Parenteral medications are given through a route other than the alimentary canal,
These routes are intradermal, subcutaneous, intramuscular, or intravenous.
The angle of injection and the of penetration will indicate the type of injection.
Principles involved in the administration of injections:
1. The knowledge of the anatomy and physiology of the body is essential for the safe administration of the injection.
a) to avoid injury to the underlying tissues
b) to minimize pain
c) to aid in absorption of the drug
2. If carelessly given, injection are a means of introducing infection into the body.
3. Drugs that change the chemical composition of the blood will endanger the life of the client, if not given cautiously,
4. Any unfamiliar situation produces anxiety
5. Once a drug is injected, it is irretrievable. Antidote may be available for particular medications but the best antidote is prevention.
6. Organization and planning results in the economy of time, material and comfort.
· Give injection only on the doctor's written orders
· Follow strict aseptic techniques
· Always ensure that the syringes and needles are in good working condition
· Change the needle after withdrawing drug from a rubber capped Vial as the needle become blunt
· Follow the 10 rights of medication administration
· Never use a drug if the expiry date is over
· Always have the client relaxed and placed in a comfortable position
· Watch the client for some time after the injection for any reaction
· Always give a best dose in case of antibiotics before the first dose is administered to rule out any allergic reaction
· Expel any air from the syringe before injecting the medication
· Select an appropriate site for injection
· Rotate the sites, especially for clients getting insulin to prevent lipodystrophy ( wasting of subcutaneous tissue )
· Use correct technique of injection
· After inserting the needle, always withdraw the piston to make are it is not in a blood vessel. If there is blood in the syringe, withdraw the needle and give the injection at another site
· Solutions for injections should be clear, sterile, isotonic if possible, non-hemolytic and contain only substances that are soluble in water when used for IV injections
· Do not Massage the area at the site of injection
· Injection administration should be charted immediately after it is administered by the person who has given it along with the signature.
Administering medications by inhalation
Medications administered by handheld inhalers are dispersed through an aerosol spray, mist or powder via a metered-dose inhaler or by nebulization so that the medication is delivered directly to the membranes of the airways. The alveolar-capillary network absorbs medications rapidly.
Medications administered by inhalation, such as bronchodilators, are frequently given to clients who have chronic respiratory disease such as asthma, emphysema, or bronchitis.
A metered-dose inhaler (MDI) is a handheld nebulizer (HHN) that can be used by clients to self administer measured doses of an aerosol medication
Metered-dose inhalers (MDIs) are usually designed to produce local effects such as bronchodilation.
Clients who have chronic respiratory disease such as asthma, emphysema or bronchitis often receive medications by inhalation.
An MDI delivers a measured dose of medication with each push of a canister.
Spacers are holding chamber into which the medication is fired and from which the client inhales, so that the dose is not lost by exhalation.
Using a Metered-Dose Inhaler:
· Ensure that the canister is firmly and fully inserted into the inhaler,
· Remove the mouthpiece cap. Holding the inhaler upright, shake the inhaler vigorously for 3 to 5 seconds to mix the medication evenly.
· Exhale comfortably (as in a normal full breath).
· Hold the canister upside down.
a) Hold the MDI 2 to 4 cm (l to 2 in.) from the open mouth.
b) Put the mouthpiece far enough into the mouth with its opening toward the such that the lips can tightly close around the mouthpiece
An MDI with a spacer or extender is always placed in the mouth, This method should not be used for steroid medications via an MDI because it is not considered as efficient in delivery or the medication. (Bower, 2005).
ADMNISTERING THE MEDICATION
Press down once on the MDI canister (which releases the dose) and inhale slowly (for 3 to 5 seconds) and deeply the mouth.
Hold your breath for 10 seconds or as long possible. This allows the aerosol to reach deeper airways.
Remove the inhaler from or away from the mouth,
Exhale slowly through pursed lips. Controlled exhalation keeps the small airways open during exhalation.
Repeat the inhalation if ordered. Wait 20 to 30 seconds between inhalations of bronchodilator medications so the first inhalation a chance to work and the subsequent dose reaches deeper into the lungs,
Following use of the inhaler, rinse mouth with tap water to remove any remaining medication and reduce irritation and risk of infection.
Clean the MDI mouthpiece after each use. Use mild soap and water, rinse it, and let it air dry bet-ore replacing it on the device.
In acute asthma, inhaled beta-2-agonists have in the been administered for relief of bronchospasm using wet nebulisation. More recently, clinicians and researchers have argued that metered-dose inhalers with a holding chamber (spacer) are just as effective, easier to use as they do not require a power source or regular maintenance and less expensive.
A systematic review of the research comparing the effects of holding chambers compared with nebulisers for the delivery of beta-2-agonists for acute asthma undertaken. 2295 children and 614 adults were included from 27 trials from emergency room and community settings, In addition. six trials on inpatients with acute asthma (213 children and 28 adults) were also reviewed.
Metered-dose inhalers with holding produced outcomes that were at equivalent to nebuliser delivery.
Holding chambers may have some advantages compared with nebulisers for children with acute asthma.