NCM 103- FUNDAMENTALS

IN NURSING PRACTICE:
Parenteral Medication with
Computation

Group A3:
Magbanua, Gwenn Marie
Malazarte, Val Voltaire
Maldo, Marielle Anne
Malolot, Nicole
Megraso, Ralvien Ceasar
Natividad, Gabriel
Paraguas, Rizhel Ninia Mae
Pateres, Angelu Mae
Perandos, Mia Clare
Perdigones, Dave
Pica, Natassja Leigh

Facilitator: Mrs. Marichelle Valerie Pil-Merioles, MAN, RN

Date Submitted: February 12, 2022
 TABLE OF CONTENTS

TITLE PAGE

CLO#1: define the following terms related to Parenteral Medication 3

CLO#2: discuss the scientific principle involved and the role of informed 7
consent in parenteral medication

CLO#3: cite the advantages and disadvantages of parenteral medication. 10

CLO#4: identify the factors affecting parenteral medication. 11

CLO#5: identify the following: 13

● types and parts of needles used in parenteral medication.

● types and parts of the syringe.

● types of needle gauges used in parenteral medication.

CLO#6: compare the three (3) routes of parenteral medication as to its: 16

● purpose.

● kinds of syringe.

● angle of insertion.

● gauge and length of needle.

CLO#7: locate the safe anatomical site for the three (3) routes of 22
injection using the different anatomical landmarks:

● intradermal route.

● subcutaneous route.

● intramuscular route

CLO#8: discuss the evidence-based guidelines in administration of parenteral 26

medication.

CLO#9: discuss ways to reduce patient discomfort during an injection. 32

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CLO#10: describe the techniques to avoid complications associated with 34
injection.

CLO#11: explain the nursing responsibilities before, during and after 31

administration of parenteral medication.

CLO#12: list down the materials used in oral medications 41

CLO# 13: demonstrate the beginning skills in parenteral medications 45

References 46

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 Parenteral Medication with Computation

CLO #1 : define the following terms related to Parenteral Medication.

absorption
: the transportation of the unmetabolized drug from the site of administration to
the body’s circulation system.

Absorption Rate:
1. Intravenous
2. Intramuscular
3. Subcutaneous
4. Intradermal

ampule
: a small glass container with an extended neck sealed with a heat lock; used to
hold a single measured amount of solution for injection
should not introduce air

aspirate
: to draw in or out by suction
: the pulling back of the plunger of a syringe before injection to see if any blood
returns into the syringe, usually done for 5-10 seconds
:most commonly performed during an intramuscular (IM) or subcutaneous (SC)
injection; meant to ensure that the needle is at the desired site, and not
accidentally puncturing a blood vessel

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 In intradermal Injection Site a hand's width
from the wrist and 3-finger widths below the
antecubital space.

bleb
: fluid deposited within the dermal tissue in a raised mark of the skin
: should appear under the skin after intradermal injection. It indicates that the
medication is in the dermis.

after intradermal injection

diluent
: a product added to a solution or powder in order to dissolve, reconstitute or to
reduce the concentration of a another product
: some drugs for parenteral medications, such as penicillin, are dispensed as
powders stored in vials. In order for it to be injected, a liquid diluent has to be
added.
: examples include normal saline (NS), sterile water for injection (SWFI),
Dextrose 5% in water (D5W), or lidocaine 1% plain.

hematoma
: a localized swelling/collection of blood caused by a breakage in the wall of a
blood vessel

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 : unintentional nicking of the blood vessels during injection may result to effusion
of blood into extravascular spaces, followed by hematoma formation
: may appear as a reddish blue swelling (bruise).

injection
: the act of using a needle and a syringe to introduce a drug or liquid into a
person's body

parenteral medication
: any non-oral means of medication administration (does not go through the
digestive system), generally through injection

routes of administration
: means by which a drug or agent enters the body

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 : examples of parenteral routes of medication administration are intradermal
(ID), subcutaneous (SC), intramuscular (IM), and intravenous (IV).

site of administration
: specific location on the body where medication is given or injected.
: example: deltoid, ventrogluteal, vastus lateralis

vial
: a small glass bottle with a sealed cap used to contain liquid medicine; it can be
single-dose or multidose introduction of air

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 wheal
: an area of the skin which is temporarily raised, typically reddened, and usually
accompanied by itching

allergic reaction usually an

inflammation brought by allergic
reaction

CLO# 2: discuss the scientific principle involved and the role of informed
consent in parenteral medication.

Principles in parenteral medication

● Physics
Pressure is a factor which concerns all needle injections. When a solution is drawn to
the patient from an ampule into a syringe, the needle is put into the fluid and the
plunger is pulled back, thus lowering the pressure in the syringe. Friction is also needed
between a syringe and the fingers in order to obtain a firm and steady hold on a
syringe. using different needles

● Microbiology
The nurse must disinfect the injection site prior to administration of the medication to
avoid infection. Nurses apply the microbiology knowledge in health care for drug
production, diagnosis and sterilization methods and cleanliness.

● Pharmacology
Nurses treat their patients and carry out the requests of the patient’s physician. Nurses
also administer drug dosages that the doctor prescribes. They must be given through
their appropriate route. Example, Insulin is administered through a subcutaneous route
and there is only one type of insulin which can be administered intravenously, the
regular insulin. They must also know the medication’s mechanism of action, side effects,
etc. the nurse returns the opened insulin vial in the refrigerator to keep its potency.
- keeping a medication potent

Dosage of the medication is calculated based on the client's weight - pharmacology and mathematics
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● Anatomy and Physiology
Nurses should give a careful and proper shot to the patients onto the correct injection
site such as: the dermis of the forearm is the most common site for intradermal
injections, and in the muscles, the deltoid, gluteus maximus, and vastus lateralis are
sites for safe intramuscular injections.

● Chemistry
Nurses use appropriate diluents in reconstituting medications. To avoid wrong
combinations of drugs that can lead to adverse effects, nurses must understand how
particular medicines will react in different patients.

● Psychology
Nurses carry out guidance for the patients so that they can keep peace of mind, and
then cooperate with the relevant treatment and nursing actively. Psychological nursing
intervention include such strategies as stress management, self-coping skills,
psychological therapies. the nurse performs the procedure with competence and ease

● Sociology
The nurse eases the client’s anxiety by communicating with him/her. They can do this
by properly explaining the procedure and evaluating the client’s condition to the client
ask the client's reaction to the procedure

● Safety and Security

Nurses maintain safety and security in parenteral medication through locating safe
injection sites guided by the landmark, proper client identification, and observing the
rights in medication administration. This is to lessen the risk of injury to the recipient.
skin testing is performed prior to the administration of antibiotic drug
right patient, right dose
● Time and Energy
Nurses must have time management and enough energy to help themselves in
organizing and prioritizing patient care, internal administrative tasks, educational
responsibilities and personal obligations.

Informed consent in parenteral medication

● The procedure is invasive. Thus, consent has to be obtained.
This is a process of communication between you and your health-care practitioner that
often results in a decision or permission to receive care, treatment, or services that the
patient is not in agreement with. Before surgeries and treatments, the patient has the

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right to be informed and to ask questions. Medical treatment cannot begin until adult
patients are intellectually capable of making their own decisions.

● Explain procedure to client as to its nature and process.

The informed consent process makes sure that the patient’s health care provider has
given information about the patient’s condition along with testing and treatment options
before the patient decides what to do.

This information can include:

● The name of your condition

● The name of the procedure or treatment that the health care provider
recommends
● Risks and benefits of the treatment or procedure
● Risks and benefits of other options, including not getting the treatment or
procedure

Signing informed consent means

● The patient has received all the information about your treatment options from
your healthcare provider.
● The patient understands the information and you have had a chance to ask
questions.
● The patient uses this information to decide if you want to receive the
recommended treatment options that have been explained to you. Sometimes,
you may choose to receive only part of the recommended care. Talk to your
health care provider about your options.
● If the patient agrees to receive all or some of the treatment options, you give
your consent by signing a consent form. The completed and signed form is a
legal document that lets your doctor go ahead with the treatment plan.

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CLO# 3: cite the advantages and disadvantages of parenteral medication.

Advantages:
1. The parenteral route of drug delivery is preferred for pharmaceuticals with low
GIT (gastrointestinal tract) absorption and/or drugs like insulin that are unstable
in the GIT and/or in the GIT (e.g. insulin, heparin).
2. The intramuscular route provides immediate action and fast absorption rate of
medication.
3. Parenteral methods could be utilized in patients who are unconscious,
uncooperative, or vomiting, or in situations when action must be taken quickly.
4. Bioavailability is more predictable and faster.
5. Medication is not subjected to first pass metabolism.
6. There is no risk of food or digestive enzymes interfering.
7. It is sometimes necessary for the active form of the medicine to be absorbed.
8. Medication is rapidly delivered to the site of pharmacologic action.
9. To induce a gradual or delayed onset of action, subcutaneous methods can be
employed.

Disadvantages:
1. These routes of drug administration are irreversible and carry more hazards than
the others.
2. It is an intrusive method of medication delivery, which can result in fear, pain,
tissue damage, and/or infection.
3. The possibility of a needle breaking off from the hilt while still in the client could
result from defective equipment or improper injection technique.
4. Injections have limits when it comes to delivering protein products, especially
those that need to be kept at a constant level.
5. Failure to aspirate during the injection process may cause a subcutaneous or
intramuscular injection to be given intravenously.
6. It is generally riskier since parenteral medication poses significant harm when it
is used in error. Complications may occur if the medication is injected incorrectly,
or there is an error in the preparation (such as calculation and med selection), or
incorrect use of equipment (such as needle and syringe), or if there is an error in
administration or post-assessment of the patient receiving the medication.

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 7. When administering a parenteral dose type, assistance is sometimes required.
Especially, in situations where parenteral medication is administered to a patient
with aggressive or challenging behavior.
8. An injection can cause injury to tissues, nerves, veins and other vessels.
9. The injection preparation must be sterile.
10. It poses a risk for infection.
11. It is painful and it causes anxiety or fear to a client.
12. A skilled person is required.
13. Intravenous injection can traumatize a vein and cause hematoma, phlebitis, or
tissue damage.

CLO# 4: identify the factors affecting parenteral medication.

Factors affecting parenteral medication

● Body Mass Index

-A BMI of 25 or above is considered overweight, while 30 or higher is considered obese.
Because there is more body mass for the drug to saturate in patients with excess body
weight, the drugs may not reach those optimal levels. For the proper dose to be
administered, there will be an increase in the dosage required for people with an
obvious increase in lean body weight. Furthermore, the standard needle length used for
parenteral medications may vary between patients with normal weight conditions and
obese ones due to the disproportionally high amount of adipose tissue in their bodies,
inhibiting the needle from reaching the intended area of absorption, thus affecting the
efficacy of the medication. Due to this alteration in the absorption of intramuscular,
subcutaneous, and transdermal medications by obese patients, individual dose
adjustment and the volume of distribution should be taken into consideration.

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● Angle of Insertion
-Inserting the needle at the proper angle (depending on the type of injection) and
entering the skin smoothly and quickly can reduce the amount of pain during injection.
The different routes of administration have different angles of insertion. First, for the
intramuscular, the angle of insertion should be at 90°; Subcutaneous is positioned at an
angle of 45°; intravenous injection is at 25°; in the intradermal injection, the angle of
administration is at 5-10°.

● Route
-The route of administration changes how effective your medicine will be. There are
four parenteral medication routes. Each has a specific skill set for making sure that the

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medicine is administered properly in the correct location. Intravenous (IV) injection,
medication or solution is injected into a vein via an existing IV line or a short venous
access device (saline lock). Because of this, it is considered the fastest route for
parenteral medications. Intramuscular (IM) directly places the injection deep into the
muscle. Its absorption rate is relatively faster compared to the subcutaneous and
intradermal due to the larger blood vessels present in the muscles; Subcutaneous (SC)
injection has a slower reaction in comparison to the intravenous but is faster than the
intradermal route as it administers the solution to the loose connective tissue under the
dermis; Lastly, an Intradermal (ID) injection has the longest absorption time among the
others as it targets the dermis just under the epidermis of the skin.

● Age
-The aging process can have an impact on how medication is absorbed, used in the
body, and excreted. Changes that reduce your body's ability to break down or remove
certain medications from your system may result in medications remaining in your
system for a longer period of time. The dosage given to geriatric and pediatric clients
may vary to ensure that the medication has been properly accepted by their bodies. For
pediatric patients, which are further divided into subcategories (premature and term
newborns, infants, toddlers, children, and adolescents), the dosage will be administered
based on the child’s age. On the other hand, the dosage of geriatric patients may be
reduced as they age due to their decreased metabolism, reduced gastric pH, and
increased sensitivity to medications.

● Length of needle
-Correct needle length allows medication to be delivered to the proper site and can
reduce complications such as abscesses, pain, and bruising. The needle should be
chosen based on the patient's size, gender, injection site, and amount of medication
injected. For infants and children, their age should be considered when choosing the
appropriate needle size, while in adults, weight should be taken into account. A
1"–11/2" needle is recommended for women weighing 152–200 lbs (70–90 kg) and

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men weighing 152–260 lbs (70–118 kg). A 11/2" needle is recommended for women
weighing more than 200 lbs (90 kg) or men weighing more than 260 lbs (118 kg). Due
to the difference in fat distribution between men and women, women tend to be
affected by the needle length. Therefore, they need a bigger/longer needle than the
standard length to ensure that the medication is properly absorbed. Lastly, the needle
length that will be utilized depends on the parenteral medication route chosen to ensure
optimal absorption to the target area.

CLO# 5: identify the following:

● types and parts of needles used in parenteral medication.
● types and parts of the syringe.
● types of needle gauges used in parenteral medication.
Parts of needles
bevel
-The bevel is the angled surface of a needle that forms the tip and allows for
nontraumatic entry into tissues.
shaft or cannula
-The needle's shaft is a long, slender stem. Continue to the needle hub at one end, and
bevel the other ends to form the point.
hub
-The hub part consists of a needle adapter that is at one end of the needle that is
attached to the syringe. When using a syringe, the hub helps to keep the needle in
place.

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 Types of Syringes
hypodermic syringe
-A hypodermic needle is a hollow needle that is commonly used in conjunction with a
syringe to inject substances into or extract fluids from the body.

insulin syringe
-The needle is short and thin, with a fine layer of silicone covering it to enable it to pass
easily through the skin and reduce pain. Before use, a cap covers and protects the
needle. These syringes are used to administer insulin into the subcutaneous layer below
the skin as insulin cannot be ingested in the form of pills as there's the possibility of the
body’s digestive enzymes to break down the insulin. By using insulin syringes, the
insulin will be absorbed directly into the bloodstream where it can circulate to the cells
throughout the entire body.

tuberculin syringe
-Tuberculin syringes are devices that use a needle to measure and deliver a specific
amount of liquid. They are used to administer medicines, vaccines, or other substances
subcutaneously or intradermally. The difference between tuberculin syringes from
insulin lies on the amount of fluid one can hold and the medications it administers.
Tuberculin syringes can take ½ to 1 cubic meter of fluid which features decimal marking
of millimeters; Insulin comes in ⅓,½, and 1 cubic cm sizes and it is measured in insulin
units. Furthermore, insulin syringes are used to administer insulin while tuberculin are
used to deliver medication and perform PPD (tuberculosis test).
you cannot use tuberculin in the absence of insulin and vice versa

Hypodermic syringe Tuberculin syringe

Insulin syringe

Pre-filled Syringes are insulin pen kanang naa nay medisina daan

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Types of syringe according to its tip
luer-lok
- allows a Luer Lok needle to be screwed onto the tip and securely locked in place
ensuring no liquids can leak.

Non-luer-lok/luer slip
-allows a needle to be quickly and conveniently pushed straight on to the end of the tip
(if a needle is required).

Slip tip/ non-luer-lok tip

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Parts of a syringe
tip
-the end of the syringe that connects the needle. There are 4 basic types of syringe tips
used for parenteral medications:
● Luer lok
● Slip tip
● Eccentric tip
● Syringe with permanently attached needle.

barrel
-This is the area of the needle where the fluid is injected or withdrawn.

plunger
-This is a movable component within the barrel that creates a vacuum to draw out or in
the fluid.

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 The bigger the gauge number the smaller the diameter of the needle
Subcutaneous (SC)- 25-30
Intradermal (ID)- 25-27
Intramuscular (IM)- 22-25
Intravenous (IV)- 20 or 22

The diameter of a needle is referred to as its gauge. Needles come in a variety of gauge
sizes, ranging from small to large (25 to 29 gauge) (18 to 22 gauge). The smaller the
gauge number, the larger the diameter of the needle. The higher the gauge
number, the smaller the diameter of the needle. To administer thicker
medications or blood products, larger diameter needles (18-22 gauge) are typically
used.

Syringes with safety features

example: auto-disable syringe

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CLO# 6: compare the three (3) routes of parenteral medication as to its:
● purpose.
● kinds of syringe.
● angle of insertion.
● gauge and length of needle.

Route Purpose Kinds of Angle of insertion Gauge and Volume

syringe Length of of fluid
needle

Intraderm -Intradermal Tubercul Gauge:25 0.1 mL

al injections in – 27
(ID) are injections syringe
administered into Length:
the ¼ to
dermis, just below ⅝ inches
the epidermis.

-The ID injection
route has the
longest
absorption time of
all parenteral
routes.

-The Bacille
Calmette-Guerin
(BCG) vaccine is
currently
administered
intradermally to
newborns or
neonates using a
hypodermic
needle and is
injected into the
left upper arm.
BCG is the only

19
 vaccine that uses
this route of
administration.
BCG is the only
vaccine with this
route of
administration.
The goal of BCG
vaccination in
infants is to
prevent TB
meningitis and
miliary TB. BCG
vaccine should be
given to infants in
high-risk
communities as
soon as possible
after birth,
preferably before
6 weeks of
post-natal age or
discharge into the
community.

- These types of
injections are
used for
sensitivity
tests/screenings,
such as TB,
allergy, and local
anesthesia tests.

Subcutane -The 1 – 2mL 45° (for longer Gauge: 0.5-1mL

ous subcutaneous syringe needles; ⅝ 25, and
layer (SC) and inch), 30 (for
injections are a Insulin 90° angle (for insulin)
administered into syringe shorter; 3.8 inch)
layer of adipose
tissue. Length:
5/8 inch
3 finger widths and 3/8
below the acromion
process inch

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 -SC injections are needles,
used for 4-6m
medications that (for
must be absorbed insulin
into the needle)
bloodstream
slowly and
steadily.

-Used for
administration of
vaccines, insulin
and heparin.

Intramusc -Intramuscular 1mL Gauge: 0.5-1mL

ular (IM) Syringe 23 - 25 (deltoid),
injections deposit (deltoid) for deltoid,for
medications into and ventrogl
the 3-5mL 21 or 22 uteal:
muscle fascia, syringe for maximu
which has a rich (ventrog Ventroglut m of 3
blood supply, luteal) eal mL for
allowing adult
medications to Length: 1 with
be absorbed inch well-dev
faster length (for eloped
through muscle deltoid); gluteal
fibres. 1.5 muscle
inch length and
-The IM site is (ventroglut 1-2mL
used for eal) for
medications that adults
require with less
a quick absorption develope
rate but also a d gluteal
reasonably muscle
prolonged action.

-immunization,
administration of
medication
greater than 1mL

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 -Due to their rich
blood supply, IM
injection sites can
absorb large
volumes of
solution, which
means a range of
medications ,
such as sedatives,
antiemetics,
hormonal
therapies,
analgesics, and
immunizations.

Intramuscular Injection Site - Ventrogluteal Site; the patient should be in a lateral position and in flexed knees
Nurse's right hand is used to locate the landmark on the patient's left leg and vice versa

CLO# 7: locate the safe anatomical site for the three (3) routes of injection
using the different anatomical landmarks:
● intradermal route - In this type of injection, it provides a local and very little systemic effect. It
is usually utilized for tuberculin skin testing and may also be utilized for allergy testing
● subcutaneous route. - In this type of injection, a short needle is used to inject a drug into the
tissue layer between the skin and the muscle. Usually, medication given this way is absorbed more slowly
compared to injection into a vein.
● intramuscular route. - is utilized when effects are wanted to last over a longer period of time;
than can be expected after intravenous injection

Safe anatomical sites of injection

● Intradermal: inner lower arm, upper chest, back beneath the scapulae and the
inner forearm

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● Subcutaneous: outer aspect of the upper arms, anterior aspect of the thighs,
abdomen, scapular areas of the upper back, upper ventrogluteal, and dorsogluteal
areas.

●Intramuscular : deltoid, ventrogluteal, and vastus lateralis

Divide the right side in 4 quadrants, select the outer upper quadrant

Dorsogluteal site is less commonly used for intramuscular injection due to the increased risk of hitting the sciatic nerve.

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Site of injection and its landmark/s
● Deltoid Why is it important to know the safe injection site?
- acromion process This is to Ensure patient safety and prevent complications

- Palpate 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. The injection site is in the
center of the triangle, about 3- 5cm (1-2 inches) below the acromion process. The
injection site is then three finger widths below the acromion process.

● Ventrogluteal safer compared to dorsogluteal

- greater trochanter
- anterior superior iliac spine

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- iliac crest
- Locate the ventrogluteal muscle by positioning the patient in a supine or lateral
position. Flexing the knee and hips helps to relax this muscle. Place the palm of your
hand over the greater trochanter of the patient’s hip with the wrist perpendicular to the
femur. Use the right hand for the left hip and left hand or the right hip. Point the thumb
towards the groin and the index finger toward the anterior superior iliac spine; extend
the middle finger back along the iliac crest toward the buttock. The index finger, middle
finger and the iliac crest form a V-shape triangle; the injection site is the center of the
triangle.

● Vastus Lateralis
- greater trochanter ideal for infants and children whose gluteal muscles are poorly developed
- lateral femoral condyle
- In the adult, the landmark is established by dividing the area between the greater
trochanter of the femur and the lateral femoral condyle into thirds and selecting the
middle third.

injection site is located at the

outed middle third

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CLO# 8: discuss the evidence-based guidelines in administration of
parenteral medication. Dependent Nursing Action

Guidelines in parenteral medication

● Check the doctor's order.

Checking the doctor's order directs the nurse as to which drug to administer, the
frequency of doses, the amount of each dose, and the route of administration to use, as
indicated in the order. This is necessary to ensure that the nurse is properly preparing
the right medication in a safe and accurate manner, avoiding the possibility of
mistakenly providing the wrong medication to the patient prior to parenteral medication.
It is also to verify any updates regarding the medication, if it has been discontinued, or
if a new one is in order.

● Maintain aseptic technique at all times

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 The term "aseptic" denotes the absence of disease-causing microbes and
pathogens. Aseptic technique in the clinical setting refers to the process of preventing
microbial contamination from one person or object to another. This technique aids in
the prevention of healthcare-associated infections (HCAIs), which might occur as a
result of receiving medical treatment from a healthcare professional.

Parenteral medications should be accessed in an aseptic manner. That is, to

reduce the number of microorganisms transferred to the patient from the nurse's
hands, surfaces, or equipment in order to prevent transmission and cross-contamination
during medical care, such as administering injections. It includes drawing up
medications with a new sterile syringe and sterile needle while preventing contact
between the injection materials and the non-sterile surroundings, as well as disinfecting
the rubber septum with alcohol to clean the exposed top of the vial. Furthermore,
thorough hand hygiene and equipment preparation should be conducted before, during,
and after handling medications.
● Use new and sterile equipment with each injection

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 Each patient must be provided a single syringe and needle, which must be
discarded once used. Reusing needles or syringes from one patient to another, or
withdrawing medicine from a vial, poses a major risk to the client's health and has the
potential to transmit disease. In addition, always inspect the packaging for intactness,
dryness, rips, damaged corners, and the expiry date. If single-use equipment is not
available, make use of syringes and needles intended for steam sterilization.

● Use separate needles for aspiration of medication and injection

To avoid contamination before providing medication, aspiration and injection

must be done with separate needles. Following the insertion of the needle into the vial,
the needle used to aspirate the medication must be discarded in the waste receptacle
and replaced with a new needle before administering the medication to the patient.

● Do not touch the rim of the ampule with the needle tip or shaft.

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 An ampule with a broken rim is considered contaminated. The needle will remain
sterile if it is not in contact with the rim of the ampule at its tip or shaft. When the
ampule is inverted, the solution flows out of the needle tip or shaft and makes contact
with the ampule's rim, thus, making it susceptible to being contaminated.

● Air must be injected into a vial before the medication can be withdrawn.

To add air to the vial, remove the cap from the needle and insert it through the
rubber stopper at the top of the vial. Inject the entire volume of air into the vial. Ensure
to avoid touching the needle to keep it clean.

The volume of air instilled in the vial must be equal to the volume of medication
extracted from the vial prior to medication removal. It will aid in pressure regulation and
prevent a vacuum from forming inside the vial. It will be difficult to remove the
medication if there is not enough air injected into the vial, whereas too much air may
cause the medicine to be forced out of the syringe. As a result, the air injected into the
vial prevents the formation of negative pressure in the vial and allows the medicine to
be withdrawn more easily.

● Injection site must be free from scar, mole, lesions, wound, rashes, or any
disturbance in tissue growth.

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 Choosing the proper injection location is critical since it can affect the visual
inspection of the test results. Therefore, it must be free from scars, moles, lesions,
wounds, rashes, or any disturbance in tissue growth. It is also necessary to prevent
further skin irritation and injury in that particular area, as well as provide an accurate
reading of the test site at the appropriate time.
This is to make sure that the medication stays in the bleb. Check the bleb 30 minutes after.

● Prepare patient’s skin before injection

Alcohol swabs are commonly used to prepare the skin prior to injection and
application. Infections caused by bacteria on the skin being injected into the tissue can
be prevented by disinfecting the injection site with an alcohol swab. This must be done
in a firm circular motion, beginning in the center and expanding the circle outward, and
allowing the area to dry thoroughly. Furthermore, visibly soiled or dirty skin must be
washed with soap and water.

● Never allow a patient to stand while receiving an injection

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 Having the patient sit rather than stand is important to help them feel relaxed
and reduce the risk of the patient falling, as some may faint at the sight of a needle or
during an injection. This is also done to prevent needle-stick injuries while administering
injections to patients who may suddenly move during the procedure.

● Withdraw the needle quickly from the injection site at the same angle it was inserted.

Pulling along the line of insertion while depressing the skin with the nondominant
hand is the best way to remove the needle. When the needle is withdrawn smoothly
and quickly at the same angle, it reduces the client's discomfort and helps prevent
tissue damage at the injection site.

● Do not massage the bleb.

31
 In intradermal injections, clinicians should avoid massaging or rubbing the bleb,
as this may cause the solution to spread and cause dispersion of medication into the
subcutaneous tissue. This is also to prevent any errors, as the bleb indicates that the
medication is in the dermis, and any disruption may result in false-positive findings.

● Dispose top of the ampule in sharps container

In a waste container, sharps can cause punctures, cuts, and potential exposure
to waste handlers. As a result, prior to disposal, all sharps waste must be stored in
sharps containers and decontaminated.

Using sterile gauze or an antiseptic wipe packet, break off the top of the ampule
to ensure that all glass fragments fall into the packet and reduce the risk of cuts. These
must be disposed of properly in the sharps container as they may contain broken glass
fragments from the ampules, which is a biohazard to prevent possible injury.

32
CLO# 9: discuss ways to reduce patient discomfort during an injection.

Comfort measures in parenteral medication

● use sharp-beveled needle in the smallest suitable length and gauge

Some patients are afraid and intimidated by the sight of needles, especially
children. Nurses can help reassure the clients by making them feel safe and to use the
appropriate and suitable length and gauge. Always check the bevels of the needles and
avoid using blunt needles, because blunt needles are used for the drawing up of the
medication inside a vial or ampoule before it gets injected into a person. One should
know and be aware of what type of needle they have before injecting.

33
● position a patient as comfortable as possible to reduce muscular tension.

Orientating your patient in a comfortable position helps them relax, especially

when you are dealing with patients who are tense or afraid of needles. Patients are
asked to relax, specifically the muscles at the safe anatomic site that is going to be
used for injecting the patient. When the muscles at the site of insertion are tensed, it
would be harder to put the needle in and would make the pain hurt even more.

● Divert the patient’s attention from the injection through conversation using an open
ended question.

Distraction shifts the attention of the client away. Before the injection, there is
the anticipation of pain by the patient, and the actual pain during the injection.
Conversing with them as you ask open ended questions makes the client think further,
which will divert the client from the thought of pain, making the pain more bearable.

34
● Insert the needle quickly and smoothly to minimize tissue pulling

Inserting the needle quickly reduces the duration of the pain felt by the patient
during insertion because it is stimulated quickly by the pain receptors. Though it is best
to be able to insert the injection quickly, one must do it smoothly to avoid adding pain.
When the injection is on progress one must also observe the following:

● Hold the syringe steadily while the needle remains inside the tissue

● Inject the medication slowly and steadily

When the needle is inside the tissue, the needle must be steady as much as
possible to avoid stretching over the tissue that would stimulate pain which would only
cause more discomfort to the patient. The muscle tissue and its surrounding tissue will
stretch in order to accommodate the added medication, and by injecting the medication
slowly, it gives the medication enough time to settle and would minimize and avoid a
sudden strong stimulation of pain.

● Withdraw the needle smoothly at the same angle used for injection.

35
 The procedure started off by the insertion of the needle quickly and smoothly, we
also ended the procedure by removing the needle off the tissue precisely and smoothly,
so that the needle would be using the same route used during the entry of the needle.

● Apply gentle pressure at the injection site

After removing the needle off the tissue, apply pressure on the injection site with
a clean cotton to avoid exposing the entry route of the injection from microbes to avoid
infection.

CLO# 10: describe the techniques to avoid complications associated with

injection.

Complications of Parenteral Medication and its Preventive Measures:

● Infection
- use sterile injection equipment
- maintain aseptic technique all throughout the procedure

36
- discard all materials properly
- prevent needle stick injury by using one-hand technique in recapping used needles

In order to prevent infection, the use of sterile equipment decreases pathogenic load.
Proper disposal alongside sterilization of equipment removes the chances of the
equipment becoming a breeding ground for surviving germs.

● Hematoma
- Be guided by landmarks in locating safe injection sites.
- Ice the injection site for 30-60 seconds prior to giving the injection.
- Apply pressure to injection site

Hematoma is blood collecting outside of blood vessels, most often observed when the
wall of a blood vessel is injured, letting blood seep out and into the surrounding tissues.
With this, it’s best to be guided by the safe injection sites to avoid nicking a blood
vessel. Prior to giving the injection, applying ice is an effective and inexpensive way to
reduce pain and discomfort that may be caused by the injection. The applied pressure
avoids the possibility of a bruise in case blood might reach the surrounding tissues.

● Allergic Reaction/Anaphylactic Reaction

- Do skin testing prior to administration of the medication.
- Obtain drug history.

Before any medication administration, a skin test is crucial in determining probable

reactions or interactions that may interfere with the medication. This goes hand-in-hand
with the awareness of the patient’s drug history in terms of possible interactions.

● Lipodystrophy problem when an injection site is used over and over again

- Rotate injection sites.

- Do not inject cold medication into the tissues.

Lipodystrophy is the abnormal utilization and storage of body fat, may it be a buildup of
body fat, loss of body fat, or both. Often possible in injecting insulin, injection site
rotation is important in avoiding the buildup of fatty tissue from always getting shots
from the same place. When injecting medication into the tissues, it must not be cold
since it makes the injection more painful than necessary. Since this medication is
injected at a subcutaneous tissue level, the injected drug diffuses slowly but at a

37
sustained rate of absorption and the cold medication would make it rather difficult to
diffuse.

CLO# 11: explain the nursing responsibilities before, during and after
administration of parenteral medication.

Nursing responsibilities in parenteral medication

● Before
- Check the doctor's order:
Doctor’s orders serve as guidance with what medications the patients should be
administered, the amount or dosage that should be given, and the method or tool used
to administer the medication. It is important to follow such orders properly to minimize
any complications that may arise from the client.

- Perform medical hand washing

Medical handwashing involves technical maneuvers needed to be performed in
order to prevent the spreading of germs thus protecting not only the client in need of
treatment but also the nurse administering care. It can also keep the materials used to
treat and administer medications, such as syringes, sterile.

38
 - Prepare necessary materials.
Incorrect use and preparing of materials can be disastrous to the client’s health
and wellbeing. Tuberculin syringes and insulin syringes are different in structure and
vastly distinct in their purposes, for example. The former is used for vaccines and
medicines while the latter is most commonly used for the administration of syringes.

- Explain procedure to the patient.

The patient should feel safe and informed when being cared for by a nurse in
order to maintain that sense of trust and bond with the client. It is also important to
effectively and efficiently explain the procedure to the client so that they can make an
informed decision on a particular procedure.

- Maintain aseptic technique during the preparation.

Aseptic techniques involve the usage of sterile procedures that decrease the
chances of contamination by a pathogen. Common examples of aseptic techniques are,
but not limited to, wearing barriers such as sterile gloves, gowns, and masks, Hand
washing and sterilization of medical tools. As such, infection like nosocomial infections
can be prevented.

39
● During
- Protect hands with the use of gloves.
Using sterile gloves can prevent any harmful microorganisms, viruses, or
contaminated blood from coming into contact with the nurse practitioner or the client
themselves thus lowering the risk of cross contamination.

- Locate the best site for injection.

If a particular medicine is administered at an incorrect area then factors like the
rate of absorption or effectively activating the immune system may slow and thus
hinder the effectiveness of a vaccine or medication. For example, insulin shots are
mostly located at the abdomen where most of the body fat is deposited as it ensures
greater rates of absorption and faster action of insulin thus increasing its effectiveness.

40
 - Disinfect the site prior to injection.
Disinfecting the site, such as using alcohol, can prevent infections caused by
bacteria as the needle penetrates the skin.

- Inject quickly and smoothly.

Injecting the needle quickly and smoothly will lead to less of a likelihood of the
needle moving around and damaging the surrounding tissues, thus reducing pain for
the client. It would also prevent bruising of the injected area or further the
inflammatory response.

- Aspirate for blood prior to administration of medication (except for intradermal).

41
 Aspirating the needle involves drawing back on the plunger once the needle is
inserted to determine whether or not blood will return to the syringe. This is used to
prevent puncturing and delivering medications or liquid to a blood vessel or an artery
which can have harmful side effects.

- Remove the needle at the same angle as the needle was injected.
This action will reduce risks of infection and prevent further damage to the
surrounding tissue. It can also minimize discomfort for the client.

- Apply pressure on the site (except for intradermal).

Applying pressure on the site after the injection will prevent blood and liquid
from the syringe from flowing out of the injection site.

● After

42
 - Document all relevant information.
Documenting relevant information such as the type of medical tools used or the
medicine administered can help establish a record for other medical practitioners and
thus make the process more efficient. It can also serve as proof or validation that the
medicine has already been administered which prevents an extra dose from being
injected.

- Monitor clients for adverse reactions.

The medication injected may have some adverse reactions from the patient so
monitoring the client and providing therapeutic interactions at the meantime may aid in
prompt medical intervention made by medical practitioners and reduce potential
harmful effects.

- Discard syringes and needles in appropriate waste bins.

Discarding syringes and needles in appropriate waste bins will drastically reduce
the chances of needlestick injuries and will allow more efficient and effective
organization of wastes in the long run.

43
CLO# 12: list down the materials used in oral medications

Materials used in parenteral medication

● Sterile syringes and needles
○ used to inject or extract fluids from the body.
○ a syringe is a calibrated glass or plastic cylinder with a plunger at one end
and an eyelet for attaching a needle at the other.
○ the needle is a hollow metal tube with a point at one end.

● Bottle of denatured alcohol, match

○ acts as an antimicrobial, making it a must-have for cleaning and
disinfecting hospital surfaces. It contains an oxidizing agent that makes it
inedible.
○ It can produce dizziness, headaches, eye watering, respiratory tract
irritation, eye irritation, sleepiness, nausea, other central nervous system
symptoms, spotty vision, pupil dilatation, and convulsions.

44
● Desired drug solution, Sterile gauze
○ Drug solubility has one of the greatest influences on a medicine's intended
concentration in systemic circulation, and hence whether or not the drug
will have the desired impact or pharmacological response in patients.
Drugs with low water solubility absorb at a slower pace, resulting in
insufficient and unpredictable bioavailability and rendering the treatment
useless.
○ Sterile gauze pads or cotton balls can be used to apply pressure to the
venipuncture site after the needle has been withdrawn. They can also be
used to absorb and clean up any little blood droplets that may have
leaked during tube changes.

● Jar of sterile cotton ball

○ absorbent cotton or cotton wool that are mostly used for medical
purposes in hospitals, nursing homes, dispensaries at home (for first aid),
and so on due to their high fluid absorbency.
○ they are made of 100% absorbent cotton and may be used to clean
wounds, scratches, and scrapes without the need for extensive
application.

45
● Alcohol swab, 70% alcohol
○ Alcohol swabs: are used by people who use drugs to clean an injection
site before injection. People may also use a swab to clean their fingers
and thumbs before an injection, as well as to remove any blood from the
injection from their fingers and other surfaces.
○ In the pharmaceutical industry, 70% isopropyl alcohol is the most widely
used disinfection. Although you may think that a larger concentration is
more effective, experts indicate that a 70 percent concentration is really
better for disinfection. Because it contains more water, it dissolves more
slowly, penetrates cells, and kills germs. Rubbing alcohol's disinfectant
activity decreases when concentrations rise over 80%-85%.

● Sterile forceps in disinfectant

○ Medical equipment that come into touch with sterile bodily tissues or fluids
are classified as critical. When using these things, they should be sterile
because any microbial contamination might result in disease transmission.
Surgical equipment, biopsy forceps, and implanted medical gadgets are
examples of such goods.

46
● Small injection tray
○ Injection trays can be used to store and transport tiny equipment,
hypodermic needles, dressing supplies, and other items.

● Clean gloves, waste jars

○ A clean glove is one that is free of markings, stains, dirt, and debris.
○ A clean glove is used when patients are not at significant danger of
infection to reduce transmission through hand contact.
○ A waste jar is utilized not just for waste disposal by workers, but also for
removal from the premises. These are responsible for protecting the public
from punctures, infections, and any other potential hazards associated
with medical waste.

● Medication tickets

47
 ○ Medication tickets are needed to direct the nurse to follow the doctor's
written order, which specifies the medicine to be administered, the
frequency of doses, the amount of each dosage, and the mode of
administration.
○ It includes: Name of the person; – Strength and dosage; and – Frequency
against the: Medical order; • MAR; AND • Medication container.

CLO# 13: demonstrate the beginning skills in parenteral medications.

Parenteral drug calculation problems

Basic Formula

𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒
Amount to administer= 𝑑𝑟𝑢𝑔 𝑜𝑛 ℎ𝑎𝑛𝑑 × 𝑣𝑒ℎ𝑖𝑐𝑙𝑒

Problem 1:
A patient is to receive an injection of gentamicin 60 mg, IM. What volume is
required if ampoules on hand contain 80 mg/2 mL?

Given:
Desired dose: 60 mg
Drug on hand: 80 mg/2mL

Asked:
Volume required to administer gentamicin 60 mg, IM if ampoules on hand
contain 80 mg/2 mL

Solution:

48
 Basic formula:
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒
Amount to administer= 𝑑𝑟𝑢𝑔 𝑜𝑛 ℎ𝑎𝑛𝑑 × 𝑣𝑒ℎ𝑖𝑐𝑙𝑒

60 𝑚𝑔
= 80 𝑚𝑔
× 2 𝑚𝐿
= 0.75 x 2
= 1.5 mL

Answer:
The volume required to administer gentamicin 60 mg, IM is 1.5 mL

Young’s Rule
- rule used to calculate drug dosages for children ages 1 to 12 years
- based on the patient's age in years and the known recommended adult dose.

𝑎𝑔𝑒 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠

Child’s dosage= 𝑎𝑔𝑒 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 + 12 × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑎𝑔𝑒

Problem 2:
A 7 year old patient is ordered atropine sulfate to be administered as an IM
injection. The typical adult dose for this is 0.4 mg. The stock in supply is 0.6
mg/mL. What volume (in mL) is required for this injection?

Given:

average adult dose= 0.4 mg

age= 7 years old
Drug on hand= 0.6 mg/mL

Asked:

Volume (in mL) required for this injection

Solution:

49
Young’s Rule:
𝑎𝑔𝑒 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠
Child’s dosage= 𝑎𝑔𝑒 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 + 12 × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑎𝑔𝑒
7
= 7 + 12 × 0. 4
7
= 19 × 0. 4
=0.1474 mg

Basic Formula:
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒
Amount to administer= 𝑑𝑟𝑢𝑔 𝑜𝑛 ℎ𝑎𝑛𝑑 × 𝑣𝑒ℎ𝑖𝑐𝑙𝑒
0.1474
= 0.6
×1
=0.24567 mL
=0.25 mL

Answer:

You need 0.25 mL for this injection.

Fried’s Rule
- Calculates pediatric dosages based on the child’s age in months
- This formula is used for children (infant) who are younger than 1 year of age.

𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠
Child’s dosage= 150
× 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑎𝑔𝑒
Problem 3:
An infant, 30 months old, needs Streptomycin Sulfate, which is usually
administered to adults as 1 gm (1000 mg), as a daily IM injection. The ampoules
available contain 1000 mg/2.5 mL. What is the appropriate dosage (in mL) for
the infant?

Given:

Average adult dosage = 1000mg

Age of infant = 30 months

Asked:

50
 Appropriate dosage (in mL) for the infant

Solution:

Fried’s rule:
𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠
Child’s dosage= 150
× 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑎𝑔𝑒
30
= 150 × 1000 𝑚𝑔
=0.2 x 1000mg
=200 mg

Basic Formula
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒
Amount to administer= 𝑑𝑟𝑢𝑔 𝑜𝑛 ℎ𝑎𝑛𝑑 × 𝑣𝑒ℎ𝑖𝑐𝑙𝑒
200 𝑚𝑔
= 1000 𝑚𝑔 × 2. 5 𝑚𝐿
= 0.2 x 2.5
= 0.5 mL

Answer:

The appropriate dosage for the infant is 0.5 mL of the Streptomycin Sulfate
available.

Clark’s Rule:
- A way to determine dosage of medications for children older than 2 years
- Based on weight in pounds

𝑤𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑝𝑜𝑢𝑛𝑑𝑠
Child’s dosage= 150
× 𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑎𝑔𝑒

Problem 4:
A child weighing 20 pounds needs Streptomycin Sulfate, which is usually
administered to adults as 1 gm (1000 mg), as a daily IM injection. The ampoules
available contain 1000 mg/2.5 mL. What is the appropriate dosage (in mL) for
the infant?

Given:

51
 average adult dose= 1000 mg
weight= 20 lbs

Asked:

Appropriate dosage (in mL) for the child

Solution:

Clark’s rule:
𝑤𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑝𝑜𝑢𝑛𝑑𝑠
Child’s dosage= 150
× 𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑎𝑔𝑒
20
= 150 × 1000
= 133.33 mg

Basic Formula:
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒
Amount to administer= 𝑑𝑟𝑢𝑔 𝑜𝑛 ℎ𝑎𝑛𝑑 × 𝑣𝑒ℎ𝑖𝑐𝑙𝑒
133.33 𝑚𝑔
= 1000 𝑚𝑔
× 2. 5 𝑚𝐿
= 0.333325
= 0.3 mL

Answer:

The appropriate dosage for the child is 0.3 mL

52
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