Identify route of drug administration:

NORCET 6 Prelims -2024

Nursing Foundation

Medium

Appeared in: NORCET 6 Prelims -2024

Explanation

The image displays the Z-track method, where the skin and subcutaneous tissue are pulled laterally before injection.
The needle is inserted at a 90-degree angle, which is characteristic of an intramuscular (IM) injection, ensuring the medication is delivered deep into the muscle.
This combination of skin displacement and deep muscle injection is known as an IM injection with the Z-track technique.
The purpose of this technique is to seal the medication within the muscle, preventing leakage into the subcutaneous tissue, which minimizes irritation and pain.

Option A: A subcutaneous injection is administered into the fatty tissue layer, which is more superficial than the muscle layer shown in the image. Although a Z-track can be used, the depth of injection in the diagram is clearly into the muscle.
Option C: An intravenous (IV) injection delivers medication directly into a vein. The image shows the needle in muscle tissue, not a blood vessel.
Option D: An intradermal injection is the shallowest type, administered just beneath the epidermis at a 10 to 15-degree angle, forming a small bubble or 'bleb'. The image shows a deep injection at a 90-degree angle.

Visual 1: Diagram - A comparative chart showing the different angles of insertion (10-15°, 45°, 90°) and corresponding tissue layers (dermis, subcutaneous, muscle) for intradermal, subcutaneous, and intramuscular injections.
Visual 2: Step-by-step infographic of the Z-track method, showing (1) skin displacement, (2) injection, (3) waiting 10 seconds, and (4) needle withdrawal followed by skin release.

Clinical Relevance

Nursing practice connection: Knowing Parenteral drug administration techniques helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The Z-track method is a critical nursing skill to reduce patient discomfort and prevent complications like skin staining (e.g., with iron injections) and tissue irritation from certain medications.
Proper site selection and landmarking (e.g., ventrogluteal, vastus lateralis) are crucial when performing IM injections to avoid injury to nerves and blood vessels.
What if the medication was insulin? The route would change to subcutaneous. The nurse would typically pinch the skin (not pull it sideways) and inject at a 45 or 90-degree angle into the adipose tissue, not the muscle.

How to Approach the Question

First, carefully analyze the image provided. Pay close attention to the angle of the needle, the depth of penetration, and how the nurse's hands are interacting with the patient's skin.
Identify the key actions shown: the skin is being pulled to the side (laterally), and the needle is inserted at a 90-degree angle deep into the tissue.
Recall the different parenteral routes of administration (Intradermal, Subcutaneous, Intramuscular, Intravenous) and their defining characteristics (angle, tissue layer).
Recognize that pulling the skin laterally is the specific technique known as the 'Z-track' method.
Combine the observations: a 90-degree injection into muscle + the Z-track technique points directly to 'IM with Z track'.
Evaluate the given options to find the one that accurately describes this combination of actions.

Concept Tested & Keywords

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