Administration of Medications in Pediatrics

2. Administration of Medicationsin Pediatrics By Dr. Nahed Said El-nagger

3. Learning Objectives Prepare medications for administration. Administer drugs to patients by variety of routes. Calculating dosage formulas. Demonestrates nurses role in drug administration.

4. Purposes of drug administration Hydrate body cells and tissues. Relieve symptoms. Promote health and prevent disease. Aid in diagnosis.

5. Essential parts of a drug order The child’s name, room and bed number. Date and time the order is written. Drug name. Dosage of drug Time and frequency of administration Route of administration Signature of the person writing the order.

6. Ten rights of medication administration Right medication Right dose Right time Right route Right child Right child/caregiver education Right documentation Right assessment Right evaluation

7. Rules Calculating dosage formulas 1. Calculating on basis of age: Adult dose Xthe child’s age = child dose 150 )a.Fried’s rule)used for infant under 2years Ex. Digoxin is prescribed for a 15 month old infant using formula 0.25mg.

8. Rules Calculating dosage formulas 1. Calculating on basis of age: Adult dose X the child’s age (Yrs) = child dose Child’s age + 12 )b.Young’s rule). Ex. If the adult dose is 600mg every 6 hrs, the 3 years old child is follows:

9. Rules Calculating dosage formulas II.Calculation on basis of Weight: Weight of the child in (kg)X adult dose = child dose 70 )Clark’s rule).accurate for 2 years child& more Ex. Aspirin (10mg) is prescribed for 2 years old child who wt. is 14 kg.

10. Routes of drug’s administration 1. Oraladministration

11. Routes of drug’s administration 2. Topical route (eye, oral, nose, ear, rectal, skin ) • applied directly to the mucus membrane are absorbed quickly, may cause systemic effects. • Drugs applied on the skin are absorbed into the dermis where they have a local effect.

12. Routes of drug’s administration Eyeadministration (drops or ointment)

13. . Buccal In buccal administration a medication is held in the mouth against the mucous membranes of the cheek until the drug dissolves Provide a local effect

14. . Rectal

15. 3. Respiratory route Inhalants such as Oxygen, & Nebulizer

16. 4. Parenteral The Parenteral route is defined as other than through the alimentary or respiratory tract , that is by needle. More common routes: Subcutaneous Intramuscular Intradermal Intravenous

17. Subcutaneous Route: Into the subcutaneous tissue, just below the skin (45 angle). Used for immunization as Measles (0.5 ml in the right arm). Can administer only small volume. Not use needle more than 1.5 ml. Used for insulin injection.

18. Intradermal Under the epidermis (into the dermis) Used for immunization of B.C.G (Bacillus of Calmette- Gurein( 0.05 ml in the left upper arm. Disadvantage Amount of drug administered must be small Breaks skin barrier

19. Intramuscular Into a muscle Can administer large volume than subcutaneous. Drug is rapidly absorbed. Used in drug administration & immunization of: - DPT (0.5ml left thigh) - Hepatitis B (0.5ml Right thigh).

20. Intramuscular injection

21. Intramuscular Injection Purpose :- A drug is administered by intramuscular route when: A more rapid action is required than oral. Giving medication into muscle.

22. Intramuscular Injection Equipment :- Tray. Appropriate syringe and needle size. Spirit lotion in container and swabs. Prescription sheet. Drug to be administered (vial or ampoule). Sterile saline bottle or ampoule of sterile distilled water.

23. Intramuscular Injection Explain to the parent or to the child what you plan to do. Rationale: To reassure the child or the parent through knowing of what will happen and to gain co-operation. 2. Select the site.

24. Recommended Injection Sites for children: Vastus lateralis (for infant and young child). Rectus femoris (for infant and young child). Ventrogluteal area (any age). Gluteal region (children who have been walking for at least one year). Deltoid muscle for older child.

26. Intramuscular Injection

27. Intramuscular Injection

28. Intramuscular Injection The proper location for an injection is in the upper outer quadrant of either buttock.

29. Intramuscular Injection Upper arm (deltoid muscle)

30. Intramuscular Injection Wash hands. To avoid transferring of microorganisms. Hold infant in cradle position with arms and legs secured by mother or assistant. To avoid movements leading to unnecessary injury.

31. Intramuscular Injection Clean the site with an antiseptic swab using a circular motion from inner to outer. Remove the needle cover. Expel air bubbles unless one is to be left.

32. The muscle mass of the thigh to be injected in firmly grasped in one hand to stabilize the limb and compress the muscle mass for injection with other hand.

33. Intramuscular Injection Insert the needle at 90degree angle using quick darting motion. This angle facilitates medication to reach muscle.

34. Intramuscular Injection Stretch the skin taut between thumb and forefinger. Grasping the muscles in children increases muscle mass and insures needle placement. In muscle belly rather than striking bone.

35. Intramuscular Injection Fix the syringe with left hand and aspirate before injecting if blood is revealed, the needle must be withdrawn and reinserted. To avoid injuring to the small vessels or nerves.

36. Intramuscular Injection Inject the content of syringe slowly. To avoid distention of tissues. Press the cotton against the injection site and pull the needle quickly. Move the limb or massage the site with sponge, if bleeding occurs apply pressure (with dry sponge) to the site until it stops.

37. Intramuscular Injection Dispose of supplies according to agency procedures. To protect you and others from injury and contamination. Hold the child and try to please or give him/her any toy according to his age. .

38. Intramuscular Injection Wash hands. Record the medication time, date, route, site, dosage, how the child tolerated the medication administration, any observation and signature.

40. Intravenous therapy • Definition It is an effective and efficient method of supplying fluid directly into veins producing rapid effect with availability of injecting large volume of fluid more than other method of administration.

41. Indications of I.V. therapy Intravenous infusions are used when: • Childs need fluids, electrolytes, or nutritional supplements. • Infuse blood or blood products. • Administration of intravenous medications.

42. Types of Intravenous Solutions • Isotonic solutions: • Most IV solutions are isotonic, having the same concentration of solutes as blood plasma. • Isotonic solutions are often used to restore vascular volume. • E.g. 0.9% NaCl ( normal saline ). • Lactated Ringer’s. • 5% dextrose in water ( D5W ).

43. Types of Intravenous Solutions (cont.) • Hypertonic solutions : • Have a greater concentration of solutes than plasma. • E.g. 5% dextrose in normal saline(D5NS ). 5% dextrose in 0.45% NaCl. • 5% dextrose in lactated Ringer’s. • Hypotonic solutions : • Have a lesser concentration of solutes. • E.g. 0.45% NaCl (half strength normal saline ) and 33% NaCl (one-third normal saline).

44. Categories of intravenous solutions according to their purpose: • Nutrient solutions. • Electrolyte solutions. • Volume expanders.

45. Parenteral Nutrition (PN) Parenteral nutrition is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes , vitamins, minerals, and fluids via the IV route to meet the metabolic functioning of the body.

46. Venipuncture Sites • The site chosen for Venipuncture varies with the client’s: • Age. • Length of time the infusion is to run. • Type of solution used. • Condition of vein.

47. Commonly used Venipuncture sites For infants: • Veins in the scalp and dorsal foot veins are often used.

48. Catheter Selection • Butterfly. Only used for scalp veins, sometimes used for obtaining blood samples procedure only. Discouraged due to shorter dwell time. • Catheter used in newborn services is in sizes 24 gauge, and 22 gauge).

49. Vein Selection • The first choice of sites is the periphery to maximize available vein sites. • In neonates, the veins of the anterior aspect of the hands and feet are the most visible. • Scalp IVs are to be avoided. If necessary, this is usually performed by an ANP • Veins used for long line insertion are not to be cannulated.

50. Select a site in where • the vein is relatively straight • the area is not bruised • there is a vein that has not been infiltrated previously.