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给 药
(三)
中国医科大学护理学院
王健
Medications
(three)
PARENTERAL MEDICATIONS
Nurses given parenteral
medications intradermally (ID),
subcutaneously (SC or SQ),
intramuscularly (IM), or
intravenously (IV). Because these
medications are absorbed more
quickly than oral medications and
are irretrievable once injected, the
nurse must prepare and administer
them carefully and accurately.
Administering parenteral drugs
requires the same nursing
knowledge as for oral and topical
drugs; however, because injections
are invasive procedures, aseptic
technique must be used to minimize
the risk of infection.
Equipment
syringes
To administer parenteral
medications, nurses use injectable
equipment (ie, syringes, needles,
vials, and ampules). Syringes have
three parts: the tip, which connects
with the needle; the barrel, or
outside part, on which the scales
are printed; and the plunger, which
fits inside the barrel (Figure 33-13).
Needles
Needles are made of stainless
steel, and most are disposable. A
needle has three discernible parts:
the hub, which fits onto the syringe;
the cannula, or shaft, which is
attached to the hub; and the bevel,
which is the slanted part at the tip
of the needle (Figure 33-17).
Ampules
An ampule is a glass container
usually designed to hold a single
dose of a drug. It is made of clear
glass and has a distinctive shape
with a constricted neck. Ampules
vary in size ranging from 1 mL to 10
mL or more. Most ampule necks
have colored marks around them,
indicating where they are prescored
for easy opening.
Vials
A vial is a small glass bottle
with a sealed rubber cap. Vials
come in different sizes, from
single to multidose vials. They
usually have a metal or plastic
cap that protects the rubber seal.
Common Parenteral medications
Intradermal Injections
An intradermal injection is the
administration of a drug into the
dermal layer of the skin just
beneath the epidermis. Usually
only a small amount of liquid is
used, for example, 0.1 mL.
Common sites for
intradermal injections are the
inner lower arm, the upper
chest, and the back beneath
the scapulae (Figure 33-27).
After the site is cleaned, the skin is
held tautly, and the syringe is held at
about a 15-degree angle to the skin,
with the bevel of the needle upward.
The needle is then inserted through
the epidermis into the dermis, and the
fluid is injected. The drug produces a
small bleb just under the skin (Figure
33-28).The needle is then withdrawn
quickly,and the site is very lightly
wiped with an antiseptic swab.
Subcutaneous Injections
Among the many kinds of drugs
administered subcutaneously are vaccines,
preoperative medications, narcotics, insulin,
and heparin. Common sites for subcutaneous
injections are the outer aspect of the upper
arms and the anterior aspect of the thighs.
These areas are convenient and normally
have good blood circulation. Other areas that
can be used are the abdomen, the scapular
areas of the upper back, and the upper
ventrogluteal and dorsogluteal areas (Figure
33-29).
1.Check the medication order for
accuracy.
2.Prepare the medication from the vial or
ampule.
3.Identify the client, and assist the client
to a comfortable position.
4.Select and clean the site.
5.Prepare the syringe for injection.
6.Inject the medication (Figure 33-30).
7.Remove the needle.
8.Dispose of supplies appropriately.
9.Document all relevant information.
10.Assess the effectiveness of the
medication at the time it is expected
to act.
Intramuscular Injections
Injections into muscle tissue,
or intramuscular injections, are
absorbed more quickly than
subcutaneous injections because
of the greater blood supply to the
body muscles.
A major consideration in the
administration of intramuscular
injections is the selection of a safe
site located away from large blood
vessels, nerves, and bone.
1.Check the medication order for
accuracy.
2.Prepare the medication from the vial
or ampule.
3.Identify the client, and assist the
client to a comfortable position.
4.Select, locate, and clean the site.
5.Prepare the syringe for injection.
6.Inject the medication using a Z-track
technique (Figure 33-40).
7.Withdraw the needle.
8.Discard the uncapped needle and
attached syringe into the proper
receptacle.
9.Document all relevant information.
10.Assess effectiveness of the
medication at the time it is expected
to act.
Thank you !