Transcript Routes of Administration

Administering Medications
Chapter 34
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Safety in Drug Administration
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Safety precautions in the management of medication
administration should be consistently applied.
MA must clearly understand the medication, dose,
strength, and route of administration for the drug
ordered by the physician.
Once the order is clarified, look up the drug in the PDR.
A drug should not be given until the MA knows the
purpose, potential side effects, precautions, and
recommended dose.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 2
Seven Rights of Drug Administration
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Right patient
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Right drug
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Right dose
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Right route of administration
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Right time
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Right technique
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Right documentation
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 3
Drug Label Checks
EACH TIME a medication is dispensed, the MA
MUST do the three label checks. Compare the
physician’s written order with the label:
1. When removing the drug from the storage site
2. Just before dispensing the medication from the
container
3. When replacing the container or before discarding it
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 4
Additional Safety Steps
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Dispense medications in quiet, well-lit area.
Consult physician if there is ANY difference between medication
ordered and medication available.
Store medications as directed on package.
The person administering the medication is responsible for any
drug errors.
Physician should write every medication order before the
medication is dispensed.
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Routinely check medication expiration dates.
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Discard drug containers with damaged labels.
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Discard medication that has been dispensed but not administered.
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Observe all patients for minimum of 20 minutes after drug
administration.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 5
Patient Assessment Factors
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Before administering any medication the MA should
assess the patient, the drug, and the environment.
Use the holistic approach to patient assessment:
– Complete and accurate patient history
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Current and past use of prescription and OTC drugs
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Accurate list of drug allergies
Assess patient ability to understand the drug regimen
and afford the treatment.
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Record accurate age and weight.
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Liver or kidney disease may alter drug orders.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 6
Patient Population Precautions
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Precautions with pregnant and lactating women; drugs
can pass through placenta into fetus and into breast
milk.
Pediatric special precautions are necessary because of
alterations in absorption, distribution, metabolism, and
excretion of drugs.
– Explain to the child why medication is needed.
– Attempt to gain the child’s cooperation.
– Offer choices if possible.
– Use diversion during stressful moments.
– Encourage parents to help.
– Offer a treat at the end of the visit.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 7
Geriatric Precautions
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Aging patients more sensitive to effects of drugs
because:
– Metabolic rate slows with aging causing susceptibility to
accumulated effects and toxic reactions
– Loss of subcutaneous fat may affect parenteral routes of
administration
– Accompanying circulatory, liver, kidney diseases may affect
distribution, metabolism, and excretion of medications
– Many aging patients are ordered multiple drugs, which
increases risk of drug interactions and contraindications
– Poor diet may affect drug therapy
– May not be able to afford medications
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Slide 8
Geriatric Patient Guidelines
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Clearly write instructions for medication therapy.
Monitor patient for swallowing difficulty (may crush
medication or mix with food).
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Encourage patient to drink plenty of water.
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Reinforce that patient take medication as ordered.
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Request that patient bring all medications currently taking to
the office visit and keep accurate records of each.
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Suggest patient use the same pharmacy for all prescriptions.
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Suggest use of daily or weekly pill dispensers.
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Encourage patients not to save or share medication.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 9
Assessment of the Patient’s Environment
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Allergy injections should not be given unless a
physician is present.
Place the patient in a correct and safe position for
injections.
Make sure patient’s head is elevated before giving oral
medications.
Make sure emergency medications are accessible to
counteract adverse reactions that might occur.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 10
Drug Forms and Administration
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Oral medications include both solid and liquid
preparations; mucous membrane medications are
absorbed either rectally, vaginally, orally, nasally, or
through the skin topically.
Each form has specific guidelines for administration, but
all require the consistent use of the three label checks
and the seven rights.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 11
Solid Oral Dosage Forms
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The basic forms are tablets, capsules, and lozenges
(troches).
Caplets are oblong, like capsules.
Capsules are gelatin-coated and dissolve in the
stomach, or they may be coated to protect them from
the acid action of the stomach.
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Slide 12
Caplets and Capsules
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Some tablets are coated with a volatile liquid that
dissolves in the mouth, such as an antacid tablet.
Tablets are compressed powders or granules that,
when wet, break apart in the stomach, or in the mouth
if they are not swallowed quickly.
– Cannot crush:
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Enteric-coated tabs—coating that resists gastric secretions;
protects stomach mucosa
Buffered tabs—prevent stomach irritation by combining
drug with buffering agent
Timed or sustained release (SR) capsules or spansules—
dissolve at different rates over period of time
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Slide 13
Caplets, Capsules, and Tablets
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Slide 14
Scored Tablets
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Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Only those tablets that
are scored can be cut in
half.
This is accomplished with
a pill cutter.
Slide 15
Liquid Oral Dosage Forms
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Liquid forms differ mainly in the type of substance used
to dissolve the drug: water, oils, or alcohol.
Solutions are drug substances contained in
a homogeneous mixture with a liquid.
There are multiple forms of liquid preparations.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 16
Liquid Medications
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Syrups: Solutions of sugar and water, usually
containing flavoring and medicinal substances.
Cough syrups are the most common.
Aromatic waters: Aqueous solutions contain volatile
oils such as oil of spearmint, peppermint, or clove.
Liquors contain a nonvolatile material, such as alcohol,
as the solute.
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Slide 17
Suspensions
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Suspensions are insoluble drug substances contained
in a liquid.
– Emulsions: Mixtures of oil and water that improve the taste of
otherwise distasteful products such as cod liver oil.
– Gels and magmas: Minerals suspended in water. Minerals
settle, so products containing minerals must be shaken before
use (Milk of Magnesia).
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Slide 18
Oral Administration
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Taken with plenty of water unless designed to coat
mouth or throat (such as cough syrup).
Make sure patient is able to swallow.
Liquid medications best type of administration for
children.
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Oral syringes can be used for pediatric administration.
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N/V requires alternative route of administration.
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Always remain with patient until medication is
swallowed.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 19
Oral Syringes
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Slide 20
Mucous Membrane Forms
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Rectal administration:
– Rapid absorption without irritation to gastric mucosa.
– Suppositories melt and release the medication.
– Administer after bowel movement.
– Patient remains lying down for 20 to 30 minutes.
– Insert suppository 2 inches above rectal sphincter.
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Vaginal administration:
– Suppositories, tabs, creams, fluid solutions.
– Treat local infections; creams and foams for contraception.
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Slide 21
Rectal Suppositories
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Slide 22
Mucous Membrane Forms (cont’d)
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Oral administration:
– Sl tabs: placed under tongue and rapidly absorbed into
bloodstream; systemic absorption that bypasses gastric
mucosa (nitroglycerin)
– Buccal: placed between cheek and upper molars; quickly
absorbed
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Nasal administration:
– Nose drops and nasal sprays for localized action
– May cause systemic reactions including tachycardia,
hypertension, CNS stimulation
– Treatment of nasal congestion, nose bleeds; instillation of
medications
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Slide 23
Topical Forms
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Lotions: relieve pruritus, treat localized infection
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Liniments: emulsion; protect skin
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Ointments (ung): have a petroleum and lanolin base
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Transdermal patches: absorbed slowly for a timereleased systemic effect (nitro, hormone patches)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 24
Transdermal Patch Recommendations
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Write application date on patch and document on
patient chart.
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Patient may shower with patch intact.
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If ordered to apply every 24 hr, apply new patch at
same time every day.
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Keep old patch on for 30 min after applying new one.
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Rotate application sites to prevent irritation.
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Avoid areas with scars or large amount of body hair.
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Use caution when disposing of used patch.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 25
Transdermal Patch
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Slide 26
Parenteral Administration
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Parenteral medications must be sterile and in liquid
form.
Are manufactured in ampules, single-dose or multidose
vials, prefilled syringes, or cartridge systems.
Before dispensing, check expiration date and examine
solution for possible deterioration.
Drug characteristics and individual patient factors
determine the correct gauge and length of needle
needed.
Must use Standard Precautions when disposing of
needles and wear gloves when administering.
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Slide 27
Parenteral Administration
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Slide 28
Needle Gauge
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Bevel—angled tip of a needle
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Gauge—diameter or lumen size of a needle
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The larger the gauge number, the smaller the
diameter of the needle
– Smallest gauges are 27 to 28 for ID injections
– Gauges 25 to 26 for SC injections
– Gauges 20 to 23 for IM—viscous drugs and deeper injections
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Slide 29
Needle Length
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Length depends on two factors
– Area of body for injection
– Depth of administration (SC versus IM)
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Lengths vary from 3/8 inch to 4 inches
– ID: 3/8 inch; bevel only part of needle injected
– SC: 1/2 to 5/8 inch
– IM: 1 to 3 inches; length depends on the muscle being used
and patient size
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Slide 30
Syringes
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Parts of syringe—barrel, calibrated scale, plunger, tip
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3-cc syringe—calibrated with cc and minims
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Tuberculin syringe—holds 1 ml
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Insulin syringe—calibrated in units, 50U or 100U
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The appropriate syringe is determined by the type of
medication and the amount of drug. Specialty syringe
units, such as the Nova Pen and the EpiPen, are
designed for quick administration of certain medications
in public or in an emergency.
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Slide 31
Disposable Syringe
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Slide 32
Anaphylactic Signs and Symptoms
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Hypotension resulting from systemic vasodilation
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Urticaria
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Dyspnea caused by bronchoconstriction
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Vomiting and diarrhea
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Slide 33
Anaphylactic Reactions
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May be treated with epinephrine or self-administered
with an EpiPen.
EpiPen can be injected through clothing.
Firmly press tip of injector on outer aspect of thigh and
hold in place for 10 seconds.
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Remove EpiPen and massage to promote absorption.
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Notify physician or go to ER for follow up.
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Periodically check unit expiration date.
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Store in a readily available location.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 34
Routes of Administration
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Parenteral routes of administration include intradermal
(ID), subcutaneous (SC), and multiple intramuscular
(IM) sites.
Route and site of administration determined by type of
medication, physician order, and unique characteristics
of patient. Avoid scar tissue, moles or warts, bones,
blood vessels, and nerves.
Site must be able to hold the amount being injected.
Must use sterile technique while dispensing,
transporting, and administering injections.
Do not combine medications unless approved by
physician.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 35
Guidelines
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OSHA guidelines include using syringe units with
retractable needle covers and wearing disposable
nonsterile gloves.
Never recap a contaminated needle, and immediately
discard it into a sharps container.
Dispose of contaminated nonsharp materials in
biohazard containers.
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Disinfect contaminated work areas.
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Wash hands before and after procedures.
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Slide 36
Intradermal Injections
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Drug administered within the skin layers just under the
epidermis.
Many nerves present, so injection causes burning and
stinging.
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Inject minute amount of solution.
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Insert only the bevel point of the needle.
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Proper administration causes a wheal to rise at injection
site.
Used for allergy testing and tuberculin screening.
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Slide 37
Tuberculosis Screening
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Mantoux test
– Injects 0.1 ml of PPD in center of anterior forearm.
– Angle of injection 15 degrees, almost parallel to skin surface.
– Monitor site 48 to 72 hr later for induration.
– Patient may read results at home or at return visit.
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Slide 38
Intradermal Injection
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The intradermal injection is administered just under the
epidermis.
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Slide 39
Recommended Sites for Intradermal
Injections
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Slide 40
Subcutaneous Injections
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Given under the skin in adipose tissue.
Insertion angle of 45 degrees; insulin and heparin
administered at 90-degree angle.
Posterior upper arm typical injection site; abdomen,
thigh, upper back also SC sites.
Sites must be rotated to prevent trauma and aid
absorption.
Patients should keep rotation site record.
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Slide 41
Subcutaneous Injection
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Slide 42
Subcutaneous Injection Sites
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Slide 43
Insulin Administration
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Follow policy for mixing types of insulin in the same
syringe.
Always ordered in unit doses.
Use appropriate syringe (50U or 100U) for total amount
of insulin ordered.
Insulin should be stored in refrigerator.
Gently rotate insulin vial between hands to warm before
dispensing.
Do not massage site after injection.
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Slide 44
Insulin Administration
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Slide 45
Intramuscular Injections
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Based on patient size, choose needle long enough to
reach muscle.
Angle of insertion 90 degrees.
IM sites include the deltoid, vastus lateralis, gluteus
medius, and ventrogluteal muscles.
Muscular site used for three reasons:
– Irritating drug for SC tissues
– Requires more rapid absorption
– Large volume of medication needed
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Slide 46
Intramuscular Injection
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Slide 47
Intramuscular Injection Sites
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Slide 48
Deltoid Site
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Muscular cap of shoulder located at top of upper arm.
Injection site located 2 fingerbreadths below the
acromial process.
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Avoid the acromion and humerus.
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Can hold up to 2 cc of medication.
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Acceptable site for adults and older children.
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Should not be used if muscle is small or underdeveloped.
– Small arm: 25-gauge, 5/8-inch needle
– Average arm: 23-gauge, 1-inch needle
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Slide 49
Deltoid Site
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Slide 50
Vastus Lateralis
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Part of the quadriceps group of the thigh
Developed at birth, so is safest IM site for infants and
young children
Fewer major nerves and blood vessels, so excellent site
for adults
Located at the midpoint of the upper, outer thigh
Adult location: 1 handwidth below greater trochanter and
above patella; inject at 90-degree angle
Pediatric location: below greater trochanter but within the
upper lateral quadrant of the muscle; inject at 45-degree
angle with needle pointing toward feet
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Slide 51
Dorsogluteal Site
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Traditional site for deep IM injections in adults
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High risk of sciatic nerve damage
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Must take great care in locating the exact site
– Patient should be in Sims’ position
– Palm on greater trochanter of femur with finger pointed toward
posterior iliac spine
– Inject into gluteus medius muscle above the imaginary line
drawn between the two anatomic markings
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Slide 52
Dorsogluteal Site
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Slide 53
Ventrogluteal Site
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Safe IM site that uses the gluteus medius muscle
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Good alternative to the dorsogluteal site
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Free from major nerves and blood vessels and safe for
children and adults
– Position adult patient in Sims’ position
– Palm of hand on greater trochanter
– Point index finger toward anterior iliac spine
– Spread fingers to form triangular injection site
– 1-inch needle for child; as long as 2½-inch needle for obese
patient
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Slide 54
Ventrogluteal Site
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Slide 55
Z-Track Injection
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Used when medication irritates skin and SC tissues
Displace upper tissue before inserting needle, to
prevent leakage of medication from deep muscle to
upper SC tissues
– Change needle after dispensing medication
– Skin pushed aside and held, site cleansed
– Needle inserted and medication slowly injected into deep
muscle
– After needle withdrawn, release skin
– Do not massage after injection
– Rotate sites to prevent tissue damage
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Slide 56
Principles of IV Therapy
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IV therapy is often the route of choice when the
physician wants to speed up the action of a drug.
The medical assistant must be familiar with both legal
restrictions and employer policies before having
anything to do with IV therapy.
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Slide 57
IV Terminology and Practices
Three types
– Isotonic
– Hypotonic
– Hypertonic
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Slide 58
Dangers of Intravenous Treatment
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Infection or inflammation
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Localized phlebitis
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Fluid overload
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Medication error
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Slide 59
Intravenous Administration Set
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Slide 60
Role of the Medical Assistant in Assisting
with IV Therapy
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Follow state practice acts.
Gather a comprehensive health history to determine
indications for IV therapy.
Weigh patient before and monitor vital signs during
infusion to alert physician of possible complications; do not
take blood pressure in arm with IV.
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Be alert for signs of infiltration and phlebitis.
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Monitor equipment for problems.
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Watch for the too-rapid infusion of fluids, which might lead
to circulatory overload.
Document all pertinent information in the patient record.
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Slide 61
Drug Treatment
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The more the patient knows and understands about
how to take the medication and why it is prescribed,
the greater the chances that the drug treatment will
be successful.
Patient education is absolutely crucial to the correct
administration of medication at home.
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Slide 62
Patient Education
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The patient should understand:
– Purpose of the drug
– Time, frequency, and amount of the dose
– Any special storage requirements
– Typical side effects
– That all medicine should be taken as prescribed
– That all expired drugs should be discarded
– That medications should be kept away from light, heat, air,
moisture
– That medications from several containers should not be combined
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Slide 63