Chapter 25 Flashcards
1
Q
- confusions between adult and pediatric formulations
- errors with oral liquid dosage forms that are available in multiple pediatric concentrations
- incorrect preparations of meds that require dilutions
- improper education of parents or caregivers for child regarding preparation of meds and administration
- calculation errors due to multiple calculations to individualize dosages on basis of age, weight, mg/kg, or Body Surface Area (BSA)
- use of incorrect measuring devices (household teaspoons) as opposed to devices such as oral dosing devices for small volume doses
- parents mix up terms such as mL, tsp, and tbsp
A
Causes of med errors or adverse drug reactions
2
Q
- pediatric pts are 3 times more likely than adults to experience a harmful med error with pediatric clients
- administering meds to children becomes even more of a priority
- alarming number of parents are unintentionally giving their children incorrect doses of liquid meds
- oral syringes should be used instead of dosing cups to administer small doses to children
A
Pediatric med admin
3
Q
- size, weight, and BSA of the infant and child
- higher percentage of water per kg of body weight
- physiological capabilities (lessened ability to metabolism meds, immaturity of systems, differences in rate of med absorption and excretion) differ in comparison to adults
- increased metabolism
- to maximize drug effects and minimize adverse effects before administering meds to children, the nurse must carefully calculate the dose, and know whether the ordered dose is safe for the individual child
- a miscalculation, even small discrepancies, may be dangerous for a child
- if the dosage is higher than normal it may be unsafe, and a dosage lower than normal may not have the desired therapeutic effect, which also unsafe
- always double check dosages
A
Factors that make children more susceptible to adverse effects of drugs
4
Q
- be able to covert a child’s weight
- conversion: 1 kg=2.2 lb
A
Calculation of dosages based on Body Weight
5
Q
- indicated on the med label under children’s dosages
- usually expressed in mg/kg for a 24 hr period to be given in one or more divided doses
A
Recommended dosage (safe dosage)
6
Q
-upper and lower limits of the dosage as stated by an approved med reference
A
Safe Dosage Range (SDR)
7
Q
-obtained by multiplying the child’s weight after being converted with the use of a reputable med reference: multiply child’s weight in kg by dosage expressed as mg/kg
A
Total Daily Dosage
8
Q
- represents the dosage a child should receive ea time the med is administered
- divided into a certain number of individual dosages
- total daily dose is divided equally and administered so many times per day
- usually intended for one-time administration or PRN based on mg/kg/dose
A
Divided Dosage (single dose)
9
Q
- done by comparing the ordered dosage with the recommended dosage
- decided by comparing and evaluating the 24 hr ordered amount with the recommended dosage
- ask yourself if the dosage is safe
A
Deciding if the dosage is safe
10
Q
- recommended as a total daily dosage, mg/kg/day
- divided into a number of dosages per day
- attention to time intervals for the day is important in determining whether a dosage is safe
A
Dosages around the clock
11
Q
- total surface area of the body expressed in square meters
- chemotherapy meds, meds given to pts with severe burns, receiving radiation treatment, and those with renal disease
- calculated using height and weight body measurements
- all children are not the same size at the same age
- formula:
- metric BSA (m2) = weight (kg) x height (cm)/3,600 (then do square root)
- household (m2)=weight (lbs) x height (in) / 3,131 (then do square root)
- safest and most accurate way to calculate BSA
- round the final answer only to the nearest hundredth to obtain a more accurate BSA for med dosage
- always check dosage against BSA in square meter recommendations using appropriate resources
- a child’s BSA is expressed in square meters and inserted to this formula:
- BSA of child (m2)/ 1.7(m2) x adult dosage = estimated child dosage
A
Calculating Pediatric dosages using BSA
12
Q
- very specific because of their physiological development, microdrop sets are used for infants and small children
- rate of infusion must be carefully monitored (as frequently as every hour)
- must be slow for small children to prevent complications such as cardiac failure because of fluid overload
- a solution to flush the IV tubing is administered after the medication
- make sure the med has cleared the tubing and the total dosage has been administered
- an excessively high concentration of an IV med can cause vein irritation and potentially life threatening effects
- dilution calculation is essential
- calculated based on BSA
- to determine whether an IV dosage is safe, consult a med resource for the recommended dosage
- when a dosage is w/in normal limits, calculate and administer the medication
- if a dosage is not w/in the normal limits, consult the prescriber before administering
A
IV therapy and children
13
Q
- the fluid a child receives over a 24 hr period
- closely monitor the amount of fluid a child receives
- includes medication
- includes both parenteral and oral fluids
- depends on the weight in kg
- does not include replacement for losses through vomiting, diarrhea, or fever
- formula:
- 100mL/kg/day for the first 10kg of body weight
- 50 mL/jog/day for the next 10 kg of body weight
- 20 mL/kg/day for ea 20 kg of body weight
A
Daily Fluid Maintenance
14
Q
- calculated using the same method as adults
- dosages are smaller for children
- most oral meds come in liquids for children to facilitate swallowing
- oral route is preferred
- not more than 1 mL is injected IM for small children and older infants; small infants should not receive more than 0.5 mL by IM injection
- parenteral dosages are frequently administered with a tuberculin syringe
- always double check dosages, never assume
A
Pediatric Oral and Parenteral Meds
