Mrs. Yeager's Homepage

Nursing 205 Homepage

Nursing 202 Homepage

Nursing 204 Homepage

---

Student's Name: ____________________

Grade (circle one):

P = achieved 3 or above in all categories

F = achieved 2 or below in one or more categories

The following scale is utilized:

ACTION	S	G	SA	U	F
Gather the supplies	5	4	3	2	1
Explain the procedure to the patient	5	4	3	2	1
Wash and dry hands carefully	5	4	3	2	1
Determine the necessary needle and syringe size needed for administration of the intramuscular injection to the patient	5	4	3	2	1
Arrange the patient's MAR next to or on the medication cart	5	4	3	2	1
Review the patient's MAR by determining if each contains the essential parts of a medication order (patient's name, drug name, drug dosage, route of drug administration, time for drug administration)	5	4	3	2	1
Obtain the appropriate ampoule from the patient's medication drawer in the medication cart or other storage area	5	4	3	2	1
Compare the label on the medication vial against the MAR by determining if both contain the essential parts of a medication order (patient's name, drug name, drug dosage, route of drug administration, time for drug administration)	5	4	3	2	1
If the label on the medication vial and the patient's MAR do not contain the same essential parts of a medication order, check the original order in the patient's chart	5	4	3	2	1
If the MAR and the original order in the patient's chart do not contain the same essential parts of a medication order, report the discrepancy to the nurse in charge and/or physician	5	4	3	2	1
Perform any necessary drug calculations	5	4	3	2	1
Assemble the needle and syringe if not already assembled	5	4	3	2	1
Mix the solution in the vial by rotating it between the palms of your hands	5	4	3	2	1
Hold the ampoule in your nondominant hand	5	4	3	2	1
Flick the upper stem of the ampoule several times with the index or middle finger of your dominant hand	5	4	3	2	1
Place a sterile gauze pad or alcohol swab around the neck of the ampoule with your dominant hand	5	4	3	2	1
Break off the top of the ampoule along the prescored line at its neck with your dominant hand by bending it toward your body using a snapping motion	5	4	3	2	1
Dispose of the upper stem and neck of the ampoule in an appropriate receptacle	5	4	3	2	1
Place the opened ampoule upright on the medicaiton cart	5	4	3	2	1
Remove the needle cap from the needle	5	4	3	2	1
Hold the barrel of the syringe with your dominant hand	5	4	3	2	1
Stabilize the ampoule on the medication cart with your nondominant hand	5	4	3	2	1
Insert the needle into the center of the upright ampoule with your dominant hand, being careful not to touch the needle to the glass rim of the ampoule	5	4	3	2	1
Move your dominant hand to the plunger of the syringe	5	4	3	2	1
Hold the barrel of the syringe with your nondominant hand	5	4	3	2	1
Pull back on the plunger of the syringe with your dominant hand until the correct dosage of medication is withdrawn into the barrel of the syringe	5	4	3	2	1
Withdraw the needle from the ampoule with your dominant hand	5	4	3	2	1
Invert the syringe and push on the plunger of the syringe with your dominant hand to expell any air in the syringe	5	4	3	2	1
Replace the cap over the needle utilizing the single-handed scoop method with your dominant hand	5	4	3	2	1
Take the medication into the patient's room	5	4	3	2	1
Identify the patient by comparing the name on the patient's MAR with the name on his/her identification bracelet and ask him/her to state his/her full name	5	4	3	2	1
Lock the wheels of the bed	5	4	3	2	1
Raise the bed to waist level	5	4	3	2	1
Lower the siderail nearest you	5	4	3	2	1
Assist the patient in assuming a supine, lateral, prone, or sitting position, depending if the ventrogluteal, vastus lateralis, rectus femoris, or deltoid site is to be used	5	4	3	2	1
Select a site on the patient's ventrogluteal, vastus lateralis, rectus femoris, or deltaoid site that is not heavily pigmented, covered with hair, free of tenderness, hardness, swelling, scarring, itching, burning, or localized inflammation, and that has not been used frequently	5	4	3	2	1
Don disposable gloves	5	4	3	2	1
Clean the site with an alcohol swab, by 1) starting at the center of the site, 2) cleaning the site in a widening circle to about 5 centimeters (2 inches), and 3 allowing the site to dry thoroughly	5	4	3	2	1
Place and hold the alcohol swab between the third and fourth fingers of your nondominant hand or position it on the patient's skin above the cleansed site	5	4	3	2	1
Remove the needle cap from the needle	5	4	3	2	1
Grasp the syringe and hold it in your dominant hand between your thumb and fingers with your palm facing down	5	4	3	2	1
Spread or pinch the patient's skin at the insertion site with your nondominant hand	5	4	3	2	1
Insert the needle, bevel up, at a 90 degree angle into the muscle with your dominant hand with a firm, steady push	5	4	3	2	1
Move your nondominant hand to the barrel of the syringe	5	4	3	2	1
Move your dominant hand to the end of the plunger of the syringe	5	4	3	2	1
Pull back on the plunger of the syringe with your dominant hand to aspirate for blood	5	4	3	2	1
Push on the plunger of the syringe with your dominant hand using slow, even pressure to inject the medication	5	4	3	2	1
Pull on the barrel of the syringe with your dominant hand to remove the needle	5	4	3	2	1
Massage the site lightly with an alcohol swab	5	4	3	2	1
Assist the patient in returning to a comfortable position	5	4	3	2	1
Lower the bed to the lowest level	5	4	3	2	1
Raise the siderail nearest you	5	4	3	2	1
Assure that the patient's call light is readily available	5	4	3	2	1
DIspose of soiled supplies in an appropriate receptacle	5	4	3	2	1
Wash and dry hands carefully	5	4	3	2	1
Record preparing parenteral medication from an ampoule and administering via an intramuscular injection on the patient's MAR per agency policy	5	4	3	2	1
Comments:

Return to Top