18.7: Applying the Nursing Process

Assessments Prior to Injection Administration

When administering any parenteral injection, the nurse assesses the patient prior to administration for safe medication administration. See Table \(\PageIndex{1}\) to review assessments prior to medication administration.

Table \(\PageIndex{1}\): Assessments Prior to Injection Administration

Assessment	Rationale/Considerations
Check the MAR with the written medication prescription for accuracy and completeness.	Prevent medication errors.
Perform the rights of medication administration, including patient’s name, medication name and dose, route, time of administration, and verify the expiration date. Label syringes with medication names as you prepare them.	Prevent medication errors. Discard medication if expired. Label syringes during the procedure to administer medications safely according to the Joint Commission.^[1]
Assess and review a patient’s current medical condition, past medical history, and medication history.	Identify the need for the medication, as well as any possible contraindications for the administration of prescribed medication to the specific patient.
Assess the patient’s history of medication allergies or nondrug allergies that may interfere with the medication. If there is a history of allergic reactions, document the type of reaction if possible (e.g., hives, rash, swelling, difficulty breathing). If there is an allergy to prescriber medication, do not prepare it and notify the prescribing provider.	Safely administer medication.
Review a current, evidence-based drug reference to determine medication action, indication for medication, normal dosage range, and potential side effects. Identify peak and onset times, as well as any nursing considerations.	Safely administer medication and plan to monitor the patient’s response. For example, by knowing the peak onset of fast-acting insulin, the nurse anticipates when the patient may be most at risk for a hypoglycemic reaction.
Review and assess pertinent laboratory results (i.e., blood glucose, prothrombin times). Be aware of abnormal kidney and liver function results because they may affect metabolism of medication. Notify the prescriber of any concerns.	Collect data to determine if the medication should be withheld to ensure proper dosage and to establish a baseline for measuring the patient’s response to the drug.
Observe the patient’s verbal and nonverbal reactions to the injection.	Be aware of the patient’s level of anxiety and use distractions and other therapeutic techniques to reduce pain and anxiety.
Perform patient assessments, such as vital signs, lung sounds, or pain level, as indicated, prior to medication administration.	Obtain baseline data to ensure medication administration is appropriate at this time and to establish a baseline for measuring the patient’s response to the medication.
Assess for contraindications to subcutaneous or intramuscular injections such as muscle atrophy or decreased blood flow to the tissue.	Assess for contraindications because reduced muscle and blood flow interfere with the drug absorption and distribution.
Assess the patient’s knowledge of the medication.	Perform patient education about the medication as needed.
Assess the skin and tissue quality around the area of the intended injection site. Note any bruising, nonintact skin, abrasions, masses, or scar tissue. Avoid these areas and choose another recommended location.	Assess skin and tissue quality to avoid unnecessary or further injury to the already compromised skin integrity. Areas that are scarred or atrophied can affect the absorption and distribution of the medication.

Evaluation

Nurses evaluate for possible complications of parenteral medication administration that may occur as a result of a medication error or as an adverse reaction. Complications may occur if a medication is prepared incorrectly, if the medication is injected incorrectly, or if an adverse effect occurs after the medication is injected. Unexpected outcomes can occur such as nerve or tissue damage, ineffective absorption of the medication, pain, bleeding, or infection.

An adverse reaction may develop as a result of an injected medication. An adverse reaction may also occur despite appropriate administration of medication and can happen for various reasons. A reaction may be evident within minutes or days after the exposure to the injectable medication. An unexpected outcome may range from a minor reaction, like a skin rash, to serious and life-threatening events such as anaphylaxis, hemorrhaging, and even death.

If a suspected complication occurs during administration, immediately stop the injection. Assess and monitor vital signs, notify the health care provider, and document an incident report.

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1. The Joint Commission. (n.d.). 2020 Hospital national patient safety goals. https://www.jointcommission.org/standards/national-patient-safety-goals/↵