Unit 3 [part 1: ch 6-11 Flashcards
What stage of life do you have to consider when dealing with pediatric patient?
developmental stage; core patient variables differ from adult bc of these
what are the physiological factors affecting drug action?
1) reduced gastric acidity
2) small muscle mass
3) high portion of water in body–> dilution effect–> decreases effectiveness of drug in blood
4) immature renal system
5) unpredictable hepatic enzyme production
6) reduced protein- binding capability
7) increased thinness and permeability of skin
8) immature blood brain barrier in neonate and infants
what does it mean to be a pediatric patient?
16 years of age or younger & 50 kgs or less
why are drugs for peds used as off label use and not for adults in this way?
few drugs have been adequately tested to be safe for children; off label use is used for a purpose not clearly stated on its label but the prescriber believes the drug will prodcue a desired therapeutic effect
what are pediatric doses of meds based on/
on the weight of the child in kg; when a childs dose is not specified–> can be calculated based on the body surface area of the child(external surface of the body expressed in sq meters–> it is inversely proportional to length–> the shorter and less the child weight= more surface area
what are the differences in pharcodynamics and pharmcokinetics?
mechanism of action is the same but: age, growth, and maturation affects how the body absorbs, distributes, metabolizes and excretes a drug
*dosages must by adjusted to accomadate dimmature or imapired body systems in neonates and infants
what special precautions should you be advised for giving meds to a peds patient?
oral
1) drug volume should not exceed what can be swallowed
2) mix with a small amount of liquid so the dose is all taken
3) avoid adding to formula
4) balance dosing schedules with eating; make sure to give it with/without food as instrucuted
IM
1) see if less painful route possible
2) if unavoidable, apply topical anesthetic to numb site
3) locate appropriate sites for injection
4) evalutae muscle mass, skin condition and poss complications
5) seek help to hold the child
IV
1) give topical anesthetic
2) check IV site
3) monitor for signs of overland
4) double check dosage with another nurse
5) control IV infusion with pipette or syringe pump
6) supply no more than 1hr’s worth of fluid on continuous IV pump
ALWAYS WEIGH CHILD BEFORE GIVING DOSE AND HAVE SOMEONE CHECK YOU CALCULATIONS
What considerations are needed when admn meds to different peds groups?
Toddlers(13M to 3Y)- having a parent nearby usually helps the childs cooperation
Preschoolers(3y-5y)- offer choices
School aged (6y-12y) offer choices to help exercise control- greatest fears of drug therapy are usually related to negative past experiences
Adolescents (13y-16y) –> more likely to cooperate when they have a complete understanding ; privacy and control is imp. to remember; offer choices
When are med errors most likely to occur for peds patients?
in teh prescribing and amdn phase
what do you have to consider when admn meds to a pregnant woman/
there is more than one life to consider
* drugs may cross the placental barriet–> just like a memebrane; anything that can pass through a memebrane can pass here
What physiologic changes occur with pregnancy?
hormonal, cardiovascular(32 weeks–> CO has increased by 50% and arterial BP decreased), respiratory, GI, renal(3rd trimester- renal blood flow has increased by 40%-50%; GF has increases by 50%–> may increase drug excretion)–> all may affect absorption, distribution and effectiveness
DRUG METABOLISM IS NOT AFFECTED BY PREGNANCY OR BREAST FEEDING
What are the types of fetal drug effects?
1) tetretogenic(causes fetal defects)
2) mutagenic(causes genetic mutation)
3) carinogenic(causes development or accelration of cancer)
What are the devlopmental stages of the fetus and what is happening in them? does it play a major role?
1st trimester- major organs being formed(orgaogensis- can cause damage to organs, tissue dev., cause growth retardation, fetal death or stillbirth)
2nd trimester- organs still being formed
3rd trimester- certain drugs can become fatal only in this stage; placental barrier gets thinner and thinner so organs more sucetible to damage
what are preecplamisa and eclampsia?
pre- hyptertensive state that can devlop during pregnancy
eclampsia- life threatning conditon resulting from pre- with cerebral edama and poss sz
What are the catergories the FDA established for meds poss risk for pregnant or breast feeding mothers?
Category A- no risk for the fetus during pregnancy
category B- animal studies no risk to fetus, but no studies with pregnant women
Category C- animal studies report adverse effects on fetus
Category D- evidence of human fetal risk; but potential benefits from use of drug in pregnant women may be acceptable
category X- studies in both animals and humans indicate fetal abnormalities or adverse reactions that put fetus at risk
