Chapter 35: Key pediatric Nursing Interventions Flashcards
Pharmacodynamics
Behavior of the medication at the cellular level. The physiologic immaturity of some body systems in a child can affect it.
Pharmacokinetics
Movement of drugs throughout the body the absorption, distribution, metabolism, and excretion. The child’s age, weight, body surface area, and body composition can affect it. And infants it is affected orally by slower gastric emptying, increased intestinal motility, a large small intestine surface area, higher gastric pH, decreased lipase and amylase secretions. Intramuscular is affected by muscle mass, tone, and perfusion, and vasomotor instability. Subcutaneously there is decreased perfusion. The absorption may be decreased. With topical absorption medication is increased which can result in adverse effects not seen in adults.
Distribution
The movement of the drive from blood to interstitial spaces and into sales. It is affected by:
higher percentage of body water than adults,
more rapid extracellular fluid exchange,
decrease body fat,
liver immaturity, altering first pass elimination,
decreased amount of plasma proteins available for drug binding, immature blood brain barrier especially in neonates
Metabolism
Is altered because of differences in hepatic enzyme production and the child increased metabolic rate. Biotransformation is the alteration of chemical structures from their original form which allows for the eventual excretion of the substance. It is affected by the same variations as distribution. The immaturity of the kidneys until 1-2 years old affects the renal blood flow and results in a longer half life.
Body surface area
Measure the child’s height, measure the child’s weight. Chart them on the nomogram, draw the line to connect them, determine the point where it intersects in the middle. This expressed as meters squared.
Inserting an IV
Gather all equipment.
Select a site using hand veins rather than wrist or upper arm veins to reduce the risk of phlebitis.
Avoid using lower extremity veins or areas of flexion.
Ensure adequate pain relief using pharmacologic and nonpharmacologic methods prior to insertion.
Allow antiseptic used to prepare the site to dry completely before attempting insertion.
Use a barrier under the tourniquet to avoid pinching.
If veins are difficult to locate use a transilluminate device to eliminate them.
Make only two attempts to gain access and then allow another person to try.
Encourage parent participation for positioning and comforting. Coordinate care with other departments to minimize the number of venipunctures.
Secure IV line using a minimal amount of tape or transparent dressing.
Protect the site from bumping by using a security device such as the IV house dressing
Calculating the amount of fluids for an IV per day
100 milliliters per kilogram of body weight for the first 10 kg
50 mL per kilogram of body weight for the next 10 kg
20 mL per kilogram of body weight for the remainder of the body weight in kilograms
Measuring output
1 g of weight is equal to 1 mL of fluid
Expected urine output is 1 to 2 mL per kilogram per hour
enteral nutrition
Delivery of nutrition into the G.I. tract via a tube
Inserted through the nose, mouth, or an opening in the abdominal area. Nasogastric or oral gastric feedings are commonly referred to as gavage feedings. Is indicated for children who have a functioning gastrointestinal tract but cannot ingest enough nutrients Orally. Conditions include failure to thrive, inability to suck, abnormalities of the throat or esophagus, swallowing difficulties or risk for aspiration, respiratory distress, metabolic conditions, GERD, surgery, severe trauma.
parenteral nutrition
IV delivery of nutrient substances
Inserting a nasogastric or orogastric tube
Four instance insertion via the mouth is appropriate because they are obligate nose breathers. It also promotes sucking. To determine the tube length, use the age related - height based method. Traditional methods are used to measure it if under 2 weeks old.
To verify placement obtained an x-ray. After initial confirmation document the pH of the aspirate, document insertion distance in external length. Measure the pH which should be less than five. Observe The appearance of the aspirate. Respiratory secretions are usually white, yellow, straw-colored, or clear. Install air into the tube and auscultate for the sound. Check external Markings on the tube and external length to see if it has been moved. signs of displacement include gagging, vomiting, cough, respiratory distress, decreased oxygen saturation. If in doubt obtain an x-ray.
