injection

Time Specific Objectives Content Teaching-Learning Activity Evaluation

30 sec INTRODUCTION:-

Drug therapy plays a major role in the treatment of patients. Although prescribed by the doctor, the safe and accurate administration of medications is one of the important responsibilities. She must know the therapeutic action and usual dosage of a drug. The nurse should be alert to observe adverse effect of the drug. She should realize that the patient’s condition may alter the effect of a drug and that there may be interactions with concurrent therapy. Nurse must be aware of regulations affecting drug administration.ANNOUNCEMENT OF TOPIC :-

Today,we will discuss important aspect of medication i.e. injection.

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1minAfter the class group will be able to :-

To define the term injection.

DEFINITION:

Injection is a type of parenteral medication which is an invasive procedure and it must be performed under a strict aseptic technique.It involves administration of drug by a route through injection into the body tissue.

Teacher defines the term injection by using lecture cum discussion along with ppt.

Define injection.

1 minTo list down the common types of injection.

Types of injection:- Intradermal: when

medication are injected into dermis.

Subcutaneous:when medication is injected into the muscle

Intramuscular: when medication are injected into muscles.

Intravenous:when medication and fluids administer in veins.

Teacher explains type of injection with the use of flash card.

What are the different types of injection?

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Time Specific Objectives Content Teaching-Learning Activity

Evaluation

2 min To illustrate the purpose of injection.

Purpose of injection:1. To get a rapid and systemic effects of the

drug.2. To obtain maximum effect of the drug

even when the patient is unconscious,unable to swallow due to neurological or surgical alteration affecting the throat and mouth or when patient is un cooperative.

3. When the drug is toxic and irritating to gastro intestinal tract.

4. To obtain a local effect at the site of injection.

5. To restore blood volume by replacing the fluid e.g. Inn shock.

Teacher explains it with the use of chart.

What is the purpose of injection?

2 min To list down the factors contributing to effective absorption.

Factors contributing to effective absorption:-

1. Injections are more quickly absorbed in the area that is richly supplied with blood.

2. Isotonic fluids are absorbed more easily in the blood.

3. Absorption of medicine is retarded in the patients with edema, neurogenic, cardiogenic and vasogenic shock.

4. Absorption of medication is delayed in cases of skin lesion, fibrosis.

Teacher describe factor contributing in effective absorption of medicine with the help of ppt.

What factors affect medicine absorption?

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Evaluation

3 min To enlist the complications of injection.

Complication of injection:- Infection: handling and improper

sterilization of syringes, needles and fluid used for injections may introduce infection in the body.

Pyogenic reaction: patients getting intravenous injection may develop fever due to pyrogens present in the fluid.

Allergic reaction: certain drugs produce allergic reactions in patients.it can be prevented by a test dose.

Tissue trauma: repeated injection on the same site can cause scar formation and injury to nerve.

Pain swelling: if given on the site, it will result in pain and swelling.

Foot drop: dropping of foot from a tibial lesion that causes paralysis of the anterior muscles of the leg due to nerve injury.

Air embolism: air embolism due to the introduction of air into blood vessel

Circulatory overload Serum hepatitis Over dose and under dose of medication

may cause complications.

Teacher explains it with the use of ppt.

What are the complications of injection?

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Time Specific Objectives

Content Teaching-Learning Activity

Evaluation

5 min To calculate drug dosage in children’s

CALCULATION OF DRUG DOSAGE:-

Medication based on body surface area:

Child dose=child BSA*adult doseadult BSA

Young’s rule:

Child dose=age of child *adult doseage +12

Clark’s rule:

child dose=weight of child in pound *adult dose

150

Fried’srule:

Child dose=child’s age in month*adult dose

150

Teacher use ppt to explain calculation of drug dosage.

How will you calculate drug dosage in children?

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Evaluation

2 min To enlist criteria for selection of syringes and needle.

Criteria for selection of needles and syringes:1. The route prescribed.2. Viscosity of medication.3. Size of child.4. Amount of medication to be administered.5. Amount of muscle tissue available.6. Needle length should be appropriate to the

site.7. Needle should be fit to the site.

Teacher use ppt for the explanation of criteria for selecting needle and syringes.

How will you select a needle or syringe?

2 min To elaborate the guide lines for injection.

Guideline for injection:1. Five right for medication to be ensured.2. Proper hand washing and sterile

technology/techniques when handling with syringes and medicine.

3. Maintain privacy during administration.4. Proper refrigeration of medicine.5. Accurate labeling in vial for future use.6. Safe and proper disposable of needle.7. Rotation of size to reduce pain.8. Lesion can be seen to avoid side effects.

Teacher explain it with the use of ppt.

What are the guidelines before giving injection?

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Evaluation

1min To define intra dermal injections.

Intradermal injection:It is a route for administration of medication into dermal layer of skin.

Teacher defines intradermal injection with the use of lecture.

What is intra dermal injection?

1 min To list down intra dermal injection purpose in children’s.

Purpose of intradermal injection in children:1) To perform sensitivity test.2) To perform tuberculin test.3) To administer vaccination.

Teacher explain purposes of intradermal injection with the use of ppt.

What is the purpose of intra dermal injection?

1 min To describe articles required in intradermal injection.

Articles required:1) Medication card.2) Medication vial.3) Clean gloves4) Sterile syringe and needle.5) Alcohol swab.6) Kidney tray.

Teacher explains articles in intradermal injection with the help of demonstration.

What are the articles required for intradermal injection?

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Evaluation

5min To explain procedure of intradermal injection.

Procedure of intradermal injection:1) Check physician order of

medication and verified patient.2) Explain the procedure to parents

and child according to their level of understanding.

3) Wash hand and prepare medication from ampule.

4) Wash hand and wear gloves.5) Assemble equipment to patient

side.6) Position child and locate site for

intradermal injection and take help of other person also.(inner aspect of forearm, upper chest or upper back beneath scapulae.

7) Cleanse the site in circular motion moving outward. Allow skin dry. Keep cotton in clean tray for rescue when taking out the needle.

8) Remove needle cap with the non-dominant hand to spread skin taut over injection site.

Teacher explain The procedure of intradermal injection with the use if demonstration.

How will you give intradermal injection?

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Evaluation

9) Place needle almost flat against patient’s skin and insert into the skin about 1/8 inch.

10)Slowly inject the drug (0.001-0.1 ml) watch for bleb to develop. If not present, withdraw needle slightly and inject medication.

11)Withdraw needle quickly in the same angle it was inserted.

12)Do not massage the area.13)Do not recap the needle.14)Assist patient to comfortable

position.15)Remove gloves and wash hands.16)Record medication and

administration.17) Draw a circle using blue or black

pen around injection site.Write date and time of administration of medication and medication name on skin. And check reaction after specified time.

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Evaluation

1 min To define subcutaneous injection.

Subcutaneous injection:Administering medication in subcutaneous tissue.

Teacher defines sub cutaneous injection with the help of discussion.

What is sub cutaneous injection?

1 min To enlist the article required in sub cutaneous injection.

Articles in sub cutaneous injection:1) Medication card2) Sterile syringe and needle.3) The prescribed medication.4) Alcohol swabs5) Clean gloves.6) Kidney tray.

Teacher describes articles for sub cutaneous injection with the use of demonstration.

What are the articles required in subcutaneous injection?

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Evaluation

7 min To explain the procedure of sub cutaneous injection.

Procedure of sub cutaneous injection:-1) Assemble all equipment and check

physician order.2) Identify patient.And explain the

procedure to child and parent to facilitate the co-operation in treatment.

3) Wash hand and prepare medication.4) Assemble equipment included

loaded medication from ampule.5) Help patient assume position

depending on selected sit Outer aspect of upper arm Anterior thigh Abdomen

6) Wear gloves.Clean the area around the injection site with alcohol swab.Use firm circulation,allow the site to dry.

7) Remove needle cap with non-dominant hand pulling straight off.

8) Grasp and pinch the area surrounding the injection site or spread at site.

Teacher explains procedure of sub cutaneous injection with the help of demonstration.

How will you give sub cutaneous injection?

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Evaluation

9) Hold the syringe in dominant hand between thumb and forefinger. Inject needle quickly at an angle of 45-90 degree, depending on the amount of tissue, turgor of tissue and length of needle.

10) After the insertion,release the tissue and immediately move your non dominant hand to steady lower end of syringe your dominant hand to top of the barrel.

11) Do not aspirate heparin or insulin.12) Inject medication slowly.13) Withdraws needle quickly at the same

angle as it was inserted,while applying counter traction around the injection site with non-dominanthand.

14) Massages the area gently with alcohol swab .do not massage heparin or insulin.Because massaging heparin may cause bruise and after insulin unpredictable absorption may occur.

15) Do not recap needle.16) Assist patient in comfortable position.17) Place patient in comfortable position.18) Document medication with date,

time,dose and route.

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Evaluation

1 min To define intramuscular injection.

Intramuscular injection:A form of parenteral administration of medication, where a drug is injected into a deep muscle tissue.

Teacher describes intramuscular injection with the help of lecture cum discussion.

Define intramuscular injection.

1 min To list down the articles required in intramuscular injection.

Articles required in intramuscular injection:

1) Medication card.2) Sterile medication3) Syringe and needle of

appropriate size.4) Alcohol swab.5) Clean gloves.6) Kidney tray.

Teacher describes articles in intramuscular injection with the help of demonstration.

What are the articles required in intra muscular injection?

1 min To elaborate site for intramuscular injection.

Site for intramuscular injection:1) Deltoid muscle.2) Ventrogluteal muscle.3) Dorso gluteal4) Vastuslateralis.

Vastuslateralis, ventro gluteal and dorso gluteal are common site used in infant.

Teacher explains sites for intramuscular injection with the use of chart.

What are site commonly used in children for intramuscular injection?

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Evaluation

5min To explain estimate site for intramuscular injection.

Different site for intra muscular injection:a) Deltoid muscle-

The nurse palpates the lower edge of the acromion process. The injection site is about 2.5 to 5 cm below the acromionprocess. The nurse may locate the site by placing three fingers across the acromion process.

b) Ventro gluteal muscle:It involves the gluteal muscle involves the gluteal medius and minimus. The nurse locates the muscle by placing her hand over the greater trochanter of the patient’s hip. Place the index finger over the anterior superior ileac spine and extend the middle finger along the iliac crust towards the buttocks .index fingers, middle finger and iliac crest form a v shaped triangle and injection site is its center.

c) Dorso gluteal:Dorso gluteal is located in the inner, outer angel of the upper outer quadrant of the buttocks approx. 5-8 cm below iliac crest.

d) Vastuslateralis:The muscle is located on the anterior, lateral aspect of thigh and extends in adults from 4---5 fingers below the greater trochanter of the femur to 4-5 fingers below the greater trochanter of the femur to 4-5 fingers above the knee.

Teacher explain site of intramuscular injection with the use of chart.

What are the sites of intramuscular injection?

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Evaluation

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Evaluation

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Evaluation

5 min To explain the procedure of intra muscular injection.

Procedure of intramuscular injection:1) Check physician order and identify

patient.2) Explain the procedure to child and

parent.3) Wash hands.4) Prepare medications.5) Wash hand and wear gloves.6) Position patient according to site of

injection.7) Select locate and clean site:

Select site free from lesions,swelling and tenderness.

Muscle should be adequatefor amount of medication to be administered.

Locate exacts site of injection. Clean the site with alcohol swab. Transfer and hold the swab

between 3rd and 4th finger of non-dominant hand.

8) Remove needle cover without contaminating the needle by pulling straight off.

9) Confirm the medication and dosage.10) Ensure that medication is not dripping on

needle prior to injection. If so change needle.

Teacher describes procedure of intramuscular injection with the help of demonstration.

How will you give intramuscular injection?

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Evaluation

11) Inject the medication: Grasp and pinch the area surrounding

the injection sie or skin at the site as appropriate.

Hold the syringe between the thumb and fore fingers in pen holding manner and pierce skin at the skin at 90 degree and insert the needle.

Aspirate by holding the barrel steady with dominant hand and pulling back the plunger with your dominant hand.

Withdraw needle if blood appears in the syringe.

Inject the medication slowly and steady if blood does not appear in the syringe on aspiration.

12) Withdraws the needle slowly and steady while supporting at the hub of syringe and needle. With non-dominant hand support skin.

13) Apply gentle pressure at the site and dry sponging and if bleeding persist apply pressure, do not massage as it irritate the skin.

14) Record the procedure.

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Evaluation

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Evaluation

1 min To illustrate pediatric variation in intramuscular injection.

Pediatric variation:1) A syringe that can measure very small

amount of solutions such as 0.5 ml syringe for less than 0.5 ml medication or tuberculin syringe.

2) The needle length should be sufficient to penetrate the subcutaneous tissue and deposits the medication in the muscle.

3) The needle gauge should be small to deliver fluid safely.

4) If the muscle is grasped to bunched, the needle length recommended for insertion is 25 mm .if the muscle is stretched or flattened, a needle length of 16 mm is recommended.

Teacher explain it with the use of ppt.

What are the pediatric variations in intramuscular injection?

2 min To define intravenous injection.

Intravenous injectionIntroducing a single dose of concentrated

medications directly into the systemic circulation. The iv bolus can be given as follows:

Directly into vein Into an existing iv line through an

injection port Through saline.

Teacher explain intravenous route with the help of lecture cum discussion.

What is intravenous injection?

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Evaluation

1min To list down the articles required in intravenous injection.

Articles:a) Iv push(existing line)

Clean gloves Medication ampule. Syringe 3-5 ml Sterile needle Swab Wrist watch Medication

administration route

Teacher explains articles with the use of demonstration.

What are the articles required for intravenous injection.

5min to elaborate intra venous injection

Procedure of intravenous injection:-1) Check the physician order and

identify the patient.2) Assess condition of the needle

insertion site for signs of infiltration and phlebitis.

3) Check patient history for any drug reaction.

4) Assemble supplies in medication room.

5) Wash hand and wear gloves.6) Prepare medication.7) Check patient name and medication

card again.

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Evaluation

8) Spread the mackintosh and the towel under the site to be punctured for IV injection.

9) Prepare the vein by applying tourniquet above the vein and ask the patient to close the fist.

10)When the needle is in the vein, ask the client to relax the fist and remove the tourniquet and push the medication.

11)Remove the needle and put pressure on the puncture site with sterile swabs.

12) Make the patient comfortable and record the procedure.

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SUMMARY:So today we have studied nurse’s responsibilities in injection. We have also studied what are the common sites for injection, purpose of injection, procedure of injections, complications regarding injection and nursing responsibility in injection.

CONCLUSION:So after the class we came to know that how nurses are important in administering medication safely and efficiently. So she must have thorough knowledge of the medicine and the patient who is receiving it. The nurse should have physical assessment skill and follow the schedule for drug therapy. a patient’s wellbeing depends upon the principal of drug application.

EVALUATION:Student will be evaluated by the questions written in evaluation column and multiple choice questions given by student teacher.

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Bibliography:

Book:-

1) Marlow and Redding. Text book of pediatric nursing. Sixth edition. Elsevier publication.2010. 287-290.2) Wongs and Werry. Text book of pediatric nursing. Third edition, Elsevier publication.2005. 205-2083) Taylor. “Fundamental of nursing”. 5th edition, Lippincott Williams and Wilkins publication.2005.734-748.4) Trained nurses association of India.” Fundamental of nursing-procedure manual”. First edition. Secretary

General on behalf of Trained nurses association publisher.370-382.5) Jacob Annamma and r.rekha et.al. “Clinical nursing procedure: the art of nursing practice “second edition.

2005. Jaypee publication. 265-275.6) Clement.I “basic concept of nursing procedure”. Second edition. 2005. Jaypee publication. 165-172.

Net:-

1) http://www.intelihealth.com

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http://www.intelihealth.com/

injection

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