Safe Administration of Medication

Question 1

Assessment

Answer 1

Medication and food allergies.
Appropriateness of medication dose for the child’s age and weight.
Childs developmental age.
Childs physiological and psychological condition.
Tissue and skin integrity when administering intramuscular, subcutaneous, and topical medications.
IV potency when administering IV mediations.

Question 2

Medication Administration Overview

Answer 2

Calculate the safe dosage for medication.
Notify the provider if medication dosage is determined to be outside the safe dose range, and for any questions about medication preparation or route.
Double check high risk and facility regulated medications with another nurse.
Use two client identifiers prior to administration: client name and DOB. Use parent(s) for verification of infants or non verbal children. Two identifiers from the ID band must be confirmed: client name, DOB, or hospital identification number.
Determine parental involvement with administration,.
Allow the child to make appropriate choices regarding administration (choosing left or right leg, whether the parent or nurse will administer the medication)
Prepare the child according to age and developmental age.

Question 3

Oral route

Answer 3

This route of medication administration is preferred for children.
Determine child’s ability to swallow pills.
Use the smallest measuring device for doses of liquid medication. Use an oral mediation syringe for smaller amounts, and a medication cup for larger amounts.
Avoid measuring liquid medication in a teaspoon or tablespoon.
Avoid mixing medication with formula or putting go tin a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula.
Hold the infant in a semi reclining position similar to feeding position.
Hold the small child in an upright position to precent aspiration.
Administer medication in the side of the mouth in small amounts. This allows the infant or child to swallow.
Only use the droppers that come with the medication for measurement.
Stroke the infant under the chin to promote swallowing while holding the checks together.
Teach the child to swallow tablets that are not available in liquid for and cant be crushed. Teach in short sessions using verbal instruction, demonstration, and positive reinforcement.
Provide atraumatic care:
Mix the medication in small amount of nonessential foods (like applesauce).
Offer juice, a soft drink, or snack after administration.
Add flavoring to medication as available.
Use a nipple to allow the infant to suck the medication.
Administer medications via feeding tube:
Confirm placement.
Use liquid formulation.
Do not add medication to the formula bag.
Flush with water to clear tubing of residual medication.

Question 4

Optic

Answer 4

Place the child in a supine or sitting position.
Extend the child’s head and ask the child to look up.
Pull the lower eye lid downward and apply medication in the pocket.
Administer ointments before nap or bedtime.
Provide atraumatic care:
If infants clinch their eyes closed, place the drops in the nasal corner. When the infant opens their eyes, the medication will enter the eyes.
Apply light pressure to the lacrimal punctuation for 1 minute to precent unpleasant taste.
Play games with younger children.

Question 5

Otic

Answer 5

Place the child in a prone or supine position with the affected ear upward.
Children younger than 3 years: pull the pinna downward and straight back.
Children older than 3 years: pull the pinna upward and back.
Provide atraumatic care:
Allow refrigerated medications to warm to room temperature.
Massage the outer area for a few minutes following administration.
Play games with younger children.

Question 6

Nasal

Answer 6

Position the child with the head extended.
Use a football hold for infants.
Provide atraumatic care:
Insert the tip into the naris vertically, then angle it prior to administration.
Play games with younger children.

Question 7

Aerosol

Answer 7

Use a mask for younger children.
Provide atraumatic care:
Allow parents to hold the child during treatment.
Use distraction

Question 8

Rectal

Answer 8

Insert beyond both rectal sphincters.
Hold the buttocks gently together for 5-10 minutes.
Halve the medication lengthwise, if necessary.
Provide atraumatic care:
Preform the procedure quickly
Use distraction

Question 9

Injection

Answer 9

Change the needle if it pierced the rubber stopper on a vial.
Secure the infant or child prior to injections.
Assess the need for assistance.
Avoid tracking of medication.
When selecting sites, consider the following:
Medication amount, viscosity, and type.
Muscle mass, condition, assess of site, and potential for contamination.
Treatment course and number of injections.
Age and size of the child.

Question 10

Intradermal

Answer 10

Administer on the inside surface of the forearm.
Use a TB syringe with a 26- to 30-gauge needle with an intradermal bevel.
Insert needle at 15 degree angle.
Do not aspirate.

Question 11

Subcutaneous

Answer 11

Given anywhere there is adequate subcutaneous tissue. Common sites are the lateral aspect of the upper arm, abdomen, and anterior thighs.
Inject volumes less than 0.5mL.
Use a 1mL syringe with a 26- to 30- gauge needle.
Insert a ta 90 degree angle, Use a 45 degree angle for children who are thin.
Check policy for aspiration practices.

Question 12

Intramuscular

Answer 12

Use a 22- to 25-gauge, 1/2 -to 1-inch needle.
Vastus lateralis is the recommended sire for infants and small children.
Position the child supine, side lying, or sitting.
Inject up to 0.5mL for infants.
Inject up to 2mL for children.

Question 13

Ventrogluteal

Answer 13

Position the child supine, side-lying, or prone.
Inject 0.5-1mL, depending on the muscle size of the infant.
Inject up to 2mL in children.

Question 14

Deltoid

Answer 14

Position the child sitting or standing.
Inject up to 1mL.
Provide atraumatic care:
Apply eutectic mixture of lidocaine and prilocaine (EMLA) to the site for 60 minutes prior to injection.
Change needed after puncturing the rubber stopper.
Use the smallest gauge needle possible.
Use therapeutic hugging.
Secure the child firmly to decrease movements of the needle while injecting.
Use distractions.
Encourage parents to hold the child after.
Offer praise.
Use play therapy.
Offer sucrose pacifiers to infants.

Question 15

Intravenous (IV)

Answer 15

Assess venipuncture sire per facility protocol and prior to administration of medication.

Question 16

Peripheral Venous Access Devices

Answer 16

Use a 24- to 24- gauge catheter.
Use for continuous and intermittent IV medication administration.
Short term IV therapy can be completed at home with the assistance of a home health nurse.

Question 17

Central Venous Access devices

Answer 17

Short term: non tunneled catheter or peripherally inserted central catheter.
Long term: tunneled catheter or Implanted infusion ports.
Provide Atraumatic care:
Insert PICC before multiple peripheral attempts.
Use a transilluminator to assist in vein location.
Avoid terminology such as a “bee sting” or a “stick”
Attach an extension tubing to decrease movement of catheter.
Use play therapy.
Apple EMLA to the site for 60 minutes prior to attempt.
Keep equipment out of site until the procedure begins.
Preform procedure in treatment room.
Use nonpharmacologic therapies.
Allow parents to stay if they prefer.
Use therapeutic holding.
Avoid using the dominant or sucking hand.
Cover the sire with a colorful wrap.
Swaddle infants.
Offer nonnutritive sucking to infants before, during, and after the procedure.