FUNDAMENTALS

OF NURSING

BY: FRANCIS JAMES L. RIGODON, RN

WHAT IS NURSING?

“the act of utilizing the

environment of the patient to
assist him in his recovery.”
-Florence Nightingale
WHAT IS NURSING?

“Nursing is the protection,

promotion and optimization of
health and abilities, preventions of
illness and injury, alleviation of
suffering through the diagnosis and
treatment of human response.”

-American Nurse’s Association, 2003

WHO ARE OUR CLIENTS?

– Individuals
DID YOU KNOW?
Patient came from the
– Family latin word patior
meaning “to suffer” or
“to bear”

– Community people
FOUR MAJOR AREAS:

– PROMOTION OF HEALTH AND WELLNESS

– PREVENTION OF ILLNESS AND DISEASE
– RESTORATION OF HEALTH
– CARING OF THE DYING
HEALTH VS. WELLNESS

– HEALTH
- WHO: the state of complete physical, mental and social
well-being and not just merely the absence of disease or
infirmity.

– WELLNESS
-Subjective experience of health or general well being
DISEASE VS. ILLNESS

– DISEASE
- Objective dysfunction or alteration of functioning

– ILLNESS
- Subjective dysfunction or alteration of functioning or
the human experience of disease
Nurse’s Role:

– To assist client in achieving and

maintaining optimum levels of
health

– Attending to our client’s

“NEEDS”
ABRAHAM MASLOW’S HIERARCHY OF
NEEDS
 LEVELS OF DISEASE
PREVENTION

– PRIMARY PREVENTION
– SECONDARY PREVENTION
– TERTIARY PREVENTION
 PRIMARY PREVENTION
(Health Promotion and Disease
Prevention)

Health Promotion
– Emphasizes the importance of
maintaining the highest level of health
and wellness

– Ex: Healthy Diet, Exercise, stress

reduction
 PRIMARY PREVENTION
(Health Promotion and Disease
Prevention)

Disease Prevention
– Focuses on taking measures to
prevent illness and diseases from
occurring.

– Ex: Vaccination or immunization,

Environmental sanitation
 SECONDARY PREVENTION
(Early Detection and Prompt treatment)

Early Detection and Prompt Treatment

– Focuses on the detection of a disease
condition and the treatment required to
limit or prevent disability.

– Ex: Monthly BSE, Blood Pressure Taking,

Annual pap smear exam
 TERTIARY PREVENTION
(Rehabilitation and Health Restoration)

Rehabilitation
– Helps people to achieve the highest
level they are capable of given their
current health status after a disease
occured and as much as possible
return to it’s normal health.

– Ex: Teaching a client who has

diabetes to identify and prevent
complications
 THE NURSING PROCESS
(ADPIE)
– A 5 step process that is based on scientific reasoning and critical
thinking used to identify, diagnose and treat human response to
health and illness (ANA, 1995)
 ASSESSMENT PHASE
– Systematic collection and verification data
– To establish a database about the client response to
health concerns or illness
4 types of Assessment:
I – Initial Assessment
P – Problem Focused Assessment
E – Emergency Assessment
T – Time Lapsed Assessment
 ASSESSMENT PHASE
Types of Data:
– Objective Data (Overt)
– Detectable, measured and observed with the use of
senses.
– Ex: Blood pressure, Temperature
– Subjective Data (Covert)
– Described by the affected person
– Ex: “I feel so hot”,
“It’s too painful”
 ASSESSMENT PHASE
Sources of Data:
– Primary
– Coming from the client
– Secondary
– All sources other than the client
– Ex: Family members, other health
professionals, records
 ASSESSMENT PHASE
Methods of Data Collection:
– Observing
– Interview
– Examining
 ASSESSMENT PHASE
INTERVIEW:
– DIRECTIVE TYPE
– Specific, Close-ended questions

– NON-DIRECTIVE TYPE
– Open-ended questions
– Promotes rapport building
 ASSESSMENT PHASE
Examining:
– Conducts physical assessment
Techniques:
I – Inspection I – Inspection
Pa – Palpation A – Auscultation
Pe – Percussion Pe – Percussion
A – Auscultation Pa – Palpation
 DIAGNOSIS PHASE

– Statement describing the

client’s actual or potential
health problem
– Utilizes NANDA book
 PLANNING PHASE
– Formulation of client goals and designing nursing
intervention to prevent, reduce or eliminate the client’s
health problem.
GOALS:
S – Specific
M – Measurable
A – Attainable
R – Realistic
T – Time-bounded
 IMPLEMENTATION PHASE
– Performs the nursing activities that were developed in the
planning phase and documents the resulting client response.
– Reassessment is a must before doing any intervention
Components:
- Cognitive skills
- Interpersonal skills
- Technical skills
 EVALUATION PHASE

– Planned, continuous, purposeful

– Determines the client’s progress
towards outcome goal
– Determines the effectiveness of
the nursing care plan
 DOCUMENTATION
– A written, formal document of
client records
Purpose:
– Communication
– Planning client care
– Educational purposes
– Legal Documentation
– Research
 DOCUMENTATION
TYPES OF RECORDS:
– SOMR (Source-Oriented Medical
Record)

– POMR (Problem-Oriented
Medical Record)
 SOURCE-ORIENTED
MEDICAL RECORD
– Also referred as the traditional client record
– Each care provider/department has their own forms
in a separate section on the client’s chart.
Example:
-Admission Department – Admission sheet
-Physician – Physician’s order sheet
-Nurse – Nurse’s progress notes
SOURCE-ORIENTED
MEDICAL RECORD
– Uses NARRATIVE CHARTING
– Routine care
– Normal findings
– Client problems
 PROBLEM-ORIENTED
MEDICAL RECORD
– Data are arranged according to the problems the
clients has rather than the source of information.
Basic Components:
– Database
– Problem list
– Plan of care
– Progress notes
 PROGRESS
NOTES
FORMATS:
– SOAP
– (Subjective, Objective, Assessment, Plan)
– SOAPIE
– (Subjective, Objective, Assessment, Plan, Interventions,
Evaluation)
– SOAPIER
– (Subjective, Objective, Assessment, Plan, Interventions,
Evaluation, Revision)
 DOCUMENTATION

Other progress notes model:

Focus Charting PIE Charting
D – Data P – Problem
A – Action I – Intervention
R – Response E – Evaluation
VITAL SIGNS
 VITAL SIGNS

֍ Body temperature
֍Pulse
֍ Respiration
֍ Blood pressure
֍ Pain
֍ Pulse oximeter
 VITAL SIGNS
(Guidelines)

– Used as initial assessment and baseline data

– Can be DELEGATED but the nurse is responsible in
interpreting results
– All vital signs must be documented and be
reported to the HCP for abnormal results
Frequency (Recommendation):
- Every 2 hours for close monitored patients
- Every 4 hours for other patients
 BODY TEMPERATURE
– Balance between the heat produced and heat lost
from the body
– Hypothalamus (Regulates Body Temperature)
– Kind of Body Temperature:
֍ Core Temperature – temperatures of the deep
tissues in the body. (e.g. Abdominal cavity)
֍ Surface Temperature – temperature of the skin
and subcutaneous tissue.
 BODY TEMPERATURE
FACTORS IN HEAT PRODUCTION:
֍ Basal Metabolic Rate (BMR)
֍ Muscle Activity
֍ Thyroxine Output
Thyroxine ---- Cellular Metabolism = heat
production
֍ Sympathetic Nervous System stimulation
֍ Fever
 BODY TEMPERATURE
FACTORS IN HEAT LOSS:
֍ Radiation – heat transfer from one object to
another without contact in the form of infrared
rays. (e.g.
֍ Conduction – heat transfer through physical
contact
֍ Convection – heat dispersion by air currents
֍ Evaporation – conversion moisture into gas. (e.g.
Sweating)
 BODY TEMPERATURE
FACTORS AFFECTING TEMPERATURE:
֍ AGE
֍ DIURNAL VARIATIONS (CIRCADIAN RHYTHYMS)
֍ EXERCISE
֍ HORMONES
֍ STRESS
֍ ENVIRONMENT
 BODY TEMPERATURE
ASSESSMENT:
SITES ADVANTAGE
Normal Body temperature:
1. ORAL MOST ACCESSIBLE
Range: 36 ◦C – 37.5 ◦C
2. AXILLARY SAFEST
Conversions:
3. RECTAL MOST ACCURATE
• Celsius to Fahrenheit AND RELIABLE

F = (Celsius x 1.8) + 32 4. TYMPANIC FASTEST

MEMBRANE
• Fahrenheit to Celsius
C = (Fahrenheit – 32) ÷ 1.8
 BODY TEMPERATURE
Conversions:
• Celsius to Fahrenheit • Fahrenheit to Celsius
F = (Celsius x 1.8) + 32 C = (Fahrenheit – 32) ÷ 1.8
Convert 37◦C to ◦F Convert 98.6◦F to ◦C
F = (37 x 1.8) + 32 C = (98.6 – 32) ÷ 1.8
= 66.6 + 32 = 66.6 ÷ 1.8
F = 98.6 C = 37
 NURSING
CONSIDERATION:
֍ ORAL
- Wait 15- 30 minutes before taking
temperature
If the client:
- Consumed hot or cold foods or liquids
- Smoked
- Chewed a gum
 NURSING
CONSIDERATION:
֍ RECTAL
- Position: Sim’s position
- Thermometer must be LUBRICATED
Contraindications:
- Cardiac patients,
- Rectal surgery and Rectal bleeding
 BODY TEMPERATURE
ALTERATIONS
֍ Pyrexia/Hyperthermia/Fever
-Temperature above the normal range but
not higher than 41◦C
֍ Hyperpyrexia/Very High Fever
-Temperature above 41◦C
֍ Hypothermia
-Temperature below 36◦C
 TYPES OF FEVER
֍ Intermittent Fever
-Fluctuation of body temperature from fever to
normal/subnormal levels. (e.g. Malaria)

֍ Relapsing Fever
- short febrile periods mixed periods of 1-2 days
of normal temperature then fever recurs again
 TYPES OF FEVER
֍ Remittent Fever
- Fever with temperature fluctuations
(more than 2◦C) which are all above normal that
occurs over 24-hour period. (e.g. Colds, Influenza)
֍ Constant Fever
- minimal body temperature fluctuations
that remains above normal or 38◦C (e.g. Typhoid
Fever)
Nursing Interventions:
– Monitor Vital Signs
– Monitor intake and output
– Provide adequate nutrition and fluids
– Administer antipyretics as ordered
– Provide rest to limit heat production
 PULSE
– Palpable bounding of blood flow
created by the contraction of the
Left ventricle.
Types:
֍ Peripheral Pulse
֍ Apical Pulse
 PULSE

AGE Normal Range

֍ Tachycardia
Newborn 130 (80-180)
– rate above normal for age Infants 120 (80-140)

֍ Bradycardia Preschool 100 (75-120)

School-Age 70 (50-90)
– rate below normal for age
Adolescent 75 (50-90)

Adult 80 (60-100)
 PULSE
FACTORS AFFECTING PULSE:
֍ Age
֍ Gender
֍ Exercise
֍ Fever
֍ Medications
֍ Stress
PULSE SITES AND USES
SITES SPECIFIC USES
TEMPORAL - Used when radial pulse is not accessible
CAROTID - Used during cardiac arrest/shock for adults
- Used to determine circulation to the brain
APICAL - Routinely used for infants and children up to 3 years of
age
BRACHIAL - Used to measure blood pressure
- Used during cardiac arrest for infants
RADIAL - Most accessible
FEMORAL - Used to determine circulation to the leg
POPLITEAL - Used to determine circulation to lower leg
POSTERIOR TIBIALIS - Used to determine circulation to the foot
DORSALIS PEDIS - Used to determine circulation to the foot
 NURSING
CONSIDERATION:
֍ APICAL PULSE
- Counted in a full minute in patient’s with
cardiac problems or irregular radial pulse prior
to giving medication. (i.e. Digoxin)
 NURSING
CONSIDERATION:
֍ PULSE DEFICIT
- Condition where peripheral pulse is lesser than
apical pulse due to ineffective cardiac
contractions
- Lack of peripheral perfusion
 RESPIRATIONS
Involves:
Ventilation – movement of air in and out of
the lungs (i.e. Inhalation and Expiration)
Diffusion – the process where movement
of oxygen from alveoli to capillaries and
movement of carbon dioxide from the
blood vessel to the alveoli
 RESPIRATIONS
Regulations:
֍ Pons and Medulla – Respiratory centers
֍ Muscle involved – Diaphragm by the
Phrenic nerve
֍ CO2 levels or Hypercapnia – normal
stimulus for breathing
 ALTERED BREATHING
PATTERNS
Rate:
֍ Tachypnea – abnormally fast and shallow
֍ Bradypnea – abnormally slow
֍ Apnea – cessation of breathing
Volume:
֍ Hyperventilation – Overexpansion of the lungs with rapid and
deep breathing
֍ Hypoventilation – Underexpansion of the lungs with shallow
breathing
 NORMAL BREATH SOUNDS
Tracheal Sound
- Inspiratory and
expiratory sounds are
about EQUAL.
Location:
Over the trachea in the
neck
 NORMAL BREATH SOUNDS
Bronchial Sound
- Expiratory sounds last
longer than inspiratory
ones.
Location:
Over the Manubrium
 NORMAL BREATH SOUNDS
Bronchovesicular Sound
- Inspiratory and
expiratory sounds are
about EQUAL.
Location:
1st and 2nd intercostal
space and between the
scapulae
 NORMAL BREATH SOUNDS
Vesicular Sound
- Inspiratory sounds
last longer than
expiratory ones.
Location:
Entire lung field except
over the upper
sternum
 ADVENTITIOUS BREATH
SOUNDS

“Crackles (Rales)”

-Are discontinuous Etiology:

popping(bubbling) Fluid in the airways or
sounds that occur alveoli
during INSPIRATION
Ex. Pneumonia
 ADVENTITIOUS BREATH
SOUNDS
“Wheezes”
-Continuous, musical, Etiology:
high-pitched, whistle-like Airway narrowing
sounds heard during
expiration Ex. Bronchospasm,
Asthma
 ADVENTITIOUS BREATH
SOUNDS
“Rhonchi”
- Deep, low-pitched Etiology:
rumbling sounds heard Secretions in the large
primarily during airways
EXPIRATION
Ex. Pleural Effusion
-“SNORING sound”
 ADVENTITIOUS BREATH
SOUNDS

“Friction Rub”
- Harsh, crackling sound, Etiology:
like two pieces of leather Inflammation of the
being rubbed together pleural cavity

Ex. Pleurisy(Pleuritis)
 BLOOD PRESSURE
– A measure of pressure exerted by blood as it
flows through the arteries.

Systolic Pressure – blood pressure exerted during

ventricular contraction
Diastolic Pressure – blood pressure exerted during
ventricular relaxation
Pulse Pressure – difference between systolic and
diastolic pressure
 BLOOD PRESSURE
Determinants of Blood Pressure:
֍ Cardiac Output ֍ Peripheral Vascular Resistance
CO = BP PVR = BP
CO = BP PVR = BP

֍ Blood Volume
Blood Volume = BP
Blood Volume = BP
 FACTORS AFFECTING
BLOOD PRESSURE
FACTORS
AGE - Increased with age
EXERCISE - Increases cardiac output and blood pressure
STRESS - Stimulation of SNS
GENDER - Women has lower blood pressure before 65 years of age and a
higher BP than men after menopause
MEDICATIONS - Certain medications can lower BP
OBESITY - Predispose to hypertension
DIURNAL Lowest at early morning and peaks late afternoon
VARIATION
DISEASE PROCESS Any condition that affects blood viscosity, cardiac output, blood
volume affects BP
 CLASSIFICATION OF
BLOOD PRESSURE
CATEGORY SYSTOLIC BP DIASTOLIC BP
NORMAL <120 <80
PREHYPERTENSION 120 – 139 80 – 89
STAGE 1, HYPERTENSION 140 – 159 90 – 99
STAGE 2, HYPERTENSION >160 > 100
HYPOTENSION < 90 < 60

Orthostatic Hypotension – BP that falls

when the patient sits or stands caused by
peripheral vasodilation.
 OXYGEN
SATURATION
– Measured by a Pulse Oximeter that estimates a
client’s arterial blood oxygen saturation (SaO2)
– Normal Range: 95 – 100%
Sites:
֍ Finger
֍ Earlobe
֍ Toe
֍ Nose
SAFETY
 FIRE SAFETY
R – Rescue the client P – Pull the pin
A – Activate the alarm A – Aim at the base of fire
C – Confine the fire S – squeeze the nozzle
E – Extinguish the fire S – Sweep side to side

*Remember RACE PASS!

 RADIATION SAFETY
NURSING CONSIDERATIONS:
1. Follow the ALARA Precaution
PROPER:
• Shielding – Use of Lead Apron, Lead Gown and
Dosimeter badge
• Distancing – 3-6 feet away from the patient
• Time – maximum of 30 minutes per shift
 RADIATION SAFETY
NURSING CONSIDERATIONS:
2. Place the patient in a PRIVATE ROOM
3. Never touch dislodged radiation implants
4. NOT ALLOWED:
- Pregnant
- Teens (18 years old and Below)
 SEIZURE
PRECAUTIONS
– Pad the bed
– Suction Machine: prepare at bedside
During Seizure:
- Stay with the client
- Turn client to lateral position, if possible
- Remove objects in the environment
- Support the head if not in bed
- Apply oxygen
 RESTRAINTS
– Protective device used to limit physical
activity of the client or a part of the body.
Types:
֍Physical Restraint – manual method with
the use of equipment or mechanical
device
֍Chemical Restraint – use of medications
such as sedatives to control disruptive
behavior
 Which client should we apply
restraints?
Standard for application:
- Client is a danger to self or
others
- Temporary immobilization
following a procedure
GUIDELINES IN APPLICATION OF
RESTRAINTS
R – Requires doctor’s order/Informed consent
*Validity of Order: (Renewed Daily)
Behavioral – 4 hours
Medical-surgical procedures – 12 hours
E – Evaluate restraints
S – Skin Assessment done every 30 minutes
T – Tie safely in a movable part of the bed (Bed Frame)
R – Release restraints for ROM exercise and toileting (q 2 hours)
A – Application purpose (Behavioral, Med-Surgical)
I – Inspect circulation every 30 minutes
N – Never Delegate
T – Tie should be in a quick release knot (Safety Knot)
S – Stay with the client when releasing restraints
 DRUG
ADMINISTRATION
 MEDICATION
ORDERS
֍ STAT order - Given immediately and only once (e.g.
Morphine sulfate 10mg IV STAT)
֍ STANDING order - Carried out in advance carried out
under specific circumstance. (e.g. multivitamins daily)
֍ SINGLE order - Given once at a specified time (e.g.
Seconal 100 mg hs before surgery)
֍ PRN order - Given as needed according to the health
worker’s own judgment. (Acetaminophen 500 mg p.o.
q4h prn for pain)
 PARTS OF DRUG
ORDER
֍ PATIENT’S FULL NAME
֍ DATE AND TIME
֍ NAME OF DRUG
֍ DOSAGE OF DRUG
֍ FREQUENCY OF ADMINISTRATION
֍ ROUTE OF ADMINISTRATION
֍ SIGNATURE OF PERSON WRITING THE ORDER
 COMMON
ABBREVIATIONS
Abbreviation Meaning
ac Before meal
pc After meal
bid, tid, qid Twice a day, three times a day, four
times a day
gtt Drops
IM, IV, ID, SQ Intramuscular, Intravenous,
Intradermal, Subcutaneous
PO Per orem (mouth)
q2h, q4h, q12 Every 2hours, every 4 hours, every 12
hours
tab Tablet
hs Before bed time
 10 RIGHTS OF DRUG
ADMINISTRATION
֍RIGHT DRUG ֍RIGHT ASSESSMENT
֍RIGHT DOSE ֍RIGHT EVALUATION
֍RIGHT TIME ֍RIGHT DOCUMENTATION
֍RIGHT ROUTE ֍RIGHT PATIENT EDUCATION
֍RIGHT PATIENT ֍RIGHT TO REFUSE
 RIGHT DRUG
– Names of Drugs (i.e. Brand name, Generic Name)
– Actions:
Pharmacokinetics – body to drugs (i.e. Absorption,
Distribution, Metabolism, Excretion, Elimination)
Pharmacodynamics – drugs to body (i.e.
Therapeutic Effect, Side effects, Adverse effects)
– Follows and check’s doctors order
– Checked atleast 3 times (from pharmacy/cabinet,
before and after preparation)
 RIGHT PATIENT
– Must check at least two identifiers:
- ID Band
- Ask for patient’s Full name
– Inform client of medication and
purpose
– Stay with the client until meds are
taken
 RIGHT TIME
– Give the medication at the right
frequency and timing (i.e. q2h,
q4h, PRN, etc.)

– Right time standard: Within 30

minutes before and after the
scheduled time
 RIGHT ROUTE
– Give the medication by the
ordered route.
E.g. Route:
֍ Oral
֍ Sublingual
֍ Buccal
֍ Ear
֍ IM, ID, IV
 RIGHT DOSAGE
– Give the right amount of drug ordered
Formula:
 RIGHT ASSESSMENT

– Some medications require specific

assessment prior to administration.

Example: Before administration of

Digoxin, apical pulse must be checked
first
 RIGHT EVALUATION

– Conduct appropriate follow up after

giving the medication.

– Check if the desired effect was

achieved or did the client experience
side effects and adverse reactions.
 RIGHT DOCUMENTATION

– Document medication
administration right after giving
it.

– Follow agency’s policy for

medications which are not
given
RIGHT PATIENT EDUCATION

– Explain information about the

medication to the client (i.e.
What to expect, any precaution
about the medication)
 RIGHT TO REFUSE
– Clients has the right to refuse any
medication
– Nurse must ensure that the client is
fully informed about the
consequences of refusing the
medication and to communicate
client’s refusal to the health care
provider.
 ROUTES OF
ADMINISTRATION
֍ ORAL ROUTE:
– Most accessible route
Contraindication:
– Nausea and Vomiting
– Dysphagia
– NPO
**Enteric-coated tablets: must not be crushed
**Liquid preparation: Read amount at
Meniscus level and at eye level
 ROUTES OF
ADMINISTRATION
֍ SUBLINGUAL ROUTE:
– Medications placed under the tongue
– Do NOT swallow or take with fluids

֍ BUCCAL ROUTE
– Placed against the mucous membrane
of the cheek.
– Do NOT swallow or take with fluids
 EYE ADMINISTRATION
- OD = Right eye; OS = Left Eye;
OU = Both eyes
֍ Eyedrop Administration:
- Instruct client to look up and drop prescribed
medication to the lower conjunctival sac.
- Press the tear ducts (to prevent systemic
absorption of the drug)
֍ Eye Ointment Application
– Apply from inner to outer canthus of the eye
 EAR ADMINISTRATION
Straighten the ear canal:
- 3 years and older – Pull the pinna up and
back
- Under 3 years old – pull the pinna down
and back
** Make sure to warm medication before
instilling medication (to avoid vertigo)
** Press the tragus of the ear to assist the flow
of medication
** Remain in side lying position for 5 minutes
 PARENTERAL
MEDICATIONS
Given Through:
֍ Intramuscular (IM)
֍ Intravenous (IV)
֍ Intradermal (ID)
֍ Subcutaneous (SQ)
 INTRADERMAL
INJECTION (ID)
Purpose:
- For allergy testing
- TB screening
Common sites:
- Inner lower arm
- Upper chest
- Scapula
Administration:
- Bevel up, 5-15 degree angle to
form a wheal or bleb
 INTRADERMAL
INJECTION (ID)

Equipment:
Syringe – 0.1-1ml (tuberculin)
Needle – Gauge 25-G27;
¼ -5/8 long
 SUBCUTANEOUS
INJECTION (SQ)
– Has a lesser absorption rate
compared to IM injection.
– Common Drugs administered:
(Vaccines, Insulin, Heparin)
Common sites:
- Outer aspects of the upper arm
- Anterior aspects of thighs
- Abdomen (2cm away from umbilicus)
- Upper back
- Gluteal area
 SUBCUTANEOUS
INJECTION (SQ)
Equipment:
Syringe – 3 mL
Needle – Gauge 25 – 27;
3/8 or 5/8 inch long

Administration:
- Pinch the skin to form SC fold
- Insert at:
- 45 degree angle: if 1 inch grasped tissue or thin clients
- 90 degree angle: if 2 inches grasped tissue or fat
clients and in abdomen
 SUBCUTANEOUS
INJECTION (SQ)
Important Points:
- Don’t massage or aspirate for
insulin and heparin injections
For patients with insulin:
- Standard Needle gauge:
Gauge 30 (5/16 Length)
- Rotate Insulin injection site to
avoid lipodystrophy
 INTRAMUSCULAR
INJECTION (IM)
– Absorbed more quickly than SQ
injection due to greater blood
supply
Common sites:
- Ventrogluteal site
- Dorsogluteal site
- Vastus lateralis
- Rectus Femoris
- Deltoid
 INTRAMUSCULAR
INJECTION (IM)
Equipments:
Syringe – 2-3 ml
Needle – Gauge 21-23; 1 ½ inch Long

Administration:
- Hold like a dart and insert at 90 degree
angle
- Aspirate to check if it has inserted into
a blood vessel
 INTRAMUSCULAR
INJECTION (IM)
Other Method:
Z-Track technique – less painful than traditional method
and decreases leakage of irritating and discoloring
medication into the subcutaneous tissue.
E.g. Injection of iron supplement
 DRUG & IV
CALCULATIONS
1. Drop rate / Flow Rate
Total volume x Drop factor
-------------------------------
Hours x 60 minute /hr

2. Hourly Volume

Total volume
----------------
Hr
DROP RATE/ FLOW RATE
Problem: Nurse Karen will infuse 1 L of Normal Saline in over 8 hours; Drop factor:
15 gtt/mL. What will be the drop rate of the solution?

𝑇𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑥 𝐷𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟

𝐷𝑟𝑜𝑝 𝑅𝑎𝑡𝑒 =
𝐻𝑜𝑢𝑟𝑠 𝑡𝑜 𝑐𝑜𝑛𝑠𝑢𝑚𝑒 𝑥 60 𝑚𝑖𝑛/ℎ𝑟
1000𝑚𝑙 𝑥 15 𝑔𝑡𝑡/𝑚𝑙
=
8 ℎ𝑟 𝑥 60𝑚𝑖𝑛/ℎ𝑟
15,000 𝑔𝑡𝑡𝑠
=
480 𝑚𝑖𝑛

= 31.25 or 31 gtts/min