1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 54 Administering Medications Lesson 2: Injection Methods

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. List and define the four sites for intramuscular injections. State the rationale for using the Z-track injection method. List the precautions used when administering an injection to an infant or small child.

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Sites for Intramuscular Injections IM Injections are given in one of four sites: –Deltoid –Vastus Lateralis –Dorsogluteal –Ventrogluteal

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Deltoid Muscle The upper outer surface of the upper arm Site of small muscle mass Works well for small- volume injections only For example: tetanus boosters in adults Never use this site with infants

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Deltoid Muscle The muscle is found by measuring two finger widths below the acromion process of the shoulder Do not give shots in back of arm Use 23-gauge, 1-inch needle For smaller arms use 25 gauge, 5/8 inch needle

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Vastus Lateralis Muscle On the outer portion of the upper thigh Part of the quadriceps Safest site for IM injections Can be used with infants Patient may sit or lie down for injection

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Vastus Lateralis Muscle In Infants Lies below the greater trochanter of the femur Within the upper lateral quadrant of the thigh Well developed in infants

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Vastus Lateralis Muscle In Adults –Extends from the middle of the anterior thigh to the middle of the lateral thigh –One handbreadth above the knee

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Dorsogluteal Muscle Used for large volume, deep IM injections or irritating medications Used for antibiotics Danger of damage to sciatic nerve Carefully observe landmarks to ensure proper placement

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Dorsogluteal Muscle Patient should lie prone and point toes inward Draw an imaginary line from the greater trochanter of the femur to the posterior superior iliac spine Give injection above and lateral to the line Or divide buttocks in four equal parts and give injection in the upper outer quadrant

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Ventrogluteal Muscle Safer than the dorsogluteal muscle Safe for infants, children, and adults

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Ventrogluteal Muscle Place the palm of the right hand on the greater trochanter and the index finger on the superior iliac crest Stretch the index finger as far as possible along iliac crest and then spread the middle finger away from your index finger Inject in the space between the index and middle finger Give at a 90 degree angle

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Subcutaneous Injections Given just under the skin in the fat tissue Used for small doses of nonirritating meds Used in deltoid, upper back, abdomen, thighs Given at a 45 degree angle

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Position for a Subcutaneous Injection

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Rotation Sites for Administering Insulin When patients frequently self-inject, such as with insulin injections, the site of injection should be rotated The patient should be taught to keep a rotation chart

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Administering Subcutaneous Injections Perform hand hygiene and apply gloves Select medication using “three befores” Roll the medication between your hands to mix Prepare syringe Identify and position patient Clean patient’s skin Check dosage Remove cover of needle

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Administering Subcutaneous Injections Place alcohol sponge or cotton between two fingers of nondominant hand Grasp syringe in dominant hand With nondominant hand, form tissue mass with the skin Insert needle with one swift movement Insert into the subcutaneous tissue at 45 degrees

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Administering Subcutaneous Injections Do not move needle once you have inserted it Aspirate Inject medication slowly, without moving needle Place sponge or cotton over site, and withdraw needle Place sponge or cotton firmly over injection site

19. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Administering Subcutaneous Injections Gently massage site Observe patient Correctly dispose of all materials, remove gloves and discard; document the procedure

20. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Administering Intramuscular Injection With your nondominant hand stretch the skin tightly where you will insert the needle Grasping the syringe in a dart-like fashion, insert the entire needle with one swift movement Insert needle directly into the muscle at a 90- degree angle

21. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan The Z-Track Method Used when a medication is irritating to the subcutaneous tissues or the medication may discolor the skin When giving a medication using the Z-track method, you need to pull the skin to the side prior to inserting the needle The pulling of the skin displaces the tissue Then inject the medication, release the skin, and the medication will not be able to seep back to the skin’s surface

22. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Z-track Injection

23. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Intradermal (ID) Injection Commonly used for allergy skin testing in which a minute amount of material is injected within the top layer of skin to determine a patient’s sensitivity Common sites to perform an ID injection include the upper chest and upper back, as well as the anterior forearm Because just the top level of skin is entered, a small “wheal” or bubble that contains the injection fluid appears on the skin Do not rub the area after giving the injection

24. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Intradermal Skin Test

25. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Tuberculin Skin Test Administered intradermally Done to see if a patient has ever had tuberculosis A small amount of TB protein (antigens) is injected under the top layer of skin on the patient’s inner forearm If the person has ever been exposed to the TB bacteria, the skin will react to the antigens by developing a firm red bump at the site within 2 days The test cannot tell if the infection is active or inactive (latent)

26. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Performing a Tuberculin Skin Test Ask the patient to sit down and turn the inner side of his or her forearm up The skin where the test is done should be cleansed and allowed to dry Using a tuberculin syringe, a small injection of the TB antigen (PPD) is put under the top layer of skin The fluid makes a little bump (wheal) under the skin

27. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Performing a Tuberculin Skin Test A circle may be drawn around the test area with a pen Do not cover the site with a bandage Tell the patient that some redness at the skin site is expected and that the site may itch, but that it is important that it not be scratched, because scratching may cause redness or swelling that would make the test difficult to read Instruct the patient to return to the office within 2 to 3 days after the test to have the skin test checked

28. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Tuberculin Skin Test Results Redness alone at the skin test site is a negative reaction A firm bump is a positive reaction to the skin test The size of the firm bump (not the red area) should be measured 2 to 3 days after the test to determine the result Although the medical assistant is responsible for reporting the findings of “positive” or “negative” to the physician, interpreting” such test results is not within the scope of practice for the medical assistant

29. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan What is Intravenous Therapy? Process that involves administering fluids and solutions directly into the bloodstream State practice acts designate which health care professionals can initiate IV fluid therapy and medication administration Medical assistants must consult their state practice act before attempting any IV procedure

30. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan How to Prepare an IV Tray Perform hand hygiene and apply gloves Prepare IV set Place absorbent disposable sheet on the tray Assemble equipment on tray Hang IV solution on pole Notify appropriate personnel Remove and discard gloves and perform hand hygiene Document procedure Clean work area according to OSHA guidelines

31. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?