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PHARMACOLOGY > PEDIATRIC CONSIDERATIONS > Flashcards

PEDIATRIC CONSIDERATIONS Flashcards

1
Q

is limited to available research in the provision of dosing protocols, safe practices, key assessments, and important nursing implications.

A

Pediatric pharmacology

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2
Q

______ and ______ are reluctant to provide permission for children to participate in research studies because of the risk involved and the potentially invasive nature of data gathering.

A

Parents and guardians

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3
Q

Pharmaceutical companies invest fewer resources in pediatric drug research because of the _________ afforded to pediatric drugs.

A

smaller market share

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4
Q

As a result, less is known about the effects, uses, and dosages of pediatric drugs, and nurses must investigate pediatric drugs carefully to provide __________ for children.

A

knowledgeable nursing care

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5
Q

Safe use for children may be guided by _______ or the _________ and may be based on _______ rather than _______.

A

small studies; judgment of the clinician; anecdotal evidence; scientific study

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6
Q

requires drug manufacturers to study pediatric drug use and offers incentives for pediatric pharmacology research

A

Pediatric Research Equity Act (PREA) in 2012

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7
Q

Despite the permanent reauthorization of the Pediatric Research Equity Act (PREA) in 2012, which requires drug manufacturers to study pediatric drug use and offers incentives for pediatric pharmacology research, only ____ of all drugs carry ________ for use in children.

A

half; federally approved indications

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8
Q

This means many drugs prescribed for children are being prescribed _____, which means the drug is being used for some purpose for which it has not been approved.

A

off label

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9
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

Owing to _______ and _______, infants and young children may receive drug dosages much different from those of adults.

A

developmental factors; smaller body size

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10
Q

What can prevent errors in drug administration? (3)

A

Careful calculations, double-checking math, and checking with another RN

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11
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

Ensure that families understand the __________ for a drug. Confusion may occur with the discussion of ____, _____, and other ______ systems.

A

units of measurement; metric, household, and other measurement systems

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12
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

For safety when administering injectable drugs to children, use the ____ syringe that ensures the ____ measurement of the drug.

A

smallest; most exact

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13
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

Use the _____ and ____ to ensure safe dosing.

A

correct drug and procedure

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14
Q

What can complicate administration of appropriate pediatric dosages? (3)

A

Dilutions, different concentrations, and different solutions of a prescribed drug

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15
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

Infants and children may not be able to confirm _____, _____, or _____. The nurse must be positive of such information before drug administration.

A

identity, allergies, or drugs

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16
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

Nurses must be vigilant for _______ or _______ to drugs because information on pediatric drug response is ____.

A

severe side effects or adverse reactions to drugs; limited

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17
Q

Preventing Drug Administration Errors in Pediatric Pharmacology

Regulatory agencies caution that drug administration errors are more common in _____ patients, which warrants _____ precautions in drug administration.

A

pediatric; increased

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18
Q

Pediatric Age Classification

Classification: Term neonate
Age: ?

A

Birth at 38 or more weeks gestation to 27 days

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19
Q

Pediatric Age Classification

Classification: Infant/toddler
Age: ?

A

28 days to 23 months

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20
Q

Pediatric Age Classification

Classification: Children
Age: ?

A

24 months to 11 years

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21
Q

Pediatric Age Classification

Classification: Adolescent
Age: ?

A

12 years to 16 or 18 years

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22
Q

Pharmacokinetics: Absorption

The degree and rate of drug absorption are based on factors such as ____, ______, _____, and _________.

A

age, health status, weight, and route of administration

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23
Q

Pharmacokinetics: Absorption

As children grow and develop, the absorption of drugs generally becomes more ____; therefore less developed absorption in neonates and infants must be considered in ______ and ______.

A

effective; dosage and administration

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24
Q

What may cause slowing of drug absorption? (3)

A

poor nutritional habits, changes in physical maturity, and hormonal differences during the adolescent years

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25
Q

What may be significant factors in the absorption of drugs? (3)

A

Hydration status, presence of underlying disease, and GI disorders in the child

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26
Q

Pharmacokinetics: Absorption
_________ is most pronounced in infancy, making the ____ and _____ periods those most affected by changes in absorption physiology

A

Lack of maturation of the GI tract; neonatal and infancy periods

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27
Q

Pharmacokinetics: Absorption

_______ and _______ are unpredictable in neonates and infants; however, it approaches that of adults between _ and _ months of age.

A

Gastric emptying and GI motility; 6 and 8 months

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28
Q

Pharmacokinetics: Absorption

Gastric emptying is affected by ______, and _____ infants have faster gastric emptying than _____ infants.

A

feeding; breast-fed; formula-fed

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29
Q

Pharmacokinetics: Absorption

________ may hinder or enhance absorption of oral drugs, depending on the usual site of chemical absorption.

A

Unpredictable GI motility

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30
Q

Pharmacokinetics: Absorption

________ may also affect drug absorption; neonates have inadequate production of _______ and _______, which leads to reduced absorption of _______.

A

Immature enzyme function; bile salts and pancreatic
enzymes; lipid- soluble drugs

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31
Q

Pharmacokinetics: Absorption

For drugs administered via the _______ or __ routes, absorption occurs at the tissue level. The level of _______ and effectiveness of _____ affects drug absorption.

A

subcutaneous or IM routes; level of peripheral perfusion and effectiveness of circulation

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32
Q

What are the conditions that alter perfusion? (3)

A

dehydration, cold temperatures, and alterations in cardiac status

33
Q

Pharmacokinetics: Absorption

Conditions that alter perfusion – dehydration, cold temperatures, and alterations in cardiac status – may impede (delay) ___________.

A

absorption of drugs in the tissues

34
Q

Pharmacokinetics: Absorption

The skin of infants and young children is _____ than that of adults; additionally, the ratio of body surface area to body mass of infants and children is _______ than for adults such that many drugs are more readily absorbed in children, and ____ may result.

A

thinner; proportionately higher; toxicity

35
Q

Pharmacokinetics: Distribution

Drug distribution is affected by factors such as: (4)

A

body fluid composition, body tissue composition, protein-binding capability, and effectiveness of various barriers to drug transport

36
Q

Pharmacokinetics: Distribution

In neonates and infants, the body is about __ water, compared with __ in adults which allows for a ______ of fluid in which to distribute drugs, which results in a ____ drug concentration.

A

75%; 60%; greater volume; lower drug concentration

37
Q

Pharmacokinetics: Distribution

Neonates and infants have _______ compared with adults, and they have fewer ______ with an affinity for drug binding in the first __ months after birth; this results in higher levels of ______ and an increased risk of _____.

A

decreased protein concentrations; protein receptor sites; 12; unbound drug; drug toxicity

38
Q

Pharmacokinetics: Distribution

Anatomic barriers to drug distribution, such as the ___, must be considered when drugs are administered to _____ patients. This barrier in neonates is relatively _____ and allows drugs to pass easily into _____, thereby increasing the likelihood for toxicity.

A

BBB; pediatric; immature; CNS tissue

39
Q

Pharmacokinetics: Metabolism

Metabolism is carried out primarily in the ____, with the ____ and ____ playing a small part in metabolism.

A

liver; kidneys and lungs

40
Q

Pharmacokinetics: Metabolism

Infants have reduced ________ and ________; however, by the time they reach _ year of age, hepatic blood flow has reached that of an adult.

A

hepatic blood flow and drug- metabolizing enzyme; 1

41
Q

Pharmacokinetics: Metabolism

Drug prescribing should be based on ________ and ________.

A

therapeutic effect and drug concentration

42
Q

Pharmacokinetics: Excretion

______ is the predominant means of drug elimination.

A

Renal excretion

43
Q

Pharmacokinetics: Excretion

The GFR in term neonates is roughly __% that of adults.

A

30%

44
Q

Pharmacokinetics: Excretion

During infancy, the GFR ____, and by __ months, it reaches adult levels.

A

rises; 12

45
Q

Pharmacokinetics: Excretion

Nurses must carefully monitor ________, ________, and ________ to evaluate the effect of drug administration on patient status.

A

renal function, urine flow, and drug effectiveness

46
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring

The calculation of pediatric dosages is based in part on _______ recommendations; as a result of the Best Pharmaceuticals for Children Act (BPCA) and PREA, pediatric dosing is now available for more than ___ drugs.

A

US Food and Drug Administration (FDA); 450

47
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring

For those drugs without pediatric dosing schedules, dosing is based on ________, ________, and ________.

A

approved protocols, research studies, and provider experience

48
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring

Drugs for pediatric patients are ordered based on either the child’s weight in ______ (__/__), or ______(___; __/__).

A

kilograms (mg/kg), or body surface area (BSA; mg/m2)

49
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Dosing and Monitoring

Dosing must also consider the individual child’s status, including ___, _______, _____, and _______.

A

age, organ function, health, and route of administration

50
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

_______ and _______ differences must always be considered in pediatric drug administration. It is important for the nurse to differentiate the child’s _______ age from _______ age, because this difference has an effect on the child’s response to drug administration.

A

Developmental and cognitive differences; developmental; chronological

51
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

The pediatric patient’s ability to _________, the _________, and the need to _________ must always figure prominently in the nurse’s plan of care.

A

understand the process, the reason for drug administration, and the need to cooperate with the procedure

52
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

The concept of ______ is essential to ensuring safety during and after health care interventions, especially drug administration.

A

family-centered care

53
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

Teaching is directed toward both _______ or _______ and _______, commensurate with the cognitive level of the
child.

A

family members or caregivers and patients

54
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

When possible, ______ or ______ should be solicited to assist in drug administration. These significant persons in the child’s life, individuals who see the child on a day-to-day basis, are usually in the best position to evaluate the effectiveness of a drug and observe for adverse reactions.

A

family members or caregivers

55
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

TRUE OR FALSE
Family members or caregivers may request not to participate in invasive procedures such as injections.

A

TRUE

56
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

TRUE OR FALSE
Family members or caregivers should always be supported in their caring function so that the child feels safe and secure.

A

TRUE

57
Q

Pharmacodynamics
NURSING IMPLICATIONS: Pediatric Drug Administration

Pediatric patients must be assessed for the ability to understand the ______ for the drug, the ______ for the drug despite unpleasant taste or method of administration, and the need to complete all ______ and ______ of the drug.

A

reason for the drug, the need for the drug despite unpleasant taste or method of administration, and the need to complete all doses and courses of the drug

58
Q

The following are tips to enhance safe drug administration and facilitate comfort:
may react violently and negatively to drug administration. Simple explanations, a firm approach, enlisting the imagination of a ____ through play may enhance success.

A

Toddlers

59
Q

The following are tips to enhance safe drug administration and facilitate comfort:
_______ are fairly cooperative and respond well to age-appropriate explanations. Allowing some level of choice and control may facilitate success with _____ children.

A

Preschoolers

60
Q

The following are tips to enhance safe drug administration and facilitate comfort:

_______ children, although often cooperative, may fear bodily injury and should be permitted even more control, involvement in the process, and information.

A

School-age

61
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Age-appropriate fears related to pain, changes in body image, and injury are prevalent among _______ and _______ patients.

A

older school-age and adolescent patients.

62
Q

The following are tips to enhance safe drug administration and facilitate comfort:

The nurse should establish a _____ with the patient, develop the ____ in collaboration with the patient, and ensure ____ in all aspects of drug administration.

A

positive rapport; plan of care; privacy

63
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Most pediatric drugs are administered via the ____ route. This is the least invasive and easiest to use and can be used by family members or caregivers.

A

oral

64
Q

The following are tips to enhance safe drug administration and facilitate comfort:

______, ______, and ______ routes are also used to deliver drugs to pediatric patients for whom the oral route is contraindicated.

A

Topical, rectal, and parenteral routes

65
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Because of tissue differences among children, the __ route is more predictable than other routes.

A

IV

66
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Most oral drugs administered to children under _ years of age are given using an oral syringe.

A

6

67
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Nurses may need to _____ pills or ____ the contents of capsules in ____ for administration to pediatric patients.

A

crush; dissolve the contents of capsules in fluid

68
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Some drugs, particularly ______ and ______ drugs, should not be crushed or dissolved.

A

timed-release and enteric-coated

69
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Based on the cognitive level of the child, other nonpharmacologic methods of pain and anxiety control such as ______, ______, ______, and ______ can also be used to decrease the perception of pain.

A

distraction, diversion, relaxation, and creative imagery d

70
Q

The following are tips to enhance safe drug administration and facilitate comfort:

_____ sites must be protected, especially in infants and toddlers, who do not understand the rationale or importance of maintaining the __ site.

A

IV infusion

71
Q

The following are tips to enhance safe drug administration and facilitate comfort:

Any injection site on a preschooler should be covered with a _____, preferably a decorated one, so that the child does not fear “_____” from the area.

A

bandage; leakage

72
Q

Considerations for the Adolescent Patient

_________ and _________ may necessitate changes in drug dosages.

A

Hormonal changes and growth spurt

73
Q

Considerations for the Adolescent Patient

_________ and _________ may greatly increase during the teen years, along with _________ and _________, which may affect the scheduling of and response to drugs.

A

Sleep requirements and metabolic rates; appetite and food consumption

74
Q

Considerations for the Adolescent Patient

A _________ must be solicited from adolescent patients to ensure appropriate drug administration.

A

comprehensive history

75
Q

Considerations for the Adolescent Patient

The nurse must also be conscious of the need to exercise care in offering _____.

A

confidentiality

76
Q

Nursing Process: Family-Centered Collaborative Care

In working with pediatric patients, ________ must be considered when administering and monitoring drugs.

A

key developmental differences

77
Q

Nursing Process: Family-Centered Collaborative Care

The ________ provides the framework to guide nursing practice in administering drugs, planning and evaluating nursing care, providing patient and family teaching, and incorporating the family into all aspects of treatment.

A

nursing process

78
Q

Nursing Process: Family-Centered Collaborative Care

_______ and _____ teaching is a key role for the nurse.

A

Family and patient teaching

79
Q

Nursing Process: Family-Centered Collaborative Care

____ to the drug regimen is of paramount importance with children and families.

A

PHARMACOLOGY (11 decks)

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