Medication Administration

IM Case Study

The physician has ordered a Hepatitis B vaccination for a 68 year-old female patient.  The patient is frail and has recently lost weight.  The vaccine is in an aqueous solution and come in a 0.5 mL dose to be given IM.
  1. In choosing the needle size, which is better for this patient--a 1" or 1 1/2" needle size?
  2. In choosing the needle gauge, which would be more appropriate for this patient--a 25 gauge or 20 gauge?
  3. In choosing an injection site for this patient, what are three things the nurse will consider?
  4. What IM injection technique is recommended to prevent irritation along the injection track?
Answers:
  1. A 1" needle size is preferred because of the patient's frailty.
  2. A 25-gauge needle is more appropriate for the aqueous solution and the patient's condition.
  3. Age, type of solution, the muscle, amount of adipose tissues covering the muscle, and tissue integrity are worth considering.  (Any three of these answers are correct.)
  4. The Z-track technique is recommended to prevent irritation along the injection track.