Chapter 12 Administering Medication



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Steps

Rationale and Key Points

1.Wash hands and wear mouth mask

2.Assemble equipment and check the physician’s order. If necessary, draw medication from an ampule or a vial at preparation room

3.Take the equipment to the bedside of the client. Identify the client. Explain procedure to the client

4.Select appropriate site

5.Sterilize the skin with an alcohol swab while wiping with a firm, circular motion and moving outward from the injection site. Allow the skin to dry.

6.Check again, and eject air in syringe thoroughly.

7.Use the nondominant hand to spread the skin taut over the injection site. Place the needle against the client’s skin at 5-degree angle, with the bevel up, and insert the needle into the skin until the bevel inserts into the skin completely. Place the syringe flat against the skin. Firm the hub with thumb of the nondominant hand. Slowly inject the medication about 0.1ml with the dominant hand while watching for a small wheat to appear
8.Withdraw the needle quickly at the same angle that it was inserted

9.Check again. Dispose of equipment properly

10. Assist the client to take a comfortable position. Wash hands.


●Follow sterile principles strictly

●To ensure correct medication administration

●To encourage client’s cooperation and reduce anxiety

●Ask the client’s allergic history


●Pathogens on the skin can be forced into the tissues by the needle

●Introducing alcohol into tissues irritates the tissues and is uncomfortable for the client if skin doesn’t dry

●The antiseptic solution containing iodine can not be used, which will interfere with the test results

●Taut skin provides an easy entrance into intradermal tissue

●Holding the needle as nearly parallel to the client’s skin as possible when inserting. If the angle of inserting is lager, the needle may insert into subcutaneous tissue

●Inserting the bevel of needle into the skin completely to avoid leaking of medication

●If a small bleb appears, the reagent is in intradermal tissue
●Don’t massage the area after removing the needle and instruct the client not to massage the area because medication may disperse into deeper tissue or out through the needle insertion site





Steps

Rationale and Key Points

11.observe response of the client. Make judgment and record the result.

●Generally, observe the result in 15 to 20 minutes after the injection

●If necessary, inject 0.1ml of 0.9% normal saline solution at the same site of the other forearm for comparative study



Evaluation

1.Whether the nurse has followed the principle of the threechecks and seven rights and the sterile techniques. Observe the size of the wheal in the site of injection. Whether there is bleeding, infiltration or discomfort in the injection site.

2.The client’s systemic reaction to the medications

3.The client’s knowledge about medication and methods of administration

Skill12-4 Administering a Subcutaneous Injection

Purposes


1. To inject medications that need to produce effect within given time but cannot be administered orally

2. To inject vaccine

3.To give local anesthesia

Equipment




● Medical tray

● Antiseptic solution

Medication

● Medication card

● Sterile swab

● Sterile tweezers and vat

● File and vial opener

● 1 to 3ml syringe, 5 to 6-gauge needle

● Contamination container


Procedures and Key Points



Steps

Rationale and Key Points

Steps 1 to 4 are the same as described in 12-3

5.Close door and windows.

6.Assist client to comfortable position appropriate for the site selected

(1) If the outer aspect of upper arm is selected, the client may have a sitting or lying position, the arm should be relaxed at the site of the body.

(2) If the anterior thighs are selected, the client may sit or lie with the leg relaxed

(3) If the abdomen is selected, the client may lie in a semirecumbent position or supine position with the knees flexed

(4) If the scapular area is selected, the client may be prone, on side, or assume a sitting position

7. Sterilize the area as routine and allow the skin to dry

8. Inject medication

(1) Remove the needle cap with the nondominant hand

(2) Grasp and bunch the area surrounding the injection site or spread the skin at the site

(3) Hold the syringe flat in the dominant hand and keep bevel side up. Insert the needle quickly at an angle of 30- to 40-degree and stop at the 1/2 or 2/3 length of the needle

(4) After the needle is in place, release the grasp on the tissue and immediately move your nondominant hand to steady the hub of the needle. Slide your dominant hand to the end of the plunger.

(5) Aspirate by pulling back gently on the plunger of the syringe to determine whether the needle is in a blood vessel

(6) If no blood appears, inject the solution slowly

● To provide privacy

● Proper position will make the local tissue relax and reduce the discomfort of the client

● It is necessary to rotate sites if the client is to receive frequent injection for a long time


● This provide for easy, less painful entry into the subcutaneous tissue

● If the client is thin, skin needs to be pinched to prevent too deep insertion

● If the client is thin, the angle of inserting should be smaller

● If blood appears, the needle should be withdrawn and discarded, and a new syringe with new medication prepared

● It is not suggested that nurses aspirate when injecting heparin, an anticoagulant, in order to prevent bleeding

●Irritating medications should not be administered subcutaneously

● Rapid injection of the solution creates pressure in the tissues, resulting in discomfort






Steps

Rationale and Key points

(7) After medication injection, withdraw the needle quickly. Massage the area gently with dry sterile swab
9.Check again

10.Assist the client to a comfortable position. Dispose of equipment. Wash hand. Record the relevant data if necessary



●Slow withdrawal of the needle pulls the tissues and causes discomfort

●Massage helps distribute the solution and hastens its absorption


Evaluation

1.Whether the nurse has followed the three checks principle and antiseptic techniques

2.Observe the size of the wheal in site of injection, and whether there is bleeding, infiltration, discomfort in the injection site, and the client’s systemic reactions to the medications.

3.The client’s knowledge about medication and methods of administration.

Skill12-5 Administering an Intramuscular Injection

Purposes

1.To inject medications that need to produce effect within a period of time and cannot be administered orally

2.To produce rapid effects, but the medication cannot be administered by intravenous injection

3.To inject irritating medication or a large volume of medication


E
● Sterile tweezers and vat

● File and vial opener

● 2 to 5ml syringe, 51/2 to 7-gauge needle

● Contamination container


quipment


● Medical tray

● Antiseptic solution

● Medication

● Medication card

● Sterile swab

Procedures and Key Points




Steps

Rationale and Key Points

Steps 1 to 4 are the same as described in 12-3

5.Using screen to provide for privacy

6.Assist client to comfortable position appropriate for the site selected

(1) If the dorsogluteal is selected, the client may lie prone with toes pointing inward or on the side with the upper leg straight and relaxed and the lower leg flexed

(2) If the ventrogluteal are selected, the client may lie on the back or on the side with upper leg straight and lower leg flexed

(3) If the vastus lateralis is selected, the client may lie in a supine position or sit

(4) If the deltoid is selected, the client may sit or lie with arm relaxed

7. Select the injection site


8.Sterilize the site as routine. Allow it to dry

9.Injecting medication

(1) Hold dry sterile swab between the third and fourth fingers of nondominant hand. Remove the needle cap by pulling it straight off.

(2) Spread the skin at the site using thumb and forefinger or nondominant hand

(3) Hold the syringe in a dart-like manner. Quickly dart the needle into the tissue at a 90-degree angle in 2/3 length of needle shaft

(4) As soon as the needle is in place, move your nondominant hand to hold the hub of the needle and the syringe, slide your dominant hand to the knob of the plunger




●To ensure the local muscle relax

●Good visualization is necessary to establish the correct location of the site and assess the local condition

●Locate the site of choice correctly and ensure that the area is not tender and is free of lumps or nodules


●Swab remains readily accessible when needle is withdrawn

●Taut tissue makes it easy for the needle to enter the tissue and minimize discomfort

●Fix the hub with middle finger when holding syringe

●Determine the depth of injection according to the age and weight of client

●Once the needle is broken, the nurse should ask the client keep the position, steady the local tissue, take out the needle by using sterile forceps or ask a surgical doctor for help

●A quick injection is less painful

●To reduce pain





Steps

Rationale and Key Points

(5) Aspirate by slowly pulling back on the plunger to determine whether the needle is in a blood vessel. If blood is aspirated, discard the needle, syringe, and medication, prepare a new sterile set, and choose another site

(6) If no blood is aspirated, inject the solution slowly. Observe the client’s responses


(7) Remove the needle quickly while applying a swab gently over the site. Massage the injection site with the sterile swab using gentle pressure

10.Check again

11.Assist the client to have a comfortable position. Dispose of equipment. Wash hands. Record the relevant data if necessary


●Discomfort and possibly a serious reaction may occur if a medication for intramuscular use is injected into a vein

●Injecting slowly helps reduce discomfort

When injecting oily medication, firm hub to prevent separation of hub from tip of syringe by great force

●When injecting suspension, shake the medication first, and then, inject the medication quickly to prevent sediment

●Slow removal of the needle pulls tissues and may cause discomfort

●Massaging helps distribute the solution and hastens its absorption by increasing blood flow to the area


●Tenderness caused by long-term repeated injecting at the same muscle site can be treated by not compress or physiotherapy

Evaluation

1. Whether the nurse has carried out the principle of the three checks and seven rights and the principle of sterilization. Observe whether there is bleeding, infiltration, or discomfort in the injection site, assess mobility of limbs

2.The client’s systemic reactions to the medications

3.The client’s knowledge and skills about medication and methods of administration

Skill 12-6 Administering an Intravenous Injection

Purposes

1. To inject medication which are not suitable for other routes

2.To get desired effect rapidly, especially for the client with critical illness

3.To use for diagnosis test, for example, X-ray examinations of liver, kidney, or gallbladder

4.To get blood sampling

Equipment




● Medical tray

  • Antiseptic solution

(Povidone-iodine)

● Medication

● Medication card

●Sterile swab

● Sterile tweezers and vat

a syringe based on the volume of medication, 6- to 9-gauge needle



●File and vial opener

●Container of speicimen

●Tourniquet

●Small pad

Contamination container

●Gloves (if necessary)

●Sterile dressing (if necessary)

Procedures and Key Points




Steps

Rationale and Key Points

Peripheral intravenous injection

Steps 1 to 4 are the same as described in 12-3

5.Select an appropriate site and palpate accessible veins

6.Dilate the vein

(1) Apply tourniquet approximately 6cm above site chosen. Direct the ends of the tourniquet away from the site of entry. Check to be sure that radial pulse is still present

(2) If using arm, have client clench the hand. Palpate vein. If a vein cannot be felt, release the tourniquet and have the client lower his arm below the level of the heart to fill the veins. Reapply tourniquet and gently tap over the intended vein to help it distend or remove tourniquet and place warm compresses over the intended vein for 10 to 15 minutes




●Shave the needle insertion area if too hairy

●Interrupting the blood flow to the heart causes the vein to distend. Interruption of the arterial flow will impede venous filling

●The end of the tourniquet directed away could prevent contamination of the injection area





Steps

Rationale and Key Points

7. Sterilize the site as routine. Permit the solution to dry. Reuse tourniquet.

8. Injecting medication or collecting blood specimen

(1) Check again, eject air in syringe

(2) Place the nondominant hand about 5cm below the entry point. Hold the skin taut against the vein

(3) Hold syringe in the dominant hand. The needle, with the bevel side up, is directed to proximal limb. Enter the skin gently at a 15- to 30-degree angle in upper to side of vein, and when the needle is through the skin. Lower the needle until it is nearly parallel to the skin, while following the course of the vein, advance the needle into the vein.

(4) When blood returns, it indicates that the needle is inserted into the vein. Decrease needle angle and prepare to thread needle approximately from 0.5 to 1cm into vein

(5) Release the tourniquet and unclench the hand
(6) Inject medication slowly or collect blood specimen. Observe responses of the client

(7) Remove needle quickly and apply gentle pressure over the site with a sterile swab immediately for 2 to 3 minutes

(8) Once bleeding has stopped, apply a sterile adhesive dressing. Ask client crook the arm

9. Check again. Assist the client to a comfortable position. Dispose of equipment. Wash hands. Record the administration of the medication if necessary

Femoral intravenous injection

Step 1 to 5 are the same as peripheral intravenous injection described above



●Nurses should be cautious not to contaminate the aseptic area

●To anchor the vein by placing thumb over vein and stretching skin against direction of insertion 5cm distal to site

●A sensation of “give” can be felt when the needle enters the vein

●Inserting angle should not be larger in order to avoid piercing through vein. Once infiltration appears, remove needle immediately, and press the site with sterile swab. Change site to insert again


●Because pressure is greater in the vein than in the needle, blood will flow into the needle when the vein is entered
●When collecting blood specimen, the tourniquet will not be released until the needed volume of specimen is collected

●When injecting irritating medication, normal saline should be used to inject at first to test the needle is in the vein. Then change the syringe with medication for injection to prevent medication irritating tissue once the insertion fails

●Control the speed of injection according to age of client and nature of medication

●Maintain pressure to aid in hemostasis

●Using sterile dressing can prevent contamination of injecting site





Steps

Rationale and Key Points

6.Help the client a supine position. Straight legs and abduct slightly

7.Touch the most distinct pump of femoral artery in femoral triangle area or select the middle point of line between superior anterior and public tubercle for injection. Then mark the site

8. Sterile the area of injection

9. Sterilize the index finger and third finger of the manipulator’s nondominant hand

10.Injection

(1) Check again

(2) Palpate the clearest pump of femoral artery by using index figure of nondominant and steady it there

(3) Hold the syringe by the dominant band and insert the needle into the femoral vein at 0.5cm of its medial side in a 90-degree angle or 45-degree angle

(4) If there is dull red blood aspirated into the barrel, it indicates the needle is inserted into the vein

(5) Steady the syringe by the dominant hand. Inject the medications or collect blood sample by pulling the plunger of syringe

(6) Withdraw the needle quickly while applying sterile swab or gauze gently over the site and press 3 to 5 minutes to stop bleeding

(7) Once the bleeding has been stopped, apply a sterile adhesive dressing

11. Check again. Assist the client to a comfortable position. Dispose of equipment. Wash hands. Record the relevant information


●To expose the site of injection completely

●Palpating the femoral artery pump to locate the site of injection


●Controlling the depth of insertion to avoid transfixing through vein

●The nurse should pay attention to the color of blood. If the color is bright red, it indicates that the needle insert into the artery. Withdraw the needle immediately. Press the site with sterile gauze for 5 to 10 minutes until no bleeding


●Withdrawing needle quickly can decrease the client’s discomfort

●Pressing local site to prevent bleeding or hematoma

●Protect the site of injection from infection





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