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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is preparing to administer an iron dextran intramuscular (IM) injection using the Z-track method to a client with severe iron deficiency anemia. The PN has already identified the client, donned gloves, cleansed the site, and prepared the syringe. In which order should the PN perform the following steps? (Arrange the actions from first to last)

  1. 1Pull the overlying skin and subcutaneous tissue laterally 1 to 1.5 inches.
  2. 2Insert the needle at a 90-degree angle using a smooth, dart-like motion.
  3. 3Inject the medication slowly and steadily over several seconds.
  4. 4Wait for 10 seconds while leaving the needle in place.
  5. 5Withdraw the needle smoothly and immediately release the retracted skin.

Answer

The correct sequence for administering a Z-track IM injection is: pull the skin laterally, insert the needle at 90 degrees, inject the medication slowly, wait 10 seconds, and finally withdraw the needle before releasing the skin.
The Z-track method is designed to prevent irritating or staining medications (such as iron dextran) from leaking into the subcutaneous tissue. The correct sequence ensures the skin is displaced prior to needle insertion and remains displaced until after the needle is fully withdrawn. This creates a zig-zag path that permanently seals the medication within the muscle.

Step-by-Step Solution

1
Pull the overlying skin and subcutaneous tissue laterally 1 to 1.5 inches.
The tissue is displaced from its normal alignment.
Displacing the tissue creates a staggered pathway that prevents medication leakage into the subcutaneous tissue.
2
Insert the needle at a 90-degree angle using a smooth, dart-like motion.
The needle enters the deep muscle.
A 90-degree angle ensures the medication reaches the vascular muscle layer rather than the subcutaneous fat.
3
Inject the medication slowly and steadily over several seconds.
The medication is delivered into the muscle.
Slow injection allows the medication to disperse evenly and minimizes tissue irritation.
4
Wait for 10 seconds while leaving the needle in place.
The medication begins to absorb.
Pausing prevents the medication from tracking back up the needle pathway immediately upon withdrawal.
5
Withdraw the needle smoothly and immediately release the retracted skin.
The needle track is sealed.
Releasing the skin after withdrawal restores the tissue alignment, sealing the track and locking the medication safely in the muscle.

Key Concept

Z-track method for intramuscular injections
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Topics

Pharmacological Therapies

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