Download Pediatric Medication

Medication Administration and
Intravenous Therapy
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Six “Rights” of
Medication Administration
• The right medication
• The right patient
• The right dose
• The right route
• The right time
• The right documentation
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Role of the Nurse in
Medication Administration
• Understanding the factors that influence or alter
how the child absorbs, metabolizes, and excretes
the medication
• Being aware of any allergies the child may have
• Administering the medications properly
• Teaching the patient and the family caregivers about
the effects and possible side effects of medications
given
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines for Medication
Administration in Children
• Do not give the child a choice in whether or not to
take the medicine
• Do give choices that allow the child some control
• Do not tell the child that the injection will not hurt
• Give simple and brief explanations
• Assure child that it is okay to be afraid and/or to cry
• Do not talk in front of the child as if he or she were
not there
• Be positive in approaching the child
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines for Medication
Administration in Children (cont.)
• Keep time between explanation and administration
brief
• Prepare for medication administration out of sight
of the child
• Obtain cooperation from family caregivers
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Methods of Computing Child Dosages for
Medication
• Body weight method
– The child’s weight in kilograms is used to
calculate a safe dose range for that child
• Body surface area (BSA) method
– The West nomogram
• A graph with several scales arranged
• When two values are known, the third can be
plotted by drawing a line with a straight edge
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Using a Nomogram
Used to estimate the body
surface area (BSA) of a child
height is on the left, weight is
on the right
The BSA is the area where a
ruled line intersects on the
middle column
Used to calculate child’s dose
from an adult dosage of
medication (average adult
BSA = 1.7 m2).
(example 12 kg/58 in.=.66 m2)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Routes of Medication Administration
• Oral
• Intramuscular
• Eye, ear, and nose drops
• Rectal medications
• Intravenous therapy
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Oral Medications
• Sit infant on your lap using the “hugging” method
(infant’s legs between your knees and one arm tucked
behind your back)
• Mix suspensions well
• If using syringe, place to the side and back of mouth
• Give slowly via cup or syringe, allowing time for
swallowing, do not put in baby’s bottle
• Older child may be able to do themselves
• May offer juice or water after administration
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Ear Drops
• To straighten ear canal:
• Children under the age of 3, pull pinna of ear down and
back
• Children older than 3, pull pinna up and back
• Gently massage area in front of ear to facilitate entry of
drops
• Keep supine for a few minutes to facilitate fluid
absorption
• Allow to warm prior to installation
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Suppository/Enema
• Guideline for enema administration:
• infant - 120 to 240 mL, insert 1 inch
• 2 to 4 years - 240 to 360 mL, insert 2 inches
• 4 to 10 years - 360 to 480 mL, insert 3 inches
• 11 years - 480 to 720 mL, insert 4 inches
• After rectal administration, hold the buttocks together
firmly to relieve pressure on anal sphincter (5-10 min.)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
IM Injections
• Preferred sites:
• vastus lateralis/rectus femoris - thigh muscles, site free
of major nerves and blood vessels, preferred site for
infants
• ventrogluteal - only use after walking for 1 year
• dorsogluteal - high risk (sciatic nerve and major blood
vessel), poorly developed in infants - DO NOT USE
• deltiod - upper arm, site for rapid absorption,
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injections
• Subcutaneous: 3/4-5/8 inch, 23-26 gauge, upper arm or
abdomen
• IM: 5/8-1 inch, 20-25 gauge, vastus lateralis, deltoid
• IM maximum amounts: 0.5 mL for infants, 1 mL for
toddlers, in school-age/adolescent deltoid 1 mL, vastus
lateralis 2 mL
• EMLA cream (topical anesthetic) can be used if time
allows (60 min. to 2 1/2 hours)
• Pediatric doses are calculated to the nearest hundreth
and usually measure in a TB syringe
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reasons for Administering IV Therapy to a
Pediatric Patient
• To maintain fluid and electrolyte balance
• To administer antibiotic therapy
• To provide nutritional support
• To administer chemotherapy or anticancer drugs
• To administer pain medication
• To administer blood products
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Candidates for IV Therapy
• Children who have poor gastrointestinal absorption
caused by diarrhea, vomiting, and dehydration
• Children who need a high serum concentration of a
drug
• Children who have resistant infections that require
IV medications
• Children with emergency problems
• Children who need continuous pain relief
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Fundamental Concepts of Fluid Balance
• Water
– Intracellular fluid
– Extracellular fluid
• Electrolytes
– Maintain acid–base
balance
• Acid–base balance
– Acidosis
– Alkalosis
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Complications Associated With the Use of
Central Venous Lines
• Contamination
• Thrombosis
• Dislodgement of the catheter
• Extravasation (fluid escaping into surrounding
tissue)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Selection of IV Sites
• Varies with the child’s age
• The best choice is the one that least restricts the
child’s movements
• Sites used include the hand, the wrist, the forearm,
the foot, and the ankle
• The antecubital fossa, which restricts movement, is
sometimes used, only if other sites are not available
• The scalp vein may be used if no other site can be
accessed
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Equipment Collected in Preparation for Starting
an IV Line
• IV tubing
• Any necessary extension tubing
• The container of solution
• The equipment to stabilize the site
• A tourniquet
• Cleansing supplies used by the institution
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Equipment Collected in Preparation for Starting
an IV Line (cont.)
• Sterile gauze, adhesive tape, cling roll gauze
• An IV pole
• An infusion pump or controller
• A plastic cannula or winged small-vein needle,
usually between 21-gauge and 25-gauge
(depending on the child’s size)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Observations of the IV Site
• Redness
• Pain
• Induration (hardness)
• Flow rate
• Moisture at the site
• Swelling
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins