INTRAMUSCULAR INJECTION

Definition

An intramuscular, or IM, injection is a procedure used to insert medications into the muscle
tissue. Some medication cannot be taken by mouth because digestive juices can alter their
effects. Others can be very irritating when they go into fatty tissues or veins. IM injections
insert medication deep into the muscle, where there is an adequate supply of blood. This
facilitates fast absorption and leads to better effects and outcomes.
Purposes

 Intramuscular injection is used for the delivery of certain drugs not recommended for
other routes of administration, for instance intravenous, oral, or subcutaneous.
 The intramuscular route offers a faster rate of absorption than the subcutaneous route,
and muscle tissue can often hold a larger volume of fluid without discomfort.
 In contrast, medication injected into muscle tissues is absorbed less rapidly and takes
effect more slowly that medication that is injected intravenously. This is favorable for
some medications.

Indications

Drugs can be administered for these purposes:-

 Diagnostic purposes e.g. assessment of liver function or diagnosis of myasthenia

gravis.
 Prophylaxis e.g. heparin to prevent thrombosis or antibiotics to prevent infection
 Therapeutic purposes. E.g. replacement of fluids and vitamins, supportive purposes
etc.

Contraindications

 Nausea
 Vomiting
 Delirium
 unconsciousness

Forms of oral medication

 Tablets
 Capsules
 Liquid drug like syrup
 Also available as powder granules.

Types of medication order

 STAT order:- needed immediately

  Single order:-given only once
 PRN order:- given as needed
 Routine orders:- given within 2 hours of being written and carried out on schedule.
 Standing order:- written in advance carried out under specific circumstances.

Sites for IM injection administration :

There are five main locations on the human body where IM injections are administered. It's
important to know them, because the correct location can vary based on a recipient's age,
body mass and type of medication.
The dorsogluteal injection site is in the upper outer quadrant of the buttock. Be careful to
identify the correct location because permanent damage to the body can occur if the injection
reaches the sciatic nerve that is close by.

The ventrogluteal injection site is located in the upper side of the hip. It is the preferred site
for most IM injections given to adults.
The deltoid injection site is one to two inches below the shoulder region. Many adult
vaccinations are administered at this site.

There are two IM injection sites located in the leg. The vastus lateralis is located mid-thigh
on the outer side of the leg. The rectus femoris is also located mid-thigh, but on the anterior
part of the leg. These are common sites used in infants and young children but can be an
alternate site for adults.
Nurse`s responsibility in administration of oral drugs

 Check the physician`s order, check the diagnosis and age of the patient.
 Check the purpose of medication
 Check the nurses record for the time of last dose given
 Check for any contraindications present (nausea, vomiting, delirium, unconsciousness
etc)
 Check the form of drug available
 Break the tablets only if it is scored.
 Explain the procedure to the patient, discuss the need of medications.
 Assist the patient sitting position if possible.
 Stay with the patient until swallow medicine.
 Nurses must know the generic and trade names of the drugs to be administered,
classification, average dose, route of administration, use, side and adverse effects,
contraindications, and nursing implications in administration.
 Essential part of medication order
 Abbreviations and symbols used in writing medication as per hospital policies
 Preparation of solutions and fractional doses.
 Follow the Rules and legal aspects.

Rights of patient during drug administration

 Right drug
 Right dose
 Right patient
 Right route
 Right preparation
 Right time
 Right handling
 Right storage
 Right expire date
  Right discard
 Right administration
 Right explanation
 Right documentation
 Right order
 Right patient chart
 Right universal precautions

Precautions

 Other routes are used when a person cannot take anything by mouth, or the drug is
poorly absorbed by the gastrointestinal tract. The nurse should check whether the
patient has any known allergies. It is useful to remember the following checks when
administering any medication: the right patient, the right medicine, the right route, the
right dose, the right site, and the right time.

Description

 Oral drugs are can be prescribed to be taken at different intervals, either before or
after food. They can be in either liquid or solid form. Questions about the frequency
with which drugs should be taken should be addressed to the primary health care
provider.

Procedure
Name of patient : Madhu , 32 years /F
Name of drug : CLOZAPINE
Class : Atypical antipsychotic
Diagnosis of patient : Schizophrenia
Dose : 50 mg
Route of administration : oral route
a. Pre medication & during medication
1. Gather equipment. Check each medication order against original physician’s order
according to agency policy. Clarify any inconsistencies. Check patient’s chart for
allergies.
2. Know actions, special nursing consideration, and adverse effects of medications to be
administered.
3. Perform proper hand hygiene.
4. Move medication cart outside patient’s room or prepare for administration in medication
area.
5. Unlock medication cart or drawer.
6. Prepare medications .
7. Select proper medication from drawer or stock and compare with order. Check
expiration dates and perform calculations if necessary.
1. Place unit dose-package medications in a disposable cup. Do not open wrapper until
at bedside. Keep narcotics and medications that require special nursing assessments
in a separate container.
2. When removing tablets or capsules from a bottle, pour the necessary number into
bottle cap and then place tablets in a medications cup. Break only scored tablets, if
necessary, to obtain proper dose.
 3. Hold liquid medication bottles with the label against palm. Use appropriate
measuring device when pouring liquids and read the amount of medication at the
bottom of the meniscus at eye level. Wipe bottle lip with a paper towel.
8. Recheck each medication package or preparation with the order as it is poured.
9. When all medications for one patient have been prepared, recheck once again with the
medication order before taking them to patient.
10. Carefully transport medications to patient’s bedside. Keep medications in sight at all
times.
11. See that patient receives medications at the correct time.
12. Identify the patient carefully. There are three correct ways to do this.
a. Check name on patient’s identification bracelet.
b. Ask patient his or her name.
c. Verify patient’s identification with a staff member who knows patient.
13. Assess for hallucinations, mental status, dementia, bipolar disorder (initially and
throughout therapy).
14. Obtain complete health history, especially psychological, neurologic and blood diseases:
including blood studies: CBC, WBC with differential, electrolytes, BUN, creatinine, liver
enzymes.
15. Obtain patient’s drug history to determine possible drug interactions and allergies.
Assist patient to an upright or lateral position.
16. Administer medications.
a. Offer water or other permitted fluids with pills, capsules, tablets, and some
liquid medications.
b. Ask patient’s preference regarding medications to be taken by hand or in cup
and one at a time or all at once.
c. If capsule or tablet falls to the floor, discard it and administer a new one.
d. Record and fluid intake I-O measurement is ordered.
e. Remain with patient until each medication is swallowed unless nurse has been
patient swallow drug, she or he cannot record drug as having been administered.
17. Perform hand hygiene.
18. Record medication given on medication chart or record using required format.
b. Post medication

 After ensuring that the drug has been taken, the nurse should record the time and the
dose that has been given.
 The nurse should monitor the patient's reaction and provide reassurance, if required.

 Advise the patient to get up from the bed or chair very slowly. Patient should sit on
the edge of the bed for one full minute dangling his feet before standing up. Check BP
before and after medication is given. This is an important measure to prevent falls and
other complications resulting from orthostatic hypotension.

 Observe the patient regularly for abnormal movements.

 Take all seizure precautions.

 Monitor TLC , DLC

 Monitor for hematologic side effects. (Neutropenia, leukopenia, agranulocytosis,

thrombocytopenia may occur, secondary to possible bone marrow suppression caused
by clozapine.)
  Observe for side effects such as drowsiness, sedation, dizziness, depression, anxiety,
tachycardia, hypotension, nausea/vomiting, excessive salivation, urinary frequency or
urgency, incontinence, muscle pain or weakness, rash, fever.

 Monitor for anticholinergic side effects: mouth dryness, constipation, urinary

retention

Complications

Possible complications include:

 Myocarditis
 Cardiomyopathy
 Venous thromboembolism
 Constipation
 Tachycardia