Pediatric medication administration

Question 1

What percentage of water makes up a pre-term infant, full term infant, and adult?

Answer 1

85%
80%
60%

Question 2

How does intracellular water change in toddlerhood?

Answer 2

Intracellular water increases

Question 3

How do ECF, ICF, and TBF change over time?

Answer 3

ECF decreases
ICF increases
TBF decreases

Question 4

Which is lost faster in children: ECF or ICF?

Answer 4

ECF

Question 5

How does the loss of ECF affect infants and children?

Answer 5

Electrolyte imbalances show twice as fast as in adults

Question 6

How do you calculate daily maintenance fluid requirements for children?

Answer 6

100ml/kg for the first 10kg
50ml/kg for the second 10kg
20ml/kg for each additional kg of body weight
Divide by 24 to obtain cc/hr

Question 7

How do children physiologically process medications differently from adults?

Answer 7

Neonates have less plasma albumin
Infants have more rapid gastric emptying
Infants have immature renal function
Metabolic rate of a child is 2-3x greater than the adult

Question 8

How does a child’s metabolic rate affect them?

Answer 8

More rigorous
Greater caloric needs
Greater MBR
Increased H20 need to make up for normal fluid losses

Question 9

Who has a greater BSA: children or adults?

Answer 9

Children

Pound per pound, kids have a greater surface area than adults

Question 10

When do the kidneys reach full renal function?

Answer 10

Latter part of the first year

Question 11

How does the child’s immature buffer system affect them?

Answer 11

They are at a greater risk for acid/base imbalances

Question 12

How are the majority of pediatric meds given?

Answer 12

Orally

Question 13

What factors influence the absorption in infants and children?

Answer 13

Irregular peristalsis
pH
Enzyme activity

Question 14

How does the immature liver affect drug metabolism?

Answer 14

Immature liver cannot conjugate molecules with glucoronide to permit excretion by the liver
Deadly blood levels can accumulate

Question 15

When does the BBB mature?

Answer 15

~2 years old

Question 16

What can an immature BBB cause?

Answer 16

Encephalopathy
Dysfunction of the brain
Coma

Question 17

What percentage of muscle mass makes up an infant/adult?

Answer 17

25%

50%

Question 18

Why can an IM injection be bad for children?

Answer 18

Little muscle tissue available

May have erratic blood flow to muscle tissue -> decrease medication absorption

Question 19

Infants need _________ doses of water soluble medication because of increased H20

Answer 19

Increased

Question 20

Infants need _________ doses of fat soluble medication because of decreased body fat

Answer 20

Decreased

Question 21

What percentage of body fat is in an infant, 1 year old, preschooler, and adult?

Answer 21

16%
23%
8-12%
15%

Question 22

How long should a child be walking before using a dorsogluteal site?

Answer 22

One year

Question 23

What are the best IM site choices in kids?

Answer 23

Ventrogluteal
- Free of impt nerves and vascular structures
- Easily ID
- Thinner layer of subq tissue here
- Less painful than vastus lateralis
Vastus lateralis
- Large, well-developed muscle
- Can tolerate larger quantities of fluid
- No impt nerves or blood vessels

Question 24

What should you never do when administering medications to kids?

Answer 24

Mix with food or formula
Mix with child’s favorite food
Pretend you’re giving them something else
Use medication as a reward

Question 25

How should you administer nose drops?

Answer 25

Position the head extended over the bed or pillow

Administer drops and hold for 1 min

Question 26

How should you administer ear drops?

Answer 26

Pull pinna back and down for child <3

Pull pinna back and up for child >3

Question 27

How should you administer eye drops?

Answer 27

Pull lower lid down

Squeeze drops into sac