Transcript Timby: Fundamental Nursing Skills and Concepts

Chapter 34
Parenteral Medications
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Question
• Is the following statement true or false?
The parenteral route means a route of drug
administration other than oral or through the
gastrointestinal tract.
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Answer
True.
The parenteral route means a route of drug
administration other than oral or through the
gastrointestinal tract.
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Parenteral Administration Equipment
• Syringes: all syringes contain a barrel, a
plunger, and a tip or hub
– Calibrated in milliliters (mL), cubic
centimeters (cc), units (U), and in some
cases minims (m)
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Parts of a Syringe
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Parenteral Administration Equipment
(cont’d)
• Needles are supplied in various lengths
and gauges
– Shaft: length of the needle
– Gauge: diameter of the needle
• Lengths vary from approximately 0.5 to
2.5 inches
• Filter needles are used when withdrawing
medication from a glass ampule
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Parenteral Administration Equipment
(cont’d)
• Needle gauge refers to width
– For most injections, 18- to 27-gauge
needles are used; the smaller the
number, the larger the diameter
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Common Sizes of
Syringes and Needles
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Parenteral Administration Equipment
(cont’d)
• Modified safety injection equipment:
– Avoids needlestick injuries to reduce the
risk for acquiring a blood-borne viral
disease such as hepatitis or AIDS
o Plastic shields that cover the needle
after use, needles that retract into the
syringe, and gas-pressured devices
that inject medications without needles
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Parenteral Administration Equipment
(cont’d)
• Two techniques with standard equipment to
prevent needlestick injuries:
– Before administering an injection, the
protective cap covering a needle is
replaced by using the scoop method
– After administering an injection, the
needle is left uncapped and deposited in
the nearest biohazard container
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Safety Injection Devices
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Ampule, Vial, and Prefilled Cartridge
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Question
• What is the function of a syringe barrel?
a. Holds the medication
b. Withdraws the medication
c. Instills the medication
d. Attaches the needle
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Answer
a. Holds the medication
The barrel is the part of the syringe that holds
the medication. The plunger is a part of the
syringe within the barrel that moves back and
forth to withdraw and instill the medication.
The tip or hub is the part of the syringe to
which the needle is attached.
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Drug Preparation
• Ampule: sealed glass drug container
• Vial: glass or plastic container of parenteral
medication with a self-sealing rubber stopper
– Reconstitution: process of adding liquid,
known as diluent, to a powdered
substance
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Withdrawing Medication
From the Ampule
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Withdrawing Medication
From the Vial
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Drug Preparation (cont’d)
• Prefilled cartridges: sealed glass cylinder of
parenteral medication
– Cartridge comes with an attached needle
and the cylinder is made so that it fits in
a specially designed syringe
• Combining medications in one syringe: exact
amounts must be withdrawn from each drug
container; once the drugs are in the barrel of
the syringe there is no way to expel one
without expelling some of the other
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Injection Routes
• Intradermal injections: between the layers
of the skin
– Diagnostic purposes
o Examples: tuberculin tests and allergy
testing
– Injection sites: inner aspect of the
forearm
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Injection Routes (cont’d)
• Injection equipment: tuberculin syringe
– 25- to 27-gauge needle measuring onehalf inch in length is commonly used
• Injection technique: nurse instills the
medication shallowly at a 10° to 15° angle
of entry
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Question
• Which angle is used by the nurse to
administer a subcutaneous injection to a
thin client?
a. 90°
b. 15°
c. 10°
d. 45°
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Answer
d. 45°
The nurse inserts the needle at a 45° angle
for thin clients. For obese clients, and when
administering intramuscular injections, the
nurse inserts the needle at a 90° angle.
When giving an intradermal injection, the
nurse instills the medication shallowly at a
10° to 15° angle of entry.
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Injection Routes (cont’d)
• Subcutaneous injections: beneath the skin
but above the muscle
– Medication is instilled between the skin
and muscle and absorbed fairly rapidly
– Commonly used to administer insulin and
heparin
– Injection sites: insulin and heparin are
administered in the abdomen
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Injection Routes (cont’d)
• Injection equipment used for a subcutaneous
injection depends on the type of medication
prescribed
– Example: insulin is prepared in an insulin
syringe and heparin is prepared in a
tuberculin syringe
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Injection Routes (cont’d)
• Injection technique
– For obese clients, the nurse inserts the
needle at a 90° angle
– For thin clients, the nurse inserts the
needle at a 45° angle
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Injection Routes (cont’d)
• Administering insulin: hormone required by
some clients with diabetes
– Common route for administration:
subcutaneous or intravenous injection
o Inhaled form of insulin: Exubera
o Insulin syringe: calibrated in units
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Injection Routes (cont’d)
• Administering insulin (cont’d): injection site
for insulin is rotated each time the injection
is administered to avoid
– Lipoatrophy: breakdown of subcutaneous
fat at the site of repeated insulin
injections
– Lipohypertrophy: buildup of subcutaneous
fat at the site of repeated insulin
injections
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Low-Dose and Standard
Insulin Syringes
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Injection Routes (cont’d)
• Preparing insulin: when preparing other than
rapid-acting and short-acting insulin or the
long-acting insulin, glargine (Lantus), the
nurse rotates the vial between the palms to
redistribute the additive and insulin before
filling the syringe
• Mixing insulins: insulins tend to bind and
become equilibrated
– Should be injected within 15 minutes of
being combined
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Mixing Insulins
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Injection Routes (cont’d)
• Administering heparin: an anticoagulant drug
administered subcutaneously as well as
intravenously, heparin prolongs the time it
takes for blood to clot
– Nurse removes needle after withdrawal of
the drug from a multidose vial and replaces
it with another before administration
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Injection Routes (cont’d)
• Administering heparin (cont’d):
– To prevent bruising in the area of the
injection, the nurse changes the needle
before injecting the client
– The nurse rotates the sites with each
injection to avoid a previous area where
there has been local bleeding
– The nurse does not aspirate the plunger
once the needle is in place
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Injection Routes (cont’d)
• Intramuscular injections: in muscle tissue
– Absorption from an intramuscular
injection occurs more rapidly than from
the other parenteral routes
– Injection sites
o Dorsogluteal site: upper outer quadrant
of the buttocks
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Injection Routes (cont’d)
• Ventrogluteal site: gluteus medius and
gluteus minimus muscles in the hip for
injection
• Vastus lateralis site: vastus lateralis muscle,
one of the muscles in the quadriceps group
of the outer thigh
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Injection Routes (cont’d)
• Rectus femoris site: anterior aspect of the
thigh
• Deltoid site: lateral aspect of the upper arm
• Injection equipment: 3- to 5-mL syringes
are used to administer medications by the
intramuscular route
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Injection Routes (cont’d)
• Injection technique: nurses use a 90° angle
for piercing the skin
– Z-track technique: technique for
manipulating the tissue to seal
medication, especially an irritant, in the
muscle
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Giving Injection by
Z-Track Technique
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Reducing Injection Discomfort
• Nurses use these alternative techniques to
reduce discomfort associated with injections:
– Use the Z-track method for intramuscular
injections
– Apply pressure to the site during needle
withdrawal
– Massage the site afterward, if appropriate
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Reducing Injection Comfort (cont’d)
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Question
• Which intramuscular injection site is used
for clients with debilitated and poorly
developed gluteal muscles?
a. Deltoid
b. Vastus lateralis
c. Rectus femoris
d. Ventrogluteal
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Answer
b. Vastus lateralis
The vastus lateralis site is used for clients
with debilitated and poorly developed gluteal
muscles. The deltoid site is used for adults.
The rectus femoris site is used for infants.
The ventrogluteal site is used for children.
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Nursing Implications
• Nurses who administer parenteral
medications may identify nursing diagnoses
such as:
– Acute pain
– Anxiety
– Fear
– Risk for trauma
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General Gerontologic Considerations
• Clients with diabetes often have visual
problems interfering with their ability to selfadminister insulin
• Clients who can administer insulin injections
but cannot fill their own syringes may choose
to use prefilled syringes or an insulin pen
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General Gerontologic Considerations
(cont’d)
• Age-related changes and possible chronic
diseases impair the older person’s ability to
absorb and metabolize medications
• Injections should not be administered into
limbs that are paralyzed, inactive, or
affected by poor circulation
– For clients with mastectomy or with a
vascular site for hemodialysis, avoid arm
on the affected side
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General Gerontologic Considerations
(cont’d)
• Deltoid or ventrogluteal muscles may be the
preferred intramuscular sites for older adults
experiencing impaired mobility
• Dorsogluteal site should be avoided because
of the risk of damage to the sciatic nerve
with diminished musculature
• Selection and identification of injection site
may be difficult when working with clients
experiencing dementia or musculoskeletal
deformities such as contractures
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