1. Chapter 23 Mathematics Review and Medication Administration
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Fractions Definitions Types of Fractions
Numerator: Top number of a fraction
Denominator: Bottom number of a fraction
Types of Fractions
Proper fractions: Numerator is less than the denominator
Improper fractions: Numerator is larger than the denominator
Mixed fractions: Consist of a whole number plus a fraction
Give examples of proper fractions, improper fractions, and mixed fractions.

3. Fractions Changing an Improper Fraction to a Whole or Mixed Number
Divide the denominator into the numerator.
Changing a Mixed Number to an Improper Fraction
Multiply the denominator into the whole number.
Add the numerator to the product; the sum is now the new number.
Reducing Fractions to the Lowest Term
Find a number that will evenly divide into the numerator and the denominator.
Give an example of changing an improper fraction to a whole number.
Give an example of changing a mixed number to an improper fraction.
Provide an example of reducing a fraction to its lowest term.

4. Fractions Determining Which Fraction Is Larger
If the denominators are the same, the fraction with the larger numerator is the larger fraction.
If the denominators are different, you must find a “common denominator.”
Finding a common denominator means to find a number into which both denominators can be divided.
After the common denominator is found, an equivalent numerator for each fraction must be found. (Divide the first denominator into the equivalent denominator; multiply the answer by the first numerator.)
Give an example in which a nurse might have to determine which fraction is larger.

5. Fractions Adding Fractions That Have the Same Denominator
Add the numerators and place the sum of the numerators over the denominator.
Adding Fractions That Have Different Denominators
Find common denominators for all fractions in the problem.
Find the equivalent numerators.

6. Fractions Adding Mixed Numbers
Add the fractions of the mixed number. Then add the sum of the fractions to the whole number.
Subtracting Fractions with the Same Denominator
Subtract the numerator and place it over the denominator.
Subtracting Fractions with Different Denominators
Find a common denominator, and then subtract.
Provide an example of adding a mixed number.
Provide an example of subtracting fractions with different denominators.

7. Fractions Subtracting Mixed Numbers Multiplying Fractions
When the numerator of the top fraction is smaller than that of the bottom fraction, borrow one whole number from the whole number of the mixed fraction and express it as a fraction.
Multiplying Fractions
Multiply the numerators; multiply the denominators.
Multiplying Fractions and Mixed Numbers
Change the mixed number to an improper fraction.
Multiply.
Give an example of multiplying fractions with different denominators.

8. Fractions Dividing Fractions Dividing Fractions and Whole Numbers
Write the problem down correctly; invert the second fraction.
Multiply.
Dividing Fractions and Whole Numbers
Change the whole number to a fraction
Divide.
Give an example of dividing fractions with whole numbers.

9. Decimal Fractions
The decimal fraction is a type of fraction that uses a decimal to indicate the denominator of the fraction.
The placement or position of the decimal point determines whether the denominator is 10, a multiple of 10, or a division of 10.

10. Decimal Fractions Names of Decimal Places .0001 Ten thousandths
One hundred thousandths
Ten thousandths
Thousandths
Hundredths
Tenths
Unit (whole number)
Tens
Hundreds
Thousands
10, Ten thousands
100, One hundred thousands

11. Decimal Fractions Names of Decimal Places (continued)
A decimal point found left of a whole number means that the number is a fraction of a whole number.
A decimal point found after a number means that it is a whole number.
A number without a decimal point is understood to have an “invisible” decimal point behind it.
Give an example of a fraction when the decimal is to the left of a number.
Describe an “invisible” decimal point.

12. Decimal Fractions Adding Decimals Subtracting Decimals
Align the decimal point of each decimal fraction in a column.
Add.
Subtracting Decimals
Subtract.
Rounding a Number
A number found after the decimal point that is 5 or larger can increase the number before it by one whole number.
Give an example of adding and subtracting figures with decimal points.
Give an example of rounding a number up or down.

13. Decimal Fractions Multiplying Decimals Dividing Decimals
Multiply. Decimal points in the problem do not have to be aligned.
The decimal place in the answer is determined by how many numbers are found to the right of the decimal points in the numbers multiplied.
Dividing Decimals
Change a decimal fraction in the divisor to a whole number by moving the decimal point all the way to the right.
Move the decimal point in the dividend the same number of places moved in the divisor.
Give examples of multiplying numbers with decimal points.

14. Decimal Fractions Dividing Decimals (continued)
Place the decimal point in the answer directly over the decimal point in the dividend after moving the decimal point in the dividend.
If a decimal point is in the divisor, but not in the dividend, move it the same number of places as the divisor. Remember, there is an unexpressed decimal point at the end of all whole numbers. Add zeros after the decimal point in the dividend as needed.
If the dividend contains a decimal fraction and the divisor does not, leave the divisor as it is.
Give examples of dividing numbers with decimal points.

15. Decimal Fractions Changing Fractions to Decimals
Divide the numerator by the denominator.
Changing a Decimal Fraction to a Common Fraction
To change a decimal fraction to a common fraction, give the decimal fraction a denominator according to the position of the decimal point in the decimal fraction.
Demonstrate how to change a fraction to a decimal.
Give an example of how to change a decimal to a fraction.

16. Percents The word “percent” and its symbol, %, mean “hundredths.”
A hundredth is a fraction of a whole number; therefore, a number followed by percent sign (%) is a fraction.
The denominator of the fraction is understood to be 100.

17. Percents Changing a Percent to a Decimal Fraction
Remove %; move the decimal point two places to the left to indicate “hundredths.”
Changing a Fraction to a Percent
Change a fraction to a percent by dividing the numerator by the denominator.
Multiply the answer by 100.
Label the answer with the percent symbol, %.
Multiplying by Percent
Change the percent to a decimal.
Multiply.
Give examples of how to:
change a whole number to a percent
change a fraction to a percent
multiply a percent.

18. Ratios
Ratios show the relationship of one number or quantity to another number or quantity.
Numbers of a ratio are separated by a colon.
A ratio is also a fraction.
The value of a ratio is not changed if both terms are multiplied or divided by the same number.
When numbers are written in ratio, they must all be expressed in the same units.
A fraction may be written as a ratio.
Give examples of situations in which ratios are seen within health care.

19. Proportions
Proportion shows that the relationship between two ratios has equal value.
Definitions
Means: inner terms of the proportion
Extremes: outer terms of the proportion
Set up the left side of the proportion as the “known” side using information that is known or given.

20. Proportions Set up the known side.
Set up the unknown side. Use x for what you are trying to find.
Set up the units in the same position on each side of the problem.
Multiply the means.
Multiply the extremes
Solve for x (divide the number with the x into the number on the opposite side of the problem).
Label the answer with the unit of measurement that accompanies the x in the problem.
Demonstrate how proportions are basic algebra.
Give examples of how to solve for x.

21. Proportions Review of Proportion Method
Set up problems in the same order on both sides.
Multiply the means; multiply the extremes.
The number multiplied with the x is always that number with the x to the right of it.
Divide the number with the x into the number on the other side of the problem.
Label the problem by looking to see what unit of measurement the x is with the proportion.

22. The Metric System The metric system is based on the decimal system.
The decimal system uses the divisions and multiples of a unit, which is always in ratios of tens.
The metric system uses the following units:
liter (L) = volume (amount) of fluids
gram (g) = weight of solids
meter (m) = measure of length

23. The Metric System
Smaller units of the system are designated by the following prefixes:
deci = 0.1 of the unit (liter, gram, meter); tenths
centi = 0.01 of the unit; hundredths
milli = of the unit; thousandths
Larger units of the system are designated by the following prefixes:
deka = 10 times the unit (liter, gram, meter)
hecto = 100 times the unit
kilo = 1000 times the unit
Give examples of an item that is equal but is displayed differently, such as 1000 mg = 1 g.
Give an example of kilograms to grams in which the amounts are equal.

24. The Metric System Units of Weight Units of Volume
1 gram (g) = milligrams (mg)
0.001 gram (g) = 1 milligram (mg)
1 kilogram (kg) = grams (g)
0.001 kilogram (kg) = 1 gram (g)
Units of Volume
1 liter (L) = milliliters (mL)
0.001 liter (L) = 1 milliliter (mL)
1 milliliter (mL) = 1 cubic centimeter (cc)
Give examples in which metric units of weight would be used.
Give examples in which metric units of volume would be used.

25. The Metric System
Approximate Equivalents of the Metric System and the Apothecary System
Volume
1 milliliter (mL) = 15 or 16 minims
4 or 5 milliliters (mL) = 1 fluid dram
30 milliliters (mL) = 1 fluid ounce
500 milliliters (mL) = 1 pint
1000 milliliters (mL) = 1 quart
Give an example of a typical household item and determine what the equivalent would be in mL.
Such as a pint of milk = 500 mL.

26. The Metric System
Approximate Equivalents of the Metric System and the Apothecary System (continued)
Weight
60 milligrams (mg) = 1 grain (gr)
1000 milligrams (mg) = 15 grains
4 grams (g or gm) = 1 dram
30 grams (g) = 1 ounce
0.45 kilogram (kg) = 1 pound (lb.)
1 kilogram (kg) = 2.2 pounds (lbs.)
Give an example of a typical over-the-counter medication in which the label could provide grains. Aspirin.
Give an example of how to figure how many grains equals x mg.

27. The Metric System Metric Measurements of Length
The basic unit of length is the meter.
The meter is equal to inches.
0.001 meter = 1 millimeter (mm)
0.01 meter = 1 centimeter (cm)
0.1 meter = 1 decimeter (dm)
10 meters = 1 decameter (dam)
100 meters = 1 hectometer (hm)
1000 meters = 1 kilometer (km)

28. The Metric System Metric Measurements of Length
Most frequently used equivalents
1 meter (m) = 1000 millimeters (mm)
0.001 meter (m) = 1 millimeter (mm)
1 meter (m) = 100 centimeters (cm)
1 centimeter (cm) = 10 millimeters (mm)
1 millimeter (mm) = 0.1 centimeter (cm)

29. Pediatric Considerations
Young’s Rule
A method for the calculation of the appropriate dose of a drug for a child 2 years of age or older; applies to children up to the age of 12
Age of child _
(Age of child + 12)
 Average adult dose = Child’s dose
Give an example utilizing Young’s rule.

30. Pediatric Considerations
Clark’s Rule
A method of calculating the approximate pediatric dosage of a drug for a child
Weight of child (lbs.)
150
 Average adult dose
= Child’s dose
Give an example utilizing Clark’s rule.

31. Pediatric Considerations
Fried’s Rule
This rule is used for infants younger than 2 years of age.
Age in months
150
 Average adult dose = Child’s dose
Give an example utilizing Fried’s rule.

32. Pediatric Considerations
Estimating Body Surface Area in Children
Body surface area is defined as the total area exposed to the outside environment.
Use body surface area scale to find the correct surface area (SA).
SA (m2)
1.73 m2
 Adult dose = Child’s dose
Give an example and estimate the body surface area of a toddler.

33. Pharmacology
This is the study of drugs and their action on the living body.
Substances derived from plants and animals, from vitamins and minerals, and from synthetic sources can be used as drugs in the treatment and prevention of disease.
The action of any drug on the body is a complicated process.

34. Pharmacology Pharmaceutical Phase Pharmacokinetic Phase
The making of the drug until absorption of the drug takes place in the patient’s body
Pharmacokinetic Phase
The movement of the drug’s active ingredients from the body fluids into the entire system and to the site where the intended action of the drug takes place
Pharmacodynamic Phase
Interaction of the drug’s active ingredient with the intended body tissues; the body’s cells respond to the action of the drug and change as the drug is metabolized
Provide an example of the pharmaceutical phase.
Provide an example of the pharmacokinetic phase.
Provide an example of the pharmacodynamic phase.

35. Pharmacology Drug Dosage
The dosage is the amount of a drug prescribed for the patient by the physician.
A dose of medicine refers to a single prescribed amount of drug given at one time.
Nurses must become familiar with therapeutic dosages of frequently used drugs to confidently administer dosages of medication to each patient.
Give an example of a typical over-the-counter medication and its dosage.

36. Pharmacology Drug Actions and Interactions Two general types
Local: Affect only the area where the drug is placed
Systemic: Affect the entire body
Drug interaction: One drug alters another drug
Potentiation: One drug increases the action or effect of another drug
Incompatibility: Drugs that do not combine chemically with other drugs
Antagonist: Drug that will block the action of another drug
Give an example of a drug interaction.
Give an example of an antagonist.
Give an example of a potentiation effect.

37. Pharmacology
An idiosyncratic response to a drug is an individual’s unique hypersensitivity to a particular drug.
A reduced response to a drug is called tolerance.
An adverse drug reaction is a harmful, unintended reaction to a drug administered at a normal dosage.
Contraindications are conditions under which the drug should not be given.
Interactions are modifications of the effect of a drug when administered with another drug.
Give an example of an idiosyncratic response.
Give an example of an adverse drug reaction.

38. Pharmacology
Factors that may affect how patients respond to medication:
Age
Weight
Physical health
Psychological status
Environmental temperature
Gender
Amount of food in the stomach
Dosage forms
How does age have an effect on medication response?
How does weight have an effect on medications?
How does food in the stomach affect medications?

39. Medication Orders
The nurse is ethically and legally responsible for ensuring that the patient receives the correct medication ordered by the physician.
Medication orders should include the following:
Patient's name
Date and time of the order
Name of the drug
Dosage of the drug
Route of administration
Time or frequency drug is given
Signature of the physician
Any special instructions
Why it is important that the nurse ensure that the medication order contains these criteria?
Why is the date and time the order was written important?

40. Medication Orders Controlled Substances
Opioids, barbiturates, and other controlled drugs that have a high possibility for abuse or addiction are double-locked.
“Narcotic keys” are kept by designated nurses per shift.
Each controlled drug used is logged into the narcotic log book.
At the end of each shift, controlled drugs are carefully counted by a nurse from the outgoing shift and a nurse from the incoming shift.
Always have a witness to the “wasting” of a controlled substance.
How are controlled substances monitored by the government?
Why are wasted narcotics witnessed by another nurse?
Why are narcotics counted?

41. Medication Orders Types of Orders Standing orders Verbal orders
Already written by a physician for all patients on a particular unit or area
Carried out without having to call the physician
Verbal orders
May be given in the presence of an LPN/LVN or an RN directly or over the telephone
Should be written on the chart and signed by the physician as soon as possible
What is the difference between standing and verbal orders?
Does the physician order these medications?

42. Medication Administration
Six Rights
Right medication
Right dose
Right time
Right route
Right patient
Right documentation
Why are the six rights important to follow when administering medications?
Give examples of situations that could be detrimental if these six rights are not followed.

43. Medication Orders
Important Considerations of Medication Administration
If you did not pour it, do not give it.
If you gave it, chart it.
Do not chart for someone else or have someone else chart for you.
Do not transport or accept a container that is not labeled.
Do not put down an unlabeled syringe.
If given a verbal order, repeat it to the physician.
If you make an error, report it immediately.
Why is it important not to give a medication you did not pour or withdraw into a syringe?
Why does a nurse not document a medication given for another nurse?
Why is it unsafe to leave an unlabeled syringe?

44. Medication Orders
Important Considerations of Medication Administration (continued)
Never leave a medication with a patient or family member. Watch the patient take it and swallow it.
Always return to assess the patient’s response.
Chart as soon as possible after giving medication.
If a patient refuses medication, do not force it; chart “Refused medication because of ”
If you elect to omit a dose based on your nursing judgment, let another nurse help make the decision. If medication is not given, document “Dose omitted because ” Report to the physician.
Why should the nurse witness the patient taking his/her medication?
Why should the nurse return after a patient has taken a medication?

45. Routes of Administration
Enteral
Via the GI tract
Powders
Pills
Tablets
Liquids or suspensions
Suppositories
Give an example of when the enteral route might be chosen for medications.

46. Routes of Administration
Percutaneous
Through the skin or mucous membranes
Topical
Instillation
Inhalation
Describe over-the-counter medications that can be administered by these routes: topical, instillation, and inhalation.

47. Routes of Administration
Parenteral
Methods other than the GI tract; needle route
Ampules
Vials
Intramuscular
Subcutaneous
Intradermal
Intravenous
Describe these routes and sites for administration: subcutaneous, intramuscular, and intravenous.

48. Enteral Administration
Preparation of Tablets, Pills, and Capsules
These preparations enter the GI tract and are absorbed more slowly into the blood stream than via any other route.
The slow absorption rate makes the PO (by mouth) route relatively safe.
Some PO medications are irritating to the patient’s GI tract, and larger tablets may be difficult for some patients to swallow.

49. Administering tablets, pills, and capsules.
Skill 23-1: Step 5
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Administering tablets, pills, and capsules.

50. Enteral Administration
Preparation of Liquid Medications
Liquid medications are often given to children; to patients who cannot swallow tablets, pills, or capsules; and to geriatric patients.
Medications may be given PO or via a nasogastric, gastrostomy, or jejunostomy tube.
Liquids must not be given to unconscious patients because of the possibility of aspirating.
Some liquid medications are not to be followed by water, and some may stain the teeth.
Give examples in which liquid medications should not be administered.
What types of medications should not be followed by water?

51. Administering liquid medications.
Skill 23-2: Step 13
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Administering liquid medications.

52. Enteral Administration
Tubal Medications
Nasogastric (NG) tubes are used to administer liquid medications to unconscious patients, dysphagic patients, and those who are too ill to eat.
Many medications come in liquid form; if they do not, solid tablets may be pulverized in a mortar and pestle, and capsules can be opened.
Not all tablets are safe to use when crushed, and not all capsules are safe to use when opened.
Give an example in which tubal medications can be administered.

53. Administering tubal medications.
Skill 23-3: Step 13a
Administering tubal medications.

54. Administering tubal medications.
Skill 23-3: Step 16
Administering tubal medications.

55. Enteral Administration
Suppositories
Cone-shaped, egg-shaped, or spindle-shaped medication made for insertion into the rectum or vagina
Dissolves at body temperature and absorbed directly into the bloodstream
Useful for infants, patients who cannot take oral preparations, and patients with nausea and vomiting
Stored in cool place so they do not melt
Give examples in which suppositories would be appropriate routes to administer medications.
What over-the-counter medications come in suppository forms?

56. Percutaneous Administration
With these routes, medications are absorbed through the skin or the mucous membranes.
Most produce a local action, but some produce a systemic action.
Drugs include topical applications, instillations, and inhalations and ointments, creams, powders, lotions, and transdermal patches.
Absorption is rapid but of short duration.
Give an example of which patient population might require this type of route. Asthmatic and COPD patients.
Give examples of medications that are typically used in this manner.

57. Percutaneous Administration
Ointments
An oil-based semisolid medication; may be applied to the skin or a mucous membrane
Creams
Semisolid, nongreasy emulsions that contain medication for external application
Lotions
Aqueous preparations that are used as soothing agents that relieve pruritus, protect the skin, cleanse the skin, or act as astringents
What is the difference between ointments, creams, and lotions?

58. Percutaneous Administration
Transdermal Patches (Topical Disk)
Adhesive-backed medicated patches applied to the skin provide sustained, continuous release of medication over several hours or days.
Eyedrops and Eye Ointments
Care should be taken to keep all ophthalmic preparations sterile by not touching the dropper or the tube to the eye.
Eardrops
Containers of solutions to be used as eardrops will be labeled “otic.” They must be at room temperature when applied.
Give an example of over-the-counter medications that are available in these forms: transdermal patches, eyedrops, and ear drops.

59. A variety of medications are available as transdermal patches.
Figure 23-4
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
A variety of medications are available as transdermal patches.

60. Percutaneous Administration
Nosedrops
Nosedrops are for individual use only.
Nasal Sprays
Sprays absorbed quickly; less medication is used and wasted when administered in this manner.
Inhalation
Drugs may be absorbed through the mucous membranes of the respiratory tract.
Inhalation produces a relatively limited effect or a systemic effect.
This method is actively used by respiratory therapy and anesthesiologists.

61. Percutaneous Administration
Sublingual Administration
Drug is administered by placing it beneath the tongue until it dissolves.
Drug may be a tablet or liquid squeezed out of a capsule.
It is rapidly absorbed into the bloodstream.
Buccal Administration
A tablet is placed between the cheek and teeth, or between the cheek and the gums.
Absorption into the capillaries of the mucous membranes of the cheek gives rapid onset of the drug’s active ingredient.
Give examples in which sublingual and buccal administration would be appropriate.

62. Parenteral Administration
Equipment
Syringes
Syringe consists of a barrel, a plunger, and a tip.
Outside of the barrel is calibrated in milliliters, minims, insulin units, and heparin units.
Types
Tuberculin syringe
Insulin syringe
Three-milliliter syringe
Safety-Lok syringes
Disposable injection units
What is the difference between a tuberculin and an insulin syringe?
What is a Safety-Lok syringe?
In what situations would a disposable injection syringe be appropriate?

63. Figure 23-5 Parts of a syringe.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Parts of a syringe.

64. Tuberculin syringe calibration.
Figure 23-6
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Tuberculin syringe calibration.

65. Calibration of U100 insulin syringe.
Figure 23-7
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Calibration of U100 insulin syringe.

66. Reading the calibrations of a 3-mL syringe.
Figure 23-8
Reading the calibrations of a 3-mL syringe.

67. Figure 23-10
Safety-Glide syringe.

68. Figure 23-12 Parts of a needle.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Parts of a needle.

69. Percutaneous Administration
Equipment (continued)
Needles
Parts are the hub, shaft, and beveled tip.
Opening at the needle’s beveled tip is the lumen.
Size of the diameter of the inside of the needle’s shaft determines the gauge of the needle; the smaller the gauge, the larger the diameter.
Needle gauge selection is based on the viscosity of the medication.

70. Percutaneous Administration
Equipment (continued)
Needle length
Selected based on the depth of the tissue into which the medication is to be injected
Intradermal: 3/8 to 5/8 inch
Subcutaneous: 5/8 to 1/2 inch
Intramuscular: 1 to 1 1/2 inch
Intravenous needles
Butterfly (scalp needle)
Over-the-needle catheter (Angiocath, Jelco)

71. Needle length and gauge.
Figure 23-13
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Needle length and gauge.

72. Percutaneous Administration
Equipment
Needleless devices
Devices are designed with a sheath or guard that covers the needle after it is withdrawn from the skin.
Intravenous catheters have been designed with blunt-edged cannulas, valves, or needle guards to minimize injuries.
IV tubing with recessed and shielded needle connectors has been designed, further reducing needlesticks.
What benefits are there to needleless devices?
Describe needleless IV tubing.

73. Percutaneous Administration
Intramuscular Injections
Involves inserting a needle into the muscle tissue to administer medication
Site selection
Gluteal sites
Vastus lateralis muscle
Rectus femoris muscle
Deltoid muscle
Z-track method
Used to inject medications that are irritating to the tissues
Give examples in which the gluteal site would not be an appropriate administration site.
Give examples in which the deltoid muscle would not be an appropriate administration site.
When should the Z-track method be utilized?

74. Locating IM injection for ventrogluteal site.
Figure 23-15, C
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Locating IM injection for ventrogluteal site.

75. Giving IM injection in vastus lateralis site on adult.
Figure 23-16, C
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Giving IM injection in vastus lateralis site on adult.

76. Rectus femoris muscle. A, Child/infant. B, Adult.
Figure 23-17
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Rectus femoris muscle. A, Child/infant. B, Adult.

77. Giving IM injection in deltoid site.
Figure 23-18, C
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Giving IM injection in deltoid site.

78. Figure 23-19
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
A, Z-track method. B, Using an air lock. C, Administering IM injection by airlock technique.

79. Percutaneous Administration
Intradermal Injections
Introduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as a serum, vaccine, or skin test agent
Not aspirated
Small volumes (0.1 mL) injected to form a small bubblelike wheal just under the skin
Used for allergy sensitivity tests, TB screening, and local anesthetics
A tuberculin syringe used with a 25-gauge, 3/8- to 5/8-inch needle
Where is the dermis located?
Why is it inappropriate to aspirate when administering an intradermal injection?
Why is a short needle length utilized for intradermal injections?

80. Figure 23-20
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Angles of insertion for intramuscular (90°), subcutaneous (45°), and intradermal (15°).

81. Percutaneous Administration
Subcutaneous Injections
Injections made into the loose connective tissue between the dermis and the muscle layer
Drug absorption slower than with IM injections
Given at a 45-degree angle if the patient is thin or at a 90-degree angle if the patient has ample subcutaneous tissue
Usual needle length is 1/2 to 5/8 inch and 25 gauge
Used to administer insulin and heparin
Where is the loose connective tissue located?
Why is a longer needle length, when compared to an intradermal injection, utilized for a subcutaneous injection?

82. Figure 23-21
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Subcutaneous injection. Angle and needle length depend on the thickness of skinfold.

83. Percutaneous Administration
Intravenous Therapy
Provide fluid and electrolyte maintenance, restoration, and replacement
Administer medication and nutritional feedings
Administer blood and blood products
Administer chemotherapy to cancer patients
Administer patient-controlled analgesics
Keep a vein open for quick access

84. Percutaneous Administration
Methods of Intravenous Administration
IV push
Intermittent venous access device
Intermittent infusion (or piggyback)
Continuous infusion
Electronic pumps and controllers
Patient-controlled analgesia
Volumetric chambers
What does the term “IV push” mean?
What is a “piggyback”?
What are volumetric chambers?

85. Figure 23-23 PCA infusion pump.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
PCA infusion pump.

86. Figure 23-24
Volumetric chamber.

87. Percutaneous Administration
Nursing Responsibility
The nurse must ensure that fluid of the ordered type and amount is started and that the fluid is regulated to infuse over the period ordered.
To find the drops per minute (the drip rate), you must know which type of IV tubing will be used with the infusion and obtain the drip factor for the tubing to be used.
Why is it important for the nurse to ensure proper infusion of the IV ordered?
What is a drip rate?

88. Percutaneous Administration
Nursing Responsibility (continued)
Monitor intravenous therapy
Check the infusion and the IV needle site at least every hour.
Flow of fluid
IV site: erythema, wetness, and edema
Phlebitis: inflamed vein
Infiltration: fluid passes into the tissues
Assess for chills, fever, headache, nausea, vomiting, anxiousness, and dyspnea.
Why is it important to assess the IV site every hour?
Why is it necessary to assess for chills, fever, headache, nausea, vomiting, anxiousness, and dyspnea?

89. Percutaneous Administration
Nursing Responsibility (continued)
Assess for anaphylactic shock
Respiratory distress
Skin reactions
Signs of circulatory collapse
GI signs and symptoms
Change in mental status
Requires immediate intervention.
What is anaphylactic shock?
Why does the nurse need to respond immediately to a patient who is experiencing anaphylactic shock?

90. Nursing Process Nursing Diagnoses Anxiety Health-seeking behaviors
Injury, risk for
Knowledge deficient
Mobility, impaired
Noncompliance: drug regimen
Sensory/perception, disturbed
Give an example of a patient situation in which the nursing diagnosis of “Injury, risk for” would be appropriate.
Give an example of a patient situation in which the nursing diagnosis of “Noncompliance: drug regimen” would be appropriate.