N3 Anatomy and Physiology AY 2023-2024

ACTIVITY 3

1. It is immunization day at the health center. The first patient is a 2-month old well female infant who is scheduled for the following vaccinations: pneumococcal conjugate vaccine (PCV), pentavalent vaccine (Penta), and oral polio vaccine. PCV and Penta are given via intramuscular route. 
   • Where are the sites of injection?
     • Anterolateral thigh. Since the patient is a 2-month old infant, the preferred site of injection for her vaccines is the anterolateral thigh. Note that PCV and Penta vaccination via intramuscular route should be injected separately into the opposite thighs (PCV on the right and Penta on the left).
   • What muscle is targeted in the injection?
     • Vastus lateralis

• • Write down its origin, insertion and action.

• • • Origin: Greater trochanter and linea aspera of femur
    • Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament.
    • Action: Extends the leg at the knee joint

• • How do you locate this area?
    • To locate the vastus lateralis, first position the patient lying down. Just below the greater trochanter and above the lateral femoral condyle or knee joint, palpate the muscle. Then, divide the muscle into thirds and inject the vaccine into the middle third (outer anterolateral, lateral to the midpoint of the thigh).

2. The baby’s 65-year-old grandfather also came to the center because influenza vaccine is being offered to senior citizens. The flu vaccine is given intramuscularly.

• • Which muscle is the preferred site for IM injection in this case?
    • Deltoid 
  • Write down its origin, insertion and action.

• • • Origin: Acromial extremity of clavicle (anterior fibers), acromion of scapula (lateral fibers), and spine of scapula (posterior fibers).
    • Insertion: Deltoid tuberosity of humerus.
    • Action: 
      • Lateral fibers abduct arm at shoulder joint
      • Anterior fibers flex and medially rotate arm at shoulder joint
      • Posterior fibers extend and laterally rotate arm at shoulder joint

• • How do you locate this area?
    • To locate the deltoid muscle, instruct the patient to sit comfortably with arms visible from the shoulder to the top of his elbow. Then, find and palpate the outer edge of the scapula. Next, trace an imaginary inverted triangle beneath his shoulder. Administer the injection in the middle of the imaginary inverted triangle, about 3 to 5 centimeters below the acromion.

REFERENCES:

The Open University. (n.d.). Immunization module: Vaccine preparation and administration routes of the EPI Vaccines. https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=53352&printable=1 

Tortora, G. J., & Derrickson, B. (2017). Principles of anatomy and physiology (15th ed.). Wiley Custom Learning Solutions. https://handoutset.com/wp-content/uploads/2022/05/Principles-of-anatomy-and-physiology-Wiley-2017-Derrickson-Bryan-H._-Tortora-Gerard-J..pdf

Schneider, M. (2022, May). Intramuscular Injections. The Royal Children’s Hospital Melbourne. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Intramuscular_Injections/