Key Pediatric Nursing Interventions Flashcards
Eight Rights of Peds Medication
- right medication
- patient
- time
- route
- dose
- documentation
- right to be educated
- right to refuse
Pharmacodynamics
- behavior of medication at the cellular level
- affected by the physiologic immaturity of some body systems in a child
Pharmacokinetics
-movement of drugs throughout the body via absorption, distribution, metabolism, and excretion
Factors Affecting Oral Medications
- slower gastric emptying
- increased intestinal motility
- proportionally larger small intestine surface area
- higher gastric pH
- decreased lipase and amylase secretion compared w/ adults
Factors Affecting Intramuscular Absorption
- amount of muscle mass
- muscle tone and perfusion
- vasomotor instability
Factors Affecting SubQ Absorption
decreased perfusion
Factors Affecting Topical Absorption
- increased due to greater body surface area
- greater permeability of infant’s skin
Factors Affecting Distribution of Medication
- higher percentage of body water
- more rapid extracellular fluid exchange
- decreased body fat
- liver immaturity
- decreased amounts of plasma protein
- immature blood-brain barrier
Factors Affecting Metabolism
- differences in hepatic enzyme production
- increased metabolic rate
- biotransformation
How do you determine the child’s dose?
- weigh the child
- check drug reference for safe dose range
- calculate low safe dose
- calculate high safe dose
- determine if dose order is in range
Pediatric dosage should what?
not exceed the minimum recommended adult dosage
Guidelines to Determine Body Surface Area
- measure height
- determine weight
- use nomogram
- determine where lines intersect in surface area column
Forms of Oral Medications
- Liquids
- powders
- tablets
- capsules
Forms of Liquid Meds
Elixirs
Syrups
Suspension
What should you use to measure liquid medications?
Calibrated equipment such as medicine cup, spoon, plastic oral syringe, or dropper
How do you give medicine w/ oral syringe or dropper to infants or young children?
- Direct liquid to posterior side of mouth
- Give drug slowly, in small amounts
- Allow child to swallow before more medication is given
You should always do what to liquid medication before administering?
Shake it
What can increase the risk of aspiration and prevent trusting relationships when giving medication?
- Forcing child to take oral meds
- Pinching the child’s nose
Guidelines for Administering Meds via Jtube
- verify correct placement
- give liquid meds directly into tube
- Mix powder w/ warm water first
- Verify if ok to crush pills and mix w/ warm water
- Open capsules and mix w/ warm water
- Label each syringe appropriately
- Flush tube w/ water after unless contraindicated
When giving a rectal suppository to a child under 3 what finger would you use?
Fifth finger
What finger would you use to give a suppository to an older child?
Index finger
What to do for Suppositories?
- use water soluble lubricant
- side-lying position
- gloves
- hold buttocks together for several minutes
If the patient has a bowel movement after a suppository what should you do?
inspect the poop
What to do for Ophthalmic Meds?
- Keep eyes closed until administration
- Room temperature
- Control the head
- Avoid injury to eye
- Supine
- Sterile technique
If the child is uncooperative for eye drops what can you do?
Administer on the inner canthus with eyes closed, then have child open eyes
How do you position the ear for drops of a child younger than 3?
Pull pinna down and back
How do you position the ear for drops of a child 4 and older?
Pull pinna up and back
Cold ear drops can cause what?
vertigo or vomiting
Otic Drops
- room temperature
- supine or side lying
- massage
- use cotton ball of needed
What determines the IM injection site?
Muscle development and the amount of fluid to be injected
Less than 7 months IM injection site
vastus lateralis
> 7 months IM injection site
consider ventrogluteal as well as vastus lateralis
Dorsogluteal site is not recommended for who?
Children younger than 5
> 3 years and toddlers w/ sufficient muscle mass
Deltoid
How much meds can you give to an infant in their vastus lateralis?
0.5 mL
How much can you give to the toddler in the vastus lateralis?
0.5-1 mL
How much can you give to the toddler in the deltoid?
0.5 mL
How much can you give the preschooler in the vastus lateralis?
1 mL
How much can you give the preschooler in the deltoid ?
0.5 mL
How much can you give the school age child in the vastus lateralis?
1.5-2 mL
How much can you give the school age child in the deltoid?
0.5-1 mL
How much can you give the school age child in the dorsogluteal?
1.5-2 mL
An IM injection should be given at what angle?
90 degree angle
SubQ Injections
- distributes meds into the fatty layers of the body
- insulin, heparin, and certain immunizations
Intradermal Meds
- deposits meds just under the epidermis
- TB screening and allergy testing
Factors Affecting the Choice of Equipment for IV therapy
- solution or meds to be administered
- duration of therapy
- age and developmental level of the child
- child’s status
- condition of veins
Atraumatic Care for Managing IV’s
- gather equipment before approaching child
- Select hand rather than wrist or arm
- Ensure adequate pain relief
- allow anesthetic to dry
- use barrier to avoid pinching skin
- use device to illuminate vein if needed
- encourage parent participation
- minimal tape
- protect site from bumping
How many times should you attempt to place an IV?
2
What is the expected urine output for children and adolescents?
1.0 to 2.0 mL/kg/hr
1 g of weight is equal to how many mL’s of fluid?
1 mL
Site care for central venous access device:
Sterile technique and flush according to policy
PICC Line Care
Follow manufacturers recommended syringe size
Using 5 mL or larger exerts less pressure on the PICC and reduces risk of rupture
Two common complications for IV’s?
infiltration and inflammation
Prevent Infection Care
- proper hand hygiene
- maximal barrier protection during insertion
- assess site frequently
- proper site care using sterile technique
- ensure central venous catheter is removed as soon as it is no longer needed
How often does HICPAC recommend changing an IV that is used no more than 72-96 hours?
every 7 days
How often does HICPAC recommend changing IV’s used for blood, blood products, or parenteral nutrition?
every 24 hours
Atraumatic Care to Discontinue IV
- water or adhesive remover to help loosen tape
- pull up opposite corners using motion parallel to skin surface
- avoid scissors
- turn off infusion solution and pump
- gently slide the IV catheter out
- apply pressure to site w/ dry gauze and cover w/ band aide
Enteral Nutrition
“tube feedings” involve insertion of tube so that feedings can be delivered directly into the child’s GI tract
How can Enteral Feedings be given?
nasogastric, orogastric, nasojejunal, nasoduodenal, gastronomy, or jejunostomy
What are 3 ways you can determine enteral tube length, check tube placement, and provide skin and insertion site care?
- age related height based method
- nose to ear to mid-xiphoid to umbilicus
- nose to ear to mid-xiphoid method
Tube placement must be confirmed when?
Each time the tube is inserted and before each use
What is the most accurate way to check tube placement?
X-ray
How should you secure Gtube?
by taping to cheek not forehead
Intermittent feedings are commonly called what?
bolus feedings
Tube Feedings Instructions
- check gastric residual according to policy and before each intermittent
- supine with head and shoulders elevated 30 degrees
- flush w/ small amounts of water
- solution at room temp
- administer per facility policy
- flow by gravity
- 15-30 mins
- clamp to prevent air
- disconnect
What should the parents do if the tube comes out at home?
- cover w/ small clean dressing tape
- call MD w/ immediate replacement
- sometimes families are taught once the tube is more than 6 weeks old
What determines the type of parenteral nutrition?
Concentration and components of the solution
Parenteral nutrition given via a central venous access is termed what?
Total Parenteral Nutrition
What to do when TPN stops?
- be prepared to begin an infusion of 5-10 % dextrose solution at the same infusion rate as the TPN
- helps prevent hypoglycemia
- body will increase insulin secretion in response to highly concentrated TPN solution
Measures to Reduce Complications w/ TPN
- monitor vitals closely
- strict aseptic technique
- ensure system remains closed at all times
- use occlusive dressing
- adhere to agency policy for flushing
- asses I/O’s
- Monitor BG levels and order lab tests as ordered to evaluate changes in fluid and electrolytes
