The nurse has an order for medication to be administered intrathecally. The nurse is aware that medications will be administered by which method?

1. A

   Intravenously

2. B

   Rectally

3. C

   Intramuscularly

4. D

   Into the cerebrospinal fluid

Appeared in: RAK Nursing Officer - 2019

Explanation

• The term 'intrathecal' specifically means injecting a substance into the subarachnoid space of the spinal canal.
• The subarachnoid space is the anatomical location that contains cerebrospinal fluid (CSF).
• This route is chosen when a medication needs to act directly on the central nervous system (brain and spinal cord), bypassing the protective blood-brain barrier.
• Examples include spinal anesthesia, certain types of chemotherapy, and management of severe pain or spasticity.

Why Other Options Were Wrong

• Option A: Intravenous (IV) administration involves injecting medication directly into a vein, allowing it to enter the systemic circulation immediately.
• Option B: Rectal administration involves inserting medication into the rectum. It can be used for local effects (e.g., laxatives) or systemic effects (e.g., anti-nausea suppositories).
• Option C: Intramuscular (IM) administration involves injecting medication into a muscle. The drug is then absorbed from the muscle tissue into the bloodstream.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Route of Medication Administration: Intrathecal helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Intrathecal administration is a high-risk procedure that requires specialized training. A critical nursing responsibility is ensuring that only preservative-free medications specifically prepared for intrathecal use are administered to prevent severe neurotoxicity.
• Nurses must meticulously monitor for complications, especially post-dural puncture headache (PDPH), which is caused by CSF leakage. Initial management includes keeping the patient flat, ensuring hydration, and administering analgesics as ordered.
• What if? If the order was for an 'epidural' injection, the nurse would prepare for administration into a different anatomical space (the epidural space). This would involve a different needle type, potentially a larger volume of medication, and an expectation of a slower onset of action compared to the intrathecal route.

How to Approach the Question

• First, identify the key term in the question: 'intrathecally'.
• Break down the medical term. 'Intra-' means 'within', and 'theca' refers to a sheath, specifically the thecal sac or dura mater that encloses the spinal cord.
• Recall the basic anatomy of the spinal cord and its coverings. The space within the thecal sac (the subarachnoid space) is filled with cerebrospinal fluid (CSF).
• Therefore, 'intrathecal' administration means delivering a substance into the cerebrospinal fluid.
• Evaluate the given options. 'Into the cerebrospinal fluid' is a direct definition of the intrathecal route.
• Eliminate the other options as they describe different, well-known routes of administration: Intravenous (into a vein), Rectal (into the rectum), and Intramuscular (into a muscle).

Concept Tested & Keywords

• Concept Tested: Route of Medication Administration: Intrathecal
• Stem keywords: intrathecally, medication, administered
• Lead-in keywords: which method

Question ID

QNAtOV1IwLah4qgfMPZ7ds

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 137-139

E6 Nursing Fundamentals Taylor p. 839-841