injection
Content
Time
Specific Objectives
Content
30 sec
Teaching-Learning Activity
INTRODUCTION:-
Drug therapy plays a major role in the treatment of patients. Although prescribed by the doctor, the safe and accurate administration of medications is one of the important responsibilities. She must know the therapeutic action and usual dosage of a drug. The nurse should be alert to observe adverse effect of the drug. She should realize that the patient’s condition may alter the effect of a drug and that there may be interactions with concurrent therapy. Nurse must be aware of regulations affecting drug administration. ANNOUNCEMENT TOPIC :-
2
OF
Evaluation
Today,we will discuss important aspect of medication i.e. injection.
Time
Specific Objectives
Content 3
Teaching-Learning Activity
Evaluation
1min
After the class group will be able to :DEFINITION: To define the term injection.
1 min
Injection is a type of parenteral medication which is an invasive procedure and it must be performed under a strict aseptic technique.It involves administration of drug by a route through injection into the body tissue. Types of injection: Intradermal: when medication are injected To list down the common into dermis. types of injection. Subcutaneous:when medication is injected into the muscle Intramuscular: when medication are injected into muscles. Intravenous:when medication and fluids 4
Teacher defines the term injection by using lecture cum discussion along with ppt.
Define injection.
Teacher explains type of What are the injection with the use of flash different types of card. injection?
administer in veins.
Time
Specific Objectives
Content
5
Teaching-Learning Activity
Evaluation
2 min
To illustrate the purpose of injection.
2 min
To list down the factors contributing to effective absorption.
Purpose of injection: 1. To get a rapid and systemic effects of the drug. 2. To obtain maximum effect of the drug even when the patient is unconscious,unable to swallow due to neurological or surgical alteration affecting the throat and mouth or when patient is un cooperative. 3. When the drug is toxic and irritating to gastro intestinal tract. 4. To obtain a local effect at the site of injection. 5. To restore blood volume by replacing the fluid e.g. Inn shock. Factors contributing to effective absorption:1. Injections are more quickly absorbed in the area that is richly supplied with blood. 2. Isotonic fluids are absorbed more easily in the blood. 3. Absorption of medicine is retarded in the patients with edema, neurogenic, cardiogenic and vasogenic shock. 4. Absorption of medication is delayed in cases of skin lesion, fibrosis. 6
Teacher explains it What is the with the use of chart. purpose of injection?
Teacher describe factor contributing in effective absorption of medicine with the help of ppt.
What factors affect medicine absorption?
Time
Specific Objectives
3 min
To enlist the complications of injection.
Content
Teaching-Learning Activity Complication of injection:Teacher explains it Infection: handling and improper with the use of ppt. sterilization of syringes, needles and fluid used for injections may introduce infection in the body. Pyogenic reaction: patients getting intravenous injection may develop fever due to pyrogens present in the fluid. Allergic reaction: certain drugs produce allergic reactions in patients.it can be prevented by a test dose. Tissue trauma: repeated injection on the same site can cause scar formation and injury to nerve. Pain swelling: if given on the site, it will result in pain and swelling. Foot drop: dropping of foot from a tibial lesion that causes paralysis of the anterior muscles of the leg due to nerve injury. Air embolism: air embolism due to the introduction of air into blood vessel Circulatory overload Serum hepatitis Over dose and under dose of medication 7
Evaluation What are the complications of injection?
may cause complications.
8
Time
Specific Objectives
5 min
To calculate drug dosage in children’s
Content
CALCULATION OF DRUG DOSAGE: Medication based on body surface area: Child dose=child BSA*adult dose adult BSA Young’s rule:
Child dose=age of child *adult dose age +12 Clark’s rule: child dose=weight of child in pound *adult dose 150 Fried’srule: Child dose=child’s age in month*adult dose 150
9
Teaching-Learning Activity Teacher use ppt to explain calculation of drug dosage.
Evaluation
How will you calculate drug dosage in children?
Time
2 min
Specific Objectives To enlist criteria for selection of syringes and needle.
Content
Teaching-Learning Activity
Criteria for selection of needles and syringes: 1. The route prescribed. 2. Viscosity of medication. 3. Size of child. 4. Amount of medication to be administered. 5. Amount of muscle tissue available. 6. Needle length should be appropriate to the site. 7. Needle should be fit to the site.
Teacher use ppt for the explanation of criteria for selecting needle and syringes.
10
Evaluation
How will you select a needle or syringe?
2 min
To elaborate the guide lines for injection.
Time
Specific Objectives
1min
To define intra dermal injections.
Guideline for injection: 1. Five right for medication to be ensured. 2. Proper hand washing and sterile technology/techniques when handling with syringes and medicine. 3. Maintain privacy during administration. 4. Proper refrigeration of medicine. 5. Accurate labeling in vial for future use. 6. Safe and proper disposable of needle. 7. Rotation of size to reduce pain. 8. Lesion can be seen to avoid side effects.
Content
Intradermal injection: It is a route for administration of medication into dermal layer of skin.
11
Teacher explain it with the use of ppt.
Teaching-Learning Activity
What are the guidelines before giving injection?
Evaluation
Teacher defines What is intra intradermal injection dermal with the use of injection? lecture.
1 min
To list down intra dermal injection purpose in children’s.
Purpose of intradermal injection in children: 1) To perform sensitivity test. 2) To perform tuberculin test. 3) To administer vaccination.
Teacher explain purposes of intradermal injection with the use of ppt.
What is the purpose of intra dermal injection?
1 min
To describe articles required in intradermal injection.
Articles required: 1) Medication card. 2) Medication vial. 3) Clean gloves 4) Sterile syringe and needle. 5) Alcohol swab. 6) Kidney tray.
Teacher explains articles in intradermal injection with the help of demonstration.
What are the articles required for intradermal injection?
Time
Specific Objectives
Content
12
Teaching-Learning Activity
Evaluation
5min
To explain procedure of intradermal injection.
Procedure of intradermal injection: 1) Check physician order of medication and verified patient. 2) Explain the procedure to parents and child according to their level of understanding. 3) Wash hand and prepare medication from ampule. 4) Wash hand and wear gloves. 5) Assemble equipment to patient side. 6) Position child and locate site for intradermal injection and take help of other person also.(inner aspect of forearm, upper chest or upper back beneath scapulae. 7) Cleanse the site in circular motion moving outward. Allow skin dry. Keep cotton in clean tray for rescue when taking out the needle. 8) Remove needle cap with the nondominant hand to spread skin taut over injection site.
13
Teacher explain The procedure of intradermal injection with the use if demonstration.
How will you give intradermal injection?
Time
Specific Objectives
Content 9) Place needle almost flat against patient’s skin and insert into the skin about 1/8 inch. 10)Slowly inject the drug (0.001-0.1 ml) watch for bleb to develop. If not present, withdraw needle slightly and inject medication. 11)Withdraw needle quickly in the same angle it was inserted. 12)Do not massage the area. 13)Do not recap the needle. 14)Assist patient to comfortable position. 15)Remove gloves and wash hands. 16)Record medication and administration. 17) Draw a circle using blue or black pen around injection site.Write date and time of administration of medication and medication name on skin. And check reaction after specified time.
14
Teaching-Learning Activity
Evaluation
Time
Specific Objectives
Content
1 min
To define subcutaneous injection.
Subcutaneous injection: Administering medication in subcutaneous tissue.
1 min
To enlist the article required in sub cutaneous injection.
Articles in sub cutaneous injection: 1) Medication card 2) Sterile syringe and needle. 3) The prescribed medication. 4) Alcohol swabs 5) Clean gloves. 6) Kidney tray.
15
Teaching-Learning Activity Teacher defines sub cutaneous injection with the help of discussion. Teacher describes articles for sub cutaneous injection with the use of demonstration.
Evaluation What is sub cutaneous injection? What are the articles required in subcutaneous injection?
Time
Specific Objectives
Content
7 min
To explain the procedure of sub cutaneous injection.
Procedure of sub cutaneous injection:1) Assemble all equipment and check physician order. 2) Identify patient.And explain the procedure to child and parent to facilitate the co-operation in treatment. 3) Wash hand and prepare medication. 4) Assemble equipment included loaded medication from ampule. 5) Help patient assume position depending on selected sit Outer aspect of upper arm Anterior thigh Abdomen 6) Wear gloves.Clean the area around the injection site with alcohol swab.Use firm circulation,allow the site to dry. 7) Remove needle cap with nondominant hand pulling straight off. 8) Grasp and pinch the area surrounding the injection site or spread at site. 16
Teaching-Learning Activity Teacher explains procedure of sub cutaneous injection with the help of demonstration.
Evaluation
How will you give sub cutaneous injection?
Time
Specific Objectives
Content
17
Teaching-Learning Activity
Evaluation
9) Hold the syringe in dominant hand between thumb and forefinger. Inject needle quickly at an angle of 45-90 degree, depending on the amount of tissue, turgor of tissue and length of needle. 10) After the insertion,release the tissue and immediately move your non dominant hand to steady lower end of syringe your dominant hand to top of the barrel. 11) Do not aspirate heparin or insulin. 12) Inject medication slowly. 13) Withdraws needle quickly at the same angle as it was inserted,while applying counter traction around the injection site with non-dominanthand. 14) Massages the area gently with alcohol swab .do not massage heparin or insulin.Because massaging heparin may cause bruise and after insulin unpredictable absorption may occur. 15) Do not recap needle. 16) Assist patient in comfortable position. 17) Place patient in comfortable position. 18) Document medication with date, time,dose and route.
Time
Specific Objectives
Content 18
Teaching-Learning
Evaluation
1 min
To define intramuscular injection.
1 min
To list down the articles required in intramuscular injection.
1 min
To elaborate site for intramuscular injection.
Time
Specific
Activity Intramuscular injection: Teacher describes A form of parenteral administration of intramuscular injection medication, where a drug is injected into a with the help of lecture deep muscle tissue. cum discussion. Articles required in Teacher describes intramuscular injection: articles in 1) Medication card. intramuscular injection 2) Sterile medication with the help of 3) Syringe and needle of demonstration. appropriate size. 4) Alcohol swab. 5) Clean gloves. 6) Kidney tray. Site for intramuscula r injection: 1) Deltoid muscle. 2) Ventrogluteal muscle. 3) Dorso gluteal 4) Vastuslateralis. Vastuslateralis, ventro gluteal and dorso gluteal are common site used in infant.
Content 19
Teacher explains sites for intramuscular injection with the use of chart.
Teaching-
Define intramuscular injection. What are the articles required in intra muscular injection?
What are site commonly used in children for intramuscular injection?
Evaluation
Objectives
Learning Activity
5min
To explain estimate site for intramuscular injection.
Different site for intra muscular injection: a) Deltoid muscleThe nurse palpates the lower edge of the acromion process. The injection site is about 2.5 to 5 cm below the acromionprocess. The nurse may locate the site by placing three fingers across the acromion process. b) Ventro gluteal muscle: It involves the gluteal muscle involves the gluteal medius and minimus. The nurse locates the muscle by placing her hand over the greater trochanter of the patient’s hip. Place the index finger over the anterior superior ileac spine and extend the middle finger along the iliac crust towards the buttocks .index fingers, middle finger and iliac crest form a v shaped triangle and injection site is its center. c) Dorso gluteal: Dorso gluteal is located in the inner, outer angel of the upper outer quadrant of the buttocks approx. 5-8 cm below iliac crest. d) Vastuslateralis: The muscle is located on the anterior, lateral aspect of thigh and extends in adults from 4---5 fingers below the greater trochanter of the femur to 4-5 fingers below the greater trochanter of the femur to 4-5 fingers above the knee.
Teacher explain site of intramuscular injection with the use of chart.
Time
Specific Objectives
Content
TeachingLearning Activity
20
What are the sites of intramuscular injection?
Evaluation
21
Time
Specific Objectives
Content
22
Teaching-Learning Activity
Evaluation
Time 5 min
Specific Objectives
Content
To explain the procedure of Procedure of intramuscular injection: intra muscular injection. 1) Check physician order and identify patient. 2) Explain the procedure to child and parent. 3) Wash hands. 4) Prepare medications. 5) Wash hand and wear gloves. 6) Position patient according to site of injection. 7) Select locate and clean site: Select site free from lesions,swelling and tenderness. Muscle should be adequatefor amount of medication to be administered. Locate exacts site of injection. Clean the site with alcohol swab. Transfer and hold the swab between 3rd and 4th finger of nondominant hand. 8) Remove needle cover without contaminating the needle by pulling straight off. 9) Confirm the medication and dosage. 10) Ensure that medication is not dripping on needle prior to injection. If so change 23
TeachingLearning Activity
Evaluation
Teacher describes How will you give procedure of intramuscular intramuscular injection? injection with the help of demonstration.
needle.
Time
Specific Objectives
Content 24
Teaching-Learning Activity
Evaluation
11) Inject the medication: Grasp and pinch the area surrounding the injection sie or skin at the site as appropriate. Hold the syringe between the thumb and fore fingers in pen holding manner and pierce skin at the skin at 90 degree and insert the needle. Aspirate by holding the barrel steady with dominant hand and pulling back the plunger with your dominant hand. Withdraw needle if blood appears in the syringe. Inject the medication slowly and steady if blood does not appear in the syringe on aspiration. 12) Withdraws the needle slowly and steady while supporting at the hub of syringe and needle. With non-dominant hand support skin. 13) Apply gentle pressure at the site and dry sponging and if bleeding persist apply pressure, do not massage as it irritate the skin. 14) Record the procedure.
Time
Specific Objectives
Content
25
Teaching-Learning Activity
Evaluation
26
Time 1 min
Specific Objectives To illustrate pediatric variation in intramuscular injection.
Content
TeachingEvaluation Learning Activity Pediatric variation: Teacher explain it What are the 1) A syringe that can measure very small with the use of ppt. pediatric variations amount of solutions such as 0.5 ml in intramuscular syringe for less than 0.5 ml injection? medication or tuberculin syringe. 2) The needle length should be sufficient to penetrate the subcutaneous tissue and deposits the medication in the muscle. 3) The needle gauge should be small to deliver fluid safely. 4) If the muscle is grasped to bunched, the needle length recommended for insertion is 25 mm .if the muscle is stretched or flattened, a needle length of 16 mm is recommended.
27
2 min
Time 1min
To define intravenous injection.
Specific Objectives To list down the articles required in intravenous injection.
Intravenous injection Introducing a single dose of concentrated medications directly into the systemic circulation. The iv bolus can be given as follows: Directly into vein Into an existing iv line through an injection port Through saline.
Content Articles: a) Iv push(existing line) Clean gloves Medication ampule. Syringe 3-5 ml Sterile needle Swab Wrist watch Medication administration route
28
Teacher explain What is intravenous route intravenous with the help of injection? lecture cum discussion.
TeachingLearning Activity Teacher explains articles with the use of demonstration.
Evaluation What are the articles required for intravenous injection.
5min
to elaborate intra venous injection
Time
Specific Objectives
Procedure of intravenous injection:1) Check the physician order and identify the patient. 2) Assess condition of the needle insertion site for signs of infiltration and phlebitis. 3) Check patient history for any drug reaction. 4) Assemble supplies in medication room. 5) Wash hand and wear gloves. 6) Prepare medication. 7) Check patient name and medication card again. Content
29
TeachingLearning Activity
Evaluation
8) Spread the mackintosh and the towel under the site to be punctured for IV injection. 9) Prepare the vein by applying tourniquet above the vein and ask the patient to close the fist. 10)When the needle is in the vein, ask the client to relax the fist and remove the tourniquet and push the medication. 11)Remove the needle and put pressure on the puncture site with sterile swabs. 12) Make the patient comfortable and record the procedure.
Time
Specific Objectives
Content
Teaching-Learning Activity
30
Evaluation
SUMMARY: So today we have studied nurse’s responsibilities in injection. We have also studied what are the common sites for injection, purpose of injection, procedure of injections, complications regarding injection and nursing responsibility in injection. CONCLUSION: So after the class we came to know that how nurses are important in administering medication safely and efficiently. So she must have thorough knowledge of the medicine and the patient who is receiving it. The nurse should have physical assessment skill and follow the schedule for drug therapy. a patient’s wellbeing depends upon the principal of drug application. EVALUATION: Student will be evaluated by the questions written in evaluation column and multiple choice questions given by student teacher. 31
Bibliography: Book:1) 2) 3) 4)
Marlow and Redding. Text book of pediatric nursing. Sixth edition. Elsevier publication.2010. 287-290. Wongs and Werry. Text book of pediatric nursing. Third edition, Elsevier publication.2005. 205-208 Taylor. “Fundamental of nursing”. 5th edition, Lippincott Williams and Wilkins publication.2005.734-748. Trained nurses association of India.” Fundamental of nursing-procedure manual”. First edition. Secretary General on behalf of Trained nurses association publisher.370-382. 5) Jacob Annamma and r.rekha et.al. “Clinical nursing procedure: the art of nursing practice “second edition. 2005. Jaypee publication. 265-275. 6) Clement.I “basic concept of nursing procedure”. Second edition. 2005. Jaypee publication. 165-172. Net:1) http://www.intelihealth.com
32
Specific Objectives
Content
30 sec
Teaching-Learning Activity
INTRODUCTION:-
Drug therapy plays a major role in the treatment of patients. Although prescribed by the doctor, the safe and accurate administration of medications is one of the important responsibilities. She must know the therapeutic action and usual dosage of a drug. The nurse should be alert to observe adverse effect of the drug. She should realize that the patient’s condition may alter the effect of a drug and that there may be interactions with concurrent therapy. Nurse must be aware of regulations affecting drug administration. ANNOUNCEMENT TOPIC :-
2
OF
Evaluation
Today,we will discuss important aspect of medication i.e. injection.
Time
Specific Objectives
Content 3
Teaching-Learning Activity
Evaluation
1min
After the class group will be able to :DEFINITION: To define the term injection.
1 min
Injection is a type of parenteral medication which is an invasive procedure and it must be performed under a strict aseptic technique.It involves administration of drug by a route through injection into the body tissue. Types of injection: Intradermal: when medication are injected To list down the common into dermis. types of injection. Subcutaneous:when medication is injected into the muscle Intramuscular: when medication are injected into muscles. Intravenous:when medication and fluids 4
Teacher defines the term injection by using lecture cum discussion along with ppt.
Define injection.
Teacher explains type of What are the injection with the use of flash different types of card. injection?
administer in veins.
Time
Specific Objectives
Content
5
Teaching-Learning Activity
Evaluation
2 min
To illustrate the purpose of injection.
2 min
To list down the factors contributing to effective absorption.
Purpose of injection: 1. To get a rapid and systemic effects of the drug. 2. To obtain maximum effect of the drug even when the patient is unconscious,unable to swallow due to neurological or surgical alteration affecting the throat and mouth or when patient is un cooperative. 3. When the drug is toxic and irritating to gastro intestinal tract. 4. To obtain a local effect at the site of injection. 5. To restore blood volume by replacing the fluid e.g. Inn shock. Factors contributing to effective absorption:1. Injections are more quickly absorbed in the area that is richly supplied with blood. 2. Isotonic fluids are absorbed more easily in the blood. 3. Absorption of medicine is retarded in the patients with edema, neurogenic, cardiogenic and vasogenic shock. 4. Absorption of medication is delayed in cases of skin lesion, fibrosis. 6
Teacher explains it What is the with the use of chart. purpose of injection?
Teacher describe factor contributing in effective absorption of medicine with the help of ppt.
What factors affect medicine absorption?
Time
Specific Objectives
3 min
To enlist the complications of injection.
Content
Teaching-Learning Activity Complication of injection:Teacher explains it Infection: handling and improper with the use of ppt. sterilization of syringes, needles and fluid used for injections may introduce infection in the body. Pyogenic reaction: patients getting intravenous injection may develop fever due to pyrogens present in the fluid. Allergic reaction: certain drugs produce allergic reactions in patients.it can be prevented by a test dose. Tissue trauma: repeated injection on the same site can cause scar formation and injury to nerve. Pain swelling: if given on the site, it will result in pain and swelling. Foot drop: dropping of foot from a tibial lesion that causes paralysis of the anterior muscles of the leg due to nerve injury. Air embolism: air embolism due to the introduction of air into blood vessel Circulatory overload Serum hepatitis Over dose and under dose of medication 7
Evaluation What are the complications of injection?
may cause complications.
8
Time
Specific Objectives
5 min
To calculate drug dosage in children’s
Content
CALCULATION OF DRUG DOSAGE: Medication based on body surface area: Child dose=child BSA*adult dose adult BSA Young’s rule:
Child dose=age of child *adult dose age +12 Clark’s rule: child dose=weight of child in pound *adult dose 150 Fried’srule: Child dose=child’s age in month*adult dose 150
9
Teaching-Learning Activity Teacher use ppt to explain calculation of drug dosage.
Evaluation
How will you calculate drug dosage in children?
Time
2 min
Specific Objectives To enlist criteria for selection of syringes and needle.
Content
Teaching-Learning Activity
Criteria for selection of needles and syringes: 1. The route prescribed. 2. Viscosity of medication. 3. Size of child. 4. Amount of medication to be administered. 5. Amount of muscle tissue available. 6. Needle length should be appropriate to the site. 7. Needle should be fit to the site.
Teacher use ppt for the explanation of criteria for selecting needle and syringes.
10
Evaluation
How will you select a needle or syringe?
2 min
To elaborate the guide lines for injection.
Time
Specific Objectives
1min
To define intra dermal injections.
Guideline for injection: 1. Five right for medication to be ensured. 2. Proper hand washing and sterile technology/techniques when handling with syringes and medicine. 3. Maintain privacy during administration. 4. Proper refrigeration of medicine. 5. Accurate labeling in vial for future use. 6. Safe and proper disposable of needle. 7. Rotation of size to reduce pain. 8. Lesion can be seen to avoid side effects.
Content
Intradermal injection: It is a route for administration of medication into dermal layer of skin.
11
Teacher explain it with the use of ppt.
Teaching-Learning Activity
What are the guidelines before giving injection?
Evaluation
Teacher defines What is intra intradermal injection dermal with the use of injection? lecture.
1 min
To list down intra dermal injection purpose in children’s.
Purpose of intradermal injection in children: 1) To perform sensitivity test. 2) To perform tuberculin test. 3) To administer vaccination.
Teacher explain purposes of intradermal injection with the use of ppt.
What is the purpose of intra dermal injection?
1 min
To describe articles required in intradermal injection.
Articles required: 1) Medication card. 2) Medication vial. 3) Clean gloves 4) Sterile syringe and needle. 5) Alcohol swab. 6) Kidney tray.
Teacher explains articles in intradermal injection with the help of demonstration.
What are the articles required for intradermal injection?
Time
Specific Objectives
Content
12
Teaching-Learning Activity
Evaluation
5min
To explain procedure of intradermal injection.
Procedure of intradermal injection: 1) Check physician order of medication and verified patient. 2) Explain the procedure to parents and child according to their level of understanding. 3) Wash hand and prepare medication from ampule. 4) Wash hand and wear gloves. 5) Assemble equipment to patient side. 6) Position child and locate site for intradermal injection and take help of other person also.(inner aspect of forearm, upper chest or upper back beneath scapulae. 7) Cleanse the site in circular motion moving outward. Allow skin dry. Keep cotton in clean tray for rescue when taking out the needle. 8) Remove needle cap with the nondominant hand to spread skin taut over injection site.
13
Teacher explain The procedure of intradermal injection with the use if demonstration.
How will you give intradermal injection?
Time
Specific Objectives
Content 9) Place needle almost flat against patient’s skin and insert into the skin about 1/8 inch. 10)Slowly inject the drug (0.001-0.1 ml) watch for bleb to develop. If not present, withdraw needle slightly and inject medication. 11)Withdraw needle quickly in the same angle it was inserted. 12)Do not massage the area. 13)Do not recap the needle. 14)Assist patient to comfortable position. 15)Remove gloves and wash hands. 16)Record medication and administration. 17) Draw a circle using blue or black pen around injection site.Write date and time of administration of medication and medication name on skin. And check reaction after specified time.
14
Teaching-Learning Activity
Evaluation
Time
Specific Objectives
Content
1 min
To define subcutaneous injection.
Subcutaneous injection: Administering medication in subcutaneous tissue.
1 min
To enlist the article required in sub cutaneous injection.
Articles in sub cutaneous injection: 1) Medication card 2) Sterile syringe and needle. 3) The prescribed medication. 4) Alcohol swabs 5) Clean gloves. 6) Kidney tray.
15
Teaching-Learning Activity Teacher defines sub cutaneous injection with the help of discussion. Teacher describes articles for sub cutaneous injection with the use of demonstration.
Evaluation What is sub cutaneous injection? What are the articles required in subcutaneous injection?
Time
Specific Objectives
Content
7 min
To explain the procedure of sub cutaneous injection.
Procedure of sub cutaneous injection:1) Assemble all equipment and check physician order. 2) Identify patient.And explain the procedure to child and parent to facilitate the co-operation in treatment. 3) Wash hand and prepare medication. 4) Assemble equipment included loaded medication from ampule. 5) Help patient assume position depending on selected sit Outer aspect of upper arm Anterior thigh Abdomen 6) Wear gloves.Clean the area around the injection site with alcohol swab.Use firm circulation,allow the site to dry. 7) Remove needle cap with nondominant hand pulling straight off. 8) Grasp and pinch the area surrounding the injection site or spread at site. 16
Teaching-Learning Activity Teacher explains procedure of sub cutaneous injection with the help of demonstration.
Evaluation
How will you give sub cutaneous injection?
Time
Specific Objectives
Content
17
Teaching-Learning Activity
Evaluation
9) Hold the syringe in dominant hand between thumb and forefinger. Inject needle quickly at an angle of 45-90 degree, depending on the amount of tissue, turgor of tissue and length of needle. 10) After the insertion,release the tissue and immediately move your non dominant hand to steady lower end of syringe your dominant hand to top of the barrel. 11) Do not aspirate heparin or insulin. 12) Inject medication slowly. 13) Withdraws needle quickly at the same angle as it was inserted,while applying counter traction around the injection site with non-dominanthand. 14) Massages the area gently with alcohol swab .do not massage heparin or insulin.Because massaging heparin may cause bruise and after insulin unpredictable absorption may occur. 15) Do not recap needle. 16) Assist patient in comfortable position. 17) Place patient in comfortable position. 18) Document medication with date, time,dose and route.
Time
Specific Objectives
Content 18
Teaching-Learning
Evaluation
1 min
To define intramuscular injection.
1 min
To list down the articles required in intramuscular injection.
1 min
To elaborate site for intramuscular injection.
Time
Specific
Activity Intramuscular injection: Teacher describes A form of parenteral administration of intramuscular injection medication, where a drug is injected into a with the help of lecture deep muscle tissue. cum discussion. Articles required in Teacher describes intramuscular injection: articles in 1) Medication card. intramuscular injection 2) Sterile medication with the help of 3) Syringe and needle of demonstration. appropriate size. 4) Alcohol swab. 5) Clean gloves. 6) Kidney tray. Site for intramuscula r injection: 1) Deltoid muscle. 2) Ventrogluteal muscle. 3) Dorso gluteal 4) Vastuslateralis. Vastuslateralis, ventro gluteal and dorso gluteal are common site used in infant.
Content 19
Teacher explains sites for intramuscular injection with the use of chart.
Teaching-
Define intramuscular injection. What are the articles required in intra muscular injection?
What are site commonly used in children for intramuscular injection?
Evaluation
Objectives
Learning Activity
5min
To explain estimate site for intramuscular injection.
Different site for intra muscular injection: a) Deltoid muscleThe nurse palpates the lower edge of the acromion process. The injection site is about 2.5 to 5 cm below the acromionprocess. The nurse may locate the site by placing three fingers across the acromion process. b) Ventro gluteal muscle: It involves the gluteal muscle involves the gluteal medius and minimus. The nurse locates the muscle by placing her hand over the greater trochanter of the patient’s hip. Place the index finger over the anterior superior ileac spine and extend the middle finger along the iliac crust towards the buttocks .index fingers, middle finger and iliac crest form a v shaped triangle and injection site is its center. c) Dorso gluteal: Dorso gluteal is located in the inner, outer angel of the upper outer quadrant of the buttocks approx. 5-8 cm below iliac crest. d) Vastuslateralis: The muscle is located on the anterior, lateral aspect of thigh and extends in adults from 4---5 fingers below the greater trochanter of the femur to 4-5 fingers below the greater trochanter of the femur to 4-5 fingers above the knee.
Teacher explain site of intramuscular injection with the use of chart.
Time
Specific Objectives
Content
TeachingLearning Activity
20
What are the sites of intramuscular injection?
Evaluation
21
Time
Specific Objectives
Content
22
Teaching-Learning Activity
Evaluation
Time 5 min
Specific Objectives
Content
To explain the procedure of Procedure of intramuscular injection: intra muscular injection. 1) Check physician order and identify patient. 2) Explain the procedure to child and parent. 3) Wash hands. 4) Prepare medications. 5) Wash hand and wear gloves. 6) Position patient according to site of injection. 7) Select locate and clean site: Select site free from lesions,swelling and tenderness. Muscle should be adequatefor amount of medication to be administered. Locate exacts site of injection. Clean the site with alcohol swab. Transfer and hold the swab between 3rd and 4th finger of nondominant hand. 8) Remove needle cover without contaminating the needle by pulling straight off. 9) Confirm the medication and dosage. 10) Ensure that medication is not dripping on needle prior to injection. If so change 23
TeachingLearning Activity
Evaluation
Teacher describes How will you give procedure of intramuscular intramuscular injection? injection with the help of demonstration.
needle.
Time
Specific Objectives
Content 24
Teaching-Learning Activity
Evaluation
11) Inject the medication: Grasp and pinch the area surrounding the injection sie or skin at the site as appropriate. Hold the syringe between the thumb and fore fingers in pen holding manner and pierce skin at the skin at 90 degree and insert the needle. Aspirate by holding the barrel steady with dominant hand and pulling back the plunger with your dominant hand. Withdraw needle if blood appears in the syringe. Inject the medication slowly and steady if blood does not appear in the syringe on aspiration. 12) Withdraws the needle slowly and steady while supporting at the hub of syringe and needle. With non-dominant hand support skin. 13) Apply gentle pressure at the site and dry sponging and if bleeding persist apply pressure, do not massage as it irritate the skin. 14) Record the procedure.
Time
Specific Objectives
Content
25
Teaching-Learning Activity
Evaluation
26
Time 1 min
Specific Objectives To illustrate pediatric variation in intramuscular injection.
Content
TeachingEvaluation Learning Activity Pediatric variation: Teacher explain it What are the 1) A syringe that can measure very small with the use of ppt. pediatric variations amount of solutions such as 0.5 ml in intramuscular syringe for less than 0.5 ml injection? medication or tuberculin syringe. 2) The needle length should be sufficient to penetrate the subcutaneous tissue and deposits the medication in the muscle. 3) The needle gauge should be small to deliver fluid safely. 4) If the muscle is grasped to bunched, the needle length recommended for insertion is 25 mm .if the muscle is stretched or flattened, a needle length of 16 mm is recommended.
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2 min
Time 1min
To define intravenous injection.
Specific Objectives To list down the articles required in intravenous injection.
Intravenous injection Introducing a single dose of concentrated medications directly into the systemic circulation. The iv bolus can be given as follows: Directly into vein Into an existing iv line through an injection port Through saline.
Content Articles: a) Iv push(existing line) Clean gloves Medication ampule. Syringe 3-5 ml Sterile needle Swab Wrist watch Medication administration route
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Teacher explain What is intravenous route intravenous with the help of injection? lecture cum discussion.
TeachingLearning Activity Teacher explains articles with the use of demonstration.
Evaluation What are the articles required for intravenous injection.
5min
to elaborate intra venous injection
Time
Specific Objectives
Procedure of intravenous injection:1) Check the physician order and identify the patient. 2) Assess condition of the needle insertion site for signs of infiltration and phlebitis. 3) Check patient history for any drug reaction. 4) Assemble supplies in medication room. 5) Wash hand and wear gloves. 6) Prepare medication. 7) Check patient name and medication card again. Content
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TeachingLearning Activity
Evaluation
8) Spread the mackintosh and the towel under the site to be punctured for IV injection. 9) Prepare the vein by applying tourniquet above the vein and ask the patient to close the fist. 10)When the needle is in the vein, ask the client to relax the fist and remove the tourniquet and push the medication. 11)Remove the needle and put pressure on the puncture site with sterile swabs. 12) Make the patient comfortable and record the procedure.
Time
Specific Objectives
Content
Teaching-Learning Activity
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Evaluation
SUMMARY: So today we have studied nurse’s responsibilities in injection. We have also studied what are the common sites for injection, purpose of injection, procedure of injections, complications regarding injection and nursing responsibility in injection. CONCLUSION: So after the class we came to know that how nurses are important in administering medication safely and efficiently. So she must have thorough knowledge of the medicine and the patient who is receiving it. The nurse should have physical assessment skill and follow the schedule for drug therapy. a patient’s wellbeing depends upon the principal of drug application. EVALUATION: Student will be evaluated by the questions written in evaluation column and multiple choice questions given by student teacher. 31
Bibliography: Book:1) 2) 3) 4)
Marlow and Redding. Text book of pediatric nursing. Sixth edition. Elsevier publication.2010. 287-290. Wongs and Werry. Text book of pediatric nursing. Third edition, Elsevier publication.2005. 205-208 Taylor. “Fundamental of nursing”. 5th edition, Lippincott Williams and Wilkins publication.2005.734-748. Trained nurses association of India.” Fundamental of nursing-procedure manual”. First edition. Secretary General on behalf of Trained nurses association publisher.370-382. 5) Jacob Annamma and r.rekha et.al. “Clinical nursing procedure: the art of nursing practice “second edition. 2005. Jaypee publication. 265-275. 6) Clement.I “basic concept of nursing procedure”. Second edition. 2005. Jaypee publication. 165-172. Net:1) http://www.intelihealth.com
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