting drugs, antiemetics, analgesics
What would be included in the holistic assessment of a client receiving an intramuscular injection?
Ensure the pt is relaxed, palpate the rule out any tenderness
Ask them about things (phobia, preferred spot)
Distraction
Applying pressure after receiving
What is the most common size of syringe used for an intramuscular injection?
3mL
What is the standard length and gauge of needle used for an intramuscular injection?
1.5-inch needle & 21 or 22 gauge
What are some factors that the psychiatric nurse should consider when choosing the most appropriate needle for an intramuscular injection?
Pts body weight and amount of adipose tissue can influence the size
Obese pt require needle 7.5 cm, thin pt 1.3-2.5cm needle
How do you prepare the site for injection?
*Good skin integrity
*Adequate muscle mass
*Be free of tenderness, lesions and bruising
*Sites should be rotated – however patient preference should be considered when choosing a site for injection
Describe the technique used to administer an intramuscular injection using the standard technique
1.Prepare the medication from vial with a fill needle, or ampule with filter needle
2.Change needle to correct IM needle—standard is 21/22g 1-1 ½ long
3.Preform hand hygiene and donne clean gloves
4.Landmark and assess that skin is free from lesions, tenderness, hardness, multiple injections, inflammation
5.Clean injection site with swab from center and move outward, allow to dry
6.Use thumb and forefinger or nondominant hand, pull the skin taut within 5cm(2”) of the selected site
7.With dominant hand insert the needle at 90 degrees angle using a darting motion
8.Use nondominant hand to hold the syringe, and with the dominant hand aspirate by pulling back slightly on the plunger as per agency policy
9.Slowly inject the medication (10sec a ml)
10.Remove, engage safety device and dispose syringe into sharps container
What is the rationale for aspirating prior to injecting medication?
Assess if needle is in muscle or blood vessel
Aspirating is contraindicated in admin of vaccines
What is the Z-track technique and when would this method be used?
Recommended because it minimizes local skin irritation by sealing meds in muscle tissue
Leaves a zigzag path that seals the needle track
Med can’t escape from muscle tissue resulting in full dose being admin
Cause less irritation to skin and subc tissues
Describe the technique used to administer an intramuscular injection using the Z-track technique
Prepare site with antiseptic swab
Pull overlying skin & subcut tissue 2.5-3.5 cm laterally
Holding skin taut with nondom hand
Insert needle & slowly inject
Needle remains inserted for 10 secs to let meds disperse
What are some interventions that the nurse can use to prevent needle stick injuries?
Do not recap
Dispose in right bin
Activate needle sharps protection equipment
What is the preferred site for an adult?
Ventrogluteal site
What is the preferred site for a child under 7 months of age?
Vastus lateralis site
Ventrogluteal site
Offers deep site, situated away from major nerves & blood vessels
Offers less chance of contamination in incontinent pts
Identified easily by prominent bony landmarks
Preferred site for larger volume, more viscous
Less likely to have injury
what muscle for ventrogluteal
Gluteus medius & minimus
Why is ventrogluteal preferred site for an adult?
Away from major blood vessels
Poses less risk of abscess formation, tissue damage, muscle pain, nerve damage
What position can the client be in when receiving an injection into ventrogluteal
lying down on side = relaxed muscles
describe landmark of ventrogluteal
Nondominant hand
Find greater trochanter
Iliac crest
Iliac spine
Heel of hand over greater trochanter, point thumb towards groin, index finger to anterior iliac spine, other fingers on iliac crest, injection in V formation
Vastus Lateralis site
Lacks major nerves & blood vessels
Facilitates rapid drug absorption
Used frequently with infants
why vastus lateralis preferred site for seven months & younger
more muscle
What position can the client be in when receiving an injection into vastus lateralis
Lying down legs extended
Sitting
landmark vastus lateralis
Greater trochanter & top of knee, inject in middle of muscle
Anterior lateral aspect of thigh
Deltoid site
Easily accessible but not well developed in most
May be used for small amounts
Not used in children
Use of muscle involves potential for injury to brachial artery & radial & ulnar nerves
Recommended for hep B & rabies
why deltoid not used for IM often
Usually used for small amounts of liquid
Use of muscle involves potential for injury to brachial artery and to the radial & ulnar nerves
max volume for deltoid
2mL
landmark deltoid
Expose upper arm & shoulder
Relax arm
Palpate lower edge of acromion process (base of triangle)
Inject 3 to 5 cm below acromion process
why dorsogluteal recommended when all others aren’t
big enough muscle to insert into, need to be done correctly, receive up to 4mL
But don’t usually use this site because the sciatic nerve is close and if hit, possible paralysis & large blood vessels
position pt in for dorsogluteal
lying on stomach or standing
landmark dorsogluteal
Muscle located upper outer quadrant of butt, approx 5-8cm below iliac crest
