Question

The nurse is beginning a 12-hour shift on the medical/surgical unit of the local children’s hospital. He has four patients assigned to him: a 6-month-old infant boy, a 4-year-old preschool girl, a 7-year-old girl, and a 12-year-old girl. The nurse has assessed each child and is referring to the EMAR for each patient’s medications.

a. What are some of the factors the nurse should consider regarding the distribution of medication in children’s bodies?

b. What are the guidelines the nurse should utilize to ensure that the medication doses prescribed are accurate?

c. What are some of the different routes available to the nurse to administer medications to children?

2. The nurse on a medical/surgical unit of a children’s hospital has just received orders to administer an antibiotic via IV infusion and then to begin administering total parenteral nutrition (TPN) via IV infusion.

a. What are the rights of pediatric medication administration?

b. What are the various types of IV devices available to the nurse to administer medications/solutions?

c. What are the techniques to properly administer TPN to children?

3. Fillipia, a 3-year-old, is admitted to your unit with fever and lethargy. She is 36 pounds and 40 inches tall. Her current temperature is 101.8°F, HR 110, RR 22. Her orders include Rocephin 525 mg IM every 12 hours and acetaminophen 2 teaspoons PO every 4 hours as needed for temperature greater than 101.5°F. The safe dose range for Rocephin is 50–75 mg/kg/day and acetaminophen is 15 mg/kg/dose. The concentration for Rocephin is 350 mg/mL and acetaminophen is 160 mg/5mL.

a. Is this Rocephin dose safe? (Show your work)

b. How would you administer this medication?

c. Is this acetaminophen dose safe? (Show your work)

d. What would be your next steps?

Answer 1

ANSWER 1(A) :

A number of anatomical and physiological factors determine the pharmacokinetic profile of a drug.

• body composition for example: Lipophilic drugs have a relatively larger volume of distribution in infants compared with older children owing to their higher comparative levels of fat
• Hydrophilic drugs also have larger volumes of distribution in preschool children as extracellular water decreases during development
• Protein binding also affects the volume of distribution of drugs
• reduced lean body mass
• decreased serum albumin
• increased aplha acid glycoprotien

ANSER 1 ( B) : To ensure the accurate doses of medication;

• Checking dosages.
• Using prescribing formularies.
• Using electronic systems where available that can enhance the safety of prescribing.
• Children's doses may be calculated from adult doses by using age, body weight, or body surface area, or by a combination of these factors. The most reliable methods are those based on body surface area.
• Body weight may be used to calculate doses expressed in mg/kg. Young children may require a higher dose per kg than adults because of their higher metabolic rates.

ANSWER 1 ( C) :

Route of medication administration are:

• ORAL
• INTRADERMAL
• SUBCUTANEOUS
• AVOID IM INJECTION AS MUCH AS POSSIBLE, IT IS PAINFUL.
• INTRAVENOUSLY

ANSWER 2 ( A) :  RIGHTS OF PAEDIATRIC MEDICATION ADMINISTRATION ARE :

• RIGHT PATIENT
• RIGHT DRUG
• RIGHT TIME
• RIGHT DOSE
• RIGHT ROUTE
• RIGHT DOCUMENTATION
• RIGHT TO EDUCATION
• RIGHT DOCUMENTATION
• RIGHT EVAVLUATION
• RIGHT ASSESSMENT

ANSWER 2 (B) : DIFFERENT IV DEVICES AVAILABLE ARE:

• PERIPHERAL INTRA VENOUS

• Central Venous Access Devices (CVAD)

• Peripherally Inserted Central Catheters (PICC)

• Tunneled External Catheters

• Percutaneous Central Venous Catheters

• IV INFUSION

• IV SYRINGE PUMP

ANSWER 2 ( C) TECHNIQUES TO ADMINISTER TPN:

• TPN is administered through a needle or catheter that is placed in a large vein that goes directly to the heart called a central venous catheter.
• TPN must be administered in a clean and sterile environment.
• external tubing should be changed every day and dressings should be kept sterile with replacement every two days.
• TPN infusion on a pump during the night for 12-14 hours
• patients’ weight, CBC and electrolytes level should be monitored daily.
• monitored every 6 hours until patients and glucose levels become stable.

ANSWER 3( A) ; YES, IT IS SAFE TO GIVE Rocephin 525 mg IM every 12 hours

child's weight in kg = 16.3 kg

safe dose range = 50 - 75mg / kg /day

therefore, safe dose range per day according to weight= 815 - 1222.5 mg/ day

order given= 525 mg/ every 12 hours

that is 1050 mg / day

so it is under range.

ANSWER 3 ( B) : TO ADMINISTER ROCEPHIN :

• INTRAMUSCULARLY
• EVERY 12 HOUR
• CHANGE THE SITE FOR EVERY INJECTION
• DELTOID MUSCLE
• STERILE TECHNIQUE

ANSWER 3 ( C) : NO, TWO TEASPOON OF ACETAMINOPHEN IS NOT SAFE DOSE FOR CHILD

child's weight = 16.3kg

safe dose range = 15 mg/kg/dose.

that is ; 244.5 mg / dose

doctors order: two teaspoon = 10 ml

where concentration is 160 mg/ 5 ml

so for 10 ml: 320 mg /dose

it is a higher dose that safe dose range

ANSWER 3 ( D) :

next step is:

• notify the doctor
• confirm the doses again
• hold dose until order is not clear