CHAPTER 48: PEDIATRIC MEDICATION ADMINISTRATION AND CALCULATIONS PYRAMID POINTS CHAPTER 48: PEDIATRIC MEDICATION ADMINISTRATION AND CALCULATIONS

PYRAMID POINTS I. Oral Medications Most are liquid or suspension versus tablet Solutions may be measured with oral syringe or other acceptable measurement or administration device Mixing of suspensions required before pouring Suspensions must be administered immediately after measurement Administer with child seated upright or with head elevated Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS I. Oral Medications (continued) Never pinch child’s nostrils during administration Unpleasant tasting medications should be directed toward back of infant’s mouth via syringe, slowly, allowing swallowing Small child may be placed sideways on lap, closely held, medication administered via plastic spoon, cup, or syringe slowly If tablet or capsule is administered, check child’s mouth to ensure it is swallowed; crush if pharmacologically appropriate Follow generally accepted medication guidelines for children Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS II. Ear Medications Instill ear drops by pulling child’s earlobe down, back If medication draining from ear canal, may insert cotton ball into ear to prevent leakage Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS III. Parenteral Medications Subcutaneous and intramuscular (IM) medications Safe use of all injection sites based on normal muscle development, size of child Preferred site in infant is vastus lateralis Intravenous (IV) medications Monitor site for signs of inflammation, infiltration, extravasation Use agency policies for determination of volume of flush for peripheral and central lines Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS III. Parenteral Medications (continued) Intermittent IV medication administration May be administered through primary infusion tubing or via piggyback infusion set Should be infused on pump or controller Follow medication infusion with flush Special IV administration sets: These administer 60 gtt/mL Retrograde IV injection Medication mixed with diluent in syringe, then given into port in direction of burette Syringe pump for IV medication administration Syringe containing medication fitted into pump connected to IV tubing through Y connector Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS IV. Calculation of Medication Dosage by Body Weight Conversion of body weight: 1 kg = 2.2 lb A child weighs 3.4 kg. How many lb does the child weigh? 3.4  2.2 = 7.48, or 7.5 lb A child weighs 22 lb. How many kg does the child weigh? 22/2.2 = 10 kg Calculation of daily dosages Expressed as mg/kg per day or mg/lb per day or mg/kg per dose Daily dosages usually divided into more than one dose throughout day Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS continued … Calculate daily dose, divide according to how many doses are to be given per day: If you are to give 220 mg/day, but doses are qid, divide 220 by 4 to get 55 mg/dose Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS V. Calculation of Body Surface Area (BSA) Determined by comparing body weight and height with averages or norms on nomogram Not all children are same size for age; thus, nomogram is used Height on left-hand side of nomogram, weight on right-hand side of nomogram Use ruler on nomogram to line up height and weight, read BSA Estimated surface area given in square meters (m2) Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS VI. Calculation Based on BSA Calculate with simple multiplication for dosage recommendations for children When dosages are specified only for adults, formula is used to calculate child versus adult dosage Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PYRAMID POINTS VII. Developmental Considerations for Administering Medications Developmental age must be taken into consideration for safe, effective administration General interventions Be prepared with equipment If child gets fussy when parent(s) present, consider asking parent to leave for administration of medications Determine appropriate comfort measures pre- and postadministration of medications; institute appropriately Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

The nurse has an order to give ear drops to a 3-year-old child The nurse has an order to give ear drops to a 3-year-old child. The nurse positions the child’s ear properly by pulling the pinna of the ear: 1. Downward and outward 2. Downward and backward 3. Upward and outward 4. Upward and backward Answer: 2 Rationale: To administer ear drops to a child properly, the pinna of the ear should be pulled downward and backward. When giving ear drops to an adult, the pinna is pulled upward and outward (option 3). The other options are incorrect. Test-Taking Strategy: Use basic principles of administering otic medications to answer this question. Note the age of the child to direct you to the correct option. Remember that to administer ear drops to a child properly, the pinna of the ear should be pulled downward and backward. If this question was difficult, review the fundamental principles of medication administration. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process—implementation Content Area: Child Health Reference: Hockenberry, M., Wilson, D., & Winkelstein, M. (2005). Wong’s essentials of pediatric nursing (7th ed., pp. 1129-1130). St. Louis: Mosby. Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.