Pediatric medications and drug administration guidelines Jennifer kean msn, rn, ccrn

Pediatrics vs. adults Drug dosages for children differ greatly Different physiological differences Neonates and infants Immature kidney and liver function- delays absorption and elimination of meds Slow gastric emptying Decreased gastric secretions= decreased absorption Lower concentration of plasma proteins Less total body fat & more total body water Affects water soluble and fat-soluble meds

Oral meds Requires use of a calibrated measuring device Small plastic cup, oral dropper, measuring spoon

Oral meds Can be drawn up with an oral syringe and transferred to cup for an older child Meds should not be mixed in an infant’s or toddler’s bottle Avoid giving meds to a fussy infant, who could aspirate Some chewable MEDS ARE AVAILABLE FOR OLDER CHILDREN

INTRAMUSCULAR SITES CHOSEN ON BASIS OF AGE AND MUSCLE DEVELOPMENT ALL INJECTIONS SHOULD BE GIVEN IN A MANNER THAT MINIMIZES PHYSICAL AND PSYCHOLOGICAL TRAUMA RESTRAIN CHILD IF NECESSARY PROVIDE DISTRACTION PROCESS MUST BE PERFORMED QUICKLY, WITH COMFORT MEASURES AFTERWARD

INTRAMUSCULAR USUAL NEEDLE LENGTH FOR PEDIATRIC PATIENTS IS ½ TO 1 INCH LONG 22 TO 25 GUAGE GRASP MUSCLE BETWEEN THUMB AND FOREFINGER; NEEDLE LENGTH SHOULD BE HALF THE DISTANCE

INTRAMUSCULAR SITES NEONATE: VASTUS LATERALIS INFANT 1-12MONTHS: VASTUS LATERALIS TODDLER 1-2 YEARS: VASTUS LATERALIS, RECTUS FEMORIS OR DELTOID PRESCHOOL 3-12 YEARS: VASTUS LATERALIS, RECTUS FEMORIS, VENTROGLUTEAL, DORSO GLUTEAL OR DELTOID ADOLESCENT 12-18 YEARS: VASTUS LATERALIS, RECTUS FEMORIS, VENTROGLUTEAL, DORSO GLUTEAL OR DELTOID

INTRAVENOUS MAXIMUM AMOUNT OF IV FLUIDS NEEDS TO BE CALCULATED INTO THE PLANNING OF THEIR 24-HOUR INTAKE 24-HOUR INTAKE MUST BE MONITORED CAREFULLY TO AVOID OVERHYDRATION 100 ML/KG FOR FIRST 10 KG BODY WEIGHT 50 ML/KG FOR THE NEXT 10 KG BODY WEIGHT 20 ML/KG AFTER 20 KG BODY WEIGHT

PEDIATRIC DRUG CALCULATIONS DETERMINED BY BODY WEIGHT AND/OR BODY SURFACE AREA USUALLY, RECOMMENDED DOSAGES COME FROM THE DRUG MANUFACTURER (MG/KG, MCG/KG, UNITS/KG) BODY SURFACE AREA IS USUALLY CONSIDERED MORE ACCURATE AND SAFER NOMOGRAM IS USED TO DETERMINE BSA NEED TO KNOW CHILD’S HEIGHT AND WEIGHT REMEMBER: 2.2 LBS. = I KG PLOT ON THE NOMOGRAM AND DRAW LINE TO DETERMINE BSA

NOMOGRAM

EARDROPS TECHNIQUE: PLACE CHILD ON RIGHT OR LEFT SIDE WITH EAR FACING UP PULL THE CHILD’S EAR DOWN AND BACK PULL THE PINNA, NOT THE EARLOBE! INSTILL THE ORDERED NUMBER OF DROPS A COTTON PLEDGET MAY BE PUT OVER THE EAR NEVER INSERT A FOREIGN OBJECT INTO THE EAR CANAL!