Assessing

1. Check the order, treatment card, drug, the patient’s name and bed card.

2. Patient: Systemic conditions include the patient’s condition and treatment at present, reactions to the medicine. Local conditions include the skin of injections being in the presence or absence of wheal, scleroma, inflammation, scar and so on. Psychological status includes the patient being in the presence or absence of emotional reactions such as worry anxiously and nerves to accept administering intramuscular injections and his/her attitudes to the treatment. Health knowledge includes the patient being in the presence or absence of knowing and understanding the plan of administering medication and the patient’s economic state.

3. Environment: The ward being in the presence or absence of clean, q医学三基uietness and appropriate light.

4. Drugs and equipment: Check the quality of drug; the needle and syringe being in the presence or absence of meeting the patient’s demand; check the sterilization dates and effects of the sterile articles; the equipments being in the presence or absence of convenience, meeting demand for patient and in good order.

Planning

1. Expected objectives:

⑴ Finish the procedure in the given time (8 minutes) correctly, the patient feels good.

⑵ The patient relieves the worried emotion, increases the feeling of safety, and knows the aims of administering intramuscular injections, will cooperate with nurse.

⑶ There are no unusual reactions.

2. Preparing

⑴ The nurse: The u医学全.在线www.med126.comnit, cap, shoes and mask, wash your hands.

⑵ The patient has known the aims and guidelines of administering intramuscular injections, will cooperate with nurse.

⑶ The equipment: A tray containing a sterile needle and syringe, a sterile container and sterile forceps, a dry sterile gauze pad, a swab, a curved basin, alcohol (70%) and iodophor, dry sterile gauze, an abrasive wheel , medicine card or treatment sheet, a pen.

⑷ Environment: The ward should be clean, spacious, quiet and appropriate light.

⑸ Drug: Applying a sterile treatment tray; recheck the quality of drug; cleanse the stem of ampoule and abrasive disc, scratch the glass and cleanse it with alcohol again, grasp the stem with dry sterile sponge as it is broken off protects the fingers and the open ampoule is not contaminated; take out a syringe and needle, aspirate the drug and expel air bubbles; protect the needle from contamination with ampoule then put it in a sterile treatment tray.

Action

1. Arrange a set of equipment on a tray in order of use and carry it to the patient’s bedside, explain the aims of procedures after reading the bed card of the patient.

2. Assist the patient in a correct position: a sitting position or lying position, select correct injection site. Cleanse the injection site with a sterile iodophor sponge, using a firm circular motion from the center outward. Expel air from the syringe by pushing gently on the plunger until a drop appears on the needle tip and check ampoule again.

3. Holding the syringe between the thumb and forefinger, pierce the skin quickly at a 90-degree angle, and insert the needle into the muscle about 2.5~3.0 cm (decreasing the distance for the thin and child).  

4. Withdraw the needle and press the injection site with dry swab for few minutes and check the ampoule again.

5. Dispose of materials. The Z-track method: Suction the drug as normal ways and change a sterile needle. First, with the nondominant hand, pull the skin and subcutaneous tissue about 2.5~3.5 cm to one side at the injection site. Insert the syringe, aspirate that the needle is nit in a blood vessel, and inject the medication. Maintain the traction for 10 seconds before withdrawing the needle, and then permit the skin to return to its normal position quickly. Do not massage the site.

Evaluating

1. The nurse has known the guidelines of the procedure completely and localized the injection sites correctly. In the procedure, she has been insisted on the check rules and sterile principles

2. The patient feels well and there are no unusual reactions.

Aims

1. Drug shall be absorbed quickly but it can’t by the way of administering oral medication.

2. Inject a great amount of drug or the drug’s stimulation is great.

3. It can’t be injected by the way of intravenous injections, but requiring obtaining drug’s effect more quickly than subcutaneous injections.

Selection of injection sites

Selecting the thick muscles which far away the main stem of a blood vessel or nerve on usual. Intramuscular injections are usually given in gluteus maximums muscles of the buttocks, sometimes select gluteus mediums, minimums muscles and musculus vastus lateralis, the deltoid muscle of the upper arm and the lateral or anterior thigh for intravenous injections.

Ways of location

1. The preferred spot in the buttock can be located by drawing two imaginary intersecting lines to divide the buttock into four equal parts. Then, divide the upper outer quadrant into four equal parts again. The upper outer portion of the upper outer quadrant is the safest place for needle insertion.

2. Drawing a line from the anterior superior iliac spine to the coccyx to divide it into three equal parts. The outer 1/3 portion is the safest place for needle insertion.