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Difficulty: Very hardPharmacological Therapies

A practical nurse (PN) is administering an intramuscular (IM) injection of iron dextran, a medication known to cause severe skin irritation and staining, to an adult client. The PN will utilize the Z-track method. Arrange the following steps of this procedure in the correct chronological order.

  1. 1Select the appropriate ventrogluteal site, perform hand hygiene, and don clean gloves.
  2. 2Use the side of the nondominant hand to pull the skin and subcutaneous tissue laterally by 1 to 1.5 inches.
  3. 3Insert the needle swiftly at a 90-degree angle and inject the medication slowly with the dominant hand.
  4. 4Keep the needle inserted in the muscle for 10 seconds after the medication is completely infused.
  5. 5Withdraw the needle in a smooth motion and immediately release the displaced skin.
  6. 6Apply light pressure to the injection site with a sterile gauze pad, ensuring not to massage the area.

Answer

The correct chronological order is: Prepare the site and don gloves; pull the skin laterally; insert the needle and inject slowly; wait 10 seconds; withdraw the needle and release the skin; and finally, apply light pressure without massaging.
The Z-track method requires strict adherence to a specific chronological sequence to prevent medication leakage. The site must first be prepared. Then, tissue displacement occurs to misalign the layers. The injection is given, followed by a mandatory 10-second wait to allow dispersion. Crucially, the needle withdrawal and tissue release must happen simultaneously to break the track. Finally, gentle pressure is applied, but the site must never be massaged to avoid pushing the medication out of the muscle.

Step-by-Step Solution

1
Select site and apply standard precautions.
The ventrogluteal site is prepared, minimizing the risk of infection.
Hand hygiene, gloving, and site identification are universal prerequisites for any parenteral administration.
2
Displace the skin and tissue laterally by 1 to 1.5 inches.
The skin and subcutaneous layers are shifted out of their normal alignment with the underlying muscle.
This is the foundational step of the Z-track method, preparing the offset track that will seal the medication.
3
Insert the needle at a 90-degree angle and inject slowly.
The medication is delivered deep into the ventrogluteal muscle.
A 90-degree angle ensures intramuscular delivery, and a slow injection rate minimizes pain and tissue trauma.
4
Wait 10 seconds before removing the needle.
The medication disperses into the muscle belly.
Allowing time for dispersion reduces the risk of the medication tracking back up the needle pathway upon withdrawal.
5
Withdraw the needle and simultaneously release the displaced skin.
The tissue layers slide back into their original anatomical positions.
This breaks the needle track alignment (creating the 'Z' shape), physically sealing the irritating medication inside the muscle layer and preventing seepage.
6
Apply gentle pressure without massaging.
The site is secured without disrupting the trapped medication.
Massage is strictly contraindicated because it can force the medication out of the muscle and into the subcutaneous tissue, causing the severe irritation or staining that the Z-track method is designed to prevent.

Key Concept

The Z-track intramuscular injection method is utilized to administer highly irritating or staining medications, sealing the drug deep within the muscle tissue to protect superficial layers.
Estimated Time:2m 0s
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Topics

Pharmacological Therapies

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