PEDS Chapter 35: Key Pediatric Nursing Interventions Flashcards Preview

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1

Eight Rights of Pediatric Medication

Right medication
Right patient
Right time
Right route of administration
Right dose
Right documentation
Right to be educated
Right to refuse

2

Pharmacodynamics

Behavior of medication at the cellular level
Affected by the physiologic immaturity of some body systems in a child

3

Pharmacokinetics

Movement of drugs throughout the body via absorption, distribution, metabolism, and excretion
Affected by the child’s age, weight, body surface area, and body composition

4

Oral medications

slower gastric emptying, increased intestinal motility, a proportionately larger small intestine surface area, higher gastric pH, and decreased lipase and amylase secretion compared with adults

5

Intramuscular absorption

amount of muscle mass, muscle tone and perfusion, and vasomotor instability

6

Subcutaneous absorption

decreased perfusion

7

Topical absorption of medications

increased due to greater body surface area and greater permeability of infant’s skin

8

Factors Affecting Distribution of Medication in Children

Higher percentage of body water than adults
More rapid extracellular fluid exchange
Decreased body fat
Liver immaturity, altering first-pass elimination
Decreased amounts of plasma proteins available for drug binding
Immature blood–brain barrier, especially neonates, allowing permeation by certain medications

9

The nurse is administering amoxicillin orally to an infant with a bacterial infection. Which of the following developmental factors might affect the absorption of this medication?
a. slower gastric emptying
b. vasomotor instability
c. decreased perfusion
d. greater body surface area

a. slower gastric emptying. Slower gastric emptying might affect the absorption of amoxicillin.
Rationale: Slower gastric emptying might affect the absorption of amoxicillin since it is being given orally. Vasomotor instability might affect intramuscular absorption of medication. Decreased perfusion alters subcutaneous administration of medication and may decrease absorption. Greater body surface area may increase the effect of topical administration of medication.

10

Factors Affecting Metabolism of Medications in Children

Differences in hepatic enzyme production
Increased metabolic rate
Biotransformation
Is affected by the same variations affecting distribution in children

11

Developmentally Appropriate Explanations for Medications for Children

Why the drug is needed
What the child will experience
What is expected of the child
How the parents can participate and support their child

12

Determining Children’s Doses by Body Weight

Weigh the child.
If the child’s weight is in pounds, convert it to kilograms (divide the child’s weight in pounds by 2.2).
Check a drug reference for the safe dose range (e.g., 10 to 20 mg/kg of body weight).
Calculate the low safe dose.
Calculate the high safe dose.
Determine if the dose ordered is within this range.

13

The safe dose of a medication is 10 to 20 mg/kg. What would the nurse calculate as the low safe dose for a child who weighs 40 kg?
a. 100 mg
b. 200 mg
c. 300 mg
d. 400 mg

d. 400 mg. 400 mg is the low safe dose for a child who weighs 40 kg if the safe dose of a medication is 10 to 20 mg/kg.
Rationale: to calculate the low safe dose use the following proportion:
10 mg/1 kg = x mg/40 kg
Solve for x by cross-multiplying
1 × x = 10 × 40
x = 400 mg

14

Guidelines to Determine BSA

Measure the child’s height.
Determine the child’s weight.
Using the nomogram, draw a line to connect the height measurement in the left column and the weight measurement in the right column.
Determine the point where this line intersects the line in the surface area column. This is the BSA, expressed in meters squared (m2).

15

Forms of Oral Medications

*Liquids
-Elixirs
-Syrups
-Suspensions
*Powders
*Tablets
*Capsules

16

Is the following statement true or false?
The nurse crushing a tablet to administer it to a child should mix the medication with the child’s formula.

False. The nurse crushing a tablet to administer it to a child should not mix the medication with the child’s formula.
Rationale: The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it. It could be mixed with a small amount of applesauce or other nonessential food.

17

Subcutaneous (SQ) administration

Distributes medication into the fatty layers of the body
Insulin administration, heparin, and certain immunizations

18

Intradermal (ID) administration

Deposits medication just under the epidermis
Tuberculosis screening and allergy testing

19

Providing Atraumatic Care When Administering Medications

Using comforting positions
Using topical anesthetic prior to injections
Educating the child and parents
Preventing medication errors

20

Is the following statement true or false?
The nurse assessing the veins of a 5-month-old infant for peripheral IV therapy correctly chooses the baby’s foot.

True. The nurse assessing the veins of a 5-month-old infant for peripheral IV therapy correctly chooses the baby’s foot.
Rationale: Peripheral IV therapy sites commonly include the hands, feet, and forearms. In infants up to about the age of 9 months, the scalp veins may be used. However, use of the scalp veins can be frightening to parents who may think the fluid is infusing into the infant’s brain. Thus, scalp veins are usually used only if attempts at other sites have been unsuccessful.

21

Factors Affecting the Choice of Equipment for IV Therapy

The solution or medication to be administered
The duration of the therapy
The age and developmental level of the child
The child’s status
The condition of the child’s veins

22

Principles of Atraumatic Care Managing IV Therapy

Gather equipment before approaching child.
Select hand rather than wrist or upper arm veins.
Ensure adequate pain relief.
Allow anesthetic to prepared site to dry.
Use a barrier to avoid pinching the skin.
If needed, use a device to transilluminate the vein.

23

Principles of Atraumatic Care Managing IV Therapy (cont.)

Make only two attempts to gain access.
Encourage parental participation.
Coordinate care with other departments.
Secure line with minimal amount of tape.
Protect the site from bumping.

24

Measures to Reduce Complications With TPN

Monitor the child’s vital signs closely for changes.
Adhere to strict aseptic technique .
Ensure that the system remains a closed system at all times.
Use occlusive dressings.
Adhere to agency policy for flushing of the catheter and maintaining catheter patency.
Assess intake and output frequently.
Monitor blood glucose levels and obtain laboratory tests as ordered to evaluate for changes in fluid and electrolytes