Question

This is for pharmacology.

1. Explain when you would use the Z-Track method of injection. Explain how you would administer an injection using the Z-Track method.

2. As a nurse, you will see patients displaying Extrapyramidal Symptoms. Explain Extrapyramidal symptoms.

Mr. Smith is given azithromycin 500 mg for one dose and then azithromycin 250 mg daily for the next 5 days and ceftriaxone 1 g IV twice daily. After beginning the IV administration of ceftriaxone Mr. Smith’s heart rate increases to 110 bpm, his blood pressure is 90/60 mm Hg, and he complains of difficulty breathing and itching. The nurse notices Mr. Smith has urticaria and angioedema and is sweating profusely

3. Explain the nursing actions you would take in order of priority.

Answer 1

ANS 1 - Z TRACK METHOD of injection and WHERE DO WE USE IT?

it is a type of an intramuscular injection (IM). The Z-track method is used to prevent tracking i.e. leakage of the medication into the subcutaneous tissue which is under the skin which can then lead to complication like abscess and skin necrosis.

How do we use Z TRACK METHOD?

During this procedure we need to pull skin and subcutaneous tissue firmly while inserting a long needle into the muscle and After the medication is injected the skin and tissue are released to get it its normal shape. This is done because when we insert a needle into the tissues, it leaves a very small hole and through this small hole small amounts of medication can sometimes leak backwards through this track and be absorbed into other tissues. So pulling the skin and subcut. tissue before the injection makes the needle track to take the shape of the letter “Z,” and so it is called as z track method.

WHEN WOULD WE USE THIS Z TRACK METHOD?

It is especially used while given injection of IRON preparations like IRON DEXTRAN

ANS 2 - EPS - EXTRA-PYRAMIDAL SYMPTOMS.

Extrapyramidal symptoms which in short called as EPS are group of symptoms which includes

1) Dystonia which is continuous spasms or muscle contractions,

2) Akathisia which is feeling of inner restlessness and inability to stay still,

3) Bradykinesia which is slowness in movement,

4) Tremor, and

5) Tardive dyskinesia which is irregular and jerky movements.

What are the cause of EPS?

most common cause is typical antipsychotic drugs which acts by antagonizing dopamine D2 receptors eg. haloperidol and fluphenazine.

ANS 3 - Mr. Smith is suffering from Idiosyncratic drug reactions, sue to CEFTRIAXONE.

Idiosyncratic drug reaction is also known as type B reactions which are drug reactions that occur rarely after drug ingestion. The mechanism of action of this reaction is immune-mediated toxicity, whenever a foreign molecule i.e. drug enters the blood circulation this will sensitize the immune system to the drug and cause a response. So after ingestion of drug Mr. Smith’s has TACHYCARDIA (110 bpm), HYPOTENSION (blood pressure is 90/60 mm Hg) , with BREATHLESSNESS (difficulty breathing) and ITCHING. The nurse ALSO notices URTICARIA angioedema and profuse sweating, "This all are signs of Idiosyncratic drug reaction"

How to prevent it ?

Ans - By giving test dose of such medication like antibiotics, pain killers like diclofenac, adrenaline, lignoacaine etc