给 药给 药(( 三三 ))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 Administering parenteral drugs requires the same nursing requires the same nursing knowledge as for oral and topical knowledge as for oral and topical drugs; however, because injections drugs; however, because injections are invasive procedures, aseptic are invasive procedures, aseptic technique must be used to minimize technique must be used to minimize the risk of infection. the risk of infection.

EquipmentEquipmentsyringessyringes To administer parenteral To administer parenteral medications, nurses use injectable medications, nurses use injectable equipment (ie, syringes, needles, equipment (ie, syringes, needles, vials, and ampules). Syringes have vials, and ampules). Syringes have three parts: the tip, which connects three parts: the tip, which connects with the needle; the barrel, or with the needle; the barrel, or outside part, on which the scales outside part, on which the scales are printed; and the plunger, which are printed; and the plunger, which fits inside the barrel (Figure 33-13).fits inside the barrel (Figure 33-13).

NeedlesNeedles Needles are made of stainless Needles are made of stainless steel, and most are disposable. A steel, and most are disposable. A needle has three discernible parts: needle has three discernible parts: the hub, which fits onto the the hub, which fits onto the syringe; the cannula, or shaft, syringe; the cannula, or shaft, which is attached to the hub; and which is attached to the hub; and the bevel, which is the slanted part the bevel, which is the slanted part at the tip of the needle (Figure 33-at the tip of the needle (Figure 33-17).17).

AmpulesAmpules An ampule is a glass container An ampule is a glass container usually designed to hold a single usually designed to hold a single dose of a drug. It is made of clear dose of a drug. It is made of clear glass and has a distinctive shape glass and has a distinctive shape with a constricted neck. Ampules with a constricted neck. Ampules vary in size ranging from 1 mL to 10 vary in size ranging from 1 mL to 10 mL or more. Most ampule necks mL or more. Most ampule necks have colored marks around them, have colored marks around them, indicating where they are prescored indicating where they are prescored for easy opening.for easy opening.

VialsVials A vial is a small glass bottle A vial is a small glass bottle with a sealed rubber cap. Vials with a sealed rubber cap. Vials come in different sizes, from come in different sizes, from single to multidose vials. They single to multidose vials. They usually have a metal or plastic usually have a metal or plastic cap that protects the rubber seal.cap that protects the rubber seal.

Common Parenteral medicationsCommon Parenteral medicationsIntradermal InjectionsIntradermal Injections An intradermal injection is the An intradermal injection is the administration of a drug into the administration of a drug into the dermal layer of the skin just dermal layer of the skin just beneath the epidermis. Usually beneath the epidermis. Usually only a small amount of liquid is only a small amount of liquid is used, for example, 0.1 mL. used, for example, 0.1 mL.

Common sites for Common sites for intradermal injections are the intradermal injections are the inner lower arm, the upper inner lower arm, the upper chest, and the back beneath chest, and the back beneath the scapulae (Figure 33-27).the scapulae (Figure 33-27).

After the site is cleaned, the skin is After the site is cleaned, the skin is held tautly, and the syringe is held at held tautly, and the syringe is held at about a 15-degree angle to the skin, about a 15-degree angle to the skin, with the bevel of the needle upward. with the bevel of the needle upward. The needle is then inserted through The needle is then inserted through the epidermis into the dermis, and the the epidermis into the dermis, and the fluid is injected. The drug produces a fluid is injected. The drug produces a small bleb just under the skin (Figure small bleb just under the skin (Figure 33-28).The needle is then withdrawn 33-28).The needle is then withdrawn quickly,and the site is very lightly quickly,and the site is very lightly wiped with an antiseptic swab.wiped with an antiseptic swab.

Subcutaneous InjectionsSubcutaneous Injections Among the many kinds of drugs Among the many kinds of drugs administered subcutaneously are vaccines, administered subcutaneously are vaccines, preoperative medications, narcotics, insulin, preoperative medications, narcotics, insulin, and heparin. Common sites for subcutaneous and heparin. Common sites for subcutaneous injections are the outer aspect of the upper injections are the outer aspect of the upper arms and the anterior aspect of the thighs. arms and the anterior aspect of the thighs. These areas are convenient and normally These areas are convenient and normally have good blood circulation. Other areas that have good blood circulation. Other areas that can be used are the abdomen, the scapular can be used are the abdomen, the scapular areas of the upper back, and the upper areas of the upper back, and the upper ventrogluteal and dorsogluteal areas (Figure ventrogluteal and dorsogluteal areas (Figure 33-29).33-29).

1.1.Check the medication order for Check the medication order for accuracy.accuracy.2.Prepare the medication from the vial or 2.Prepare the medication from the vial or ampule.ampule.3.Identify the client, and assist the client 3.Identify the client, and assist the client to a comfortable position.to a comfortable position.4.Select and clean the site.4.Select and clean the site.5.Prepare the syringe for injection.5.Prepare the syringe for injection.6.Inject the medication (Figure 33-30).6.Inject the medication (Figure 33-30).

7.Remove the needle.7.Remove the needle.8.Dispose of supplies appropriately.8.Dispose of supplies appropriately.9.Document all relevant information.9.Document all relevant information.10.Assess the effectiveness of the 10.Assess the effectiveness of the medication at the time it is expected medication at the time it is expected to act.to act.

Intramuscular InjectionsIntramuscular Injections Injections into muscle tissue, Injections into muscle tissue, or intramuscular injections, are or intramuscular injections, are absorbed more quickly than absorbed more quickly than subcutaneous injections because subcutaneous injections because of the greater blood supply to the of the greater blood supply to the body muscles.body muscles.

A major consideration in the A major consideration in the administration of intramuscular administration of intramuscular injections is the selection of a safe injections is the selection of a safe site located away from large blood site located away from large blood vessels, nerves, and bone. vessels, nerves, and bone.

1.Check the medication order for 1.Check the medication order for accuracy.accuracy.2.Prepare the medication from the vial 2.Prepare the medication from the vial or ampule.or ampule.3.Identify the client, and assist the 3.Identify the client, and assist the client to a comfortable position.client to a comfortable position.4.Select, locate, and clean the site.4.Select, locate, and clean the site.5.Prepare the syringe for injection.5.Prepare the syringe for injection.6.Inject the medication using a Z-track 6.Inject the medication using a Z-track technique (Figure 33-40).technique (Figure 33-40).

7.7.Withdraw the needle.Withdraw the needle.8.Discard the uncapped needle and 8.Discard the uncapped needle and attached syringe into the proper attached syringe into the proper receptacle.receptacle.9.Document all relevant information.9.Document all relevant information.10.Assess effectiveness of the 10.Assess effectiveness of the medication at the time it is expected medication at the time it is expected to act.to act.

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