Chapter 31Chapter 31

Medication Administration and Medication Administration and Intravenous TherapyIntravenous Therapy

The Six “Rights” of The Six “Rights” of Medication Medication AdministrationAdministration

The right medicationThe right medication The right patientThe right patient The right doseThe right dose The right routeThe right route The right timeThe right time The right documentationThe right documentation

Role of the Nurse in Role of the Nurse in Medication Medication AdministrationAdministration

Understand the factors that influence or alter Understand the factors that influence or alter how the child absorbs, metabolizes, and how the child absorbs, metabolizes, and excretes the medicationexcretes the medication

Be aware of any allergies the child may haveBe aware of any allergies the child may have Administer the medications properlyAdminister the medications properly Teach the patient and the family caregivers Teach the patient and the family caregivers

about the effects and possible side effects of about the effects and possible side effects of medications givenmedications given

Guidelines for Medication Guidelines for Medication Administration in ChildrenAdministration in Children

Do not give the child a choice whether or not to take Do not give the child a choice whether or not to take the medicinethe medicine

Do give choices that allow the child some controlDo give choices that allow the child some control Do not tell the child the injection will not hurtDo not tell the child the injection will not hurt Give simple and brief explanationsGive simple and brief explanations Assure child that it is okay to be afraid and/or cryAssure child that it is okay to be afraid and/or cry Do not talk in front of the child as if he or she were Do not talk in front of the child as if he or she were

not therenot there Be positive in approaching the childBe positive in approaching the child

Guidelines for Medication Guidelines for Medication Administration in Administration in Children (cont.)Children (cont.)

Keep time between explanation and Keep time between explanation and administration briefadministration brief

Do preparation for administration out of Do preparation for administration out of sight of the childsight of the child

Obtain cooperation from family Obtain cooperation from family caregiverscaregivers

Computing DosagesComputing Dosages

Pounds to kilograms:Pounds to kilograms: 2.2 lbs2.2 lbs = = 42lbs42lbs 1 kg x kg1 kg x kg2.2 lb x X kg = 1 kg x 42 lb2.2 lb x X kg = 1 kg x 42 lb2.2 lb x X kg2.2 lb x X kg = = 1 kg x 42 lb1 kg x 42 lb 2.2 lb 2.2 lb2.2 lb 2.2 lb

X = X = 4242 2.22.2X = 19.kgX = 19.kg

Computing DosesComputing Doses

Calculating dose using body weightCalculating dose using body weight Dosage range 10-30 mg/kg is safeDosage range 10-30 mg/kg is safe Child weighs 20 kgChild weighs 20 kg

10 mg10 mg = = X mgX mg 1 kg 20 kg1 kg 20 kg10 mg x 20 kg10 mg x 20 kg = = 1 kg x X kg1 kg x X kg 1kg 1 kg1kg 1 kg200 x 1 = 1 X 200 = X200 x 1 = 1 X 200 = X200 mg is the safe low dose200 mg is the safe low dose

Computing dosesComputing doses

Now calculate for the high doseNow calculate for the high dose 30 mg30 mg = = X mgX mg 1 kg 20 kg1 kg 20 kg30 mg x 20 kg = 1 kg x Xmg30 mg x 20 kg = 1 kg x Xmg30 mg x 20 mg = 30 mg x 20 mg = 1 kg x X mg1 kg x X mg 1 kg1 kg600 x 1 = 1X 600 = X600 x 1 = 1X 600 = XThe high safe dose is 600 mgThe high safe dose is 600 mgRange is 200-600 mg for a child of 20 kgRange is 200-600 mg for a child of 20 kg

Computing DosesComputing Doses

Body surface area (BSA) methodBody surface area (BSA) method The The West nomogramWest nomogram A graph with several A graph with several

scales arranged When two values are scales arranged When two values are known, the third can be plotted by drawing a known, the third can be plotted by drawing a line with a straight edgeline with a straight edge

Draw a line between the point representing Draw a line between the point representing the child’s height on the left and the chil’d the child’s height on the left and the chil’d height on the right. The intersecting point is height on the right. The intersecting point is the body surfacethe body surface

Routes of Medication Routes of Medication AdministrationAdministration

OralOral IntramuscularIntramuscular Eye, ear, and nose dropsEye, ear, and nose drops Rectal medicationsRectal medications Intravenous therapyIntravenous therapy

Medication Medication AdministrationAdministration Children vary in age, weight, body Children vary in age, weight, body

surface, ability to absorb. Metabolize surface, ability to absorb. Metabolize and excrete medsand excrete meds

Determination of drug dosageDetermination of drug dosage Checking dosageChecking dosage Identification Identification Family aspectsFamily aspects

AdministrationAdministration OralOral Intramuscular (see table 45-5)Intramuscular (see table 45-5) Subcutaneous and intradermalSubcutaneous and intradermal IntravenousIntravenous

Parenteral Fluid TherapyParenteral Fluid Therapy Site selection (accessibility)Site selection (accessibility) Scalp vein IVsScalp vein IVs Intraosseous infusionIntraosseous infusion

Rapid, safe and lifesaving alternate route Rapid, safe and lifesaving alternate route of administrationof administration

Surgical cutdownSurgical cutdown

Equipment for Fluid Equipment for Fluid TherapyTherapy CathetersCatheters Needleless systemsNeedleless systems

Prevent accidental needle stick injuries Prevent accidental needle stick injuries during administration of IVP or piggyback during administration of IVP or piggyback medsmeds

Rely on prepierced boresRely on prepierced bores

Infusion pumpsInfusion pumps

Equipment Collected in Equipment Collected in Preparation for Starting Preparation for Starting an IV Linean IV Line

IV tubingIV tubing Any necessary extension tubingAny necessary extension tubing The container of solutionThe container of solution The equipment to stabilize the siteThe equipment to stabilize the site A tourniquetA tourniquet Cleansing supplies used by the institution Cleansing supplies used by the institution

Equipment Collected in Equipment Collected in Preparation for Starting Preparation for Starting an IV Line (cont.)an IV Line (cont.)

Sterile gauze, adhesive tape, cling roll Sterile gauze, adhesive tape, cling roll gauzegauze

An IV poleAn IV pole An infusion pump or controllerAn infusion pump or controller A plastic cannula or winged small-vein A plastic cannula or winged small-vein

needle, usually between 21-gauge and needle, usually between 21-gauge and 25-gauge (depending on the child25-gauge (depending on the child’’s size)s size)

Management of Peripheral Management of Peripheral Intravenous Lines (PIVs)Intravenous Lines (PIVs)

Securing PIVsSecuring PIVs Transparent dressings preferred because Transparent dressings preferred because

the insertion site can be visualizedthe insertion site can be visualized

Removal of PIVsRemoval of PIVs ComplicationsComplications

InfiltrationInfiltration ExtravasationExtravasation

Reasons for Reasons for Administering IV Therapy Administering IV Therapy to the Pediatric Patientto the Pediatric Patient

Maintain fluid and electrolyte balanceMaintain fluid and electrolyte balance Administer antibiotic therapyAdminister antibiotic therapy Provide nutritional supportProvide nutritional support Administer chemotherapy or anticancer Administer chemotherapy or anticancer

drugsdrugs Administer pain medicationAdminister pain medication Administer blood productsAdminister blood products

Candidates for IV Candidates for IV TherapyTherapy

Children who have poor gastrointestinal Children who have poor gastrointestinal absorption caused by diarrhea, vomiting, and absorption caused by diarrhea, vomiting, and dehydrationdehydration

Children who need a high serum concentration Children who need a high serum concentration of a drugof a drug

Children who have resistant infections that Children who have resistant infections that require IV medicationsrequire IV medications

Children with emergency problemsChildren with emergency problems Children who need continuous pain reliefChildren who need continuous pain relief

Fundamental Concepts of Fundamental Concepts of Fluid BalanceFluid Balance

WaterWater Intracellular fluidIntracellular fluid Extracellular fluidExtracellular fluid

ElectrolytesElectrolytes Maintain acid-base balanceMaintain acid-base balance

Acid-base balanceAcid-base balance AcidosisAcidosis Alkalosis Alkalosis

Complications Associated Complications Associated With the Use of Central With the Use of Central Venous Lines Venous Lines

ContaminationContamination ThrombosisThrombosis Dislodgement of the catheterDislodgement of the catheter Extravasation (fluid escaping into Extravasation (fluid escaping into

surrounding tissue)surrounding tissue)

Selection of IV SitesSelection of IV Sites Varies with the child’s ageVaries with the child’s age The best choice is the one that least restricts the The best choice is the one that least restricts the

child’s movementschild’s movements Sites used include the hand, the wrist, the forearm, Sites used include the hand, the wrist, the forearm,

the foot, and the anklethe foot, and the ankle The antecubital fossa, which restricts movement, is The antecubital fossa, which restricts movement, is

sometimes used, only if other sites are not availablesometimes used, only if other sites are not available The scalp vein may be used if no other site can be The scalp vein may be used if no other site can be

accessedaccessed

Observations of the IV Observations of the IV SiteSite

RednessRedness PainPain Induration (hardness)Induration (hardness) Flow rateFlow rate Moisture at the siteMoisture at the site SwellingSwelling