Medication Administration: Intramuscular Injection Elsevier Military

A patient has been receiving pain medication intramuscularly every 4 hours for several days. The nurse is preparing to administer another IM injection for pain control 4 hours after the patient's last injection. What action should the nurse take before administering the pain medication?

Determine which sites have been used most recently. Rationale: Injection sites should be rotated to decrease the risk of hypertrophy; the nurse should determine recently used sites and select a different site. Although the practitioner should be made aware of how much medication the patient is receiving, the nurse is not in a position at this point to classify the patient as drug seeking. By the same token, the patient is reporting pain and should not have to wait for pain relief. The use of placebos is highly controversial and not endorsed by several professional organizations.

When administering an IM injection using the Z-track method, which action is appropriate?

Pull the skin tissue laterally with the nondominant hand. Rationale: With IM injections using the Z-track method, the nurse pulls the overlying skin and subcutaneous tissue laterally with the nondominant hand. The skin is held in position until the injection has been administered. After withdrawing the needle, the nurse releases the skin, leaving a zigzag path that seals the needle track. Aspiration is not necessary. The needle is removed smoothly, quickly, and steadily followed by a release of the skin. It is important to release the skin right after the injection to seal the medication in the muscle.

After administering medication intramuscularly, what should the nurse do?

Return to the room to evaluate the patient's discomfort and assess the injection site. Rationale: The nurse should return to the patient's room within an appropriate time determined by the organization's practice and assess the patient for acute pain, burning, numbness, or tingling at the injection site. Continued discomfort may indicate injury to underlying bones or nerves. Recapping needles increases the risk of a needlestick injury. The uncapped needle (or needle enclosed in a safety shield) and attached syringe should be discarded into a puncture-proof and leakproof receptacle to prevent injury to the patient and health care personnel. After injection, the nurse should apply gentle pressure without massaging the site. Massage may damage underlying tissue. The Z track does not need to be reassessed for functionality.

The nurse is preparing to give the patient an IM injection into the ventrogluteal muscle. The nurse should assist the patient into which position?

Side-lying position Rationale: For injection into the ventrogluteal muscle, the patient lies on the side or back and flexes the knee and hip on the side to be injected. For the vastus lateralis muscle, the patient should lie flat, supine, with the knee slightly flexed. Lying supine allows for optimal visualization of the greater trochanter and knee, which are used as landmarks for the vastus lateralis muscle. For injection into the deltoid muscle, the patient may sit or lie flat with the hand on the hip or the lower arm flexed but relaxed across the abdomen or lap. The nurse should assist the patient to a comfortable position, depending on the site chosen. The patient never stands for an IM injection.

The nurse is to administer an IM injection into the ventrogluteal muscle. Which anatomic landmarks should the nurse use?

The iliac crest and the anterior superior iliac spine Rationale: To locate the ventrogluteal muscle, the iliac crest and the anterior superior iliac spine should be used as anatomic landmarks. To do this, the nurse places the heel of the hand over the greater trochanter of the patient's hip with the wrist almost perpendicular to the femur. The nurse uses the right hand for the left hip or the left hand for the right hip and then points the thumb toward the patient's groin, points the index finger to the anterior superior iliac spine, and extends the middle finger back along the iliac crest toward the buttock. The index finger, middle finger, and iliac crest should form a V-shaped triangle, and the center of the triangle should be used as the injection site. The acromion process is used to help locate the deltoid muscle. The greater trochanter and knee are used to locate the vastus lateralis muscle.

When treating an 80-kg (176 lb) adult, the nurse should inject the IM medication at which angle?

90 degrees Rationale: The nurse should administer an IM injection so that the needle is perpendicular to the patient's body or as close to a 90-degree angle as possible; 15-, 45-, and 60-degree angles are not perpendicular enough to administer the IM injection correctly.

When preparing to administer a tetanus vaccine to a 65-kg (143 lb) adult, the nurse should choose which size needle?

1-in, 23-G needle Rationale: For adults weighing 60 to 70 kg (132 to 154 lb), a 1-in needle is used, and immunizations for adults should be administered using a needle in the 22-G to 25-G range. Needle size for IM injection is determined by medication viscosity, injection site, patient's weight and age, and the amount of adipose tissue through which the injection must go. A 20-G needle has a larger lumen and may be used for more viscous medications. A 1½-in needle may be used for adults weighing more than 70 kg (154 lb).

Which is the appropriate size needle to use when performing an IM injection on a child?

25 G Rationale: When administering an injection to a child, a needle with a smaller lumen, such as a 25 G, should be used. The recommended gauge for IM injections is 22 G to 25 G. An 18-G and a 20-G needle have larger lumens and are not recommended for IM injections.

An older patient is being discharged home with an order for twice-daily IM injections. What instruction should the nurse include for this patient?

Apply topical analgesic to the injection site before administration. Rationale: Adult patients who require frequent injections should be instructed to apply topical analgesic to the injection site before administration. Self-administration of an IM injection is difficult. A family member or friend should be trained to administer the injection. Needles should be disposed of in sharps containers or containers that are in compliance with community guidelines. Cardboard does not provide safety from sharps injuries. Older adults may be at high risk for falls immediately after receiving an injection because the patient may be guarding the injection site and because of loss of muscle tone and strength due to aging.

When administering an IM hepatitis B vaccine to an 18-month-old child, the nurse should inject it into which muscle?

Vastus lateralis Rationale: The vastus lateralis muscle is a safe injection site for adults and children and is the preferred site for administration of biologics (e.g., immunizations) to infants, toddlers, and children through 2 years old. For children 3 through 18 years old, the Centers for Disease Control and Prevention recommends using the deltoid muscle for vaccines, although the ventrogluteal site may also be used. The dorsogluteal muscle is not appropriate for an IM injection.