First pass effect Needle

“The greater the first pass effect, the less - A very thin, hollow tube with a sharp
the agent will reach the systemic circulation” tip that contains a small opening at
the pointed end
Pharmacokinetics - Sterile device used to inject
 Absorption solutions into or withdraw secretions
 Distribution from the body
 Metabolism
 Excretion - 3 parts: hub, shaft, bevel

Equipment
 Syringes
 Needles
 Injectable drug (medication)
 Intravenous duct

Anatomy of syringe

Injectable drugs
 Barrel flunge (flange)? - Sterilized solutions
 Plunger flunge (flange)? - Powders that must be reconstituted
 Plunger seal with sterile solution (water or saline)
Stored as:
Syringe tip - Vial
- Ampules
- Fluid bags

 Ampule
- Thin, medical-grade class tubing
- Contains specific medications, many
of which are incompatible with the
rubber of PVC components found in
most vials
Vial

1. Intradermal injection (ID)

- Rights of Medication Administration
2. Subcutaneous injection (SC) 1. Right patient
- Injection site should be free 2. Right medication
of lesions, bony 3. Right dose
prominences, and large 4. Right route
underlying muscles or nerves 5. Right time
- 0.5ml – 1.5ml (adults) 6. Right documentation
- 0.5ml (children) ((GIVE MNEMOTICS)
- Use abdominal site if px do
not have sufficient tissue for Primary nursing interventions related to
SC medication management are:
3. Intramuscular injection (IM) - Assessment
- Adults can tolerate 2ml-5ml - Administration
- 4ml-5ml may not be - Health teaching
absorbed properly - Documentation
- Do not give more than 1ml to
small children and older Nursing Diagnoses
infants - Pain
- Do not give more than 0.5ml - Knowledge deficit
to smaller infants - Risk for infection
- Altered sensory/perceptual
Institutional policies and procedures
- The nurse must know the
institution’s administration
procedures for the client’s welfare
and the nurse’s legal protection
Review Medical Administration Records
(MAR)
- Complete client’s name
- Date of the order
- Name of drug, dose, route, time of
administration
- Physician’s name and signature
Aseptic Technique
- Do not reuse
- Do not recap used needles
- Sharps must be disposed properly in
a puncture-resistant container
- Used syringes are considered
infectious wastes
“When in doubt, throw it out”
- Must be observed from the
preparation of medicine until the
disposal of used equipment
- Always inspect the integrity of the
packaging
- Always check the expiration date of
the medications
Minimize Patient Discomfort
- Use sharp-beveled needle in the
smallest suitable length and gauge
- Position patient comfortably
- Select proper injection site, using
anatomical landmarks
- Apply topical anesthetic (if available)
Patient health teaching
- The nurse discusses the medication
and its action with the client; recheck
the medication order if the client
disagrees with the dose or the
physician’s order
Assessment
- Drug History – Allergies, prescription
drugs taken, over-the-country used
- Medical History – Biographical data,
lifestyle and beliefs, sensory and
cognitive status
- Physical Examination
- Diagnostic and Laboratory Data
Drug Knowledge
- The nurse must know the:
a) Drug’s prescribed dose
b) Method of administration
c) Actions
d) Expected therapeutic effect
e) Possible interactions with other
drugs
f) Adverse effects
Summary
- The administration of any medication
requires approval by medical control,
through direct orders given or
standing orders that are part of the
protocols
Documentation
- A critical element of drug
administration
- “If it was not documented, it was not
done”
- The nurse should document that a
drug has been given after the patient
has received the drug.
Preparing injections from an ampule
1. Tap the ampule lightly with finger
until fluid moves from neck of
ampule.
2. Place small gauze pad/unopened
alcohol swab just above the neck of
the ampule.
3. Snap neck of ampule quickly and
firmly away from hands.
4. Draw up medication, needle must be
long enough to reach the bottom of
ampule.
5. Hold ampule upside down or set in
on a flat surface with filter need in
center of the ampule opening.
6. Do not allow needle tip to touch rim