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What adaptations would the nurse make when providing care to children?
Adaptations in assessments, treatments, evaluations of nursing care because of physiological, psychological and developmental differences
How can the nurse prevent errors when caring for the pediatric population?
- Calculate carefully, double checking math & checking w/another RN
- Ensure families understand units of measurement
- Use smallest syringe when giving injections to give exact measurement (safety)
- Use correct med and procedure for safe dosing. Dilutions, different concentrations and different solutions of prescribed meds can be confusing
- Infants & children may not be able to confirm identity, allergies or meds. Be positive before giving med
- Be very vigilant for severe side effects or adverse reactions since they are not always known for kids
- Regulatory agencies caution that med errors are more common w/kid so be extra cautious
What percentage of medications are federally approved for use in children? Why?
- Because many drugs have not undergone the clinical trials required for federal approval they have not been approved for pediatric use.
What significant differences exist in drug pharmacokinetics? (Absorption, Distribution, Metabolism, Excretion?
- Absorption: degree and rate of absorption based on age, health status, weight and route of administration. As children grow and develop absorption becomes more effective; less developed absorption in neonates and infants must be considered in dosage and administration. There is slowing in absorption during adolescence due to poor nutrition, physical maturity & hormonal differences.
- Distribution: distribution affected by body fluid composition, body tissue composition, protein-binding capability and effectiveness of various barriers to med transport. Neonates and young infants re 70% water. This increased body fluid proportion in very young allows greater volume of fluid to distribute med and lower concentration of med until age 2 kids require higher doses of water-soluble meds for therapeutic level.
- Metabolism: metabolism is carried our primarily in liver (kidney and lungs play smaller part). Most children younger than 2 sustained decreases in levels of hepatic enzymes result in slower metabolism of meds.
- Excretion: before 9 mths infants experience a reduction in elimination capacity of kidneys because of decreased renal blood flow, decreased glomerular filtration rate, and reduced renal tubular function.
In the pediatric population how does pharmacodynamics differ from the adult population?
Affects onset, peak and duration of effect o a drug. The variable of Pharmacokinetics absorption, distribution, metabolism and excretion-all affect pharmacodynamics
What is the key nursing role in administering medication to children?
To monitor the pt for therapeutic effect and adverse reactions
Why is dosage calculation of particular importance in pediatric medication administration?
Because therapeutic range of most drugs are based on adult studies. Monitoring drugs and effect can help indicate when dose is to high (toxic) or too low (not therapeutic).
What factors should be considered when dosing a medication for a child?
Childs weight, height, lean body mass, status, age, organ function, health and the route of administration
How would the nurse identify the pediatric client?
Use ID wristband in inpatient setting
What is the difference between developmental age and chronological age and how does that impact medication administration?
- Developmental age: level of understanding
- Chronological age: I actual age
- Important to note difference because the difference will impact the childs response and responsiveness to medication. The childs ability to understand the process, the reason for med, and the need to cooperate with procedure must always figure prominently in the pediatric nurses plan of care
Should family members be involved in medication administration? Why or why not?
Yes, they should be taught how to administer med and how to evaluate its effectiveness along with adverse effects. Family are usually in best position to evaluate the effectiveness of med and observe for adverse reactions.
What cognitive issues affect medication administration?
- 1. Reason for medication
- 2. Need for medication despite unpleasant taste or method of administration
- 3. Need to complete all doses and courses of medication
What should the communication with the child and family consider?
- Level of knowledge
- Developmental age
- Cultural factors
- Levels of anxiety
How are most pediatric medications delivered? Why?
Oral route; least invasive and easiest to use and can be used by the family and care givers
Should the nurse dilute the medication? Put in a bottle for an infant?
Small volumes should be used to dilute medications to ensure pt gets full dose. Infants may suck medication from bottle nipple into which the measured med has been squirted from the oral syringe
How would the nurse provide atraumatic care when delivering medications?
- Atraumatic care is delivery of care through implementation of interventions that eliminate or minimize the psychological and physical distress experienced by kids and their families in health care system.
- Nurses should prepare child for procedure and use methods like topical analgesic on site before IM, SubQ or IV injections
How can the nurse protect IV infusion sites?
- By using stocking-like covers to hide site from infants before they master the concept of object permanence.
- In a preschooler, the site should be covered with a bandage, preferably a decorated one so child does not fear leakage from that area.
What considerations would the nurse utilize when administering medications to adolescents?
- Age-oriented developmental considerations include:
- Physical changes
- Cognitive level
- Emotional factors
- Impact of chronic illness
What herbal preparations can be utilized in the pediatric population?
Herbal preparations are generally not recommended for use in children
In relation to the nursing process, what would the nurse assess when delivering medications to the pediatric client?
- Record are, weight and height (drug calculations are based on these)
- Asses allergy hx and determine family allergy hx
- Assess developmental age, heath status, nutritional status and hydration status
- Assess hx of drug use (prescription, OTC, herbal)
- Assess familys understanding and childs cognitive level
What would be some nursing diagnoses related to medication administration and the pediatric client?
- Delayed growth & development r/t physiologic, congenital or environmental factors
- Risk for ineffective peripheral tissue perfusion r/t decreased fluid volume, decreased cardiac output or developmental physiologic differences
- Impaired urinary elimination r/t decreased fluid volume, renal immaturity, congenital anomalies or decreased renal perfusion
- Deficient knowledge r/t new parenting role, lack of exposure to children and adolescents language barrier, cognitive discrepancy or new diagnosis
- Risk for injury r/t developmental, cognitive and environmental factors
- Ineffective health maintenance /t cognitive experiential, environmental and social factors
- Readiness for enhanced knowledge r/t parenting an progression through childs developmental stages
What nursing interventions would the nurse utilize to deliver medications to the pediatric population?
- Use appropriate drug references t obtain rug parameters or ranges, side effects and contraindications
- Monitor infants and young children loosely for side effects because of developmental differences. Since infants and young children have limited communication skills, change in usual behavior pattern may indicate side effects
- Communicate w/HCP about drug dosages that are questionable for infants and young children because of developmental differences. Calculate childs drug dose according to weight in kg or BSA
What teaching would the nurse provide related to medication administration to the pediatric client?
- Teach parents an families about med, dosages therapeutic effects, side effects and precautions (especially for nonverbal young or at-risk kids)
- Advise responsible family member not to give OTC drugs to kids w/o consulting dr
- Advise family member to immediately report side effects to dr
- Advise mothers who are breastfeeding to consult r when taking any med because portion of drug is excreted in breastmilk
- Nurses must be aware that parents & families frequently believe that all pediatric infections are treated w/antibiotics. Teach about avoiding overuse of antibiotics for viral infections and allergic responses to avoid resistant organisms
- Advise family member to keep meds out of reach of kids
- Suggest that family member use child-resistant med containers
What cultural consideration would the nurse utilize during medication administration to the pediatric client?
- Consider cultural differences when caring for and teaching about meds
- Some cultures may adhere to folk and other health practices including herbal preparations. Make sure families understand the contraindications and precautions associated with use of herbs in kids
- When soliciting adolescent health hx consider issues r/t sexual practices, risk behaviors, recreational drug use and other issues that may affect med administration and safety. Provide privacy when asking sensitive questions
What would the nurse evaluate after a medication has been administered to the pediatric client?
- Evaluate family members knowledge about drug, dosage, schedule for administration and side effects
- Evaluate childs physiological and psychological response to drug regimen
- Evaluate therapeutic and adverse effects of med(s)