Paediatric Drug Computation

8/8/2019 Paediatric Drug Computation

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Age Group Guidelines

Time of Administration

Common Equivalent Used Computation of Peadiatric Doses

CLARKS RULE

YOUNGS RULE

FRIEDMANS RULE BODY WEIGHT Drugs Measured in Units Medication in Powder Form


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Infant: 1 month to one year

Child: 1 - 12 years Toddler: 1 - 3 years

Preschool: 4 - 5 years

School aged: 6 - 12 years

Adolescent: 13 - 18 years

Adult: > 18 years


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Abbreviation Derivation Meaning

A.c. ante cibum before mealsA.m. ante miridiem morningB.i.d bis in die twice a dayH. hora hour

H.s. hora somni at sleeping timeO.d omni die dailyP.c. post cibum after mealsP.m. post miridiem afternoonP.r.n pro re nata when requiredQ.h quaque hora every hour

Q 2 h every 2 hoursQ 3 h every 3 hoursQ 4 h every 4 hoursQ.i.d or 4 i. d. quarter in die four times a dayStat statim at onceT.i.d ter in die three times a day


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1 kg = 1000 grams 1 quart=2 pints1 kg = 2.2 lbs or pounds 1 liter=1000 cc

1 gram= 1000 mg 1 pint =1/2 liter or 500 cc1 grain= 60 mg 1 pint=16 fluid ounces1 gm= 15 grains 1 ml = 15 gtts1 gallon= 4 liters or 4000 cc 1 gtt = 4 megtts1 gallon = 4 quarts 1 gm = 1 ml1 quart = 1 liter 1 gm = 1 gtt


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1 table spoon = 15 ml or cc1 tsp = 5 ml or cc

1 fluid ounce = 30 ml or cc1 cup = 6 oz or 180 cc1 fluid oz = 2 tbsp

1 glass = 8 oz or 240 cc1 tbsp = 3 tps


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Administration of medication is traumaticfor children.

Proper approach to administration can

facilitate the process and enhance thechilds understanding of the importance

of taking medication.


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The manner of approach should indicatethat the nurse firmly expects the child totake the medication. Establishing a positiverelationship with the child will allow

expression of feelings, concerns andfantasies regarding medication.

Explanation about the medication shouldappeal to the childs level of understanding

(through play or comparison to somethingfamiliar).

The nurse must mask his or her own feelingsregarding the medication.

Always be truthful when the asks.


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It is often necessary to mix distastefulmedications or crushed pills with a small

amount of carbonated prink, cherry syrup orapplesauce.

Never threaten a child with injection whenrefusing oral medications.

Medication should not be mixed with largequantities of food or with any food that is takenregularly.

Medications should be given at meal timeunless specifically prescribed.

The nurse must know about the following abouteach medication being administered:common usage and dosages,contraindications, side effects and toxiceffects.


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The nurse is responsible for knowing the medicationbeing given is within the safe dosage range for children.

1. Know what factors determine the amount of drugprescribed.

a. Action of the drug, absorption, detoxification,

excretion are related to maturity and metabolicrate of the child.

b. Neonates and premature infants require a

reduced dosage because:

Deficient or absent detoxifying agentDecreased effective renal function

Altered blood-brain barrier and protein binding

capacity


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c. Dosage recommended for age group isnot satisfactory because a child may be

much smaller or larger than the averagechild in the age group.

2. Be alert of prescriptions that would be

inappropriate for the child.

3. Consult drug literature for therecommended dosage and otherinformation.


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Draw up medications in a plastic dropper or

disposable syringe

Elevate infants head and shoulders and dispresschin with thumb to open the mouth

Place dropper or syringe in the middle of thetongue and slowly drop the medication on thetongue

Release thumb and allow the child to swallow.

Once the correct amount of the medication ismeasured, it can be placed in a nipple and thechild can suck the medication trough the nipple.


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Draw up medication in the syringe ormedication cup. Medicine can be placedin a spoon after measuring accurately with

a syringe. Elevate the childs head and shoulders. Squeeze cup and put it in the childs lips or

place the syringe in the buccal area and

expel the medicine. Allow the child time to swallow Allow the child to hold the cup of able and

to drink it at own pace. Offer a favouritedrink as a chaser if not contraindicated.


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Child is old enough to take medication as apill or capsule.

Place the pill near the back of the tongueand swallow with water or fruit juice.

Always praise a child after taking amedication.

If the child finds it particularly difficult totake oral medications, expressunderstanding of fear and displeasure andoffer help.


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Draw up additional 0.2 -0.3 ml of air into the syringe this will clear the needle of medication andpreventing medication seepage from the site

Use tuberculin syringe when injecting less than 1 ml

of medication. Cleanse site thoroughly using friction and let it dry.

Alternate injection site and keep record atbedside.

After injecting check for blood backflow. Massage site this can prevent contracture and

fibrosis of the muscles. Can also do range ofmotion, warm soaks to prevent scar tissues


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Sites are rectus femoris (mid anterior thigh)vastus lateralis ( middle third) or ventrogluteal

Gluteous maximus and deltoid ca result tonerve damage.

A. Rectus Femoris- place child in secure position to preventmovement

- Do not use neddle more than 1 inch

- Use proper quadrant of the thighInsert neddle in 45 degrees angle in downward

position, towards the knee.


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B. Vastus Lateralis

Place child in supine or prone position

Area is a narrow strip of muscle extended

along a line from the greater trochanter tolateral femoral

Insert the needle perpendicular to skin 2-4inch deep needle parallel to the floor.


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A. Posterogluteal

Upper outer quadrant

Does not develop until the child begins towalk.

Can be used when the child has beenwalking for 1 year or more.

Complications my develop like sciatic nerveinjury or subcutaneous injury due to

medication being injected or poorabsorption


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Do not use needle more than 2.5 cm or 1

inch

Position the child in prone position Place thumb in the trochanter and

middle finger in the iliac crest let index

finger drop at a point midway betweenthe thumb amd middle finger to upper

outer quadrant of the buttock. This is the

injection site


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This site provides a dense muscle mass

tha tis relatively free of danger of injuring

the nervous and vascular system. The disadvantage is that it is visible to the

child.


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May be used for older larger children

Determine site as with an adult


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Explain to the child where you are goingto the medication and why you are

giving it Allow the child to express fear.

Carry out procedure quickly and gently.

Numb the site by rubbing firmly with

cleansing swab or with ice. Minimize pain by injecting the needle

into the muscle quickly in dartingmotion.


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Always secure the assistance of a secondnurse to help immobilize the child anddivert attention as well as to offer comfortand support.

Praise the child for behaviour after the

injection. Encourage activity that will use the muscle

site of the injection to promote dispersal ofmedication and prevent soreness. This canalso be done by massaging muscle after

injection unless contraindicated. Ensure proper site rotation.


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A. CLARKS RULE

Average adult dose x weight of child in pounds = estimated safe dose

150


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Example: How much Aspirin should a

one-year-old child weighing 21 lbs.

receive if the average adult dose is 10grains?

10 grains x21 lbs = grain 1 2/5 or 1.4 grains

150


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Adult Dose X (Age (Age+12)) = Childs Dose


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Example: How much Amoxicillinshould an 11 year old child received ifadult dose 500 mg?

500 Mg X (11 (11+12)) = Childs Dose

500 Mg X (11 23) = Childs Dose

500 Mg X .48 = Childs Dose

Childs Dose = 240 Mg


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Average adult dose x age in months = estimated safe dose

150


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Example : The adult dose of atropine

sulfate is 0.6 mg. How much should a 2-

month-old child receive?

mg

x008.0

150

2.1

150

26.0!!


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The body weight method of calculatingallows for individualizing the drug dose andinvolves three steps as follows:

Convert pounds to kilograms if necessary. Determine drug dose per body weight by

multiplying: Drug dose x body weight =

clients dose per day Follow the basic formula to calculate drug

dosage:

Q

q

H

D!


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Example: order Cefaclor (Ceclor) 20 mg/kg/day in three divided

doses .Childs weight 31 lbs

Drug label Cefaclor (Ceclor) 125 mg / 5 ml

Convert pounds to kilograms

a. 31 divided by 2.2 = 14 kg.

b. drug dose x body weight

20 x 14 = 280 mg / day280 mg divided by 3 divided doses in a day = 93 mg / dose

c. Calculate drug dosage

cross multiply

Answer: 3.7 ml is to be given per dose

ml

x

mg

mg

5125

93!


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A. PENICILLIN

some preparations penicillin come in

units / ml, whereas other come in

milligrams / ml. you can use the formula

D/H = q/Q.


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Read the medication order noting the number ofunits to be given. For example, a patch isprescribed 300,000 units of Penicillin G Procaine tobe administered IVTT every 12 hours. Penicillin GProcaine is available as 600,000/1.2 ml. Therefore,you would use the formula: D/H =q/Q

300,000 units = x = cross multiply

600,000 units 1.2 ml

600,000 units (x) = 300,000 units (1.2 ml)600,000 units 600,000 units

x = 0.6 ml of the drug will be given IVTTevery 12 hours


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B. INSULIN

Frequently, you will it necessary to mix twotypes of insulin, usually regular insulin and NPHinsulin. When you have to mix insulin, there aretwo important guidelines that you mustremember:

Do no contaminate the contents of one vialwith the contente of the other vial.

Always draw up the NPH insulin, which is a

turbid preparation, last because chemically, ithas a protein substance in it that the clearRegular insulin does not have. Drawing up theNPH insulin last helps prevent contamination ofthe regular insulin.


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Example: The doctors order reads as follow:Urine sugar q 6 hours (6 AM 12 NN 6 PM 12MN)

Give Regular insulin subcutaneously for the followingurine sugar result.

0 - none

Trace - none1+ - 5 units

2+ - 10 units

3+ - 15 units

4+ - 20 units


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Stock: Regular insulin 40 units / ml.

At 6 AM, the Regular insulin result was 2+. How many units will you give using a ) u-100

insulin syringe?

10 units = x cross multiply40 units 100 units

40 units (x) = 10 units (100 units)40 units = 40 units

x = 25 units


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The available amount of drug is in a solute form (dry

powder) and needs to be reconstituted by adding adiluent (solvent). The label on the available drug wellgive directions for adding the diluent. There are threecommon diluents that must always be sterile whenadded to the drug powder. Use either one of thethree.

Bacteriostatic water Sodium chloride (0.9%) Sterile distilled water for injection

Read the directions for reconstitution at the label for the:

recommended diluent quantity of diluent

ratio of solute to solvent after reconstitution


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Use the usual formula to calculate drug dosagerequired.

Example: The physician prescribed 250 mg ofAmoxycillin IM q 8h. The medication was availableas a powder in a 1 gram vial.

Directions for reconstitution: Reconstitute with 2.5 ml ofsterile water for injection. Shake well unit dissolved.Solution concentration ---------- equal 330 mg/ml.fluid volume will equal 3.0 ml.

250 mg

________ X 3ml

1000 mg

= 0.75 ml will be given IM every 8 hours


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Paediatric Drug Computation

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