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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 34
Parenteral Medications
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
•Is the following statement true or false?
The pare...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
True.
The parenteral route means a route of drug
ad...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parenteral Administration Equipment
• Syringes: all...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parts of a Syringe
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parenteral Administration Equipment
(cont’d)
• Need...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parenteral Administration Equipment
(cont’d)
• Need...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Sizes of
Syringes and Needles
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parenteral Administration Equipment
(cont’d)
• Modi...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Parenteral Administration Equipment
(cont’d)
• Two ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Safety Injection Devices
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ampule, Vial, and Prefilled Cartridge
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•What is the function of a syringe
barrel?...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
a. Holds the medication
The barrel is the pa...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drug Preparation
• Ampule: sealed glass drug contai...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Withdrawing Medication
From the Ampule
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Withdrawing Medication
From the Vial
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Drug Preparation (cont’d)
• Prefilled cartridges: s...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes
• Intradermal injections: between ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Injection equipment: tu...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•Which angle is used by the nurse to
admin...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
d. 45°
The nurse inserts the needle at a 45°...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Subcutaneous injections...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Injection equipment use...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Injection technique (su...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Administering insulin: ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Administering insulin (...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Low-Dose and Standard
Insulin Syringes
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Preparing insulin: when...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mixing Insulins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Administering heparin: ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Administering heparin (...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Intramuscular injection...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Ventrogluteal site: glu...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Rectus femoris site: an...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injection Routes (cont’d)
• Injection technique: nu...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Giving Injection by
Z-Track Technique
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reducing Injection Discomfort
• Nurses use these al...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reducing Injection Comfort (cont’d)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•Which intramuscular injection site is
use...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
b. Vastus lateralis
The vastus lateralis sit...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Implications
• Nurses who administer parent...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic Considerations
• Clients with ...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic Considerations
(cont’d)
• Age-...
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic Considerations
(cont’d)
• Delt...
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  1. 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 34 Parenteral Medications
  2. 2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins •Is the following statement true or false? The parenteral route means a route of drug administration other than oral or through the gastrointestinal tract. Question
  3. 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins True. The parenteral route means a route of drug administration other than oral or through the gastrointestinal tract. Answer
  4. 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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)
  5. 5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Parts of a Syringe
  6. 6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  7. 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  8. 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Sizes of Syringes and Needles
  9. 9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  10. 10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  11. 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Safety Injection Devices
  12. 12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ampule, Vial, and Prefilled Cartridge
  13. 13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  14. 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
  15. 15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  16. 16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Withdrawing Medication From the Ampule
  17. 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Withdrawing Medication From the Vial
  18. 18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  19. 19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  20. 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Injection Routes (cont’d) • Injection equipment: tuberculin syringe – 25- to 27-gauge needle measuring one- half inch in length is commonly used • Injection technique: nurse instills the medication shallowly at a 10° to 15° angle of entry
  21. 21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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°
  22. 22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
  23. 23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  24. 24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  25. 25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Injection Routes (cont’d) • Injection technique (subcutaneous) – For obese clients, the nurse inserts the needle at a 90° angle – For thin clients, the nurse inserts the needle at a 45° angle
  26. 26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  27. 27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  28. 28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Low-Dose and Standard Insulin Syringes
  29. 29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  30. 30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Mixing Insulins
  31. 31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  32. 32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  33. 33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  34. 34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  35. 35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  36. 36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  37. 37. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Giving Injection by Z-Track Technique
  38. 38. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  39. 39. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Reducing Injection Comfort (cont’d)
  40. 40. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  41. 41. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.
  42. 42. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications • Nurses who administer parenteral medications may identify nursing diagnoses such as: – Acute pain – Anxiety – Fear – Risk for trauma
  43. 43. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations • Clients with diabetes often have visual problems interfering with their ability to self- administer insulin • Clients who can administer insulin injections but cannot fill their own syringes may choose to use prefilled syringes or an insulin pen
  44. 44. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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
  45. 45. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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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