Case Study 2: Max Garcia Lopez Flashcards
(26 cards)
What is meconium ?
The first faeces, or stool, of a newborn
What is meconium ileus ?
A bowel obstruction that occurs when the meconium in the babies intestine is even thicker and stickier than normal meconium.
This creates blockage in a part of the small intestine called the ileum
Do most babies with meconium ileus have cystic fibrosis ?
Yes
What is a temporary loop ileostomy ?
This is a reversible surgical procedure done after bowel surgery so the bowl can rest and heal.
It is usually created to protect a surgical join in the large bowel or to divert the flow of stool from an obstruction.
You are the pharmacist working on the Neonatal Unit when one of the new nurses approaches you.
She has read the IV guide and doesn’t understand displacement values, she is struggling to make up Max’s cefotaxime dose. It has been prescribed to be given as a short IV infusion over 30 minutes.
Use Cefotaxime SPC to help. The nurse is going to use a 500mg vial of the wockhardt brand
What advice would you give?
Reconstitute 1x500mg Vial with 2mls of water for injection
This will give a total volume of 2.3mls
Dose required:170mg
Dose needed: (170mg/500mg) x 2.3
= 0.78 mls
Can the dose of cefotaxime be given as a “push” in this case ?
Yes, however this has been prescribed as an infusion over 30 mins
Can a further dilute t be added to the cefotaxime ?
Yes, either NaCl 0.9% or glucose 5%
For an adult dose of IV cefotaxime, what size IV bag would be most appropriate ? And why ?
100 ml as they’re easily available on most wards
For a baby who has been prescribed Cefotaxime, what size IV bag would be most appropriate ?
It depends on the babies daily fluid allowance. We would use a sensible small volume appropriate for the size of the baby or child.
For max a final volume of about 20mls would be expected
How else is cefotaxime adninistered ?
Intramuscular injection
Why is intramuscular injections not appropriate for babies and smallll children ?
It can be very painful as baby’s have a low muscle mass
How could we alleviate the pain from intramuscular injections of cefotaxime ?
Reconstitute it with lidocaine (which is a local anaesthetic)
Why is it important to know what brand of cefotaxime is used ?
The displacement value can be different depending on the drug brand used .
If the wring displacement value is used, this can lead to an under dose or overdose of the medication
When working with neonates and small children, due to the small doses used, any miscalculation can lad to a significant dose change
On his second day of life Max is still on 10% glucose intravenous fluids, his allowance is 80mls/kg and he weighs 3.4kg.
What else do you need to consider when calculating total fluid input (in particular in neonates and small children)?
How many mls/hr can he receive?
Fluid allowance in 24 hours: 80mls x 3.4
= 272mls in 24 hours
Fluid allowance per hour: 272 mls /24hrs
= 11.33 mls in 1 hour
How many grams of glucose is he getting in 24hrs and how many calories does that equate to? (It is important he doesn’t lose too much weight).
Total fluid allowance in 24hrs is 272mls
1 gram glucose = 4 calories.
10% glucose
10g in 100mls
272mls/100mls
= 2.72
10g x 2.72
=27.2g
1g glucose = 4 calories
4 x 27.2g
=108.8 calories
= 109 calories
What is bronchiolitis ?
Bronchiolitis is a common chest infection that affects babies and children under 2. It’s usually mild and can be treated at home, but it can be serious.
What virus causes bronchiolitis ?
RSV
True or false. Bronchiolitis is treated symptomatically ?
True
How can you tell is a toddler/baby is struggling to feed ?
- Trachea tug
- Chest retraction
- Nasal flares
- SUBSTERNAL/SUBCOSTAL RETRACTION
- Noices when breathing in and out
- Head bobbing
- Grunting
- Wheezing
- Whooping cough
What are the common symptoms of bronchiolitis ?
- Breathing more quickly
- Finding it difficult to feed or eat
- Noisy breathing (wheezing)
- Becoming irritable
In bronchiolitis when do symtpms get worse ? When do symtpms get between ?
Worsen on day 3-5
Gets better after 3 weeks
What vaccination is required for babies of 8 weeks old ?
Refer to immunisation booklet on notability
Can paracetamol be given to a 7 month old ?
No, paracetamol can be given to babies at 2 months old (8 weeks).
It is unlicensed for the use in children under 2 months
What is an “unlicensed” medicine ?
Most medicines in the UK have a licence (known as the marketing authorisation), which states how it can be used.
Many medicines are used in children or for conditions that are not specified in the licence
Unlicenced means giving a medicine in ‘a different way from that described in its licenced. Also known as “off-licence.
