Pediatric Medication Administration and Safety

10 rights of medication administration 

1. Right client/patient 

2. right drug 

3. right dose 

4. right time

5. right method

6. right patient education 

7. right doc

8. right to refuse 

9. right assesment 

10. right evaulation

How is pediatric medication administration different?

• Typically dosed by weight

• Cap at 50kg

• Very small margin of safety

• Absorbed and metabolized differently based on age

Pharmacokinetics in children

• absorption

• distribution

• metabolism

• excretion

• concentration

Administration of IV medications 

• site selection: considering patency in children because of their small veins

• infusion pumps:

• close monitoring: assess every hour

• prevent infection 

Med calculation right dose:

• Mg/kg/dose or mg/kg/day

• Dosing weight?

• Two-nurse independent double check

Child and family education; nursing responsibilities

• Med reconciliation (at DC)

• Med education

• Caregiver empowerment & problem solving

• Safety education

Why might kids take medication through entreral route

May not be able to handle things orally

Benefits of inhalation therapy

A way to get fast-acting meds in their system quickly

What is something to consider when administering inhalation therapy?

Considering the pH. Low pH could burn their nose

Something to consider when placing an IV on a child.

Considering their dominant hand. Placing an IV on their dominant could lead to their IV being moved around

Site used for kids

vastus lateralis 

thigh age 3-5 → deltoids

Importance of distribution of fluid

• Medium in which body solutes are dissolved

• ALL metabolic processes take place!

Two components of body fluids 

• water 

• solutes 

Fluids in adults vs. kid

Kids have a high proportion of fluid in their bodies. Infants have a high rish of dehydration because they have no control over their fluid

Water balance (I&Os)

Healthy body maintains equilibrium over a 24-hour period

• Fluid in = Fluid out (urine)

• Water from food in = Fluid out (stool & evaporation)

• Insensible water loss (skin & respiratory tract)

Increased fluid requirement

◦ Fever (sweating)

◦ Vomiting

◦ Diarrhea

◦ High urine output

◦ Diabetic Ketoacidosis

◦ Burns

◦ Shock

◦ Tachypnea

◦ Radiant warmer (preterm infant)

◦ Phototherapy (infants)

decreased fluid requirements

• Heart failure

• Syndromes of inappropriate antidiuretic hormone

• Mechanical ventilation

• After surgery

• Renal failure

• Increased (ICP) intracranial pressure

Early dehydration (2 days)

• Loss from both ECF and ICF

• Fluid shifts from ICF to ECF

Late/chronic dehydration

ICF loss becomes greater

Dehydration

• Common in infant and children

• When total output exceeds total intake

• Can be lack of oral intake or more often abnormal losses

Key assessment in dehydration

• Weight

• Intake and output

• Vital signs

• Level of activity (sensorium)

• Skin assessment

Signs of Dehydration

• Fewer wet diapers than usual

• No tears when crying; inside of mouth dry and sticky

• Lethargy

• Very poor skin turgor

• Increased respiratory rate

• Sunken fontanel

• Sunken eyes with dark circles

• Abnormal skin color, temperature

Pediatric fluid needs: Oral

Pedialyte

Pediatric fluid needs: Parenteral

IV 

Severe dehydration

• Uncontrollable vomiting

• Unable to drink

• Severe gastric distention

Signs of successful rehydration

• Moist mucous membranes

• Sodium and potassium within normal limits

• Voiding >1 mL/kg/h

• Capillary refill of 2s or less

• Skin turgor brisk (Fontenelle flat)

• Fluid intake and output balanced

• Vital signs within normal limits

A mother brings her 8-month-old female infant to the primary care clinic. The mother reports that she has had a “cold” for about 2 days. This morning she began to vomit and developed diarrhea that has continued for the past 6 h. The nurse performs an assessment and notes the following.

Select the history and assessment finding that require follow up. Select all that apply

A. The infant is breastfeeding for 10 min on each side every 3-4 h.

B. The infant is eating solids and the mother states she did not eat this morning.

C. The infant is having three times as many stools as usual (the stools are watery).

D. Temperature is 38 degrees C. (100.4 F)

E. Pulse is 98 bpm and bp is 100/54

F. Mucous membranes are slightly dry, but she has tears when she cries

G. Weight has not decreased since seen in the clinic a week ago for her well child visit.

B. The infant is eating solids and the mother states she did not eat this morning.

C. The infant is having three times as many stools as usual (the stools are watery).

D. Temperature is 38 degrees C. (100.4 F)

F. Mucous membranes are slightly dry, but she has tears when she cries

Let’s practice Calculate the hourly and daily fluids for:

• 12 kg toddler

• 25 kg child

44 mL/h and 1100 mL/day 

65 mL/h and 1600 mL/day