PYRAMID POINTS CHAPTER 48: PEDIATRIC MEDICATION ADMINISTRATION AND CALCULATIONS

PYRAMID POINTSPYRAMID POINTS

CHAPTER 48: CHAPTER 48: PEDIATRIC MEDICATION PEDIATRIC MEDICATION ADMINISTRATION AND ADMINISTRATION AND

CALCULATIONSCALCULATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

PEDIATRIC NURSING: Pediatric Medication Administration and Calculations

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I. Oral MedicationsI. Oral Medications Most are liquid or suspension versus tabletMost are liquid or suspension versus tablet Solutions may be measured with oral syringe or Solutions may be measured with oral syringe or

other acceptable measurement or administration other acceptable measurement or administration devicedevice

Mixing of suspensions required before pouringMixing of suspensions required before pouring Suspensions must be administered immediately Suspensions must be administered immediately

after measurementafter measurement Administer with child seated upright or with head Administer with child seated upright or with head

elevatedelevated



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I. Oral Medications (continued) I. Oral Medications (continued) Never pinch child’s nostrils during administrationNever pinch child’s nostrils during administration Unpleasant tasting medications should be directed toward Unpleasant tasting medications should be directed toward

back of infant’s mouth via syringe, slowly, allowing back of infant’s mouth via syringe, slowly, allowing swallowingswallowing

Small child may be placed sideways on lap, closely held, Small child may be placed sideways on lap, closely held, medication administered via plastic spoon, cup, or syringe medication administered via plastic spoon, cup, or syringe slowlyslowly

If tablet or capsule is administered, check child’s mouth to If tablet or capsule is administered, check child’s mouth to ensure it is swallowed; crush if pharmacologically ensure it is swallowed; crush if pharmacologically appropriateappropriate

Follow generally accepted medication guidelines for childrenFollow generally accepted medication guidelines for children



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II. Ear MedicationsII. Ear Medications Instill ear drops by pulling child’s earlobe down, Instill ear drops by pulling child’s earlobe down,

back back If medication draining from ear canal, may insert If medication draining from ear canal, may insert

cotton ball into ear to prevent leakagecotton ball into ear to prevent leakage



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III. Parenteral MedicationsIII. Parenteral Medications Subcutaneous and intramuscular (IM) medicationsSubcutaneous and intramuscular (IM) medications

• Safe use of all injection sites based on normal muscle Safe use of all injection sites based on normal muscle development, size of childdevelopment, size of child

• Preferred site in infant is vastus lateralisPreferred site in infant is vastus lateralis

Intravenous (IV) medicationsIntravenous (IV) medications• Monitor site for signs of inflammation, infiltration, Monitor site for signs of inflammation, infiltration,

extravasationextravasation

• Use agency policies for determination of volume of flush Use agency policies for determination of volume of flush for peripheral and central linesfor peripheral and central lines



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III. Parenteral Medications (continued) III. Parenteral Medications (continued) Intermittent IV medication administrationIntermittent IV medication administration

• May be administered through primary infusion tubing or via May be administered through primary infusion tubing or via piggyback infusion setpiggyback infusion set

• Should be infused on pump or controllerShould be infused on pump or controller• Follow medication infusion with flushFollow medication infusion with flush

Special IV administration sets: These administer 60 Special IV administration sets: These administer 60 gtt/mLgtt/mL

Retrograde IV injectionRetrograde IV injection• Medication mixed with diluent in syringe, then given into port in Medication mixed with diluent in syringe, then given into port in

direction of burettedirection of burette Syringe pump for IV medication administrationSyringe pump for IV medication administration

• Syringe containing medication fitted into pump connected to IV Syringe containing medication fitted into pump connected to IV tubing through Y connectortubing through Y connector



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IV. Calculation of Medication Dosage by Body IV. Calculation of Medication Dosage by Body WeightWeight Conversion of body weight: 1 kg = 2.2 lbConversion of body weight: 1 kg = 2.2 lb

A child weighs 3.4 kg. How many lb does the child weigh? A child weighs 3.4 kg. How many lb does the child weigh? 3.4 3.4 2.2 = 7.48, or 7.5 lb 2.2 = 7.48, or 7.5 lb

A child weighs 22 lb. How many kg does the child weigh? A child weighs 22 lb. How many kg does the child weigh? 22/2.2 = 10 kg22/2.2 = 10 kg

Calculation of daily dosagesCalculation of daily dosages• Expressed as mg/kg per day or mg/lb per day or mg/kg Expressed as mg/kg per day or mg/lb per day or mg/kg

per doseper dose

• Daily dosages usually divided into more than one dose Daily dosages usually divided into more than one dose throughout daythroughout day



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continued …continued …

Calculate daily dose, divide according to how many doses Calculate daily dose, divide according to how many doses are to be given per day: If you are to give are to be given per day: If you are to give

220 mg/day, but doses are qid, divide 220 by 4 to get 55 220 mg/day, but doses are qid, divide 220 by 4 to get 55 mg/dosemg/dose



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V. Calculation of Body Surface Area (BSA)V. Calculation of Body Surface Area (BSA) Determined by comparing body weight and height Determined by comparing body weight and height

with averages or norms on nomogramwith averages or norms on nomogram Not all children are same size for age; thus, Not all children are same size for age; thus,

nomogram is usednomogram is used Height on left-hand side of nomogram, weight on Height on left-hand side of nomogram, weight on

right-hand side of nomogramright-hand side of nomogram Use ruler on nomogram to line up height and Use ruler on nomogram to line up height and

weight, read BSAweight, read BSA Estimated surface area given in square meters Estimated surface area given in square meters

(m(m22))



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VI. Calculation Based on BSAVI. Calculation Based on BSA Calculate with simple multiplication for dosage Calculate with simple multiplication for dosage

recommendations for childrenrecommendations for children When dosages are specified only for adults, When dosages are specified only for adults,

formula is used to calculate child versus adult formula is used to calculate child versus adult dosagedosage



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VII. Developmental Considerations for VII. Developmental Considerations for Administering MedicationsAdministering Medications Developmental age must be taken into Developmental age must be taken into

consideration for safe, effective administrationconsideration for safe, effective administration General interventionsGeneral interventions

• Be prepared with equipmentBe prepared with equipment• If child gets fussy when parent(s) present, consider If child gets fussy when parent(s) present, consider

asking parent to leave for administration of medicationsasking parent to leave for administration of medications• Determine appropriate comfort measures pre- and Determine appropriate comfort measures pre- and

postadministration of medications; institute appropriatelypostadministration of medications; institute appropriately



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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 The nurse positions the child’s ear properly by pulling the pinna of the ear:of the ear:

1. Downward and outward1. Downward and outward

2. Downward and backward2. Downward and backward

3. Upward and outward3. Upward and outward

4. Upward and backward4. Upward and backward

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PYRAMID POINTS CHAPTER 48: PEDIATRIC MEDICATION ADMINISTRATION AND CALCULATIONS