给 药 ( 三 ). 中国医科大学护理学院 王健. Medications ( three). PARENTERAL MEDICATIONS
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Nurses given parenteral medications intradermally (ID), subcutaneously (SC or SQ), intramuscularly (IM), or intravenously (IV). Because these medications are absorbed more quickly than oral medications and are irretrievable once injected, the nurse must prepare and administer them carefully and accurately.
Administering parenteral drugs requires the same nursing knowledge as for oral and topical drugs; however, because injections are invasive procedures, aseptic technique must be used to minimize the risk of infection.
EquipmentsyringesTo administer parenteral medications, nurses use injectable equipment (ie, syringes, needles, vials, and ampules). Syringes have three parts: the tip, which connects with the needle; the barrel, or outside part, on which the scales are printed; and the plunger, which fits inside the barrel (Figure 33-13).
NeedlesNeedles are made of stainless steel, and most are disposable. A needle has three discernible parts: the hub, which fits onto the syringe; the cannula, or shaft, which is attached to the hub; and the bevel, which is the slanted part at the tip of the needle (Figure 33-17).
Ampules An ampule is a glass container usually designed to hold a single dose of a drug. It is made of clear glass and has a distinctive shape with a constricted neck. Ampules vary in size ranging from 1 mL to 10 mL or more. Most ampule necks have colored marks around them, indicating where they are prescored for easy opening.
VialsA vial is a small glass bottle with a sealed rubber cap. Vials come in different sizes, from single to multidose vials. They usually have a metal or plastic cap that protects the rubber seal.
Common Parenteral medicationsIntradermal InjectionsAn intradermal injection is the administration of a drug into the dermal layer of the skin just beneath the epidermis. Usually only a small amount of liquid is used, for example, 0.1 mL.
After the site is cleaned, the skin is held tautly, and the syringe is held at about a 15-degree angle to the skin, with the bevel of the needle upward. The needle is then inserted through the epidermis into the dermis, and the fluid is injected. The drug produces a small bleb just under the skin (Figure 33-28).The needle is then withdrawn quickly,and the site is very lightly wiped with an antiseptic swab.
Subcutaneous Injections Among the many kinds of drugs administered subcutaneously are vaccines, preoperative medications, narcotics, insulin, and heparin. Common sites for subcutaneous injections are the outer aspect of the upper arms and the anterior aspect of the thighs. These areas are convenient and normally have good blood circulation. Other areas that can be used are the abdomen, the scapular areas of the upper back, and the upper ventrogluteal and dorsogluteal areas (Figure 33-29).
1.Check the medication order for accuracy.2.Prepare the medication from the vial or ampule.3.Identify the client, and assist the client to a comfortable position.4.Select and clean the site.5.Prepare the syringe for injection.6.Inject the medication (Figure 33-30).
7.Remove the needle.8.Dispose of supplies appropriately.9.Document all relevant information.10.Assess the effectiveness of the medication at the time it is expected to act.
Intramuscular Injections Injections into muscle tissue, or intramuscular injections, are absorbed more quickly than subcutaneous injections because of the greater blood supply to the body muscles.
A major consideration in the administration of intramuscular injections is the selection of a safe site located away from large blood vessels, nerves, and bone.
1.Check the medication order for accuracy.2.Prepare the medication from the vial or ampule.3.Identify the client, and assist the client to a comfortable position.4.Select, locate, and clean the site.5.Prepare the syringe for injection.6.Inject the medication using a Z-track technique (Figure 33-40).
7.Withdraw the needle.8.Discard the uncapped needle and attached syringe into the proper receptacle.9.Document all relevant information.10.Assess effectiveness of the medication at the time it is expected to act.