Exam 1: Medication/Environmental Safety Flashcards
What is absorption?
The movement of the drug from where it is given to the blood.
E.g. Given rectally, how is it absorbed?
What are the 4 contributing factors as to why infants and children are so sensitive to medications?
- Absorption
- Distribution
- Metabolism
- Excretion
What are ABSORPTION alterations in infants and children compared to adults?
Infants:
- decreased gastric acid secretion
- irregular gastric emptying
- increased intestinal mobility
- frequent feedings
Children:
-Gastric pH equal to adults by 2-3 years. However, they still do not metabolize the same as adults.
What are DISTRIBUTION alterations in infants and children compared to adults?
Infants:
- have low albumin, causes limited binding of drugs to plasma protein
- BB barrier not fully developed until 1 year. High risk of neurotoxicity
- Infants total body water is 80%. Adults are 50%. Need an increased amount of water soluble meds.
Children:
- Plasma protein levels at adult levels by 1 year
- Skin and BB barrier are more effective
What are METABOLISM alterations in infants and children compared to adults?
Infants:
-Have immature liver enzymes that metabolize drugs, so drugs cannot be broken down. = higher levels of circulating drugs + greater risk of toxicity.
Children:
-decreased BMR (basal metabolic rate) after age 2, results in lowered effects of drugs
Infants need a (smaller/larger) dose of drugs that are primarily excreted by the kidneys. Why is this?
Smaller.
Infants have immature kidneys, and cannot concentrate urine well.
Liver enzymes are ____ which means drugs (can/cannot) be broken down as well. This causes a (higher/lower) concentration of the drug in circulation
immature
cannot
higher!
What are EXCRETION alterations in infants and children compared to adults?
Infants:
-Immature renal function requires smaller doses of drugs that are primarily excreted by the kidneys. Slow kidneys = slow excretion. Drug in body for longer.
Children:
-Adult levels of renal functioning are reached by age 2.
For medications absorbed in intestines, pediatric patients will need (higher or lower) doses and why?
Higher due to increased gastric motility
gastric motility - increased BMR, Increased bowel movements = less time for medication to remain in the intestines; more excretion and less absorption
Acid labile medications are absorbed in the ____ and (higher/lower) doses are needed
Stomach (can survive stomach acid!)
Lower doses needed
Younger children have a (higher or lower) BSA, which means they will need (more or less) medications that are absorbed through skin.
Higher
More meds that are absorbed through skin
Younger children have a (higher or lower) BSA, which means they will need (more or less) medications that are fat soluble
Higher
Less fat soluble meds
Younger children have a (higher or lower) TBW, which means they will need (more or less) medications that are water soluble
Higher TBW (total body water) More water soluble meds
Pediatric patients have an (increased or decreased) BMR
Increased. They have a faster metabolism until ~ 12yo.
How do you give ear drops to a child under 3?
Pull pinna (superior part of ear) down and straight back
How to give ear drops to a child over 3?
Pull pinna up and back
What is the preferred IM site for children ages 18 months and younger?
Vastus lateralis.
True or false: Both elixirs and suspensions do not have to be shaken
False. Elixirs do not have to be shaken but suspensions DO!
How to administer otic medications to a child under 3 years:
Pull pinna down and straight back
How to administer otic medications to children older than 3
Pull the pinna upward and back
How to administer oral meds to a baby:
Insert syringe in side of mouth to the back. Side of mouth reduces the risk of aspiration and back reduces risk that they will spit it out.
How to choose an appropriate needle length for Vastus Lateralis IM injection?
Grasp the lateralis and choose a needle length approx. half the distance between thumb and index finger
Desired needle sizes per age
Infant: 5/8 inch, 25-27 gauge
Toddler/preschool: 1 inch, 22-23 gauge
School age/adolescent: 1-1.5 inch, 22-23 gauge
If you only need half of a suppository, how should you give it?
Cut it vertically
Why should you massage the inner canthus of the child’s eye after administering ophthalmic medications?
Helps reduce discomfort
Prevents drainage into the nasopharynx, which tastes bad
How should you put drops in an infant’s eyes if they are closed?
Put them in the nasal corner of the eye. When the child open’s their eyes, the drops will flow in.
Why should you massage the ear after giving drops?
Massaging the area immediately anterior to the ear helps the drops enter the ear canal.
What are some interventions to prevent falls in the pediatric population?
- Night light
- Appropriate bed selection; < 3 years = crib; If child can sit ( 9months), climber crib should be used.
- Bed side rails
- Never turn back on infant without a hand on them
- Clutter free room
- Clear bed of choking hazards (syringe caps, EKG stickers, small toys, etc.)
- Educate children and parents about falls
What emergency equipment should be maintained in the environment for a pediatric patient in the hospital?
- O2
- Appropriate sized bag valve mask
- Suction
- Alarm limits if monitored
- Code cart nearby
- Reversal agents for medications
Why are infants and young children more susceptible to unintentional ingestion
Lots of hand to mouth behaviors
Closer to ground
Can absorb more through their skin due to larger BSA
They are unaware of danger
They are curious think magically, lack of understanding
What is the antidote for acetaminophen toxicity?
What is a toxic dose of acetaminophen?
N-acetyl cysteine (NAC)
Toxic dose is 150mg/kg.
Activated charcoal can also be used (must be within 1 hour of ingestion)
What is the antidote for opioid overdose?
Naloxone
What is the antidote for benzodiazepine overdose?
Flumazenil
What are some procedures that can be used to eliminate absorbed substances?
- Activated charcoal: best within 30-60 mins of ingestion
- Gastric lavage: must be done 1 hr after ingestion
- Whole bowel irrigation: for substances that cannot be absorbed by activated charcoal
- Diuretics
- Dialysis
- Chelation therapy
- O2 for CO poisoning
What is the antidote for CO poisoning?
O2 therapy
What are the signs and symptoms of anaphylaxis?
Anxiety, irritability, headache
First symptoms may include tingling lips and neck itching
Cutaenous signs: flushing, itching
Angioedema (think swollen lips/eyes/tongue/genitalia)
LOW BP
Airway narrowing due to bronchial constriction
What is the treatment for anaphylaxis?
Epi-pen
Epi-pen Jr.
0.01mg/kg
max dose - 0.3mg
Fist to thigh - then go to hospital asap
Nursing assessment steps for suspected poisoning:
Treat the patient depending on the substance
Assess ABCs then the 5 Ws: Who, What/How much, When, Where, Why
If unknown substance: asses for an ALOC, seizures, vital signs, cardiac dysrhythmias
X rays, Labs, External decontamination, contact poison control
Infants and alterations in absorption
- decreased gastric acid secretion
- irregular gastric emptying
- increased intestinal motility
- frequent feedings
Children and alterations in absorption
Gastric pH equal to adult by 2-3 years
Infants and alterations in distribution
- limited binding of drugs to plasma protein due to low albumin levels (drugs that have low affinity for plasma protein are going to be in HIGHER concentrations in babies!)
- BB barrier not fully developed until 1 year. HIGH RISK OF NEUROTOXICITY
- Infants total body water is 80%. Adults is 50% This means you will need MORE water-soluble meds!!!
Children and alterations in distribution
- Plasma protein levels = adult levels by 1 year old
- Skin and blood brain barrier become more effective
Infants and alterations in metabolism
-IMMATURE LIVER ENZYMES (enzymes that break drugs down are immature). This means drugs cannot be broken down/ rendered inactive as well, which means that there will be increased circulation of the drug!
Children and alterations in metabolism
Decreased BMR (basal metabolic rate) after age 2. This means there is a LOWERED effect of drugs! Rapid metabolizers clear the drug out quickly. Slow metabolizers clear it out slowly!
Infants and alterations in excretion
infants have immature renal function. This requires a smaller dose of drugs that are excreted by the kidneys!! Immature renal function= drugs are excreted more SLOWLY. Risk for high concentrations in body due to slow excretion (potential toxicity) and nephrotoxicity.
Children and alterations in excretion
Children reach adult levels of renal function by age 2.
