Parenteral Medications胃肠外用药
A. Parenteral means an injection route, and parenteral medications are administered by intravenous (IV), intramuscular, subcutaneous, or intradermal injection (see Fig. 10-1 for angles of injection).
胃肠外指的是注射路径，胃肠外给药就是指经静脉内（IV）、肌肉内、皮下或皮内注射给药(注射角度见图10-1)。
FIGURE 10-1 Angles of injection 注射角度
B. Parenteral medications are packaged in single use ampules, in single- and multiple-use rubber-stoppered vials, and in premeasured syringes and cartridges.
胃肠外药物分一次性安瓿瓶、一次或多次性橡皮盖小药瓶和预先刻度注射器和药筒等几种包装。
C. The standard 3-mL syringe is used to measure most injectable medications and is calibrated in tenths (0.1) of a milliliter.
标准的3 mL注射器用于计量多数可注射药物，每刻度为1/10 (0.1)毫升。
D. The syringe is filled by drawing in solution until the top ring on the plunger (i.e., the ring closest to the needle), not the middle section or the bottom ring of the plunger, is aligned with the desired calibration (Fig. 10-2).
将药物抽入注射器，充满至注射器顶部刻度圈（即最靠近针头）而非中部或底部圈(图10-2)以达到所需计量。
FIGURE 10-2 Parts of a syringe. 注射器组件
E. The nurse should not administer more than 3 mL per intramuscular injection site (2 mL for the deltoid) or 0.5 to 1.5 mL for an adult per subcutaneous injection site; larger volumes are difficult for an injection site to absorb and, if prescribed, need to be verified. Variation for pediatric client are discussed in the pediatric section of this text.
护士给药时，单个肌内注射部位给药不得大于3 mL/次(三角肌2 mL)，成人皮下注射0.5 – 1.5 mL/次。大于上述剂量时，注射部位将难以吸收。若处方药量大于上述剂量，应加以核实。小儿患者用药变化见本书小儿章节。
F. In an adult that is of normal size, a 25-gauge 5/8-inch needle at a 45-degree angle or a 1/2-inch needle at a 90-degree angle is used for subcutaneous injections.
对于正常体形成人，皮下注射采用规格25、5/8英寸针头45度角或1/2英寸针头90度角注射。
G. For an intramuscular injection in an adult client, the client's weight, site for injection, and the amount of adipose tissue influences needle size. An obese person may require a needle 2 to 3 inches long, whereas a thin person requires only a 1/2-to 1-inch needle; the gauge of the needle will depend on the viscosity of the solution being injected, with a larger gauge needed for more viscous solutions. If a Z-track method is used, a larger,deeper muscle such as the ventrogluteal muscle should be chosen as the site.
对于成人肌内注射，患者体重、注射部位和脂肪组织量均可影响针头大小。肥胖者可能需要2-3英寸针头，瘦子则可能只需要1/2 – 1英寸针头。针头规格取决于注射液粘度，规格越大，粘度越大；若采用Z字注射，注射部位应采肌肉较深、较大的部位，如臀腹肌。
H. For an intradermal injection, a tuberculin or small syringe is used. The angle of insertion for an intradermal injection is 5 to 15 degrees.
皮内注射采用结核菌素或小注射器。皮内注射进针角度是5 – 15度。
★ Always question and verify excessively large or small volumes of medication. 应始终质疑并核实超大或过小剂量用药。
I. Prefilled medication cartridge预装药筒
1. The medication cartridge slips into the cartridge holder, which provides a plunger for injection of the medication.
药筒滑入药筒支持外壳，用活塞将药物注入人体。
2. The cartridge is designed to provide sufficient space to allow for the addition of a second medication when combined dosages are prescribed.
药筒设计了充足的空间，可用于复合剂量的二次药物添加。
3. The prefilled medication cartridge is to be used once and discarded; if the nurse is to give less than the full single dose provided, the nurse needs to discard the extra amount before giving the client the injection, in accordance with agency policies and procedures.
预装药筒为一次性使用，用后即弃。若护士拟用药物少于预装的单次全部剂量，护士应在注射前先去年多余药物，并按机构政策与程序进行操作。
J. In general, standard medication doses for adults are to be rounded to the nearest tenth (0.1 mL) of a milliliter and measured on the milliliter scale; for example, 1.28 mL is rounded to 1.3 mL (follow agency policy for rounding medication doses).
一般情况下，成人标准药物剂量应四舍五入至0.1 mL，按毫升刻度计量。例如，1.28毫升四舍五入为1.3 mL(药物剂量的四舍五入按机构政策执行)。
K. When volumes larger than 3 mL are required, the nurse may use a 5-mL syringe; these syringes are calibrated in fifths (0.2 mL) (Fig. 10-3).
当所需容量大于3 mL时，护士可使用5 mL注射器。这些注射器的刻度是1/5(0.2 mL)(图10-3)。
FIGURE 10-3 Five-milliliter syringe. 5 mL注射器
L. Other syringe sizes may be available (10, 20, and 50 mL) and may be used for medication administration requiring dilution.
还有其他规格的注射器(10、20、50 mL)，这些注射器可用于需要稀释的药物。
★ When performing a calculation, if rounding is necessary, perform the rounding at the end of the calculation. When taking the NCLEX, follow the instructions provided in the question regarding the need to round. For example, the NCLEX question may read: Record your answer using one decimal place.
进行计算时，如果需要四舍五入，四舍五入在计算最后进行。参加NCLEX考试时，对于四舍五入，应按考试提供的问题说明做。例如，NCLEX题目称：记录答案时保留一位小数点。
M. Tuberculin syringe (Fig. 10-4) 结核菌素注射器(图10-4)
FIGURE 10-4 Tuberculin syringe 结核菌素注射器
1. The tuberculin syringe holds 1 mL and is used to measure small or critical amounts of medication, such as allergen extract, vaccine, or a child's medication.
结核菌素注射器容量1 mL，用于小剂量或临界剂量药物，如变应原浸出物、疫苗、或儿童药物等。
2. The syringe is calibrated in hundredths (0.01) of a milliliter, with each one tenth (0. 1) marked on the metric scale.
该注射器刻度为1/100毫升(0.01)，米尺上为每1/10(0.1)为一刻度。 N. Insulin syringe (Fig. 10-5)胰岛素注射器(图10-5)
FIGURE 10-5 A 100-unit insulin syringe 图10-5 100单位胰岛素注射器
1. The standard 100-unit insulin syringe is calibrated for 100 units of insulin (100 units = 1 mL); low-dose insulin syringes, such as a 30-unit insulin syringe or a 50-unit insulin syringe, are available for a more precise insulin draw for clients with low-dose insulin prescriptions.
标准的100单位胰岛素注射器，其刻度为100单位胰岛素(100单位=1 mL)。小剂量胰岛素注射器，如30单位胰岛素注射器或50单位胰岛素注射器用于胰岛素抽取剂量更为精确的小剂量胰岛素处方患者。
2. Insulin should not be measured in any other type of syringe.
胰岛素计量不应采用其他注射器。
★ If the insulin prescription states to administer regular and NPH insulin, combine both types of insulin in the same syringe. Use the mnemonic RN: Draw Regular insulin into the insulin syringe first, and then draw the NPH insulin. Of note, with newer insulin types on the market, such as long-acting and rapid-acting insulin, Regular and NPH insulin are used less frequently because of safety and convenience factors.
若胰岛素处方要求使用正规或NPH胰岛素，可将两种胰岛素混合在同一注射器中。可采用助记RN：先将正规胰岛素抽进胰岛素注射器，然后再抽NPH胰岛素。偶得注意的是，由于市场上有了较新的胰岛素类型，如长效和速效胰岛素，正规和NPH胰岛素由于安全性和方便因素已用得较少。
O. Safety needles contain shielding devices that are attached to the needle and slipped over the needle to reduce the incidence of needle stick injuries.
安全针头配备保护装置，与针头连接，使用时可滑盖针头，从而减少针刺伤的发生。
★Video ★
Solving Conversion Problems
★Test ★
1. A prescription reads levothyroxine, 150 mcg orally daily. The medication label reads levothyroxine, 0.1 mg/tablet. The nurse administers how many tablet(s) to the client? Fill in the blank.
Answer: tablet(s)
2. Cefuroxime sodium, 1 g in 50 mL normal saline (NS), is to be administered over 30 minutes. The drop factor is 15 drops (gtt)/1 mL. The nurse sets the flow rate at how many drops per minute? Fill in the blank.
Answer: drops per minute
1. 1.5 Rationale: You must convert 150 mcg to milligrams. In the metric system, to convert smaller to larger, divide by 1000 or move the decimal 3 places to the left. Therefore, 150 mcg equals 0.15 mg. Next, use the formula to calculate the correct dose.
Formula:
2. 25 Rationale: Use the intravenous (IV) flow rate formula.
Formula:
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