pediatric medication admin

med errors in children

higher rates due to

• calculations being weight or BSA based

• liquid calculations are mg/mL

• meds may need more dilution because more concentrated

• misplaced decimal → overdose

• adverse effects for peds are unknown for off-label meds

• children cannot communicate the adverse effects

factors influencing med admin

• organ immaturity

• decreased first pass

• immature blood brain barrier

• immature liver and kidney function

• increased water loss

• proportionately longer GI tract

• psychosocial

  • knowledge base

  • culture

  • developmental stage

  • financial status

med absorption considerations

• oral meds

  • do not crush sustained release or enteric coated meds

• IM

  • less muscle and erratic blood flow

• IV

  • dependent on adequate perfusion

med distribution

• they have differences in body fluid, fat percentages, protein and different blood brain barrier

more body fluid distribution

• higher dilution of H2O soluble meds = need for higher doses of H2O soluble meds

more fat distribution

• more fat soluble meds needed

decreased plasms proteins distribution

• less of certain meds needed to reach therapeutic effect

less selective blood brain barrier distribution

• increased distribution of meds into CNS

immature nervous system distribution

• paradoxical effects from certain meds

metabolism

• liver is primary site of drug metabolism

  • preemie to newborn - decreased ability to metabolize doses

  • toddlers - increased capacity to metabolize dose (may need more pain meds)

excretion

• main site of drug excretion = kidneys

• renal system immature at birth

• kidney cannot filter as well - may circulate longer and reach toxic levels

• dehydration

  • decreases ability to excrete meds

  • can increase effect of drug levels

concentration

• keep serum levels within safe therapeutic range to maximize effectiveness and reduce risk of toxicity

peak level

• concentration of med after it has been distributed

trough level

• level at which serum concentration is lowest (before next dose)

strategies for medicating children

• infants - cuddle and comfort

• toddlers - prepare immediately prior, minimize restraint, give praise

• preschoolers - therapeutic play, prepare immediately prior, offer choices

• school age - provide choices and explanations, rewards still important

• adolescents - explain, allow participation in decisions, praise cooperation

rights of meds

• right patient

• right med

• right dose

• right route

• right time

• right indication

• right developmental approach

• right for parent/patient to know purpose of med

• right for parent to refuse med

• right documentation

• right assessment

• right expiration date

• right response

pediatric calculations

• dosage based on Kg

• can be mg/kg/day or mg/kg/dose