WESTERN LEYTE COLLEGE OF ORMOC, INC

COLLEGE OF NURSING

Student's name: Cathy P. Sarda Date: _____________

Year&Section: BSN 2, sec.2 Group: ___2________

PREPARING MEDICATIONS FROM AMPULES AND VIALS

PREPARATION PERFORME RATIONALE

D
YES NO
1. Assemble equipment and supplies.  Organization of supplies
 MAR saves time and reduces
 Ampule of sterile medication. the chance of error.
 Small gauze
 Antiseptic swabs
 Needle and syringe
2. Check MAR
 Check the label on the ampule  Orders for certain
carefully against the MAR to medications expire after a
make sure that the correct specified time frame and they
medication is being prepared. need to be reordered by the
primary care provider
 Follow the 3 checks for
administering medications.
Read the label on the medication:
 When it is taken form
the medication chart.
 Before withdrawing the
medication.
 After withdrawing the
medication.

3. Organize the equipment.  Organization of supplies

saves time and reduces
the chance of error.
PROCEDURE:  Performing hand hygiene
4. Wash hands and observe other prevents the transmission
appropriate infection control procedures. of microorganism.
5. Prepare the medication ampule for drug
withdrawal.  This will bring all the
 Flick the upper stem of the medication down to the
ampule several times with a main portion of the
fingernail, or, hold the upper ampule.
stem of the ampule, shake the
 ampule similar to shaking down a
mercury thermometer.

 Partially file the neck of the

ampule, if necessary, to start a
clean break.
 Place a piece of sterile gauze
between your thumb and the
ampule neck, or around the
ampule neck, and break off the
top by bending it toward you.
 Disposable of the top of the
ampule in the sharps container.
 The sterile gauze protects
the fingers from the
broken glass, and any
glass fragments will spray
away from the nurse. This
method ensures that all
glass fragments fail into
the packet and reduces
the risks of cuts.

6. Withdraw the medication.

 Place the ampule on a flat
surface. Using a filter needle to
withdraw the medication,
disconnect the regular needle,
leaving its cap on, and attach the
filter needle to the syringe.
 The filter needle/straw
prevents glass particles
from being withdrawn
with the medication.

 Remove the cap from the filter  This will keep the needle
needle, and insert the needle into sterile.
the center of the ampule. Do not
touch the rim of the ampule with
the needle tip or shaft. Withdraw
the amount of drug required for
the dosage.

 With a single-dose ampule, hold  Replacing filter needle

the ampule, slightly on its side, if with another regular
necessary, to obtain all the needle prevents error
medication. while performing the
 Replace the filter needle with a procedure.
regular needle, and then tighten
the cap at the hub of the needle
before injecting the client.

VIALS

1. Assemble equipment and supplies:  Organization of supplies

 MAR saves time and reduces
 Vial of sterile medication the chance of error.
 Antiseptic swabs
  Needle and syringe
 Filter needle
 Sterile water or normal saline
2. Check the MAR.
3. Wash the hands and observe other
appropriate infection control procedures.
4. Prepare the medication vial of drug
withdrawal.
 Mix the solution, if necessary, by
rotating the vial between the
palms of the hands, not by
shaking.
 Remove the protective cap, or
clean with an antiseptic wipe by
rubbing in a circular motion.
5. Withdraw the medication.
 Attach a filter needle, as agency
policy dictates, to withdraw up
premixed liquid medication from
multi-dose vials.
 Ensure that the needle is firmly
attached to the syringe.
 Remove the cap from the needle,
then draw up into the syringe the
amount of air equal to the
volume of the medication to be
withdrawn.
 Carefully insert the needle into
the upright vial through the
center of the rubber cup,
maintaining the sterility of the
needle.
 Inject the air into the vial,
keeping the bevel of the needle
above the surface of the
 Orders for certain
medications expire after a
specified time frame and
they need to be
reordered by the primary
care provider.
 Prevents the transmission
of bacteria and
microorganisms.
 Some vials contain
aqueous suspensions,
which settle when they
stand. In some instances,
shaking is contraindicated
because it may cause the
mixture to foam.
 The antiseptic cleans the
cap and reduces the
number of
imicroorganisms.
 Using the filter needle
prevents any solid
particles from being
drawn up through the
needle.
 The air will allow the
medication to be drawn
out easily because
negative pressure will not
 medication.
 Withdraw the prescribed amount
of medication using either of the
following method:
 Hold the vial down,
move the needle tip
so that it is below the
fluid level, and
withdraw the
medication. Avoid
drawing up the last
drops of the vial or
 Invert the vial, ensure
needle tip is below
the fluid level, and
gradually withdraw
the medication.
 Hold the syringe and vial at eye
level to determine that the correct
dosage of drug is drawn into the
syringe. Eject air remaining at the
top of the syringe into the vial.
 When the correct volume of the
medication is obtained, withdraw
the needle from the vial, and
replace the cap over the needle
using the scoop method, thus
maintaining its sterility.
 If necessary. Tap the syringe barrel
to dislodged any air bubbles
present in the syringe.
 Replace the filter needle, if used,
with a regular needle and cover of
the correct gauge and length
before injecting the client.
be created inside the vial.
The bevel is kept above
the medication to avoid
creating bubbles in the
medication.
 Proponents of this
method sat that keeping
the vial in the upright
position while
withdrawing the
medication allows
particulate matter to
precipitate out of the
solution. Leaving the last
few drops reduces the
chances of withdrawing
foreign particles.
 Keeping the tip of the
needle below the fluid
level prevents air from
being drawn into the
syringe.
 This determines the
correct level of dosage to
be given to the patient.
 The tapping motion will
cause air bubbles to rise
to the top of the syringe
where they can be
ejected out of the
syringes.
 Replacing another filter
needle before injecting to
the client prevents error.
TOTAL SCORE: ____________________________________

INSTRUCTOR: ____________________________________

WESTERN LEYTE COLLEGE OF ORMOC, INC

COLLEGE OF NURSING

Student's name: Cathy P. Sarda Date: ________

Year&Section: BSN 2, Sec. 2 Group: __2_____

ADMINISTERING AN INTRADERMAL INJECTION

PREPARATION PERFORMED RATIONALE

YES NO
1. Assess  To provide a medication that
 Appearance of injection the client requires for allergy
 site. testing and TB screening.
 Specific drug action and
expected response.
 Client’s knowledge of drug
action and response.
2. Assemble equipment and supplies.  Organization of supplies saves
 Vial or ampule of the time and reduces the chance
correct medication. of error.
 Sterile 1-ml syringe
(tuberculin syringe) and a
25-27 gauze needle.
 Alcohol swabs
 Sterile gauze
 Non – sterile gloves
3. Check the MAR  Orders for certain
 Check the label on the medications expire after a
medication carefully against specified time frame and they
the MAR to make sure that need to be reordered by the
the correct medication is primary care provider.
being prepared.
 Follow the 3 checks for
administering medications.
4. Organize equipment.  Organization of supplies saves
time and reduces the chance
of error.
5. Procedure  Performing hand washing
 Wash hands. prevents microorganism from
 Prepare the medication transmitting.
from the vial or ampule of
the drug withdrawal.
 Prepare the client.
 Check the client’s
identification band.
6. Explain to the client that the  This is to ensure that the
medication will produce small patient has knowledge about
wheal, sometimes called bleb. the purpose of the
medication.
7. Provide for client privacy.  Ensuring patient privacy
promote effective
communication between the
healthcare provider and
patient and builds trust.
8. Select and clean the site.  Selecting the correct site for
 Select the site. injection prevents from
 Avoid using sites that are errors.
tender, inflamed, or swollen
and those that have lesions.
  Put on gloves.
 Cleanse the skin at the site
using a firm circular motion,
starting at the center and
widening the circle
outward. Allow the area to
dry thoroughly.
9. Prepare syringe for injection.
 Remove the needle cap
while waiting for the  A small amount of air will not
antiseptic to dry. harm the tissues.
 Expel any air bubbles from
the syringe.

 Grasp the syringe in your

dominant hand, holding it
between thumb and fore
finger. Hold the needle
almost parallel to the skin
surface, with the bevel of
the needle up.
10. Inject the fluid.
 With the non – dominant
hand, pull the skin at the
site until it is taut.
 The possibility of the
medication entering the
subcutaneous tissue increases
when using an angle greater
than 15 degrees.
 Taut skin allows for easier
entry of the needle and less
discomfort for the client.

 Insert the tip of the needle

far enough to place the
bevel through the epidermis
into the dermis. The outline
of the bevel should be
visible under the skin  This verifies that the
surface. medication entered the
 Stabilize the syringe and dermis.
needle, and inject the
medication carefully and
slowly so that it produces a
small wheal on the skin.
 Withdraw the needle
quickly at the same angle  Massage can disperse the
that it was inserted. medication into the tissue or
 Do not massage the area. out through the needle
insertion site.

 Dispose of the needle and  Do not recap the needle in

syringe safely. order to prevent needle stick
 Circle the injection site with injuries.
 ink to observe for redness.
11. Document all relevant information.
 Record the testing material  Documentation each
given, the time, dosage, medication provides accurate
route, site and nursing data for future use.
assessments.

TOTAL SCORE: ____________________________________

INSTRUCTOR: ____________________________________

WESTERN LEYTE COLLEGE OF ORMOC, INC

COLLEGE OF NURSING

Student's Name: Cathy P. Sarda Date:___________

Year&Section: BSN 2,sec.2 Group: __2______

ADMINISTERING AN INTRAMASCULAR INJECTION

PREPARATION PERFORM RATIONALE

ED
YES NO
1. Assess  To provide and maintain a constant
 Client allergies to level of a medication in the blood.
medication  To administer well-diluted
 Specific drug action, side medications at a continuous and
effects, and adverse slow rate.
reactions.
 Client’s knowledge of and
learning needs about the
medication.
 Tissue integrity of the
selected site.
 Client’s age weight, to
determine site and
needle size.
 Client’s ability or
willingness to cooperate.
2. Determine whether the size of 
the muscle is appropriate to the
 amount of medication to be
injected.
3. Assemble equipment and  Organization of supplies saves time
supplies: and reduces the chance of error.
 MAR
 Sterile medication
 Syringe and needle of a
size appropriate or the
amount of solution to
administered.
 Antiseptic swabs
 Disposable gloves
4. Check the label on the  Orders for certain medications
medication carefully against the expire after a specified time frame
MAR to make sure that the and they need to be reordered by
correct medication is being the primary care provider.
prepared and follow the “3
checks” for administering the
medication and dose.
5. Procedure:
 Wash hands and observe  Performing
other appropriate handwashing
infection control prevents microbial
procedures. transmission.
 Prepare the medication
from the ampule or vial
for drug withdrawal.
 Whenever
feasible, change
the needle on
the syringe
before the
injection.
 Invert the syringe  Ensuring patient
needle privacy promote
uppermost and effective
expel all excess communication
air. between the
 Provide for client privacy. healthcare provider
and patient and
builds trust.

 Prepare the client.

 This is to ensure that
 Explain the purpose of the patient has
the medication and how knowledge about the
it will help, using purpose of the
 language that the client medication.
can understand.
 Select, locate, and clean
site.  Proper location for
 Select a site free this procedure
of skin lesions, prevents errors.
tenderness,
swelling,
hardness, or
localized
inflammation,  To reduce the
and one that has discomfort of
not been used intramuscular
frequently. injections.
 If injections are to
be frequent,
alternate sites.
Avoid using the
same site for the  To ensure that the
injection. healthcare provider
 Locate the exact is clean while
sites for injection. performing the
 Put on clean procedure.
gloves.

 Clean the site

with antiseptic
swabs. Using a  This will help reduce
circular motion, the discomfort of the
start at the injection.
center and move
outward about 5
cm.
 Transfer and hold
the swab
between the
third and fourth
fingers of your
non-dominant
hand in readiness
for needle
withdrawal, or  Prevents seepage of
position the swab the medication into
on the client’s the subcutaneous
skin above the tissue.
intended site.
Allow the skin to
 dry prior to
injecting
medication.
 Prepare the syringe for
injection.  Using quick motion
 Remove the lessens the client’s
needle cover discomfort.
without
contaminating
the needle.
 Inject the medication
using the Z track method.  If the needle is in a
 Use the ulnar side small blood vessel, it
of the non- takes time for the
dominant hand to blood to appear.
pull the skin
approximately 2.5
cm to the side.
 Holding the
syringe steady
between the
thumb and
forefinger, pierce
the skin quickly  This step determines
and smoothly at a whether the needle
90 degree angle, has been inserted to
and insert the a blood vessel.
needle into the
muscle.
 Hold the barrel of
the syringe with  This minimizes the
your non – injury.
dominant hand,
and aspirate by  Use of an alcohol
pulling back on swab may cause pain
the plunger with or burning sensation.
your dominant
hand. Aspirate for
5 to 10 seconds.
If blood appears
in the syringe,
withdraw the
needle, discard
the syringe, and
prepare a new
injection.
 If blood does not
appear, inject the
 medications
steadily and
slowly while
holding the
syringe steady.

 Withdraw the needle.

 Withdraw the
needle smoothly
at the same angle
of insertion.
 Apply gently
pressure at the
site with a dry
sponge. Do not
massage the
area/site.
 If bleeding
occurs, apply
pressure with a
dry sterile gauze
until it stops.
6. Discard the uncapped needle and  Proper disposal of used materials
attached syringe into the proper reduces risk for infections.
receptacle. Remove gloves. Wash
hands.
7. Document all relevant  Documentation each medication
information. provides accurate data for future
 Include the time of use.
administration, drug
name, dose, route, and
the client’s reaction.
8. Assess the effectiveness of the  To observe for desired effect or its
medication at the time is effect to the patient.
expected to act.

TOTAL SCORE: ____________________________________

INSTRUCTOR: ____________________________________