care of infant and pediatric patients

Question 1

age of premature infant group

Answer 1

less than 38 week of gestational age

Question 2

age of neonate group

Answer 2

a full term newborn 0-4 week of age

Question 3

age of infant group

Answer 3

greater than 4 week to one year of age

Question 4

age of child group

Answer 4

greater than 1 year to 12 year of age

Question 5

age of adolescent group

Answer 5

greater than age 12 - 18y

Question 6

physiologic changes throughout development influence both __________ and ____________ actions of medications

Answer 6

pharmacodynamic and pharmacokinetic

(variables in absorption, distribution, metabolism, and excretion further complicate the medication process)

Question 7

True or False?

the basis of pediatric drug dosing is weight

Answer 7

true

rationale: the basis of pediatric drug dosing is weight, and determining drug doses is highly dependent of growth and development changes that occur across the lifespan, The prescriber uses weight alone to calculate pediatric dosages in an expression such as gentamicin 5mg/kg/24 hrs or determines the body surface area (BSA)

Question 8

describe pharmacodynamics in pediatrics

Answer 8

• involves drug actions on target cells resulting in alterations in cellular reactions and functions
• there are differences in target cell sites and changing numbers of protein receptors in pediatrics
• immature organ systems, body composition (vary widely in growth and maturation), and genetic makeup also influence pharmacodynamics in pediatrics
• pediatric patients are also at high risk for dehydration

Question 9

describe factors that effect absorption in pediatrics

Answer 9

• age
• intestinal motility/gastric emptying may be unpredictable in younger patients
• routes of administration greatly effect absorption
• avoid IM administration (except for vaccines) due to associated pain and unpredictable absorption
• skin permeability increases the rate of absorption of topical drugs and careful administration is important to avoid toxicity

Question 10

describe factors that effect distribution in pediatrics

Answer 10

• distribution of drugs is dependent on percentage of body water, liver function, degree of protein binding, and development of blood-brain barrier
• children differ in adults in the percentages of total body water - can be 80% in newborns
• meds that are water soluble may need to be increased in level
• hepatic function and protein binding my be underdeveloped
• because the blood-brain barrier is not fully developed, drugs can affect CNS easily (know and monitor CNS medication effect)

Question 11

describe total body water

Answer 11

• amount of water in the body
• including the intracellular and extracellular compartments, plus the water in gastrointestinal and urinary tracts

Question 12

describe factors that may affect metabolism in pediatrics

Answer 12

• enzyme cytochrome P450 (CYP450) may not be present
• immature liver: low ability to metabolize drugs
• liver is more mature by the end of the second year

Question 13

describe factors that may affect elimination in pediatrics

Answer 13

-immature kidneys, reduced GFR, slower renal clearance

Question 14

what categories are important for all ages in consider

Answer 14

communication, cooperation, and adherance

Question 15

describe age specific med administration for infants

Answer 15

• correct dosages: weight based calculations
• safety in administration (usually administered orally with dropper; suppository; or IM for vaccines)
• education of parents

Question 16

describe age specific med administration for toddlers and preschoolers

Answer 16

• involve this group with their meds - different pain assessment tools, role playing, hold items, choose bandaids
• explanations should be short and simple
• adults must control administration

Question 17

describe age specific med administration for school aged children and adolescents

Answer 17

• explain med use in more detail
• can take meds independently, but need supervision
• educate on safe me practices
• black box warning: may play casual role in suicidalty pediatric patients
• use of antidepressants in children and adolescents
• ADHD meds