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What principles of medical administration are based on psychological differences in Children?
- Consider growth and development principles and differences among age groups
- Honesty, rewards, and praise are important in gaining trust and cooperation
- Restraint may be necessary for safe administration and to help the child to stay still
- Rewards for good behavior and for trying
- EMLA cream may be applied by parent 1 hr before procedure or Tylenol
- Sucrose water may be used for infants
What are some strategies for medicating children according to age?
- Infants: get help for restraint; cuddle and comfort both before and after
- Toddlers: use play; use as little restraint as possible; give praise and use stickers as rewards
- Preschoolers: give as much control as possible; offer choices
- School age: provide choices and explanations; provide distraction and support
- Adolescents: explain and allow to participate in decisions; praise cooperation and provide outlet for frustrations. For STI and mental health, adolescents can provide consent at 14 y/o
What are the physiological differences of children's medication according to age?
- newborns and preterm infants: are at a higher risk of toxicity due to immature liver enzyme systems, decreased plasma proteins to bind with drugs, and immature function of kidneys (decreased GFR)
- Infants: increased metabolic rte and extracellular fluid needs a higher dose per kg of water soluble meds
- Infants older than 6 mo: metabolize meds similar to adults, but the liver may metabolize mds more quickly, requiring larger doses or more frequent admin (important for pain control!!!)
- Smaller muscle mass means fewer IM injection sites
- less reliable peripheral circulation means altered absorption
- Thinner skin means faster absorption of topical medications
- Slower gastric emptying and irregular peristalsis means reduced absorption of oral meds
- Blood Brain barrier is immature until 2 y/o, so risk of encephalopathy as a sign of toxicity
What are the general guidelines for pediatric medication administration?
- 1/2 all meds on market do not have a safe documented use in children
- Med dosage must be adjusted to account for physiologic differences
- Drug reactions are unpredictable and children may react violently
- Impact on growth and development must be considered (such as chronic steroid use, which stunts growth)
- Must double check digoxin, insulin, heparin, blood, and chemo with another RN
What are the procedures for pediatric medication administration?
- Should always be guided by the child's age, weight, and level of growth and development
- RN's approach to the child should convey the impression that he or she expects the child the take the medication
- The nurse must be honest with the child
- May mix distasteful med or crushed tabs with a SMALL amt of jelly, apple sauce, or gelatin (all med must be taken!)
- Never threaten child with injection if they do not take med
- Never refer to medication as candy
Why would the nurse take caution in calculating a pediatric medication dose?
- Safe dosage ranges are not well defined for children
- Not all pediatric doses are listed in drug books
- While its not the RN's responsibility to come up with the dose, it is the RN's responsibility to make sure the dose is correct (always double check)
How would you calculate pediatric medication doses using BSA?
- Using the West Namogram- considered to be the most accurate method of determining dosage
How would you calculate pediatric medication doses using the child's weight?
- mg per kg
- If med is not within range (low dose and high dose), call Dr
What is Clark's Rule?
- based on weight in pounds
What is Fried's Rule?
- For infants only, 0-12mo
What is Young's Rule?
- Children 1-12yrs
What are the MINIMUM 6 rights of medication administration?
What methods can you use to identify the patient?
- Check 2 identifiers from bracelet
- If older child, ask their name
- Ask parent/family
- Always document
What are some techniques for given PO pediatric meds?
- Avoid using essential and favorite foods to disguise meds
- Never underestimate the reaction of a child
- A sip of fruit juice or peppermint before or after the med might dull a bad taste
- Sugarless vehicles should be used for diabetics
- PO is the preferred route for a child, unless vomiting or refusing
- Kids<5 y/o have a hard time swallowing tabs so use suspension or chewable
- only divide pre-scored tablets
How can you give meds to infants?
- Draw up med in a dropper or syringe without needle and parents should be given proper measuring cup to take home
- Elevate infant's head and shoulders and hold infant in feeding position
- Depress the chin with thumb to open infant's mouth, release thumb to allow to swallow
- Direct the med towards the inner aspect of the cheek and slowly release the medication
How can you give meds to Toddlers and Preschoolers?
- Draw up med in a syringe or measure in a med cup
- Elevate the child's head and shoulders
- place syringe in child's mouth and slowly release med, directing it towards the inner aspect of the cheek OR allow child to drunk from med cup at own pace
- Offer praise
How can you give meds to school age children?
- When child is old enough to take med in tab or capsule, direct him or her to place tab near back of tongue and swallow fluid
- use straw for teaching
- Offer praise
Describe giving IM medications to pediatric patients in the Vastus lateralis
- On infants the most common site is the vastus lateralis
- -large and well developed muscle that is easily accessible
- -More painful than deltoid
- 0.5ml for infant to 2.0ml for child
- Newborns: 25 gauge 5/8 in needle
- infant >2mo 22-25 gauge 1in needle
How would you give IM meds in the ventrogluteal site?
- Less nerves and vascular structures than VL, but used less frequently
- Same needle size as VL
- Accommodates same quantity of ed as VL but is less painful and easily accessible
Who gets IM injections in the deltoid muscle? Which needle do you use?
- Toddlers & preschoolers
- Less painful than vastus lateralis
- 1/2 to 1in needle depending on muscle mass
How would you give an SC injection to pediatrics?
- use lateral aspect of upper arm, anterior lateral aspect of thigh or abdomen
- 5/8 length 25-30 gauge, up to 0.5ml
- 45 r 90 degrees angle
What are some techniques to give injections to infants?
- Place infant in secure position to avoid movement of extremity
- usually, have second person to secure the infant
- Hold, cuddle, and comfort the infant after the injection
What are some techniques for giving injections to toddlers and school age kids?
- have syringe and needle completely prepared before contact with child
- Keep need out of the child's view!
- Explain, according to developmental age the reason for the injection and where it will be given
- Do not tell them it will not hurt!
- Inspect site for unexpected tenderness or hardness prior to injection
- have a second person secure and comfort child
- Allow child to express fears
- complete procedure quickly and gently
- Praise the child after injection
How do you administer Nasal Drops? What is the most important thing to remember?
- They act as vasoconstrictors and excessive use may be harmful
- D/C after 72 hrs
- Congested nose affects infants ability to suckle, so give 20 min prior to feeding
- have tissues ready and place infant on back with head over side of mattress (you may also extend neck over blanket roll
- Hold face with hand encircling chin and cheeks
- Insert drops and use second person if mummy hold is necessary
- MOST IMPORTANT: keep child's head below level of shoulders for 1-2 minutes after instillation
Describe giving rectal medication to kids
- usually sedatives and antiemetics
- use your pinky finger and insert beyond the second anal sphincter
- Apply pressure to anus by gently holding buttocks together until desire to expel subsides in 5-10min
- Absorption may be delayed or diminished due to stool
Describe giving IV medications to pediatric patients
- Absorbed more rapidly
- Decreases the number of injections needed
- used to rest the GI tract, N/V/D, and fluid replacement
- Disadvantages include IV insertion (pain and anxiety), limited mobility (flow can also be disturbed with movement), and risk of infiltration (As well as side effects and risk of cardiac overload)
- Infant's scalp veins may be used
What nursing measures should be taken when administering IV meds?
- Secure and wrap, checking for patency, infiltration, inflammation, rate, pain, and LTC (unwrap once per ship but check site hourly)
- Use mini/micro drop chamber for control
What is important to know when administrating TPN or Hyperalimentation
- delivered by a central line
- IV line should have a filter on it
- Follow agency protocols for flushing and dressing
- Most often used: PICCs, Implanted ports, Hickmans, and Broviacs
- Complications: infections and hyperglycemia
- If you need TPN and its not avail, use D10W
How do you administer ear drops to pediatric patients?
- Child <3yrs: pull pinna down and back (pull down because babies are short)
- Child >3 yrs: pull pinna up and back (because toddlers think they're grown ups!)
- Pre-warm ear drops prior to instillation
- Remain lying on unaffected side for a few minutes after instillation
- Gently massage area immediately anterior to ear
- Pre-moisten cotton ball with medication to prevent wicking action of cotton ball
How do you administer eye drops to pediatric patients?
- cure child in the supine position and instill drops into conjunctival sac
- To distribute medication, ask child to look in all directions
- Apply pressure at lacrimal duct for 1 min to prevent drainage into nose
- Avoid the child rubbing away the medication
- Be careful not to contaminate the dropper or the unaffected eye
- Wipe excess medication from the inner canthus and outward to avoid contaminating the other eye
- If both ointment and drops are prescribed, apply drops first and wait 3 min before admin ointment
- Admin ointment at naptime or bedtime due to blurring of vision
How do you administer Oxygen to kids?
- Via hood, NC, or blow-by (kids do not like mask!)
- Monitor the pulse ox
- Preterm infants should maintain pulse ox 90-95% to prevent retinal damage
- Excessive 02 damages the lungs of any age patient
- Monitor for oxygen induced carbon dioxide narcosis in children with chronic pulmonary disease such as cystic fibrosis (switching of the hypoxic drive, such as in COPD)
How do you administer Aerosols to pediatric patients?
- For Nebulizers, use a mask or blow-by for infants
- For MDI's, use a spacer for children under 5-6yrs
- Assess breath sounds before and after the treatment
What are some important things to remember when giving topical medications to pediatric patients?
- Used to ease discomfort, prevent further injury and facilitate healing
- Give parents detailed info on how much to use, how to apply, and how long preparation should remain on the skin
- Stress that more is not necessarily better (such as steroids, which thin the skin in long term use)
- Caution against using both oral and topical meds containing the same med (such as benadryl or asprin)