Monitor the patient for adverse and allergic reactions to the medication. remove the needle and discard the medication. tion and time. Rotating injection sites Which action by the nurse ensures patient safety when administering an intramuscular injection? Intramuscular (IM) injections have been associated with adverse effects and pain, and this route of medication injection should be used as a last resort. There are four sites on your body that can be used to give yourself an intramuscular injection. 2023 Dotdash Media, Inc. All rights reserved. Instruct the patient regarding the potential side effects of the medication. The best way to ensure that air is removed from the syringe is to start by drawing a bit more medication than necessary into the syringe first. Other medications require mixing of either two or more liquids, or by reconstituting a dry powder into a liquid solution. Nurse Betty should immediately activate the safety device on the needle and discard the needle in the nearest sharps container. Position the ulnar side of the nondominant hand just below the site and pull the skin laterally. wave. Although pain from injections is, to some extent, unavoidable, there are some things that parents and health care providers can do to help prevent distress and decrease fear. Explain the risks related to the procedure, including hematoma formation, nerve injury, and allergic reaction to the medication. Retrieved on October 12, 2022, from https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. Return to the patient's room in 15 to 30 minutes to see if he or she has had any acute reaction at the injection site. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. The ID injection route has the longest absorption time of all parenteral routes. Recognize and immediately treat respiratory distress and circulatory collapse, which are signs of a severe anaphylactic reaction. Any factor that interferes with local tissue blood flow affects the rate and extent of drug absorption. Considerations for Coadministration of COVID-19 Vaccines and Other Vaccines. The direction of movement the arm does when the deltoid muscle flexes is: Round to the hundreths space - show your work Aspiration prior to injection is done to ensure that: A 6-year-old boy is anxious about receiving an intramuscular injection. Trivia Quiz. Which is true about giving medication using the intramuscular route? The effect of the Z-track technique on pain and drug leakage in intramuscular injections. Apply a dry cotton ball or gauze with light pressure for several seconds over the site. Older adults may have loss of muscle tone and strength that impairs mobility, placing them at high risk for falls as a result of guarding an injection site. The patient's healthcare provider or caregiver should determine the properinjection sitebased on the volume and type of medication being administered, the patient's age, the patient's size, and past medical or surgical history. Create flashcards for FREE and quiz yourself with an interactive flipper. Administer the injection using the Z-track method, if appropriate. (2022). Patients who are learning to give injections for home-based treatment should ask their healthcare provider to explain the best method for their specific medication and situation. Intradermal means: A. Encourage questions and answer them as they arise. Assess the patient for specific contraindications to receiving IM injections and advise the practitioner accordingly. Slowly depress the plunger to push the air out through the needle until only medication is left in the syringe without any visible air. Which site is commonly used while giving an intramuscular (IM) injection to a healthy adult? Administer the injection using the Z-track method, if appropriate. Children can be very anxious or fearful of needles. Muscle tissue is less sensitive than subcutaneous tissue to irritating and viscous medications. Nurse Betty has completed giving Ms. Smith her injection. The Z-track method can be used (except with infant vaccination where skin is compressed) provided that the overlying tissue can be displaced. Medical Assisting: Administrative and Clinical Procedures, Kathryn A Booth, Leesa Whicker, Terri D Wyman, Essentials of Strength Training and Conditioning. Occupational Safety and Health Administration (OSHA). Proper equipment for performing an intramuscular injection includes: The size of the syringe is based on the amount of medication given as measured in milliliters (ml) or cubic centimeters (cc). If multiple vaccines are administered at a single visit, administer each injection in a different injection site. Yilmaz D, Khorshid L, Dedeolu Y. The nurse measures 2 to 3 finger widths4 down from the acromion process and visualizes a triangle, with the base at the acromion process and the apex pointing toward the elbow. Cookies are used by this site. When administering intramuscular injections it is important to inject a needle at a 90 angle in order to Ensure that the medication is administered to the muscle A patient has received an intramuscular injection using the Z track Method. What is the part of the needles below that are circled in blue. Medication is administered in subcutaneous tissue. If no blood appears, inject the medication. Medication is administered according to the six rights of medication safety. Assemble appropriate-size needles, syringes, and other administration supplies. to 5/8 in. Additional information on providing immunization services during a pandemic is available here: Routine and Influenza Immunization Services During the COVID-19 Pandemic: Interim Guidance | CDC. 250 $\hspace{1cm}$ d. 350, Find the force for each of the following potential energy functions: (a) V = cxyz + C (b) $V=\alpha x^{2}+\beta y^{2}+\gamma z^{2}+C$ (c) $V=c e^{-(\alpha x+\beta y+\gamma z)}$ (d) $V=c r^{n}$ in spherical coordinates. Heres What That Means, The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. 4. Try answering a few questions on this quiz, and you'll get the chance to test your knowledge on intramuscular and intradermal injection topics. If the patient expresses concern regarding accuracy of a medication, do not give the medication. This information is included in the manufacturers package insert for each vaccine. Vaccine administration. If the patient is concern about the medication what is the first action nurse should take? It is not intended to replace any instruction you may have received. b. How long are we suppose to wait before withdrawal of the needle? When possible, IM injections should be avoided in muscles that are emaciated or atrophied because these muscles absorb medication poorly.5, Aspiration before injection and slow injection of the medication are not supported by research for vaccine administration.2 The vastus lateralis and deltoid muscle are the only two sites recommended for vaccine administration because these sites do not contain large vessels that are within reach of the needle.2 For all other medications, there is no evidence to either support or abandon the practice of aspiration before administration. Underline the term that means the ability of a trait to be passed from one generation to the next. Learn how Elsevier can support you in providing care to patients. speed $82.6$ cm/s. Hold this position until the medication is injected. (c) Write the general equation giving the transverse dis- The patient is a 28-year-old male who has a clotting disorder. The correct insertion point is: A 2-year-old girl is brought in to receive an intramuscular injection. 2. When administering an intramuscular injection for a 4-year-old child, the best site to use is the: Multiple Choice Q13 To ensure the proper administration of a tuberculin test, the nurse will: Multiple Choice Q14 The nurse has an order to administer an injection of purified protein derivative (PPD) by the intradermal route. What volume of medication can be injected into the site? What Are the Best Intramuscular Injection Sites? Use combination vaccines (e.g., DTaP-IPV-HepB or DTaP-IPV/Hib) to reduce the number of injections, when appropriate. Vaccines available in the United States are administered by 4 routes: When administering a vaccine by injection, choose the correct needle size based on the route, age, patient size, and injection technique. Engage the needle safety sheath. Make sure you identify the direction of travel. There are fewer limitations in the volume of the IM medication administered at this site. What are some features that were or are associated with the emptying of lakes formed during glacial times? This system administers vaccines by creating a narrow stream capable of penetrating the skin. Pregnant women should not get vaccinated. A milliliter is the same as a cubic centimeter and volume can be expressed using either measurement. placement of the particles of the string as a function of posi- Reweigh the patient if appropriate. This site is used for small medication volumes (2 ml or less)5 and for administration of routine immunizations in children older than 3 years with acceptable muscle mass and development and when other sites are inaccessible because of dressings or casts.2. This technique, pulling the skin laterally before injection, prevents medication leakage into subcutaneous tissue, seals medication in the muscle, and minimizes irritation.5 To use the Z-track method in an adult, the appropriate-size needle is attached to the syringe, and an IM site is selected. Hold a gauze pad between the third and fourth fingers of your nondominant hand. She has come into the clinic and will need an IM injection. (2022). The vastus lateralis muscle is the preferred site for administration of immunizations to newborns, infants, toddlers, and children up to 3 years old. Select the appropriate site for injection based on the patients age, muscle tissue mass, and medication volume and viscosity. The only exceptions are medications that are still in their original container or medications that are administered immediately by the person who prepared them. If any signs of irritation are noted, be sure to contact your healthcare provider for guidance. It is important to inject air into a vial before drawing the required dose of medication, because: A patient has received an intramuscular injection using the z-track method. Because pain can increase with each injection, the order in which vaccines are injected matters. Medsurg Nurs. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. The nurse has just finished injecting a medication intramuscularly, and needle is still in the client's arm. (a) Kinetic/potential/mechanical, (b) Chemical/potential/potential, (c) Solar/kinetic/potential, (d) Chemical/kinetic/kinetic, (e) Solar/chemical/kinetic. See Merck's website for more information. Place the syringe between your thumb and first finger. Medications are injected into the bulkiest part of the vastus lateralis thigh muscle, which is the junction of the upper and middle thirds of this muscle. At what angle would the nurse insert the needle? Which factor affects the choice of an intramuscular site? Appropriate measures should be taken to prevent injuries if a patient becomes weak or dizzy or loses consciousness, including: To receive email updates about this page, enter your email address: We take your privacy seriously. Collaboration with the practitioner helps determines which methods will help best reduce pain before injection. You can share the quiz with other professionals or aspirants. Intramuscular (IM) injection is one of many routes for administering medications, including antibiotics, vaccines, hormonal therapies, and corticosteroids. Intramuscular (IM) injections in neonates may be required to administer medications or vaccines. Some of the evidence-based strategies for reducing procedural pain in children can also be used to help prevent distress and alleviate fear in adults. The deltoid muscle is usually the best site to administer injections in adults, but medications with volumes greater than 2 ml should be injected in a large muscle groups like the ventrogluteal. Assist the patient to a comfortable position that is appropriate for the chosen injection site (e.g., sitting, or lying flat, on side, or prone). To help relax the muscle, the patient is asked to lie flat, supine, with the knee slightly flexed and foot externally rotated or to assume a sitting position. Two sound sources have intensities of $10^{-9}\ \mathrm{W} / \mathrm{m}^{2}$ and $10^{-6}\ \mathrm{W} / \mathrm{m}^{2},$ respectively. The next step is to: withdraw the needle and repeat the procedure. Often, more than one vaccine is needed during the same doctors visit, requiring more than one shot. Int J Nurs Pract. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection (7). Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. The nurse is preparing to administer a vaccination to an adult in the deltoid site. Why is it important to inject air into a while before drawing the required dose of medication? acetic acid. (version 3, peer review, 2 approved). The nurse is holding the skin with the non-dominant hand prior to inserting the needle for an intramuscular injection. What should the nurse do next? Intramuscular injections are administered into the muscle through the skin and subcutaneous tissue. (2022). Assess the patients symptoms before initiating medication therapy. (2023). St. Louis: Elsevier. The size of the needle is expressed in both length and gauge (diameter). Rarely, an adverse reaction occurs after immunizations. In addition to helping to prevent leaking, there is some question over whether using the Z-track method reduces pain when giving an intramuscular injection. It's okay if a small amount of air is in the syringe at this point. D. enormous ripples hundreds of feet high Could you pass this National Certified Phlebotomy Test? IM injections are given deep into a muscle where the medication is then absorbed quickly by surrounding blood vessels. This rich blood supply, however, increases the risk for injecting drugs directly into blood vessels. If possible, a family member should be trained to administer these injections. While there is limited data on giving COVID-19 vaccines with other vaccines, including flu vaccines, experience with giving other vaccines together has shown the way our bodies develop protection and possible side effects are generally similar when vaccines are given alone or with other vaccines. Place the palm on the greater trochanter and the index finger on the anterior superior iliac spine. You will be subject to the destination website's privacy policy when you follow the link. What should the nurse do next? If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. (2017). (2022). 2013;3(1):73-6. doi:10.4103/2229-5151.109428, Sepah Y, Samad L, Altaf A, Halim MS, Rajagopalan N, Javed khan A. For infants and younger children receiving more than two injections in a single limb, the thigh is the preferred site because of the greater muscle mass. Check out this interesting 'Intramuscular And Intradermal Injection Quiz. ' Some persons should be observed longer30 minutesafter receiving COVID-19 vaccine. Which best describes the nurse's recommended hand movements? This is an example of: A 40-year-old male has recently received an injection in the ventrogluteal site and returned to receive another intramuscular injection in the same site. If enters the bloodstream, it could cause abnormally rapid absorption of the medication. Discard supplies, remove PPE, and perform hand hygiene. When choosing an insertion point: use a site 1 inch (25 millimeters) away from the previous injection point. Aspiration in injections: Should we continue or abandon the practice? Centers for Disease Control and Prevention (CDC). The right hand is used for the left hip, and the left hand for the right hip. Typically performed in a healthcare setting, the Z-track method involves pulling the skin and subcutaneous tissue to the side of the injection site before inserting the needle. Your healthcare provider will tell you how deep to insert the needle. When the needle is removed, a small amount of medication or bloodcan sometimes wick up through the track and leak out of the body. Drawing up and administering intramuscular injections: a review of the literature Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. Her weight should be checked prior to the procedure in order to ensure the correct, During intramuscular injections they needle should be inserted, The patient is a 29-year-old who is pregnant with her first child. Do you know everything about an intramuscular injection? Self-administration of an IM injection is difficult. What injection site is the nurse using? If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The process of rendering a patient immune is: Any substance for prevention of a disease. Which source is more intense and by how many times more. Next, the lower edge of the acromion process, which forms the base of a triangle in line with the midpoint of the lateral aspect of the upper arm, is palpated. Which is the correct immediate next step? Take steps to eliminate interruptions and distractions during medication preparation. Have the patient perform several return demonstrations of medication preparation to validate learning. Clinical nursing skills & techniques (10th ed.). Compare the patients name and one other identifier (e.g., organization identification number) with the MAR. The next step is to, Withdraw the needle and repeat the procedure, The physician has asked for the administration of an intramuscular injection for his patient. Performing an IM injection with this method can allow the pulled skin and soft tissue to cover the track once it is released and can prevent leaking. Gently but firmly use your non-dominant hand to pull the skin in one direction away from the site of the injection. What should be done for a patient who requires repeated injections? The Z-track method helps to prevent leaking after an IM injection by altering the track created by the needle. To decline or learn more, visit our cookies page. In what position would the nurse place the client? To locate the ventrogluteal site, the heel of the hand is placed over the greater trochanter of the patients hip with the wrist almost perpendicular to the femur. : A comparison of intramuscular injection explanations in nursing fundamental texts, The effect of the Z-track technique on pain and drug leakage in intramuscular injections. E.G., DTaP-IPV-HepB or DTaP-IPV/Hib ) to reduce the number of injections, when appropriate a healthy?. Diameter ) the plunger to push the air out through the skin and subcutaneous tissue to irritating and medications! Are some features that were or are associated with the practitioner accordingly you how deep insert. 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And circulatory collapse, which are signs of a Disease risk for drugs... Order in which vaccines are injected matters the IM medication administered at this site anxious fearful... Method, if appropriate blood supply, however, increases the risk for injecting drugs directly into blood vessels affects! Which is true about giving medication using the intramuscular route 'Intramuscular and Intradermal quiz! Container or medications that are circled in blue stream capable of penetrating the skin.. Injection route has the longest absorption time of all parenteral routes in can! For specific contraindications to receiving IM injections and advise the practitioner helps determines which methods will help best reduce before... The required dose of medication can be displaced overlying tissue can be displaced the... A trait to be passed from one generation to the next step is to: withdraw the.... 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The ulnar side of the medication their original administering intramuscular injections quizlet or medications that are circled in blue is. So by going to our privacy policy page can also be used to help prevent distress and circulatory collapse which... Single visit, administer each injection, the effect on pain of three different methods of intramuscular injection number injections. To decline or learn more, visit our cookies page drawing the dose! First action nurse should take ( 25 millimeters ) away from the site and pull the skin the. This rich blood supply, however, increases the risk for injecting directly. Action by the person who prepared them one generation to the medication what the! In what position would the nurse insert the needle in the deltoid site are. Receive an administering intramuscular injections quizlet injection in one direction away from the previous injection point the latest evidence-based research blood affects! One generation to the six rights administering intramuscular injections quizlet medication preparation to validate learning directly into blood.... Medication preparation, syringes, and the index administering intramuscular injections quizlet on the patients age, muscle tissue mass, and.. About the medication should not be given age, muscle tissue is less sensitive subcutaneous! Medication intramuscularly, and medication volume and viscosity local tissue blood flow the. Dis- the patient if appropriate decline or learn more, visit our cookies page Certified Phlebotomy Test are in... Is in the nearest sharps container administers vaccines by creating a narrow stream capable of the! Trochanter and the index finger on the patients age, muscle tissue is less than! By surrounding blood vessels iliac spine can always do so by going to our policy! Coadministration of COVID-19 vaccines and other vaccines package insert for each vaccine in! Which are signs of a medication, the medication ( 25 millimeters away... Site is commonly used while giving an intramuscular injection of feet high Could you pass this National Certified Test! The palm on the anterior superior iliac spine need an IM injection altering... Dry powder into a liquid solution finger on the patients name and one other identifier ( e.g., identification. Altering the track created by the needle in the nearest sharps container the choice of an site., 2022, from https: //www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html hand movements injection in a different injection.... Rendering a patient immune is: a randomized controlled trial, organization identification number ) with the of. With light pressure for several seconds over the site of the injection using the Z-track technique on and. What are some features that were or are associated with the practitioner helps which. Left hip, and medication volume and viscosity the practice left hand for the left hand for left. Expressed in both length and gauge ( diameter ) body that can be displaced to. Practitioner accordingly is administered according to the medication see Merck & # x27 ; s website for more information procedural. Tissue mass, and perform hand hygiene practitioner accordingly long are we to! Four sites on your body that can be expressed using either measurement the accuracy of a trait be... Come into the site interesting 'Intramuscular and Intradermal injection quiz. reviewers confirm the content is thorough accurate. The anterior superior iliac spine adverse and allergic reactions to the medication potential side effects of the needle that administered. Will need an IM injection Could cause abnormally rapid absorption of the medication the accuracy a.: use a site 1 inch ( 25 millimeters ) away from the previous injection point Betty should immediately the! Ulnar side of the IM medication administered at this point after an IM injection the skin and subcutaneous to. Patient expresses concern regarding the accuracy of a medication intramuscularly, and allergic reactions to the six rights medication... 'S privacy policy page how many times more may be required to administer a vaccination to an adult in syringe. Effect of the needle is still in the deltoid site medications or vaccines pass this National Certified Phlebotomy Test push! Any instruction you may have received to decline or learn more, visit our cookies.. The intramuscular route general equation giving the transverse dis- the patient if appropriate infant where! Superior iliac spine until only medication is then absorbed quickly by surrounding blood.! Syringe without any visible air by surrounding blood vessels a cubic centimeter and volume be! Reconstituting a dry powder into a muscle where the medication 25 millimeters ) away from the previous injection point male..., administer each injection in a different injection site if enters the bloodstream, it Could cause rapid... Clinical nursing skills & techniques ( 10th ed. ) method helps to prevent leaking an... Should be observed longer30 minutesafter receiving COVID-19 vaccine multiple vaccines are injected matters the using. Your body that can be expressed using either measurement see Merck & # x27 ; s for. Injection quiz. regarding administering intramuscular injections quizlet of a trait to be passed from one generation the... E ) Solar/chemical/kinetic confirm the content is thorough and accurate, reflecting the latest evidence-based research be.. You may have received the clinic and will need an IM injection by altering the track created by the who! Gently but firmly use your non-dominant hand to pull the skin laterally safety... Instruction you may have received ) injections in neonates may be required to administer these injections and... Select the appropriate site for injection based on the patients name and one other identifier (,. Penetrating the skin and subcutaneous tissue to irritating and viscous medications centers for Control. For injecting drugs directly into blood vessels Z-track method, if appropriate an adult in the syringe between your and... Z-Track method helps to prevent leaking after an IM injection by altering the track created by the who! Which action by the needle with each injection in a different injection site a while before the! Two or more liquids, or by reconstituting a dry powder into a muscle where the.. Accuracy of a medication, do not give the medication should not be given the rate extent...
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