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.
Dr. Nahed Said El-nagger
Prepare medications for administration.
Administer drugs to patients by variety of routes.
Calculating dosage formulas.
Demonestrates nurses role in drug administration.
Hydrate body cells and tissues.
Promote health and prevent disease.
Aid in diagnosis.
The child’s name, room and bed number.
Date and time the order is written.
Dosage of drug
Time and frequency of administration
Route of administration
Signature of the person writing the order.
Right child/caregiver education
1. Calculating on basis of age:
Adult dose Xthe child’s age = child dose
)a.Fried’s rule)used for infant under 2years
Ex. Digoxin is prescribed for a 15 month old infant using formula 0.25mg.
1. Calculating on basis of age:
Adult dose X the child’s age (Yrs) = child dose
Child’s age + 12
Ex. If the adult dose is 600mg every 6 hrs, the 3 years old child is follows:
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.
2. Topical route
(eye, oral, nose, ear, rectal, skin )
(drops or ointment)
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
Inhalants such as Oxygen, & Nebulizer
The Parenteral route is defined as other than through the alimentary or respiratory tract , that is by needle.
More common routes:
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.
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.
Amount of drug administered must be small
Breaks skin barrier
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).
A drug is administered by intramuscular route when:
A more rapid action is required than oral.
Giving medication into muscle.
Appropriate syringe and needle size.
Spirit lotion in container and swabs.
Drug to be administered (vial or ampoule).
Sterile saline bottle or ampoule of sterile distilled water.
Explain to the parent or to the child what you plan to do.
To reassure the child or the parent through knowing of what will happen and to gain co-operation.
2. Select the site.
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.
The proper location for an injection is in the upper outer quadrant of either buttock.
Upper arm (deltoid muscle)
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.
Clean the site with an antiseptic swab
using a circular motion from inner to
Remove the needle cover.
Expel air bubbles unless one is to be left.
injected in firmly grasped in one hand to stabilize the limb and compress the muscle mass for injection with other hand.
Insert the needle at 90degree angle
using quick darting motion.
This angle facilitates medication to reach muscle.
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.
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.
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.
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.
Record the medication time, date, route, site, dosage, how the child tolerated the medication administration, any observation and signature.
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.
Intravenous infusions are used when:
5% dextrose in 0.45% NaCl.
and 33% NaCl (one-third normal saline).
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.
foot veins are often used.
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
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).
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).
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).
Solution containers are available
in various sizes (50, 100, 250, 500, or 1000 ml); may be plastic or glass.
They can be classified as primary, secondary (volume-controlled set and piggyback), and parallel or Y infusion 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.
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.
The number of drops delivered per milliliter of solution varies with different infusion sets.
total infusion volume = ml/h
total infusion time
= total infusion volume in drop factor
total time of infusion in minutes
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.