Administering medications to children presents a number of challenges: deciding which drug forms to use, determining dosages, choosing methods and sites, and taking into account implications based on the child’s development. See Table 7-1 for considerations needed when administering medications to children by various routes.
Although the drug and the dosage are determined by the prescriber, it is imperative that the nurse observe the “five rights” of medication administration before any medication is given
1- Right medication
Compare the name of the drug on the medication sheet with the name of the drug on the label of the drug container three times. Check the container’s expiration date.
– Know the action of the drug.
– Identify the potential side effects of the drug.
– Use the pharmacy, hospital, or other drug formulary as a reference for medications with which you are unfamiliar.
2- Right patient
– Verify the name on the medication sheet against the name on the child’s identification band. When in a setting with no name band (e.g., clinic), verify the child’s name with the child and parent by asking them to state the name.
3- Right time
– When ordered for a specific time, a medication should be given within 20-30 minutes of that time.
– For prn medications, check the last time the dose was given as well as the total 24-hour dose the child has received to verify that the child can receive another dose at this time.
4- Right route of administration
– Always use the ordered route for administration of a medication. If a change is needed (such as a change from oral medication when a child is vomiting), check with the prescriber to get an order for a change in route.
– Calculate the ordered dose based on the child’s weight in kilograms.
– If in doubt about what constitutes an appropriate dose, compare with the pharmacy, hospital, or other drug formulary guidelines for recommended dose.
– Question the order if the dose is outside of recommended amounts,
1- Explain all procedures or treatments to the child and parents, based on the child’s developmental stage and the level of understanding of both parties.
2- Answer all questions before giving the medication.
3- Identify any known drug allergies.
– Once a medication is given, record the name of the drug, the route, the date and nine, and, if appropriate, the site.
– Record the response to the medication, including desired effects and undesired side‘ effects.
Rationale: A record of response is especially important with medications for pain control and those for treatment of an acute problem such as respiratory difficulty.
– It is the nurse’s responsibility to calculate the dosage of the medication ordered to determine if the dosage is within the normal range for the child’s height and weight.
– Dosages can be calculated using the child’s weight (written as mg/kg) or total body surface area. This is determined by plotting the child’s height and weight on a nomogram
The physician orders morphine (available as 10 mg/mL) for a 3-year-old child why weighs 15 kg. The recommended dose for children is 0.1 mg/kg. What dose is appropriate for the child’s weight? How much volume should be drawn?
Recommended dose X Weight = Dose for patient
0.1 mg/kg x 15 kg = 1.5 mg
Dose desired/Dose on hand x Quantity in mL = Volume to be administered 1.5 mg/10 mg X 1 mL = 0.15 mL to be administered
The physician orders phenobarbital (available as 65 mg/mL) for a 5-year-old child who weighs 20 kg. The recommended loading dose for the child is 10 to 20 mg/kg. The physician orders 250 mg to be infused over 30 minutes. Is this dose appropriate for the child’s weight? How much volume should be drawn? How do you set the infusion pump?
Recommended dose x Weight = Desired dose
10 mg/kg x 20 kg = 200 mg 20 mg/kg x 20 kg = 400 mg Dose of 250 mg is within recommended range.
Dose desired/dose on hand X Quantity in mL = Volume to be administered
250 mg/65 mg X 1 mL = 3.85 mL
Pump set up
The nurse determines the volume for the setup is 50 mL. SO mL/30 min X 60 min/1 hr = mL/hr = 100 mL/hr Rate = 100 mL/hr
Children younger than 5 years of age usually have difficulty swallowing tablets and capsules. For this reason, most medications for pediatric use are also available in the form of elixirs, syrups, or suspensions. If a medication is only available in tablet or capsule form, it may need to be crushed before being administered. Be sure not to crush medications with enteric coating. Remember to wear clean gloves if your hands might come in contact with the child’s saliva.
Administering an Oral Medication:
1- Measure the medication accurately to ensure that the dose is correct.
2- If the oral medication is liquid (especially if less than 5 mL), it should be measured in a syringe or calibrated small medicine cup or dropper (Figure 7-1). A specially designed medication bottle may also be used.
3- If a tablet or pill needs to be crushed, place it in a mortar or between two paper medicine cups and crush it with a pestle. Once the tablet or pill has been pulverized, mix the powdered medication with a small amount of flavored substance such as juice, applesauce, or jelly to disguise any unpleasant flavor
EQUIPMENT AND SUPPLIES
Medicine cup, syringe, or other device for administering medication
procedure: Clean Gloves
1- A syringe or dropper provides the best control.
2- Apply gloves if needed.
3- Place small amounts of liquid along the side of the infant’s mouth. Wait for the infant to swallow before giving more.
RATIONALE: This method helps to prevent aspiration and maximizes the chance that the infant will get all the medicine rather than spitting some out.
Alternative method: Have the infant suck the liquid through a nipple.
Toddler or young child
1- Place the child firmly on the lap or the parent’s lap in a sitting or modified supine position pure 7-2).
2- Apply gloves if needed.
3- Administer the medication slowly with a syringe or small medicine cup.