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The gluteus medius originates on the outer surface of the ilium bone and runs to the greater trochanter of the femur.
Figure 3 illustrates the gluteus medius contracting to help lift the leg in Ardha chandrasana (Half Moon Pose).
Many thanks for all of your feedback on stretching the gluteus medius in last weeks “Muscle of the Week” on Facebook. Feel free to browse through The Key Muscles of Yoga and Key Poses of Yoga by clicking here.The Yoga Mat Companion Series gives you step-by-step anatomic sequencing for all of the major asanas, with a variety preparatory poses as well. Key Concept Discard any unused portion of an ampule’s contents, because no way exists to prevent contamination of an open ampule.
A prefilled syringe, for example Tubex or Carpuject, provides a single medication dose prepared by a manufacturer or pharmacy.
Key Concept Remember: Medications and their packaging cannot be disposed of in the community sewer system.
Intradermal injections, often used for diagnostic testing (“skin tests”), are shallow injections given just beneath the epidermis.
Key Concept If administering an intradermal injection, instruct the client not to scratch or pinch the site. Subcutaneous injections are administered into subcutaneous or adipose (fatty) tissues located below the dermis (Fig. Subcutaneous medications must be soluble and of sufficient strength to be effective, yet safe for surrounding tissues. Key Concept Always rotate injection sites for clients who receive injections on a regular basis. Intramuscular injections are given in muscles situated below the dermal and subcutaneous skin layers. Intramuscular injection is the best technique when medications given less deeply irritate the client’s tissues or when large amounts of medication are necessary. Nursing Alert When administering IM and SC injections, insert and remove the needle quickly (unlike the intradermal injection). Although the deltoid muscle may be used for IM injections, it is large enough only for small amounts of medication. The rectus femoris muscle lies medially to the vastus lateralis.Identify the injection site in the same manner as that for the vastus lateralis (see Fig. Nursing Alert IM injections must be given into healthy muscle tissue for proper absorption to occur.
Rotating insulin injection sites is particularly important because insulin can atrophy tissue (lipodystrophy) with repeated injection in the same site.
This muscle also helps to internally rotate the hips, thereby bringing the kneecaps to face forward. Medications for injection may be supplied in a single-dose ampule, single-dose or multidose vial, or prefilled syringe (Fig. If the entire amount of medication is not needed, discard the excess amount into the designated receptacle before administration. The major difference is the choice of the site, the needle used, and the angle at which the needle is inserted.


Rationale: Usually, bunching the skin will ensure that the injection is made into the subcutaneous tissue and not the muscle beneath. Rationale: It is important to have a needle that is short enough to just reach the subcutaneous tissue and not extend into muscle. Explain to the client who is reluctant to lie down that this will be the safest and most comfortable position. In most cases, 1 mL is the maximum amount of medication that can safely be given in this site.
This muscle may be used for IM injections in infants and children younger than 3 years because it is the largest muscle mass in this age group. If a client requires frequent IM injections, rotate the sites and note on the client’s medical administration record (MAR) or a “site rotation map,” which site was used each time. The cue for engaging the gluteus medius in Downward Dog Pose is to press the feet into the mat and then attempt to drag them apart. When mixed with a diluent, these medications are often fairly unstable and may deteriorate rapidly.
The body absorbs IM injections much more rapidly than SC injections, because of the greater amount of blood supply to muscle tissue. Spreading the skin would not allow sufficient subcutaneous tissue to prevent intramuscular injection. However, a longer needle with a larger bore is used, most often a IV2- to 2-inch, 20- to 22-G needle, depending on the type of medication.
Rationale: Clear identification of the area is difficult, and the muscles will be tenser while standing.
Little risk of injury exists with this site because no large nerves or arteries surround the area.
Its anterior fibers act to synergize flexing and internally rotating the flexed hip; its more posterior fibers synergize extending and externally rotating the extended hip. Remember, if the medication is a controlled substance, another licensed nurse must witness this procedure and document it in the designated manner. Tuberculin syringes, which identify hundredths of a milliliter and can hold a total of 1 mL, are commonly used. This method is used for small amounts of medication that require slow, systemic absorption. Subcutaneous injections are given in areas where bones and blood vessels are not near the skin’s surface. It is important for the nurse to be thoroughly familiar with IM injection sites and the technique for administering these injections.
In addition, the client may experience a vasovagal reaction and faint, sustaining injury as he or she falls. The ventrogluteal site is safer and less painful for IM injections than the dorsogluteal site, through which the sciatic nerve runs.
Use this route in children only if they are older than 4 and only if the medication to be administered is not irritating to the tissues, the volume is very small, and the medication will be absorbed quickly. Locate this site by placing the palm of one hand over the greater trochanter and the palm of the other hand over the knee; identify the injection site anteriorly and laterally, halfway between these two points (see Fig.


Many adult clients find the rectus femoris site uncomfortable; it is often used in adults only when other sites are contraindicated.
The gluteus medius is innervated by the superior gluteal nerve, which is formed from nerve roots L4, L5 and S1.
Because the tuberculin syringe has a very small diameter, it can be graduated in hundredths and tenths of a milliliter for accurate measurement of very small amounts of medication (In Practice: Nursing Procedure 64-2 and Fig. Generally, the duration of SC medications is longer than that of other parenteral medications. One common site is the outer aspect of the upper arm, above the halfway mark between the elbow and the shoulder. However; a thin client may need to be injected at an angle of a lesser degree (as small as 45 degrees). Rationale: Their muscles in this area are not yet developed and are not of sufficient mass. The fat layer is thinner in the ventrogluteal area, and the gluteal muscle is thicker, even in very thin clients. Rationale: Disadvantages of this site are that the sciatic nerve and numerous blood vessels run very close to it. Rationale: It is important to choose an injection angle that will ensure the medication is delivered into the subcutaneous tissue and not the muscle. In addition to requiring a longer and larger-gauge needle, IM injections are more difficult and dangerous than SC injections.
Rationale: This positioning aids in relaxation of the gluteal muscles, making the injection more comfortable.
One disadvantage of the ventrogluteal site is that the client may never have received an IM injection in this area, which may cause anxiety.
The deltoid muscle is located on the lateral aspect of the upper arm, 1 to 2 inches below the acromion process (see Fig. Should contact with the sciatic nerve be made while administering the injection, nerve damage—resulting in permanent damage or paralysis—may occur. If the volume of medication is greater than 1 mL, the subcutaneous route is usually not recommended or two sites must be used. The needle must be injected deeper into the client’s body, penetrating the epidermal, dermal, subcutaneous, and muscle tissues. Another disadvantage is that the client can see what the nurse is doing, which may also increase anxiety. If the medication is thick, injecting into the muscle may be more difficult (In Practice: Nursing Procedure 64-4). Identify the injection site by placing the index and middle fingers over the acromion process. Hepatitis B vaccine and tetanus toxoid are examples of medications often given in the deltoid muscle.



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