Peds Med Admin

Question 1

What the drug does to the body…

Answer 1

Pharmacodynamics

Question 2

What the body does to the drug….

Answer 2

Pharmacokinetics

Question 3

What is the caution with rehydration and IV infusions with children?

Answer 3

Fluid overload is easy to do!!!
The cardiovascular system can’t accommodate rapid fluid changes. The kidneys cannot filter fluid as quickly.

Question 4

What is the difference in absorption of topical meds in children vs adults?

Answer 4

Topical meds absorption is much greater in kids.

Question 5

When does the blood brain barrier mature? What is the significance when medicating a kid?

Answer 5

2 years old
Medications can easily cross the BBB and cause encephalopathy.

Question 6

Why do some medications create the opposite side effects in kids? (paradoxical effect)

Answer 6

Immature nervous system

Question 7

When is renal function at adult level in kids?

Answer 7

1-2 yo

Question 8

What are some factors that alter medication absorption in newborns?

Answer 8

Newborns have lower levels of plasma proteins that bind to medication…this means more stays in circulation.
High body water means that water soluble meds must be given in HIGHER doses for the effect.
Enzymes in liver are immature and can’t break down medication.
Renal system immature and can’t filter med out as fast.
—all this means medication is given in less amounts (usually) and can have unpredictable effects–

Question 9

What are some medications that you must get second nurse to check off with you before given to a child?

Answer 9

Insulin
Dextrose 20% or greater
Narcotics
Chemo agents
Digoxin or inotropic meds
Anticoags
Potassium, Sodium, Magnesium

Question 10

What is preferred site of IM injection in kids less than 2yo?

Answer 10

Vastus lateralis
–this is on OUTSIDE of thigh–

Question 11

What is preferred site of IM injection in kids over 2?

Answer 11

Deltoid

Question 12

What is usual needle size chosen for IM injection in NB?

Answer 12

23-25 gauge
3/8 inch long

Question 13

What is usual needle size chosen for IM injection in infants 2-12 months?

Answer 13

23-25 gauge
1 inch long

Question 14

What is usual needle size chosen for IM injections in older kids?

Answer 14

23-25 gauge
1 to 1 1/4 inch long

Question 15

When is the ventrogluteal muscle chosen for IM injections in kids?

Answer 15

This is muscle on hip (not the butt)
Can be used for any age child over 1 year old.
Holds larger volumes

Question 16

What is max volume of injection that can go into deltoid on adolescent?

Answer 16

1 mL
Remember that max is on an adolescent-not a toddler.

Question 17

What is max volume of injection that can go in deltoid of child from 2-14 yo?

Answer 17

0.5—1.0
Use judgment based on child’s size and muscle mass.

Question 18

At what angle does SQ injection go?

Answer 18

45 degrees

Question 19

At what angle does intradermal injection go?

Answer 19

15 degrees
This is going into shallow layer of skin not SQ.
–This is used for TB testing, allergy testing, and local anesthesia–

Question 20

What is formula for calculating daily fluid requirements for 10kg or less child?

Answer 20

100 mL/kg/day

Question 21

What is formula for calculating daily fluid requirements for child 10-20 kg?

Answer 21

100 mL/kg/day
PLUS
50 mL/kg/daily for each added kg over 10 kg
Example: 15 kg child
First 10 kg-10 kg x 100 mL=1000 mL
PLUS
The other 5 kg= 5 kg x 50 mL=250 mL
So total of 1250 mL/daily

Question 22

What is formula for calculating daily fluid requirements for child over 20 kg?

Answer 22

100 mL/kg/daily for first 10 kg PLUS
50 mL/kg/daily for kg between 10-20 PLUS
20 mL/kg/daily for kg over 20 kg
Example: 23 kg child
First 10 kg=100 mL x 10=1000
Kg between 10-20 = 50 mL x 10=500
Kg over 20=20 mLx 3 =60
Total 1560 ml/daily