Pediatric Basics Flashcards by Lexie Backer

Ten Rights of Medication Administration

right patient
right drug
right dose
right time
right route
right documentation
right assessment
right evaluation
right education
right to refuse medication

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what is the most reliable source for administering medications to child?

parents

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what is the preferred route for administering medications to children?

oral
- most meds are dissolved and suspended in liquid preparations

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caution regarding oral medication administration

many peds meds are given by drops or dropper
- many droppers are marked in tenths of mLs
- a good way to avoid error is to demonstrate the technique and mark device for administration

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what to be cautious of with a G button?

have to watch for granulation/scar tissue is not forming/blocking the stoma

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what type of water should be used to flush a gastrostomy tube?

tap water

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what are the drug dosage usually calculated in?

mg/kg

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what difference with a safe dose range is okay with pediatrics?

+/- 10%

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body water content for:

premature infant

newborn infant

one year old

>2 yo

90%

70-80%

64%

60%

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what are the ratios of % of ECF to % cellular premature infants?

65% to 25%

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what are the ratios of % of ECF to % cellular for newborns?

40-45% vs 30-35%

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what are the ratios of % of ECF to % cellular for 1 yo?

24% vs 40%

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what are the ratios of % of ECF to % cellular for >2 yo?

20% vs 40%

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what are infants and small children more vulnerable to rapid fluid and electrolyte imbalance?

greater body surface area
inc metabolic rate: so inc RR, inc HR
proportionately infants have a smaller body water reserve
body surface area is greater so insensible loss is greater
b/c of higher metabolic rate, there are more waste products ot excrete

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fluid maintenance requirements

0-10 kg: 100 mL/kg/24 hr
11-20 kg: 1000 mL + (50 * kg >10 kg)
21-70 kg: 1500 mL + (20 * kg >20 kg)

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what are the reasons for the majority of fluid and electrolyte imbalances in children?

secondary to vomiting and diarrhea

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dehydration

occurs when body fluids are lost in excess of gains
- most worried about sodium levels
common alterations due to:
- GI tract
- skin–burns
- metabolism
- lungs

isotonic dehydration

proportional losses of fluid and electrolytes
- Na is b/w 130-150
- observable losses may bot be isotonic, but other avenues make adjustments
- net loss is isotonic
- greatest loss from ECF–>shock is greatest concern

hypotonic dehydration

losses of electrolytes exceed fluid
- Na < 130
- ICF is more concentrated than the ECF, so water moves in and cells expand
- greater loss from ECF–>shock is a problem–>inc HR and dec BP

hypertonic dehydration

losses of fluids excess electrolytes
- Na > 150
- most dangerous and requires more specific tx
- ECF is more concentrated, so water moves there from ICF and cells shrink
  - so shock less apparent, b/c water moving to ECF and wouldn’t see a drop in BP
- seizures are more likely b/c of the shrinking cells

assessment of level of dehydration

assess systemic perfusion
- S/S of poor perfusion include:
  - HR inc initially then dec
  - cool extremities
  - cap refill >2 sec
  - weak peripheral pulses
  - mucous membranes pale and dry
  - urine output dec
  - BP normal then postural dec

what are significant weight changes for:

infants?

children?

adolescents?

infants: 50 g in 24 hr
child: 200 g in 24 hr
adolescent: 500 g in 24 hr
- concerned about both inc and dec in weight

what age can you start using tears as an indication of hydration status?

2-3 mos

where is the best place to assess skin turgor on an infant?

thigh or abdomen

when do the fontanels close?

* posterior: 2 mos * anterior: 18 mos

what are the appropriate urine volume parameters for pediatrics?

1 mL/kg/hour

what is normal urine specific gravity in children?

1.005-1.020

what are the normal serum carbon dioxide balance in: premies? newborns? infant/child?

* premie: 14-27 * newborn: 13-22 * infant/child: 20-28

what can you assess to determine hydration status and fluid/electrolyte balance?

* ask about vomiting, diarrhea * type, freq, amt of food given * urinating pattern * any weight loss or gain * fever? evidence of infection? * V/S: temp, HR, RR, BP * skin assessment * anterior fontanel and eyes * I&O * urine specific gravity * labs: urine and serum electrolytes, SG, ABGs, EKG

weight loss indicating mild dehydration in infants and children

* infants: 3-5% weight loss * children: 3-4% weight loss

weight loss indicating moderate dehydration in infants and children

* infants: 6-9% weight loss * children: 6-8% weight loss

weight loss indicating severe dehydration in infants and children

* infants: \> or equal to 10% weight loss * children: 10% or greater weight loss

how to assess how much weight loss the child experienced due to dehydration?

* pre illness weight minus post illness = difference * (difference divided by preillness weight)\*100=percent weight loss

goals of rehydration

* maintain intravascular volume and systemic perfusion * replace volume deficit and ongoing losses * continue to provide maintenance fluid requirements * IV fluids for children with severe fluid volume deficit is initiated to restore first--\>will expand extracellular volume

what route will we use to give meds/fluids if the child is extremely dehydrated or if veins are non-accessible?

intra-osseous route

fluid replacement in hypotonic vs isotonic vs hypertonic dehydration

* fluid replacement is RAPID during isotonic or hypotonic dehydration * b/c of the signs of shock and low BP with high HR * rapid replacement is CONTRAINDICATED in hypertonic dehydration b/c of the risk of water intoxication

oral rehydration solution (ORS)

* used for children who have intact suck and swallow, no change in LOC, and not in shock * pedialyte is most often used * mild dehydration: give 50 mL/kg of the ORS over 4 hours * moderate dehydration: give 100 mL/kg of the ORS over 6 hours

can we allow breast feeding to continue if a child is dehydrated?

* as long as suck and swallow is intact and LOC is unchanged * breast feeding can continue ad lib

what body system are we concerned about if the child is experiencing fluid volume excess or deficit?

CNS

if question asks: if a newborn weighs 2.6 kg and is admitted to the hospital, and the doctor orders similac with iron at 20 cal/oz, and the infant requires 120 cal/kg to grow, how many oz oc the similac ordered will the infant need to ingest in order to maintain his weight?

* newborn's weight in kg \* required cal/kg * 2.6 kg \* 120 cal/kg=312 cal/24 hours * (1 oz/20 cal)\*312 cal=15.6 or 16 oz/day