1229 Exam 5: Pediatric Med Administration

Question 1

Safety

Answer 1

Safe dose, action, side effects, contraindications and signs of toxicity
Growth and maturity factors
Dosage calculations
Measuring devices
Checking dosages
Identification

Question 2

Dosage Calculation

Answer 2

The most reliable method is to calculate the proportional amount of BSA to body weight.
This can be done using a West nomogram. It is estimated from the child’s height and weight.

Question 3

Medication exceeding dose

Answer 3

When med exceeds the recommended dose the nurse should always check with practitioner before administration
THE NURSE IS LEGALLY LIABLE FOR ANY DRUG ADMINISTRATION

Question 4

Oral Med

Answer 4

Ordered tsp should be measured in mL
5 mL=1 tsp
Household measuring spoons can be used
Dropper is unreliable if it is being used for any other med than it was designed for
MOST accurate way to measure small amounts of med is the plastic disposable TB syringe for amounts less than 1 mL

Question 5

Oral Med Administration

Answer 5

Be careful to prevent aspiration by propping the child up
Place the syringe along the side of infants tongue
Administer slowly in small amounts

Question 6

Oral Med Admin cont..

Answer 6

Allow child to swallow between deposits
With infants up to 11 mo or children with neuro impairments, blowing a small puff of air in the face elicits a swallow reflex
Do not add medicine to formula, the infant may refuse formula after that

Question 7

Nursing Considerations

Answer 7

Indicate that the child is expected to take med by helping them understand
Child's level of understanding
Mask own feelings regarding the med
ALWAYS be truthful
NEVER threaten the child

Question 8

Nur Considerations cont..

Answer 8

Bad tasting med or crushed pills may need to be mixed with food or drink
Do not mix med with large quantities of food or drink, or with foods or drinks that are taken regularly
Do not give med at meal time unless specifically ordered

Question 9

Admin of Oral med to Infants

Answer 9

Elevate head

Place med along side of tongue

Question 10

Admin of Oral med to Toddlers

Answer 10

Allow time to swallow

May hold med cup and drink at own pace, if cooperative

Question 11

Admin of Oral med to School Aged

Answer 11

Pill or capsule, if possible
Praise
Choices

Question 12

IM Med

Answer 12

For volumes less than 1 mL TB syringe is appropriate
These syringes with the use of specially constructed needles minimize the possibility of administering incorrect doses of meds due to dead space, which allows fluid to remain in the syringe and needle after the plunger is pushed completely forward
A minimum of 0.2 mL of solution remains in a standard needle hub

Question 13

Minimize dead space

Answer 13

Use same brand of syringe to draw up medications
Use one piece syringe units **needles permanently attached to the syringe
Adding air bubbles is not acceptable for children
Instead use Z track method for med that cause irritation to the tissue
Change the needle after withdrawing the fluid from the vial to minimize tracking

Question 14

IM injection sites

Answer 14

Rectus femoris-not used
Vastus lateralis-preferred for infants
Ventrogluteal- free of major blood vessels and nerves-children of all ages
Deltoid-18 mo and above-small volumes
Dorsogluteal-1 yr of walking

Question 15

Admin of IM injections

Answer 15

Vastus lateralis and deltoid-grasp muscle, use needle half the length of area
Ventrogluteal and Dorsogluteal-grasp tissue, choose needle length slightly more than half
22-25 gauge, 5/8 to 1 in needle
Filter needles
Do not have to aspirate anymore, but can if wanted to
WIth obese children, spread skin with the thumb and index finger to displace subcu tissue then grasp muscle

Question 16

Nursing Support

Answer 16

Explain briefly
Allow child to express fears
Be prepared
Wake the child if sleeping-avoiding this will lead to feal of falling asleep
Place child in a lying or sititng position
Have med at room temp
DIstract child with convo
Spray vapocoolant 11-15 sec before injection
Encourage parent to hold and cuddle child after injection

Question 17

Glass Ampules

Answer 17

may have glass particles in the ampule after broken
can lead to injecting glass into the pt
draw up with filter needle

Question 18

Subcutaneous Injection

Answer 18

same in children as adult

Question 19

Optic, Otic, and Nasal Admin

Answer 19

Same as adults
Optic-place med in conjunctival sac
Otic-children 3 & under pull ear down and back, older pull up and back
Nasal- remain in position 1 min afterwards

Question 20

Rectal Admin

Answer 20

Used in children who are unable to take anything by mouth
Unlikely to have large amounts of stool
Use water-soluble jelly or warm water to lub
Insert beyond rectal sphincters
Hold buttocks together for 5-10 min
Cut length wise to halve

Question 21

IV Access in children

Answer 21

The veins of the extremities are used for both infant and children
Scalp veins may be used in infants
19-12** gauge over-the-needle catheters are preferred for infants and children

Question 22

Choice of site for IV

Answer 22

Forearm
Dorsum of the hand
Antecubital fossa
Dorsum of the foot
Scalp veins

Question 23

Special Considerations

Answer 23

Avoid using the foot veins as a site in children who are walking
Avoid using the childs dominant hand
If two sites are needed do not us both antecubital veins
Use padded arm boards as splints
Only one antibiotic at a time**

Question 24

Pediatric Math

Answer 24

To convert lb to kg divide by 2.2
round to the nearest 10th
To convert kg to lb multiply by 2.2
round to nearest 10th

Question 25

Buretrol

Answer 25

Buretrol- O=open
Continuous- C=closed
If on Buretrol keep air vent open
When getting the dose its mL/hr

Question 26

Buretrol

Answer 26

a buretrol is a type of infusion device that holds limited quantities of IV fluids or med. It is generally used for pediatrics and often is designed to prevent free flow of fluids or air once the infusion is done, children are less able to handle large fluids influxes like adults can. The IV fluids are attached above the buretrol and refilled manually as the volume decreases.

Question 27

How to use a Buretrol

Answer 27

Keep vent open
Will only add one hour of meds or fluids to the buretrol
**Never add more than the ordered amt of fluid
If you have to add med with fluids, you still only need the ordered amt of solution per hour