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Administration of Medications in Pediatrics . By Dr. Nahed Said El-nagger. Learning Objectives. Prepare medications for administration. Administer drugs to patients by variety of routes. Calculating dosage formulas. Demonestrates nurses role in drug administration.

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learning objectives
Learning Objectives

Prepare medications for administration.

Administer drugs to patients by variety of routes.

Calculating dosage formulas.

Demonestrates nurses role in drug administration.

purposes of drug administration
Purposes of drug administration

Hydrate body cells and tissues.

Relieve symptoms.

Promote health and prevent disease.

Aid in diagnosis.

essential parts of a drug order
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.

ten rights of medication administration
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

rules calculating dosage formulas
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.

rules calculating dosage formulas8
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:

rules calculating dosage formulas9
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.

routes of drug s administration11
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.
routes of drug s administration12
Routes of drug’s administration

Eyeadministration

(drops or ointment)

slide13
. 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

slide15
3. Respiratory route

Inhalants such as Oxygen, & Nebulizer

slide16
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

slide17
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.

slide18
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

intramuscular
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).

intramuscular injection21

Intramuscular Injection

Purpose :-

A drug is administered by intramuscular route when:

A more rapid action is required than oral.

Giving medication into muscle.

intramuscular injection22

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.

intramuscular injection23

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.

slide24
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.

intramuscular injection28

Intramuscular Injection

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

intramuscular injection29

Intramuscular Injection

Upper arm (deltoid muscle)

intramuscular injection30

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.

intramuscular injection31

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.

slide32
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.

intramuscular injection33

Intramuscular Injection

Insert the needle at 90degree angle

using quick darting motion.

This angle facilitates medication to reach muscle.

intramuscular injection34

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.

intramuscular injection35

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.

intramuscular injection36

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.

intramuscular injection37

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.

.

intramuscular injection38

Intramuscular Injection

Wash hands.

Record the medication time, date, route, site, dosage, how the child tolerated the medication administration, any observation and signature.

intravenous therapy
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.

indications of i v therapy
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.
types of intravenous solutions
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 ).
types of intravenous solutions cont
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).

categories of intravenous solutions according to their purpose
Categories of intravenous solutions according to their purpose:
  • Nutrient solutions.
  • Electrolyte solutions.
  • Volume expanders.
parenteral nutrition pn
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.

venipuncture sites
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.
commonly used venipuncture sites
Commonly used Venipuncture sites

For infants:

  • Veins in the scalp and dorsal

foot veins are often used.

catheter selection
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).
vein selection
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.
select a site in where
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.
consider
Consider:
  • the baby's size, age, and gestation
  • the type and rate of infusion(s) and/ or medications infusing
  • why the baby needs an IV.
  • Is this the baby's last dose of antibiotics?
  • Could they be given I.M. instead?
  • Is the baby almost on full feeds?
central venous catheters
Central Venous Catheters

Central venous catheters

Are inserted into the subclavian

or jugular vein, with the distal tip

of the catheter resting in the

superior vena cava just above the

right atrium.

central venous catheters cont
Central Venous Catheters (cont.)

Indications:

  • Long term IV therapy or parenteral nutrition.
  • IV medications that are damaging to vessels

( chemotherapy).

i v infusion methods
I.V. infusion methods

1. I.V. Bolus (I.V. push):

The term bolus refers to a substance that is given all at one time. This method is used to achieve as an immediate effect (as in an emergency).

i v infusion methods cont
I.V. infusion methods (cont.)

2. Continuous-drip infusion:

Continuous-drip infusion is the slow instillation (over several hours) of a parenteral fluids and diluted drugs

in large volume (500-1000ml).

i v infusion methods cont56
I.V. infusion methods (cont.)

3. Intermittent infusion:

It is one in which I.V. medication is given within a relatively short period of time (minute up to 1 hr) or at specific intervals (e.g. every 4 hours).

intravenous equipment
Intravenous Equipment
  • Correct client.
  • Correct IV solution.
  • Proper catheter for Venipuncture.
  • IV start kit.
  • Correct tubing.
equipment of i v therapy
Equipment of I.V. therapy
  • I. Solution containers:

Solution containers are available

in various sizes (50, 100, 250, 500, or 1000 ml); may be plastic or glass.

equipment of i v therapy cont
Equipment of I.V. therapy (cont.)
  • II. I.V. administration sets:

They can be classified as primary, secondary (volume-controlled set and piggyback), and parallel or Y infusion sets.

Syringe Pump

equipment of i v therapy cont60
Equipment of I.V. therapy (cont.)
  • 1. Primary sets:

Micro drip sets, also called a minidrip or pediatric set,used when small volumes are being delivered (e.g. less than 50ml/hr), have a drip rate factor (DRF) of 60 drops/ml fluid.

equipment of i v therapy cont61
Equipment of I.V. therapy (cont.)
  • 2. Secondary sets:

Volume-controlled set

Also called metered-volume chamber as show frequently used with infants or in adult for intermittent infusion of medication, infusing small amount of fluid (100-150ml) over long period, and where the volume administered is critical.

regulating and monitoring iv infusions
Regulating and Monitoring IV Infusions
  • Drip factor:

The number of drops delivered per milliliter of solution varies with different infusion sets.

drip factor
Drip factor
  • Milliliters per Hours

total infusion volume = ml/h

total infusion time

drip factor cont
Drip factor (cont.)
  • Drops per Minute:

= total infusion volume in drop factor

total time of infusion in minutes

complications of iv cannulation
Complications of IV Cannulation
  • Local and systemic infections
  • Phlebitis
  • Thrombus
  • Air Embolism
  • Accidental insertion into an artery
  • Bleeding if disconnected
  • Extravasation
signs and symptoms of infiltration include
Signs and symptoms of infiltration include:
  • swelling
  • pain
  • coolness of skin
  • leakage at site
  • erythema
  • blistering
  • lack of blood return
recognition and prevention of iv infiltration injuries
Recognition and Prevention of IV Infiltration Injuries
  • An IV infiltration can be disastrous to a neonate's skin. Tissue necrosis can occur, as well as full thickness skin and muscle necrosis is possible.
  • Plastic surgery may be necessary in extreme cases.
  • It is extremely important to observe IV sites closely, at least hourly, more often in cases of high infusion rates, caustic solutions, and small fragile veins.
prevention measures
Prevention Measures
  • Avoid butterflies for infusion.
  • Avoid areas difficult to immobilize.
  • Avoid dorsum of foot in active babies, especially larger babies in cots. Always expose the IV site if the baby is in a cot
  • Secure so site is clearly visible.
prevention measures71
Prevention Measures
  • Tape loosely enough to maintain circulation.
  • Dilute medications per drug protocol.
  • Assess catheter site and distal region hourly
  • Stop infusion immediately if signs of infiltration are present. 
taping peripheral iv cannulae
Taping Peripheral IV Cannulae
  • IVs are taped so the site directly over the tip of the cannula is visible for observing signs of infiltration.
  • Tape is not to be placed over pre-existing tapes. If an IV require re-taping, existing tape must be removed first.
  • Tape so that it will be easy to remove. Consider making tabs at the ends of each tape to help with easier removal.
taping peripheral iv cannulae73
Taping Peripheral IV Cannulae
  • DO NOT use scissors to remove tapes.
  • Nailbeds need to be visible for assessing peripheral circulation. Do not tape too tightly which could interfere with circulation of the extremity.
taping peripheral iv cannulae74
Taping Peripheral IV Cannulae
  • Tape in a way that is developmentally appropriate for that baby. If the IV is in

the hand, ensure fingers are flexed over armboard and thumb is free. Feet are to be taped in an anatomical position with toes visible. Minimize restrictive movement as much as possible. Make sure baby will be comfortable after taping.

slide75

The End

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