1. What assessment preparation should the nurse do prior to the administration of parenteral medications? •Check patient’s name, medication name and dosage, route of administration, and time of administration. •Check accuracy and completeness of the MAR or computer printout with prescriber’s written medication order. •Assess patient’s medical and medication history. Assess patient’s history of allergies including the type and normal allergic response. •Review medication reference info related to medication, including action, purpose, side effects, normal dose, rate of administration, time of peak onset, and nursing implications.
2. What are some ways that needle-stick injuries may be avoided during parenteral medication preparation and administration? •Avoid using needles when effective needleless system or SESIP safety device are available. •Do not recap needles after medication administration. •Plan safe handling and disposal of needles before beginning a procedure that requires the use of a needle. •Immediately dispose of used needles, needleless systems and SESIP into puncture-and leak proof disposal container.
•Maintain sharp injury log that includes: the type and brand of device involved, location, description, methods to maintain privacy of employees who have experienced sharps injuries. •Participate in educational offerings regarding blood borne pathogens and follow recommendations for infection, prevention, including all the hepatitis B vaccine. •Report all needle stick and sharps-related injuries immediately according to the agency policies. •Participate in the selection and evaluation of needleless system of SESIP devices with safety features within your place of employment whenever possible.
•Support legislation that promotes the safe use of needles and sharps. (Harry & Potter, page 579) 3. What are ways that nurses can preventing infection during injection? •Use strict aseptic technique during all steps in medication administration. •Avoid letting the syringe needle touch the contaminated surfaces to prevent contamination and maintain sterility. •Wash skin soiled with dirt, drainage, or feces with soap and water. Use friction and a circular motion while cleansing with an antiseptic swab. Swab from center of site and move outward in a 5-cm radius. •Always wash hands before and after.
•Do not use the syringe to multiple patients. 4. What principles and techniques should they follow? •Use strict aseptic technique during all steps of medication preparation and administration. •To prevent contamination and maintain sterility of syringe, avoid letting the needle touch the contaminated surfaces. •Know the volume and the characteristics of the medication you will administer. •Identify the bony prominences and anatomical structures that outline the chosen injection sites. •Select a site that is free from irritation and infection; palpate the area for sensitivity or hardness.
•Insert the needle at the proper angle to deliver medication into the correct tissue. •Attempt to minimize the patient’s discomfort when administering. •Always use the guidelines for administering medications including the 6 rights. •Do not recap needles after administering and dispose in an appropriate container. 5. How would administration of parenteral medications be altered for the following individuals: •A patient with hardened, scaly tissue at the ventro gluteal site. Administer medication on the unaffected side and also assessing the affected side.
Clean the affected side and maintain moisture to avoid recurrence of dryness and possible infection. •A patient with paraplegia. Medication should be administered to the upper extremities/unaffected area. •A newborn infant and a 1¬ ? year old child. Should use needle length of 25mm (1 in. ) on the thigh and 25-32mm (1-1 1/4 in. ) on the upper outer triceps of the arm respectively and at SQ site. •A patient who has just had a left-side mastectomy. Medication should be given in the unaffected side while providing comfort and privacy. •Patients on heparin or iron preparations. Administer heparin SQ or IV.
Low-molecular-weight (LMW) heparins are more effective than heparin in some patients. To minimize pain and bruising associated with LMW heparin, it is given SQ on the right or left side of the abdomen, at least 2 in away from the umbilicus. •A patient with redness and warmth at the injection site. Notify patient’s health care provider and document possible allergic reaction to patient record. •A patient who must learn to self-administer insulin. Teach the patient to choose one anatomical site and systematically rotate sites which maintains consistent insulin absorption from day to day.
•An older adult patient of medium build who is to receive the flu vaccine. Older have decreased muscle mass that reduces drug absorption. Older adult is less elastic, delicate and fragile you have to hold the skin taut to minimize the risk of injury or bruises.
References: Potter, P. A. & Perry , A. G. (2010). Clinical Nursing Skills and Techniques. (8th ed. ) ON. , Mosby Elsevier. Potter, P. A. , & Perry, A. G. (2010). Canadian Fundamental of Nursing. (4th ed. ). Toronto, ON. Elsevier Canada.