Bahan Panum Injection

2009 The McGraw-Hill Companies, Inc. All rights reserved

Drug Administration

Panum Blok II/2014


51-2

Learning Outcomes

1 Discuss your responsibilities regarding drug administration.

2 Identify the seven rights of drug administration.

3 Explain how to administer an intradermal, subcutaneous, or intramuscular injection

4 Explain what information you need to teach the patient about drug use, interactions, and adverse effects.


51-3

Introduction Drug administration is

very important and can be a dangerous duty

Given correctly restore patient to health

Given incorrectly patients condition can worsen

Medical assistant must

Understand principles of pharmacology

Understand fundamentals of drug administration

Routes

Dosage calculations

Techniques for injection

Seven rights

Patient education

You should be familiar with the medications frequently

prescribed in your practice.


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Preparing to Administer a Drug

Drugs

Local effect applied directly to skin, tissue, or mucous membranes

Systemic effect given by routes that allow the drug to be absorbed or distributed into the bloodstream

Pay close attention

Dose

Route

Form of medication

Medical assistant

Close attention to detail

Strong patient assessment skills

Expert technique


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Preparing to Administer a Drug (cont.)

Assessment

Injection site

Drug allergies

Patient condition be alert to changes that can affect drug therapy

Consent forms


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Rules for administration Give only drugs the doctor orders use drug reference, if

necessary

Wash your hands Prepare in a well-lit area

Focus on task; avoid distractions

Calculate the dose carefully

Do not leave a prepared drug unattended never give a drug that someone else has prepared



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Rules for administration

Identify patient properly

Physician should be in the office

Observe patient following administration

Discard any ungiven medications properly

Report error to physician immediately

Document properly



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Seven Rights of Drug Administration

1. Right patient

2. Right drug

3. Right dose

4. Right time

5. Right route

6. Right technique

7. Right documentation



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Apply Your Knowledge

How do you properly identify the patient before

administering a drug?

ANSWER: To ensure that you have the right patient, you

should check the name and date of birth on the patient record

and ask the patient to state his/her name and date of birth.


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Techniques for Administering Drugs Oral

Tablets, capsules, lozenges, and liquids

Slower absorption through GI tract

Buccal or sublingual

Buccal placed between the cheek and gum

Sublingual placed under the tongue

Faster absorption; bypasses GI tract


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Parenteral

Administration of substance into a muscle or vein

Fast absorption; bypasses GI tract

Safety risks

Rapid administration; rapid action

Exposure to bloodborne pathogens

Methods of injection

Intradermal (ID)

Subcutaneous (SC)

Intramuscular (IM)

Intravenous (IV)

Techniques for Administering Drugs (cont.)


51-12

Needles

Available in different gauges the smaller the number, the larger the gauge (inside diameter)

Length long enough to penetrate the appropriate layers of tissue

Syringes

Barrel

Plunger

With or without needle

Calibrated in milliliters or units



51-13

Parenteral drug packaging

Ampule glass or plastic container that is sealed

and sterile (open with care)

Cartridge small barrel prefilled with sterile drug

Vial small bottle with rubber diaphragm that

can be punctured by needle



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Methods of injection

Intradermal

Into upper layer of skin

Used for skin tests

Subcutaneous

Provides slow,

sustained release and

longer duration of

action

Rotate sites

Intramuscular

More rapid absorption

Less irritation of tissue

Larger amount of drug

Z-track method

Intravenous

Not usually given by

medical assistants



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Educating the Patient About Drug Administration

How to read the prescription drug label

Interactions

Drug-drug interactions

Drug-food interactions


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Adverse effects

Report changes

Recognize significant

adverse effects

Instructions on taking the

drug

At the right time

In the right amount

Under the right

circumstances

Educating the Patient About Drug Administration (cont.)


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What should you instruct the patient about regarding

drug administration?

ANSWER: The patient should be taught how to read the

prescription label, drug-drug and drug-food interactions,

adverse effects, and how to take the drug correctly.

Bravo!


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Special Considerations

Pediatric patients

Physiology and immature body systems may

make the drug effects less predictable

Require dosage adjustments and careful

measurements of doses

Observe pediatric patients closely for adverse

effects and interactions

Administration sites and techniques may differ


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Pregnant patients

Remember that you are caring

for two patients

Giving the mother a drug also

gives it to the baby

Check drug information sources

for pregnancy drug risk categories

Special Considerations (cont.)


51-20

Patients who are breast-feeding

Some drugs are excreted in breast milk

Ingestion can be dangerous because baby cant metabolize or excrete drugs

Check drug information sources for contraindication during lactation



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Elderly patients

Age-related changes

affect

Absorption

Metabolism

Distribution

Excretion

May have increased risk of

Drug toxicity

Adverse effects

Lack of therapeutic effects



51-22

Patients from different cultures

Can affect a patients understanding of drug

therapy and compliance with it

Obtain drug information sheets

in the languages that are commonly

spoken by patients in your office



51-23


What do children and the elderly have in

common in relation to drug administration?

ANSWER: Both have alterations in metabolism and

absorption of drugs requiring adjustments in

dosages.

Fantastic!


51-24

INJECTIONS

Parenteral administration of medications

Administered by injection

An invasive procedure

Performed using aseptic techniques

Requires certain skills

Has a rapid effect


51-25

Intramuscular injection

Skeletal muscle highly vascular and its

capillaries contain small pores that enables

substances of small molecular weight to pass

through into the bloodstream


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Several muscles of the body have

considerable mass and are able to be injected

with quantities of up to several millilitres of

fluid, generally without undue discomfort


51-27


The gluteus medius of the buttocks is the best

muscle to use in this respect

The deltoid muscle has a richer blood supply

so good for rapid absorption, but size limit

should be no more than 1-2 ml


51-28


Intramuscular injections are not always given

for quick action

If the drug is mixed with an oil absorption is

slower. This type of injection is known as

depot


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Exercise causes an increase in skeletal muscle

blood flow improves absorption of a drug

Main danger from im injection is damage to

nerves, especially in gluteal injections

Pain and sterile abscess can occur with im


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Intramuscular (IM) Tissue

Dermis

Fatty Tissue

(SubQ)

Muscle Tissue

90Angle


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Intramuscular Sites

Vastus Lateralis

Deltoid

Injection

Site

Injection

Site


51-32

Characteristics of Intramuscular

sites Vastus lateralisLacks major nerves and blood vesselsRapid drug absorptionUsed for volumes up to 5mls

VentroglutealA deep site situated away from major nerves and blood vesselsLess chance of contamination incontinent clients or infants.Safe site for injections up to 4mls

DeltoidEasily accessible but muscle not well developed in most clients. Used for small

amounts of medications.Not used in infants or children with underdeveloped muscles.Potential for injury to radial and ulnar nerves or brachial artery.Not recommended for amounts more than 2mls


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A. Landmark for ventrogluteal site

B. Locating IM injection for ventrogluteal site.


51-34

A. Landmarks for vastus lateralis site

B. Giving IM injection in vastus lateralis


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A. Landmarks for Deltoid site

B. Giving IM injection in deltoid muscle


51-36

Intramuscular injections

Provides faster medication absorption, because of greater vascularity of muscle

Less danger of tissue damage when medications enter deep into the muscle

Risk of injecting into directly into blood vessels


51-37

Intramuscular Sites

Site selection depends on persons age muscle development

Use deltoid muscle for older children, adults (toddlers only if adequate muscle mass)

Use anatomical landmarks to locate site

Well developed person can tolerate 3mls without severe discomfort


51-38

Never administer vaccines into the buttock

May administer large doses of immune

globulin into buttock of older children or

adults


51-39

Intramuscular Needle

Gauge: 23 or sometimes 25 in very thin patients


51-40

Intramuscular Injection Technique


51-41

Z Track

For irritating preparations such as iron

Minimises irritation and staining by sealing

the medication in muscle tissue

Preference site ventogluteal


51-42

Z Track

New needle should be applied after preparation of injection

Swab site

Pull overlying skin and subcutaneous tissue approx 2.5-3.5 cm to the side

Holding skin taut inject deep into the muscle

The needle remains inserted for 10 seconds to allow medications to disperse evenly

Withdraw needle and release the skin


51-43

SUBCUTANEOUS INJECTIONS

Medication injected beneath the skin into connective tissue or fat under dermal layer

Medication should not be irritating to the tissue can cause

Severe pain

Tissue necrosis

Tissue sloughing

Slow absorption and can provide sustained effect

Unusual to use syringe greater than 5ml for a sc or im

Larger volumes create discomfort


51-44

HYPODERMIS OR

SUBCUTANEOUS LAYER

This is the deepest skin layer. Connects or binds the dermis above it to the underlying organs

Mainly composed of loose fibrous connective tissue and fat (adipose) cells

Interlaced with blood vessels

Hypodermis in females usually 8% thicker than in males

Absorption is slower as subcutaneous tissue is not richly supplied with blood


51-45

Subcutaneous (SubQ) Tissue

Dermis

Fatty Tissue

(SubQ)

Muscle Tissue

45 Angle

Dermis

Fatty Tissue

(SubQ)

Muscle Tissue

45 Angle


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SUBCUTANEOUS INJECTION

SITES

Deltoid

Abdomen

Thighs


51-47

Subcutaneous injections

Inspect skin for masses or tenderness

Site should be free from infection scars and

bony prominences

Long term therapy rotate injection site

Only small doses of water soluble

medications should be given


51-48

Subcutaneous Sites


51-49

Sites recommended for Subcutaneous

Injections


51-50


Best sc injections site are the outer posterior

aspect of the upper arms, the abdomen from

below the costal margins to the iliac crests

and the anterior aspects of the thigh

Site most recommended for heparin is the

abdomen


51-51


The injection site should be free from lesions

Bony prominences

Large underlying muscles

Nerves

Should be given at least 2.5cm away from last

injection


51-52


Thin patients may have insufficient tissue

Upper abdomen is the best site with this type of patient

If 5cm of tissue can be grasped needle should be inserted at 90 degrees

If 2.5cm of tissue can be grasped the needle should be inserted at 45 degrees


51-53

Pucker or slightly stretch skin

Swab ( not necessary for insulin as it may assist with the formation of necrotic tissue)

Insert needle with a firm quick approach

Remove needle quickly

Re-swab site Do not rub particularly after insulin administration

Check patient


51-54

Giving Subcutaneous injections in the

abdomen


51-55

Subcutaneous Needle Gauge 25

Length 5/8 inch


51-56

Prepare equipment

Check medication (follow principles )

Draw up medication

Prepare site

Inject needle

45 angle for most SC injections

90 (straight in ) for insulin


51-57

Charting Medications

Progress notes

Administration

Special problems

New symptoms

Patients statements

Patient tolerance

Be sure to have the right chart

Be specific and accurate


51-58


1. You administer a medication to Mr. Max. What and where

should you chart?

ANSWER: You should chart in the progress notes the

date, time, dosage, route, and name of the medication, as

well as how well the patient tolerated it.

I

M

P

R

E

S

S

I

V

E

!


51-59

In Summary Medical assistant

Administer drugs safely and effectively

Conversions and calculations

Patient assessment

Observe general rules

Follow seven rights of drug administration

Be aware of patients needing special considerations

Be aware of nonpharmacologic methods for managing pain control


51-60

Words are the

most powerful

drug used by

mankind.

~Rudyard Kipling

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Bahan Panum Injection