PEDIATRIC MEDICATIONS AND DRUG ADMINISTRATION GUIDELINES JENNIFER KEAN

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 -12 MONTHS: 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!