ATI Medication Administration 3
Gauge
the standard of measurement used to quantify a needle's size LOWER Numbers - Larger Needles HIGHER Numbers - Smaller Needles
Deltoid
the triangular- shaped shoulder muscle RESPONSIBLE for Abducting, Flexing, and Extending the Arm
A patient is to receive 30 mg of ketorolac (Toradol) IM every 6 hr for 48 hr. The medication is available in a 60 mg/2 mL vial. How many mL should the nurse administer for each dose?
1 mL 30 mg (desired) / 60 mg (have) = 0.5 0.5 x 2 mL = 1 mL
How to withdraw medication from an ampule?
1) Withdraw medication with the ampule upside down or with a long needle, with the ampule upright 2) Insert needle into the center (AVOID contamination and dripping of medication, do not touch the rim of the ampule with the tip or the shaft of the needle) 3) Pull back on the plunger, keeping the tip of the needle submerged in the fluid within the ampule If you do aspirate air, remove the needle from the ampule and hold the needle upright. Tap the syringe, if necessary, to move air to the top of the syringe. Pull the plunger back slightly to remove any medication from the needle. Carefully eject the air, then reinsert the needle through the ampule opening and resume withdrawing the medication
Intradermal Injections
10 degree angle, 25-27G needle, 5/8-1/2" needle, barely cover bevel under skin, do not do near a vein, do to the side, used for PPD&allergy testing
Intramuscular
18 - 25 gauge 5/8 - 11/2 inch length 90 degree angle
Intradermal Needle
25 - 27 gauge 3/8 - 5/8 inch length 5 - 15 degree angle
Subcutaneous Needle
25 - 30 gauge 3/8 - 5/8 inch length 45 - 90 degree angle
Ampule
A small sealed glass container that holds a single dose of medication.
The proper needle length when giving an intramuscular injection in the ventrogluteal area to an average-sized adult is which of the following?
A) 1/2 B) 1 inch C) 1 1/2 D) 2 inches C -CORRECT Use 1 1/2 inch needle for most adults when giving an intramuscular injection in the ventrogluteal area
To administer the serum into the dermis, you insert the needle at a
A) 5 to 15 degree angle to produce a small bleb B) 45 degree angle to prevent introduction into the subcutaneous tissue C) 90 degree angle to assure introduction into the dermis A This angle will likely deposit the serum between the layers of the skin and produce a small fluid-filled sac called a bleb. This bleb will shrink as the serum is slowly absorbed. If the bleb does not appear or if the injection site bleeds, you have probably deposited the serum into the subcutaneous tissue, thus making the test results invalid.
To make sure that you deposit the serum into the DERMAL LAYER, you select a needle that is
A) 5/8 -inch long and 25- to 27- gauge B) 1/2 -inch long and 18-guage C) determined by the patient's weight A This is the usual length and guage for an intradermal injection
Which of the following terms indicates a medication is given by injection?
A) Enteral B) Sublingual C) Transdermal D) Parenteral D
A nurse is administering a subcutaneous injection to a patient. Which of the following data should the nurse recognize as the highest priority to prevent potential complications?
A) Identify the patient's level of knowledge about the medication B) Identify if the patient has allergies to the medication C) Identify a specific site for the injection D) Identify the rationale for the patient receiving the medication B-CORRECT this is the highest priority. D is NOT -the nurse should already know this and also what the physiology is occuring after giving the injection
A nurse is preparing to give an intramuscular injection into the left ventrogluteal muscle. Which of the following should the nurse do to locate the appropriate site?
A) Measure 2 fingerbreadths below the acromion process B) Measure a handbreadth above the knee and a handbreadth below the greater trochanter C) With the heel of the hand on the greater trochanter, point the index finger up toward the anterior superior iliac spine, extending the other fingers back along the iliac crest D) Divide the buttock into four quadrants and give the injection in the upper, outer quadrant. C-CORRECT This will locate the ventrogluteal site
You assess the patient to determine the location for the injection. Which of the following is the correct method to locate the site to administer an injection into the deltoid muscle?
A) One hand width above the humerus epidcondyle B) Two finger widths lateral to the scapula C) Two inches below the acromion process C-CORRECT The injection site is 1 to 2 inches below the acromion process
After removing the needle, which of the following actions should you take?
A) Recap the needle to minimize the risk of a needlestick injury B) Detach the needle and dispose of it in a sharps container C) Place the needle and syringe assembly in a puncture-proof container C -Correct Safe handling of contaminated needles is crucial. For nurses, needlestick injuries are the primary source of exposure to bloodborne diseases. Do not recap the needle; just place the entire assembly, uncapped or enclosed in a safety shield, into a puncture-proof sharps container. Never force a contaminated sharp into the sharps container; make sure the sharps container is functional and not overfilled before administering the injection.
Which of the following is the most important to reduce the risk of injury to the patient prior to the administration of the tetanus booster?
A) Review the risk of potential adverse reactions B) Assess the patient's allergy history C) Confirm the date of the last tetanus booster B- CORRECT Assessing the patient for possible known medication allergies will help minimize the risk of an adverse reaction to the tetanus booster.
A nurse is preparing to administer an insulin injection to a patient. Which of the following is appropriate?
A) Rotate injection sites to avoid tissue injury B) Administer no more than 2 mL per injection C) Use the non-dominant hand to displace the skin and subcutaneous tissue at the site about 1 to 1 1/2 inches D) Inject the medication after aspirating the syringe A-CORRECT Rotating injection sites prevents tissue damage from repeated injections at the same site
A nurse is preparing to administer an intradermal injection. Which of the following should the nurse do to ensure proper technique?
A) Rub the injection site after withdrawing the needle B) Pinch 1/2 inch of the skin and administer the injection at a 45 degree angle C) Use a tuberculin syringe with a 3/8 to 5/8 inch, 25 to 27 guage needle D) Choose a site at least 2 inches form the umbilicus C-CORRECT
The appropriate technique for administering an IM injection includes
A) inserting the needle at a 90 degree angle B) donning gloves after washing your hands C) using the Z-track method to administer the medication D) applying pressure over the injection site after withdrawing the needle E) recapping the needle before disposing of it in a biohazard sharps containers A,B,C,D -CORRECT E is not because You NEVER recap a needle or risk for a needlestick injury
The term intradermal means that the fluid must be injected
A) into a vascular area for rapid absorption B) into the skin where the blood supply is minimal C) into a readily accessible site for easy follow-up B The dermis layer of the skin does not have an rich blood supply, therefore allows slow absorption. *Rapid absorption could trigger a severe anaphylactic reaction due to the potency of the substances given via the route. C is not correct because ease of assessment is not a criteria for the intradermal route
You explain to the patient that the best sites for a subcutaneous injection are which of the following areas?
A) on the anterior aspects of the thighs B) On the inner aspect of the forearms C) 2 inches below acromion process D) On the outer posterior aspect of upper arms E) On the abdomen from below the umbilicus to the iliac crests A, D, E A- Appropriate for subcutaneous injections. It's important that the site selected be free of skin lesions and bony prominence D- Appropriate for subcutaneous injections. This is the site most commonly recommended for injection heparin
The patient prefers that you administer the injection in his arm. The deltoid is an acceptable site for an intramuscular injection because of which of the following?
A) the deltoid can readily accept the prescribed volume of medication B) the patient is of average or above average adult weight C) the patient is capable of unrestricted movement in that arm A-CORRECT The prescribed amount is 0.5 mL. The deltiod can handle medication volumes of 3 mL or less.
Since an IM injection delivers medication into the muscle, you best determine the appropriate needle length by assessing
A) the preferred site for injection B) the patient's muscle mass and weight C) the viscosity of the medication B-CORRECT For a typical adult, an IM injection requires a 1 1/2-inch needle. Consider a 1-inch needle for an adult who is thin, a 2-inch needle for an adult who is obese, and a 5/8-inch needle for a child or for an adult who is emaciated.
The inner aspect of the forearm is usually an ideal location for an intradermal injection provided it is
A. not the patient's dominant arm or it will restrict function B. free of any skin lesions that might impede evaluation C. easily moved by the patient to facilitate absorption B It is essential that nothing will thwart the evaluation of the site 72 hours later. Scarring can interfere with absorption of the serum and make it difficult to visualize the result.
You are administering a subcutaneous injection. Which of the following syringes should you choose?
a) 1 mL syringe b) 5 mL syringe c) 10 mL syringe A 1 mL or 3 mL syringe is chosen to administer small volumes of fluid. Only small volumes of fluid, 0.5 mL to 1.5 mL, give by subcutaneous injection
TIPS on documentation
All medication by injection: - name of medication, dose or amount of medication - site - route - date, times, and your signature as per agency policy - patient response Intradermal injections: - name of medication, dose or amount of medication site - route - date, times, and your signature as per agency policy - appearance of the skin at the site - teaching done about the expected outcome, for example, if it is a screening test - patient response Subcutaneous and intramuscular injections: - name of medication, dose or amount of medication site - route date, times, and your signature as per agency policy - teaching done in preparation for self-administration - patient response
Deltoid Muscle Injection Determinate
Avg adult/adolescent: give up to 1ml w/5/8 in - 1 inch needle. NO infants & <3 Preschoolers/older children 5/8 in needle for IM
Vastus Lateralis Injection Determinate
Avg adult/adolescent: give up to 3ml w/18 - 25 gauge needle. 1 - 1 1/5 inch for oil based/viscous solutions. Use a 22- to 27-gauge, 1- to 1½-inch needle for aqueous solutions For infants, give up to 1 mL with a 1-inch needle; for small infants, give up to 0.5 mL with a ⅝-inch needle
What extra precaution can I take to avoid wrong-route errors when giving an injection?
Besides diligence in checking the first five rights of medication administration at least three times to prevent medication errors in general, be sure to assess the injection site for adequacy of tissue, identify the landmarks for proper placement of the needle, and choose the appropriate needle length. These precautions will keep you from administering an injection in the wrong tissue type.
z track technique
Displace skin/sub q tissue at the site about 1 - 1 1/2 in w/ the side of you non-dominant hand. Maintain throughout injection and release it immediately after you withdraw the needle from the skin.
SubQ Injection
Do not administer more than 1 mL with a single SubQ injection. Use a 25- to 30-gauge, ⅜- to ⅝-inch needle.
Plunger
the rubber-tipped portion of a syringe that fits inside the barrel and is pulled outward to draw fluid or air into the syringe and pushed inward to insert fluid into the body or fluid or air into a container
Scapula
the shoulder blade
How can I make an injection less painful for the patient?
If time allows, apply EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) cream to the injection site for 1 to 3 hours prior to the injection per provider prescription. Otherwise, try vapocoolant spray (an aerosolized volatile refrigerant liquid) or manual pressure just before giving the injection. Administer medications that are at room temperature, not cold, when possible. Allow the skin-cleansing antimicrobial agent to dry before administering the injection. If you used the needle to draw up the medication, replace it with a fresh, sterile needle before giving the IM injection so that any medication coating the needle will not irritate the tissues surrounding the muscle. Use the smallest-gauge needle possible. Position your patient in a flexed position and encourage him to relax his muscle. Distract your patient during the injection. Minimize movement of the needle by darting it in quickly, stabilizing the syringe while you are injecting the medication, and removing the needle quickly. Apply gentle pressure at the injection site using a dry gauze pad or a cotton ball, not a wipe wet with a potentially irritating antimicrobial agent.
Axillary Line
Imaginary line which runs down the side of the body starting at the armpit
What should I do differently if my patient is very thin?
It is important to consider your patient's body weight and amount of subcutaneous fatty tissue when selecting the needle and choosing the site and angle of insertion for subcutaneous or intramuscular injections. When giving a subcutaneous injection to patients who have very little fat, use the upper abdomen. When giving intramuscular injections to older adult patients or those who are very thin, use a smaller size needle.
Why should I rotate injection sites when giving serial or regularly scheduled injections?
Rotating injection sites prevents induration, abscess formation, and lipohypertrophy or lipoatrophy from repeated injections in the same tissue.
Antecubital Space
The space located at anterior surface of the front of the elbow
Should I take any special precautions when administering heparin?
There is a risk of bruising and pain with the administration of subcutaneous heparin, particularly low molecular weight heparin. To minimize these effects, do not remove the air bubble prior to injection. Administer the injection in the side of the abdomen. Inject the medication slowly, over 30 seconds. Wait for 10 seconds after injection before withdrawing the needle, then apply gentle pressure for 30 to 60 seconds. Do not massage the site.
How can I prevent infection when administering an IM injection?
To prevent infection, perform hand hygiene. If the injection site is visibly soiled, wash the site with soap and water before cleansing it with an antimicrobial wipe. Maintain strict surgical aseptic technique during medication preparation and administration. Check the expiration date of all medications. Use a single-dose vial only once. Label a multidose vial with the date and time when it is initially opened, and refrigerate it if indicated on the label; discard it by the expiration date or according to your agency's policy. Keep the medication, the needle, the inside of the syringe barrel, and the plunger of the syringe sterile throughout the procedure.
How can I avoid injuring the patient when I administer an IM injection?
To prevent tissue irritation, tissue damage, and nerve damage, check for adequate tissue at the injection site and place the needle properly. Rotate injection sites if giving regular injections. Choose the appropriate length and size of needle. Never give irritating medications subcutaneously; inject them only into a large muscle. The ventrogluteal muscle is the best choice for irritating or oily medications for patients of any age. Do not give too large a volume of medication for the size of the muscle; do not inject more than 3 mL into a large muscle in an adult and 2 mL into an older adult or thin patient; do not inject more than 1 mL into a subcutaneous site. Give medications by the intramuscular route only when no other route is acceptable or available. Use the Z-track technique for all intramuscular injections to keep the medication from leaking out of the muscle into surrounding tissues. Do not massage the site after injection.
Why do patients absorb medications differently even when they are given by the same route?
With subcutaneous injections, local blood flow to the tissues affects absorption. Exercise and heat or cold application influence blood flow. Circulatory shock and occlusive vascular disease also affect blood flow and are contraindications for subcutaneous injections. When giving insulin, the site you use affects the rate of absorption. Insulin given into the abdomen is the most quickly absorbed, then the arms, then the thighs, and finally the buttocks, where it has the slowest absorption rate. To minimize variation in absorption from day to day, give insulin in one area, rotating sites within that area. With intramuscular injections, both blood flow and the amount of muscle tissue affect absorption of the medication. Avoid giving intramuscular injections into atrophied, poorly developed muscles. As with subcutaneous injections, circulatory shock contraindicates intramuscular injections.
What should I do if the needle hits a bone while I am administering an injection?
Withdraw the needle about 1/4 inch but do not remove it. Proceed with administering the injection.
Greater Trochanter
a broad, flat process at the upper end of the lateral surface of the femur to which several muscles are attached and serving as a landmark for identifying the vastus lateralis injection site
Skinfold
a layer of skin and subcutaneous fat raised by pinching the skin and letting the underlying muscle fall back to the bone
Z-Track
a method of injection that involves displacing the skin and the subcutaneous tissue at the injection site, maintaining this displacement throughout the injection, and releasing it immediately after withdrawing the needle from the skin
Luer-lok
a patented, threaded tip of a syringe that can be twisted onto certain ports and needles to create a firm "lock"
Wheal
a smooth, reddened or pale, slightly elevated area on the skin that is either induced via intradermal injection or is typical of allergic reactions
Filter Needle
a special type of needle required when drawing up certain types of medications to keep small particles of medication or rubber or glass (from a vial or ampule) from entering the syringe and being injected along with the intended solution
Bevel
the slanted surface at the tip of a needle
Prior to administering a subcutaneous injection, you gently pinch 2 inches of skin at the insertion site. At which of the following angles should the needle be inserted to ensure the injection reaches subcutaneous tissue?
a) 15 degrees b) 45 degrees c) 90 degrees C If you can pinch 2 inches of skin, insert the needle at a 90 degree angle. The angle of insertion and the needle size should be adjusted depending on the patient's weight and estimated amount of subcutaneous tissue.
When instructing the patient about the self-administration of insulin, which of the following information should you include?
a) Hold the syringe as a dart b) Use the Z-track method for administration c) Aspirate gently before injecting A The client should hold the syringe as a dart with the palm down
Your patient asks why insulin is injected subcutaneously. Which of the following is an appropriate response?
a) Subcutaneous tissue has few sensory nerves, so the insulin injection is less painful than it would be if given by another route b) Medication absorption is slower from subcutaneous tissue, an important factor in the effectiveness of insulin therapy c) Subcutaneous injections are technically the easiest form of parenteral injection, making the route well suited for frequent insulin injections. B The subcutaneous layer has relatively poor vascular system. It is the abundance of the vascular supply that is the primary factor int he speed with which medication enters into the bloodstream (absorption rate)
Antimicrobial
able to destroy or suppress the growth of pathogens and other micro-organisms
Ventrogluteal Muscle Injection
adult, give up to 3 mL of medication with an 18- to 25-gauge, 1- to 1½-inch needle for oil-based or viscous solutions. Use a 22- to 27- gauge, 1- to 1½-inch needle for aqueous solutions. For infants, give up to 1 mL with a ½- to 1-inch, 21- 25-gauge needle; for small infants, give up to 0.5 mL with a ?-inch, 21- 25-gauge needle. For toddlers, give up to 2 mL with a 1-inch, 21- 25-gauge needle. For children age 3 and older, give up to 2 to 3 mL with a 1-inch, 21- 25-gauge needle. For adolescents, give up to 3 mL with a 1- to 1½-inch, 21- 25-gauge needle
Contaminate
become or make unsterile or unclean
Multidose
containing more than one portion or dosage
Reconstitute
convert medication in a powdered form to a liquid for injection by adding diluent to the powder
Iliac Spine
one of the four projections of the ilium, the large pelvic bone that supports the flank, one of which (the anterior superior iliac spine) is used as a landmark for identifying the ventrogluteal injection site
Hub
part of a needle that attaches to the syringe
Ventrodorsal Gluteal
referring to a subcutaneous injection site identified as the upper portion of the upper outer quadrant of the buttock
Ventrogluteal
referring to an injection site that consists of the gluteus medius muscle, located on top of the gluteus minimus muscle
Angle
related to injections, the measured space created by two diverging lines, one formed by the needle and the other by the skin or body part into which the needle is injected
Needle
sharp, hollow metal instrument used for inserting material into or removing from the body or a container
Anterior
situated before or toward the front or forward part
Superior
situated before or toward the top or uppermost part
Anterolateral
situated in front and to one side
Vial
small bottle containing medicine or other liquids
Diluent
sterile fluid used to prepare a powdered form of medication for injection
Darting
the action of injecting quickly and without hesitation
Barrel
the component of a syringe that encases the plunger and is marked with volume calibrations
Injection
the insertion of fluid into the body or container via a needle and syringe
Acromial Process
the lateral extension of the spine of the scapula, projecting over the shoulder joint and forming the highest point of the shoulder; also called the acromion
Vastus lateralis
the muscle at the lateral aspect of femur that is responsible for extending the leg and the knee
Aspirate
to withdraw or remove, by syringe or other apparatus the substance or material obtained by aspiration, gastric aspirate inadvertently inhaling fluid or other substances into the lungs
Intramuscular (IM)
within or into a muscle
Subcutaneous
within or into the layer of tissue beneath the skin
Intradermal
within or into the skin
Intravenous
within or into the systemic circulation via a vein