Unit 6 Pharmacology Concepts
semisolid substance that liquefies when applied
Lesson 1 Administration Medication
Lesson 2 Route of Administration: Oral
Lesson 3 Route of Administration: Parenteral Medication
Lesson 4 The Performance Checklist
Lesson 1: Administering Medications
A medication is a substance administered for the
diagnosis, cure, treatment, or relief of a symptom or for
prevention of disease. In the health care context, the
word medication and drug are generally used
interchangeably. As student nurses, it is part of your
responsibility to be familiar with different terms related
to pharmacology and medication administration.
Common Terminologies
1. Pharmacology is the study of the effect of drugs on
living organisms.
2. Pharmacy is the art of preparing, compounding and
dispensing drugs.
3. Pharmacist prepares, makes, and dispenses drugs as
ordered by a physician, dentist, nurse practitioner or
physician assistant.
4. Prescription- The written direction for the
preparation and administration of a drug.
5. Drug indication refers to
6. Drug dosage deals with
7. Contraindications refers to
8. Drug frequency is the
9. Generic name is used throughout the drug’s lifetime.
10. Brand name is the name given by the drug
manufacturer and identifies it as property of the
company.
11. Official name is the name under which a drug is listed
in one of the official publications.
12. Chemical name is the name by which a chemist
knows it, this name describes the constituent of the
drug precisely.
Types of Drug Preparations
• Aerosol spray or foam is a liquid, powder or
foam form that is deposited in the thin layer on
the skin by air pressure.
• Aqueous suspension refers to one or more drugs
dissolved in water
• Caplet is in a solid form, shaped like a capsule,
coated and easily swallowed
• Capsule refers to a gelatinous container used to
hold a drug in powder, liquid or oil form
• Cream is a non-greasy, semisolid preparation
used on the skin
• Elixir is a sweetened and aromatic solution of
alcohol used as a vehicle for medicinal agents
• Extract is a concentrated form of a drug made
from vegetables or animals
• Gel or jelly refers to a clear or translucent
to the skin
• Liniment is a type of medication mixed with
alcohol, oil or soapy emollient and applied to the
skin
• Lotion is a kind of medication preparation in a
liquid suspension applied to the skin
• Lozenge is a flat, round or oval preparation that
dissolves and releases a drug when held in the
mouth.
• Ointment is a semisolid preparation of one or
more drugs used for application to the skin and
mucous membrane
• Paste is a preparation like that of an ointment,
but is thicker and stiff and penetrates skin less
than an ointment
• Pill refers to one or more drugs mixed with a
cohesive material, in oval, round or flattened
shapes
• Powder is form of drug that us finely ground,
some are used internally, others externally
• Suppository can be mixture of one or more drug
with a firm base such as gelatin and shaped for
insertion into the body (e.g. the rectum); the
base dissolves gradually at body temperature,
releasing the drug
• Syrup is an aqueous solution of sugar often used
to disguise unpleasant tasting drugs
• Tablet is a powdered drug compressed into a
small hard disc, some are readily broken along a
scored line, others are enteric coated to prevent
them from dissolving in the stomach
• Tincture is an alcohol or water-and-alcohol
based solution prepared from drugs derived
from plants
• Transdermal patch is a semi-permeable
membrane shaped in the form of a disc or patch
that contains a drug to be absorbed through the
skin over a long period of time.
Common Medication Abbreviations
• a.c. • means before meals, from the Latin
word ante cibum
• p.c • refers to after meals, from the Latin
word post cibum
• a.d • means right ear, from the Latin word
aurio dextra
• a.s. • means left ear, from the Latin word
aurio sinister
• a.u. • refers to both ears, from the Latin
word auris utrae
• amp • refers to Ampule
• amt • means Amount
• OD • means once a day
• b.i.d • means twice daily or two times a day
from the Latin word bis in die
• TID • means three times a day from the
Latin word ter in die
 • QID • means four times a day Types of Medication Orders
• bol • means a large single dose, from the
1. Stat order indicates that the medication is to be
Latin word bolus
given immediately and only once.
• cap • refers to capsule, from the Latin word
2. Single order is a kind of order for medication to
capsula
• ċ • means with be given once at a specified single time.
3. Standing order are medication orders that may
• c • means without
or may not have a termination date. These may
• cc • refers to cubic centimeter
be carried out indefinitely.
• d/c • means to discontinue
4. Prn order are medication orders that permits the
• g • refers to Gram
nurse to give a particular medication when, in
• gr • means Grain
the nurse’s judgment, the client requires it.
• gtts • refers to drops, from the Latin word
guttae Essential Parts of Medication Order
• h, hr • means hour, from the Latin word hora
• h.s. • means at bedtime, from the Latin • Clients full name
word hora somni • Date and time the order written
• ID • means Intradermal • Name of the drug to be administered
• IM • means Intramuscular • Dosage, time and frequency
• IV • means Intravenous • Route of administration
• SC • refers to subcutaneous • Signature of the physician
• SL • means sublingual
• IVP • refers to Intravenous push Transcribing Medication Order
• inj. • refers to injection This responsibility of a nurse requires that she
• mcg • means microgram intelligently interpret a doctor’s medication order
• mg • means milligram (written or verbal). These have to be transcribed properly
• mL • refers to milliliter in the nursing Kardex and medication cards.
• mEq • refers to milliequivalent
• o.d • refers to right eye, from the Latin word You need to make sure that the 5 rights in medication
oculus dexter administration are present in the doctor’s order.
• o.s. • refers to left eye, from the Latin word
• right patient
oculus sinister
• right dosage
• o.u • means ounce
• right time,
• p.m. • means evening or afternoon, from the
Latin word post meridiem • right frequency
• prn • refers to as needed, from the Latin • right route by w/c the drug administered
word pro re nata Example: Paracetamol 300mg p.o. q4h
• p.o. • means by mouth or orally, from the
Latin word per os 1. Paracetamol is the name of the drug
• q • means every, from the Latin word 2. 300 mg is the dosage
quaque 3. p.o. is the route
• q1h • means every 1 hour, from the Latin 4. q4h is the frequency
word, quaque uno hora
• stat • means immediately, from the Latin This medication order means: Give 300mg of
word statim Paracetamol orally every 4 hours
• supp • means suppository There are common problems in transcribing medication
• susp • refers to suspension that can lead to serious medication errors. These errors
• syr • means syrup may include
• tab • refers to tablet
• top • refers to topical 1. time misinterpretation,
• tinc • means tincture 2. failure to clarify incomplete orders and
3. failure to check correct dosage. All of which
comes out from failing to check the 5 rights in
Medication Orders drug administration.
A medication order is a written directions provided by a
prescribing practitioner for a specific medication to be
administered to an individual. The prescribing Ten Rights on Medication Administration
practitioner may also give a medication order verbally to
In order to avoid such problems of medication errors, it
a licensed person such as a pharmacist or a nurse.
is highly advised to keep in mind your guide to the ten
rights on medication administration.
10 R’s On Medication 3. The Rx symbol, meaning “take thou”
4. Medication name, dosage, and strength
1. Right patient
5. Route of administration
2. Right medication
6. Dispensing instructions for the pharmacist
3. Right dose
7. Directions for administration to be given to the
4. Right route
client
5. Right time
8. Prescriber’s signature
6. Right patient education
7. Right documentation Figure 31. Sample Prescription
8. Right to refuse
9. Right assessment
10. Right evaluation

Medication Cards

After verifying for the doctor’s order, transcribing them

to medication cards serves as guide for medication
nurses. Medication cards are color coded medicine
tickets. A medication card policy varies per institution.
You have to be well oriented with these policies to avoid
errors. Medication cards are usually prepared once there
is a new medication order and eventually disposed once
the medication order is completed, revised or
terminated. Bulacan Medical Center as our base hospital
uses format and color coding of medication cards are as
follows:

Figure 30. Medication Card Format Calculating Medication Dosage

The basic formula commonly used for calculating drugs

Administration

PATIENT’S NAME dosages is easy to remember:

Room/ Bed
Number

Time of

𝐷
MEDICATION Formula: 𝑋𝑉
𝑆
DOSAGE, ROUTE, FREQUENCY
Where:

• D refers to the desired dose, the dose ordered by

• White card – OD, given a 8am
• Yellow card – BID given at 6am and 6pm
• Pink card – TID given at 8am, 1pm and 6pm
• Blue card – QID, given at 8am, 12 noon, 4pm and
8pm
• Green card – q4 given at 8am, 12 noon, 4pm,
8pm, 12mn and 4am
• Red card – STAT, q6 given at 6am, 12noon, 6pm
and 12mn
• Orange card - PRN
In preparing for the medication, checking the label of the
drug on hand is crucial. This step is usually done three
times:
the doctor
• S is the stock dose on hand, the dose on label of
bottle, vial, ampule
• V refers to vehicle or amount of stock, form in
which the drug comes, such as tablet or liquid.
Example: The doctor instructed the nurse via telephone
order for patient Sarah in Suite Room 1. The order says:
“Give Paracetamol 250mg tablet PO q4 for fever of 39C”
Upon requesting for the medication at the pharmacy,
you see that your stock dose of Paracetamol tablet is
500mg. How many tablet will you give to patient Sarah?
Given: D = 250mg | S = 500mg | V = 1 tablet

• Check the label upon taking the drug from the
pharmacy
• Check the label before preparing the medication
• Check the label before administering the
medication
Solution: 250 mg/ 500mg x 1 tablet = 0.5 tablet (1/2
tablet)
Lesson 2: Enteral and Topical Route of Administration

Parts of a Prescription A route of administration in pharmacology and

toxicology is the path by which a drug, fluid, poison, or
1. Descriptive information about the client; name, other substance is taken into the body. Routes of
address, and sometimes age administration are generally classified by the location at
2. Date on which the prescription was written which the substance is applied. This include enteral,
topical and parenteral route. This section of the lesson bottle with the label • This prevents the
will cover Enteral and Topical route of medication against the palm. label from getting
administration. Place medication cup soiled and illegible.
on a flat surface at • Allows accurate
Enteral Route of Medication Administration eye level. Pour measurement
desired amount of
This route of administration means that the drug is given
liquid and read the
through the oral cavity. This type may be swallowed or is
amount of
tipically applied in the mouth. medication at the
1. The Oral (p.o.) route is the most convenient and least bottom of the
expensive route for medication administration. The meniscus.
drug is swallowed with fluid or is given via the
gastrointestinal tract. Common forms of drugs in this Topical Route of Medication Administration
route are tablets, capsules, liquids, solutions,
suspensions, syrups and elixirs. This refers to the application of a drug directly to a
circumscribed surface area of the body. They only affect
However, its major disadvantage is that it may the area to which they are applied.
sometimes be inefficient as only part of the drug may 1. Ophthalmic administration refers to Instilling an eye
be absorbed. This is called the first pass effect. The drop or ointment into the conjunctival sac.
first- pass effect is the term used for the hepatic 2. Otic route means that the drug is administered in the
metabolism of a pharmacological agent when it is outer ear canal in the form of liquid drops. These are
absorbed from the gut and delivered to the liver via used to treat local infections of the ear while
the portal circulation. The greater the first-pass allowing minimum systemic absorption.
effect, the lesser the drug will reach the systemic 3. Nasal route or via nose drops are drugs that is
circulation when the agent is administered orally. breathed in and absorbed through the thin mucous
This is because the drugs that are absorbed orally are membranes that lines the nasal passage.
initially transported to the liver via the portal vein. 4. Inhalation route are forms of drugs that are inhaled
And certain conditions may affect this process to through the mouth, passes through the trachea
work properly like in cases of nausea and vomiting. towards the lungs. They can be administered
through the use of nebulizers, meter-dose inhalers or
2. The Sublingual route of administration is where the vapor.
dosage form is placed under the tongue as substance 5. Vaginal route refers to instilling medication into the
are rapidly absorbed by sublingual mucosa vaginal walls. They may take the form of solutions,
3. The Buccal route of administration is where the suppositories, gels, foams and tablets.
dosage form is placed between gums and inner lining 6. Rectal route takes the form of suppositories and are
of the cheek (buccal pouch). manually placed. This route offers a valuable means
Oral Route Administration of localized drug delivery into the bowel. However,
this has considerable disadvantages in terms of its
STEP RATIONALE acceptability and random drug absorption.
1. For unit-dose • The wrapper keeps
packaged the medication clean. STEP RATIONALE
medications, place This will help you 1. Clean the each eyelid • Cleaning towards the
capsule or tablet identify the and eyelashes one at outer canthus
directly in a medication in case time using sterile prevents
disposable cup. Do the client refuses or cotton ball with saline contamination of the
not open package was withheld to take solution and wipe other eye and the
until at bedside. the medication. from inner to outer lacrimal duct.
Unopened canthus.
medication can be 2. Expose the lower • This minimizes the
returned to your cart. conjunctival sac by possibility of touching
2. For medications in a • This technique placing the thumb or the cornea, and
stock container, pour minimizes transfer of fingers of your non- avoids placing
the necessary micro-organisms. dominant hand on pressure on the
number into the the client’s eyeball
bottle cap and then cheekbone just below
place the tablets in a the eye and gently
medication cup. draw down the skin
3. For liquid • This prevents on the cheek.
medications, remove contaminating the 3. Holding the tube • The outward motion
the cap and place it inside of the cover. above the prevents
upside down. Hold conjunctival sac, contamination of the
 discard first bead and other eye and the This course will only cover intradermal, subcutaneous
squeeze 2cm of lacrimal duct and intramuscular injections. Intravenous injections will
ointment from the be discussed in the succeeding semester under the
tube into the lower Intravenous Therapy (IVT) concept.
conjuntival sac from
the inner canthus of Purpose of Administering Parenteral Medication
the eye in an outward
1. To get the rapid and systemic effect of the drugs.
motion
4. Close the eyelids but • Closing the eye • Some medications are not given by mouth. Some
not squeezing them spreads the drugs are rendered ineffective in the GI tract by
shut. medication over the the action of gastric juice (insulin)
eyeball. • Some drugs are not retained in the intestines for
This procedure will be performed together with the sufficient periods for its absorption due to
Essential Newborn Care skill demonstration as discussed diarrhea, vomiting, or gastric suction.
in the previous lesson. • Some drugs are poorly absorbed from GI tract
and some drugs are toxic and irritating to the
gastric mucosa.
Lesson 3: Parenteral Route of Administration 2. To provide the required effects when the patient is
unconscious, unable to swallow due to surgical or
Administering Parenteral Medication neurological problems or when the patient is not
Administering parenteral medications refers to the cooperative.
administration of medication other than through the 3. To get local effects at the site of injection:
alimentary tract, that is, by needle. The term parenteral • For diagnostic purposes (tuberculin test)
comes from Greek words: para meaning outside and • For local anesthesia (xylocaine)
enteron meaning the intestine. Figure 32 shows the • For allergy test (penicillin test) and
different sites of administering parenteral medications. • For treating local condition (hydrocortisone
This procedure includes: injection into joint cavity).
4. To restore blood volume and electrolyte balance by
1. Intradermal where the medication is injected replacing fluids e.g. shock.
under the epidermis. (10-15°) 5. To give nourishment when it cannot be taken by
o Inner lower arm mouth.
o Upper chest
o Back, beneath the scapulae Equipment Needed for Administering Parenteral
2. Subcutaneous pertaining to the injection of Medication
medication into the subcutaneous tissue, just
1. Syringe is a device used to inject fluid into, or
below the skin. (45°)
withdraw fluid from, the body. It has different parts.
o Outer aspect of the upper arms
Figure 32 shows these parts.
o Anterior aspect of the thighs
• Barrel – the cylinder that holds the medication
o Abdomen
and contains calibration for precise measuring.
o Scapular area of the back
The barrel is typically calibrated in milliliters.
o Upper ventrogluteal and dorsogluteal
• Plunger – a plastic rod with a rubber stopper on
area
one end seals the medication within the syringe
3. Intramuscular are those medications that are
and flared edges on the other end for
injected into the muscle. (90°)
maneuvering the plunger
o Ventrogluteal
• Tip – also known as the needle adapted that
o Vastus lateralis
connects with the needle. This has two types:
o Upper-outer side of dorsogluteal
o Slip tip – a smooth tip in which the
o Rectus femoris
needle is attached just by slipping it onto
o Deltoid
the syringe.
4. Intravenous refers to the injection of
o Luer lok – which has a threaded end in
medications directly into the vein. (25°)
which the needle can be locked by
twisting.

The following are the commonly used types of syringes.

• Hypodermic syringe comes in 2, 2.5, and 3ml

sizes
• Insulin syringes are similar to hypodermic
syringes, but they use UNITS as scale and are
 specially designed for insulin administration. It
has non-detachable needle.
• Tuberculin syringe is a 1ml narrow syringe used
to administer small or precise doses such as
those for pediatric clients.
3. An Ampule is a glass flask that contains a single dose
of medication for parenteral administration. If all
medications are not used, the remainder must 181
be discarded. Medication can be removed from an
ampoule by breaking its thin neck.

STEP RATIONALE

1. Tap the stem of • This removes

ampoule or twist your medication in the
wrist quickly while stem of the ampoule
holding the ampule
vertically. (See A on
figure 34)
2. Put a gauze pad • To protect the nurses'
around the neck of face and finger from
the ampule. (See B on any shattered glass
figure 34.) Snap back fragments.
to break off the top of
2. Needles are made up of steel or other metal and are
the ampoule along
available in various sizes and lengths and come in
the pre-scored line at
disposable and non- disposable forms. Needles its neck. Make sure to
selection is determined by: keep yourself safe
• the type of medication to be administered from accidental cuts
• the route of administration, and or injuries. (See C on
• the size of the patient figure 34.)
3. Discard the head part • To avoid accidental
Needles have different parts. These include: of the ampule into cuts.
• Point – the sharpened end of the needle, cut in a proper waste
receptacle.
slanted edge called the bevel
4. Remove the cap from • The rim of the
• Lumen – the bore of a hallow needle
the needle by pulling ampoule is
• Bevel – the flat, slanted edge of the needle that it straight off. Hold considered
helps to ease the insertion of the needle into the the ampule by your contaminated. Use of
tissue non-dominant hand a needle prevents the
• Shaft – the hollow steel tube of the needle and insert the needle accidental
through which the medication passes into the into the ampule, withdrawing of small
patient being careful not to glass particles with
• Hub – the component that facilitates the touch the rim. Insert the medication.
attachment of the needle to the syringe: the hub the tip of the needle
is color-coded for easy recognition of the size into the ampule bevel
up and bring ampule
and must remain sterile when assembling the
and needle at eye
needle and syringe.
level. (See figure 35)
5. Aspirate the • By withdrawing a
Needles sizes are termed as needle gauge (G) and calculated dosage of small amount more
they refer to the diameter of the needle. Gauge the medication plus a of medication, any air
selection is determined by the viscosity or thickness small amount more. bubbles in the syringe
of the medication. The larger the gauge, the smaller can be displaced once
the diameter of the needle (for example, 22-G the syringe is
needles would be smaller in diameter than a 20-G removed
needle ) 6. Do not inject any air • Injecting air into the
bubble towards the solution increases
ampule. If any air pressure in the
bubbles accumulate ampoule and can
in the syringe, force the medication
withdraw the needle, to spill out over the
tap the barrel of the ampule.
syringe and expel the
air.
Figure 34. Breaking the neck of the ampule that the needle tip is
below the fluid level.
(See B on figure 36).
Pull the plunger down
to draw the necessary
amount of
medication, and then
withdraw the syringe
once correct dose is
Figure 35. Withdrawing medications from an ampule
withdrawn.
6. If any air bubbles • Removal of air
accumulate in the bubbles is necessary
syringe, tap the barrel to ensure that the
of the syringe to dose of medication is
move the air bubbles accurate.
on top of the syringe,
then push the
plunger to expel the
air.
7. If a multi-dose vial is • Because the vial is
being used, label the sealed, the
vial with the date and medication inside
time it is opened and remains sterile and
store the vial can be used for future
containing the injections.
4. A Vial is a glass bottle with a self-sealing stopper
remaining
through which medication is removed. They usually
medication according
have metal or plastic cap that protects the rubber to agency policy.
seal. The rubber stopper exposed is the means of
entrance into the vial. Some powder form of
medications in vials requires a liquid Figure 36. Withdrawing medication from a vial
(solvent/diluent) to dissolve so it can be withdrawn.

STEP RATIONALE

1. Remove the metal or • The metal or plastic

plastic cap on the vial cap prevents
that protects the contamination of the
rubber stopper. rubber top.

2. Swab the rubber top • To remove surface

of the vial using
cotton balls with
alcohol.
3. Remove the cap from •
the needle by pulling
it straight off.
4. Inject the amount of •
air equal to the
volume of the
medication you are
going to withdraw
then remove the
syringe. (See A on
figure 36)
5. Pick up the vial with •
your nondominant
hand and hold the vial
upside down at eye
level, making sure
microorganisms. This
should be done the
first time rubber
stopper is entered, Administering Intradermal Injections
and with any
subsequent re- Intradermal injections are usually given to clients for skin
entries into the vial. testing procedures such as tuberculin screening and
To avoid accidental allergy tests. These medications are given intradermally
needlestick because they are very potent. Since the dermis has a
reduced blood supply the medication absorption is
The air will allow the slower thus reducing the risk of an anaphylactic reaction.
medication to be
drawn out easily Sites:
because this will
• Inner lower arm
prevent creating
negative pressure • Upper chest
inside the vial. • Back, beneath the scapulae
Special Consideration
Keeping the tip of the
needle below the • Use needle gauge 25, 26,27: needle length 3/8”,
fluid level prevents 5/8”, ½”
air from being drawn • Needle is at 10-15 degree angle, bevel up
in the syringe.
Procedure for Administering Intradermal Injections
STEP
1. Clean the area •
around the injection
site with an alcohol
swab in a firm,
circular motion while
moving outward from
the injection site and
allow the antiseptic
to dry.
2. Hold the syringe with •
your dominant hand
between your thumb
and forefinger like in
writing. Remove the
needle cap with the
non-dominant hand,
pulling it straight off.
3. Place a dry cotton ball •
between the fingers
of your non-
dominant hand.
4. Still with your non- • Taut skin allows for
dominant hand, pull
the skin at the site
until it is taut. If using
the ventral surface of
the forearm, place
your non-dominant
hand at the dorsal
forearm and pull it to
tighten the ventral
skin.
5. Stabilize hand and • The possibility of
inject the needle,
bevel side up at an
angle of 10º and no
higher than 15º
parallel to the site.
Making sure that the
entire lumen of the
needle is inside the
thin layer of the
dermis
6. Slowly inject the • The wheal verifies
medication while
watching for a small
wheal or blister to
appear.
7. Withdraw the needle • Massage can disperse
at the same angle it
was inserted and
wipe excess
medication around
the area using the
cotton placed on your
non-dominant hand.
Never massage the
area
8. Encircle the site • This step is done if the
directly over the procedure is for
RATIONALE borders with a black sensitivity testing.
marking pen and
This method remove
assess the site for
pathogen away from
reaction at the
the injection site. appropriate time (30
minutes after
administering
medication).
Administering Subcutaneous Injections
This type of medication administration permits Injection
To avoid accidental of medication under the skin. Absorption in the
needlestick subcutaneous layer is slow, so action is prolonged. These
areas are convenient, readily accessible and have good
blood circulation. Usual medications administered on
this site are insulin, vaccines and heparin.
Sites:
This is for wiping • Outer aspect of the upper arms
excess medication • Anterior aspect of the thighs
outside the injection • Abdomen
site after the • Scapular area of the back
procedure.
• Upper ventrogluteal and dorsogluteal area
easier entry of the Special Consideration
needle in the dermal
layer without causing • Use needle gauge 25: needle length 3/8”, 5/8”,
too much discomfort ½”
to the client. • Needle is at 45 degree angle (5/8”), 90 degree
angle (3/8”), bevel up
• Insulin administration, gauge 30; needle length 4
to 6mm, at 90 degree angle, bevel up, use
rotating sites to avoid lipodystrophy.
Procedure for Administering Subcutaneous Injections
entering the
subcutaneous layer STEP RATIONALE
increases when the
1. Clean the area • This method remove
angle reaches more
around the injection pathogen away from
than 15 º.
site with an alcohol the injection site
swab in a firm,
circular motion while
moving outward from
the injection site and
allow the antiseptic
to dry
that the medication is
2. Hold the syringe with • To avoid accidental
in the dermal layer.
your dominant hand needlestick.
between your thumb
and forefinger like in
writing. Remove the
the medication to the needle cap with the
surrounding tissue or non-dominant hand,
out of the insertion pulling it straight off.
site.
3. Place a dry cotton ball • This is for gently
between the fingers pressing the insertion
of your non- site.
dominant hand.
4. Pinch the area • Use 45º for an inch of
surrounding the tissue grasped and
injection site with
 your non-dominant 90º when 2 inches of 2. Hold the syringe with • To avoid accidental
hand. Inject the tissue is grasped. your dominant hand needle-stick
needle at an angle of between your thumb
45º-90º depending and forefinger like in
on the amount and writing. Remove the
turgor of the tissue needle cap with the
and length of the non-dominant hand,
needle. pulling it straight off
5. After the needle is in • To facilitate injection 3. Place a dry cotton ball • This is for massaging
place, release the of the medication between the fingers and pressing at the
tissue and of your non- insertion site.
immediately move dominant hand.
your non-dominant 4. Pinch the bulk of • Pinching the muscle
hand to steady the muscle at the makes it firmer and
lower end of the insertion site by facilitates needle
syringe. Slide your placing the thumb insertion
dominant hand to the and index finger of
end of the plunger. your non-dominant
6. Inject the solution • An even pressure hand to form a V.
slowly by applying an minimizes client Inject the needle into
even push pressure discomfort. the tissue at a 90º
to the plunger angle.
7. Withdraw the needle • To provide counter- 5. After the needle is in • Aspirating
quickly at the same traction and place, release the determines whether
angle at which it was minimizing client muscle and the needle is in a
inserted. Do not discomfort. immediately move blood vessel.
massage the area, your non-dominant
instead hand to steady the
Administering Intramuscular Injections syringe at insertion
site. Slide your
An intramuscular injection is a technique used to deliver dominant hand to the
a medication deep into the muscles. This allows the end of the plunger
medication to be absorbed into the bloodstream quickly. and aspirate by
Muscles can take a larger volume of fluid without causing slowly pulling back on
too much discomfort than subcutaneous and the plunger.
intradermal route does. 6. If blood enters the • Blood contaminates
syringe on aspiration, the medication, and
Sites: withdraw the needle must be re-drawn.
and prepare a new
• Ventrogluteal
injection with a new
• Vastus lateralis
sterile set-up.
• Dorsogluteal 7. If no blood is •Injecting slowly
• Rectus femoris aspirated, inject the reduces discomfort
• Deltoid solution slowly. and allows time for
the solution to
Special Consideration
disperse in the
• Use needle gauge 23 or 25: needle length 1 inch tissues. Rapid
or longer injection may be
painful for the client.
• Needle is at 90 degree angle, bevel up
8. Remove the needle • Slow needle
Procedure for Administering Intramuscular Injections quickly. Massage the withdrawal may be
injection site with dry uncomfortable for
STEP RATIONALE cotton using gentle the client. Massaging
pressure. the site promotes
1. Clean the area • This method remove
medication
thoroughly with an pathogen away from absorption and
alcohol swab in a the injection site increases the client’s
firm, circular motion
comfort.
while moving
This procedure will be performed together with the
outward from the
injection site and Essential Newborn Care skill demonstration as discussed
allow the antiseptic in the previous lesson.
to dry.