Peds Chapter 35 Nursing Interventions Medications Lecture Notes
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102 Terms
What is mandatory when calculating pediatric medication doses?
Precise calculation of the safe dose range based on the child's weight.
How are medication doses rounded for infants and young children?
To the tenths place past the decimal.
How are medication doses rounded for older children?
To the nearest whole number.
Why should pediatric mode be used on IV pumps?
It provides pediatric medication libraries with safe dose ranges and appropriate syringe sizes.
What syringe size should be used when administering pediatric medications?
The smallest syringe necessary.
What factors determine whether a medication is appropriate for a pediatric patient?
Age, weight, safety information, and pediatric suitability.
Why must pediatric medication doses be frequently reassessed?
Rapid growth causes frequent weight changes that affect dosing.
What information should be reviewed before administering a medication?
Name, route, adverse effects, and reason for administration.
What should be checked before giving medications to prevent adverse reactions?
Allergies, vital signs, labs, and contraindications.
Which medications require a second nurse verification?
High-alert medications.
Why is parent/caregiver education important during medication administration?
To ensure understanding of medication purpose, administration, and safety.
Why should medication debris be disposed of immediately?
To prevent choking hazards and accidental exposure.
How should a nurse evaluate medication effectiveness?
Reassess vital signs, pain, and patient status.
What should be used for oral liquid medications?
A labeled oral syringe.
What should a nurse determine before giving oral medications to older children?
Whether they can swallow pills.
Can all medications be crushed or split?
No; verify if crushing or splitting is safe.
Should a medication be redosed if a child spits it out?
No.
What should be documented if a child vomits or spits out medication?
The exception and amount not received.
Why is drug absorption variable in infants?
Lower gastric acidity and immature organ systems.
How does liver immaturity affect medications?
It decreases metabolism.
How do immature kidneys affect medications?
Delayed excretion can lead to toxicity.
Why do topical medications pose greater risk in children?
Thinner skin increases absorption and risk of systemic toxicity.
Why is IM medication absorption less predictable in children?
Decreased blood flow to muscles.
What strategies can encourage children to take medications?
Playfulness, rewards, stickers, and positive reinforcement.
How should oral liquid medications be measured?
With a medication syringe or measuring device.
Should household spoons be used for medications?
No.
What should parents do after receiving medication instructions?
Return demonstrate and verbalize understanding.
What is the preferred route of medication administration in children?
Oral.
How should oral medication be administered to infants and young children?
Slowly into the side of the mouth in small amounts.
What is a Medipop?
A pacifier with a medication channel that allows slow administration.
Why should medications not be mixed into a bottle of milk?
The child may not receive the full dose.
What can be offered after medication administration to improve cooperation?
Juice, flavored drinks, snacks, or rewards.
What must be confirmed before administering medications through a feeding tube?
Correct tube placement.
What medication form is preferred for feeding tubes?
Liquid formulations.
Should medications be mixed into formula bags?
No.
How should medications be administered through feeding tubes?
Through the medication or feeding port using a syringe.
What should be done between multiple medications given through a feeding tube?
Flush with appropriate water.
How should eye drops be administered?
Into the conjunctival sac while pulling down the lower eyelid.
Where should eye ointment be applied?
From the inner canthus to the outer canthus.
When is the best time to administer eye ointment?
At bedtime or nap time.
For children younger than 3 years, how is the ear positioned for ear drops?
Pull the pinna down and back.
For children older than 3 years, how is the ear positioned for ear drops?
Pull the pinna up and back.
What should be done with refrigerated ear drops before administration?
Warm them to room temperature.
How should nasal medications be administered?
After suctioning or blowing the nose with the head hyperextended.
How should aerosol medications be administered to young children?
Using a mask.
What should be assessed before applying topical medications?
Skin integrity and dryness.
Why should transdermal patches be hidden from young children?
To prevent removal or ingestion.
Why are rectal medications generally avoided in children?
They are invasive and embarrassing.
What factors should be considered when selecting an injection site?
Age, size, medication amount, muscle mass, and accessibility.
What gauge needle is commonly used for IM injections?
22–25 gauge.
What is the preferred IM injection site for infants?
Vastus lateralis muscle.
What is the maximum IM volume for infants?
0.5 mL.
What is the maximum IM volume for children?
2 mL.
What can be used to decrease pain before injections?
EMLA cream or lidocaine spray.
Why should a needle be changed after drawing medication from a vial?
The original needle may be dulled after puncturing the stopper.
What techniques help keep a child still during injections?
Therapeutic holding, distraction, and rewards.
What are common subcutaneous injection sites?
Outer upper arm, anterior thigh, and abdomen.
What gauge needle is used for subcutaneous injections?
26–30 gauge.
At what angle are subcutaneous injections usually given?
90 degrees, or 45 degrees for thinner children.
Where are intradermal injections typically administered?
Inner forearm.
What angle is used for intradermal injections?
15 degrees.
Is aspiration performed during intradermal injections?
No.
What gauge catheter is commonly used for pediatric peripheral IVs?
22–24 gauge.
Why are transilluminators helpful during IV insertion?
They help visualize veins, valves, and bifurcations.
Where should an IV attempt begin?
At the most distal site and progress upward.
When can foot veins be used for IV access?
In nonwalking infants.
Why are scalp IVs sometimes used in infants?
They are difficult for infants to pull out and may be less painful.
What gauge IV catheter is typically used for infants?
24–26 gauge.
What is the rule when an IV site appears infiltrated or questionable?
When in doubt, take it out.
Why should IV sites be covered with wraps or mesh?
To prevent children from pulling them out.
What is a PICC line used for?
Long-term therapy, higher dextrose concentrations, and multiple medications.
What are arterial lines used for?
Blood pressure monitoring, blood gases, and lab draws.
What is an intraosseous line?
Emergency vascular access through the tibia when venous access cannot be obtained.
What is included in the Right Medication?
Verifying the correct medication and expiration date.
How is the Right Patient verified in pediatrics?
Use ID band and parent confirmation.
What does the Right Dose require?
Verification that the ordered dose is within the safe weight-based range.
What should be done if a medication dose is outside the safe range?
Hold the medication and notify the provider.
What is the Right Approach?
Using developmentally appropriate techniques.
How should medication refusal be handled in children?
Educate, reassure, support, and involve parents.
How much more often do medication errors occur in pediatrics compared to adults?
Three times more often.
Why are pediatric patients more vulnerable to medication errors?
Weight-based dosing, organ immaturity, body surface area differences, and calculation errors.
What unit must always be used for pediatric dosage calculations?
Kilograms.
What does enteral nutrition mean?
Feeding through the gastrointestinal tract.
What does parenteral nutrition mean?
Nutrition delivered intravenously.
What is the best method to verify feeding tube placement?
Gastric pH testing.
What gastric pH indicates safe feeding tube placement?
5.0 or less.
What should be done if gastric pH is greater than 5.0?
Hold feeding and notify the provider.
What signs suggest feeding tube misplacement?
Coughing, gagging, vomiting, or respiratory distress.
What position should be maintained during enteral feedings?
Head of bed elevated at least 30 degrees.
How often are bolus feedings typically given?
Every 3–4 hours over about 30 minutes.
Why might nighttime continuous feedings be preferred?
They allow normal daytime activity and development.
How should a leaking gastrostomy tube site be cared for?
Clean with warm water, dry, and use one pre-slit 2x2 gauze.
Why are blood glucose levels monitored closely with TPN?
Risk of hypo- or hyperglycemia due to dextrose and heparin.
Can the TPN rate be changed without an order?
No.
Why must strict aseptic technique be used with TPN?
To prevent central-line infections.
What does CLABSI stand for?
Central line-associated bloodstream infection.
What is the minimum urine output for a child?
1–2 mL/kg/hr.
What is the daily fluid requirement for the first 10 kg of body weight?
1000 mL/day.
What is the daily fluid requirement for the second 10 kg of body weight?
500 mL/day.
How are fluid requirements calculated for weight above 20 kg?
Add 20 mL/kg for each remaining kilogram.