Medication Administration
Premature Vastus Lateralis max amount
0.5 mL
Young child (3-6 yr) Ventrogluteal max amount
1.5 mL
Adolescent (15 yr- adult) Vastus Lateralis max amount
2-3 mL
An 8-year-old pediatric patient was prescribed a topical medication. What steps should the nurse take to prepare for the application of the medication?
Cleanse the skin allow it to dry. Examine the skin for abnormalities Teach the child to not touch treated areas. Assist the child in applying the medication.
A nurse has been asked to administer an intramuscular injection to a 1-year-old child. How does the nurse choose the appropriate needle to use?
Determine the appropriate gauge needle for the type of medication to be administered. Choose the needle length by taking into account the amount of body fat on the child. Determine the shortest length needle according to the selected muscle.
Oral medications are available in:
Liquid (elixir or suspension). Tablet or capsule. Chewable tablet. Sprinkle (powder) forms.
Selecting Needle Size and Length
Subcutaneous injections are typically given with a 25- to 27-gauge needle that is ⅜- to ⅝-inches long. Volumes for subcutaneous injections are usually 0.5 mL; maximum volume is 1 mL.
The nurse is assessing the IV site of a pediatric patient and notes yellow drainage. What action should the nurse take?
Discontinue the infusion and the IV catheter and notify the health care provider.
A pediatric patient cannot swallow pills. The medication order is for an enteric-coated medication. How should the nurse proceed?
Notify the health care provider
SAFETY ALERT
Preferred IM injection sites and maximum volumes in children are shown in the table.
Creams, Lotions, Ointments, Pastes
Topical medications (creams, lotions, ointments, patches, and pastes) can produce local as well as systemic effects when absorbed through the skin.
Infants (birth to 12 months of age)
Vastus lateralis muscle in anterolateral aspect of middle or upper thigh7/8″ to 1″ needle, 23-25 gauge
A nurse receives an order that specifies IV bolus for a medication. What is the first step the nurse should take to administer this medication?
Verify the medication can safely be given as an IV bolus.
Toddler (13-36 mo) Deltoid max amount
0.5 mL
Neonate Vastus Lateralis max amount
0.5-1 mL
Older child (6-14 yr) Deltoid max amount
0.5-1 mL
Young child (3-6yr) Deltoid max amount
0.5-1 mL
Adolescent (15yr- adult) Deltoid max amount
1 mL
Infant (1-12 mo) Vastus Lateralis Max amount
1 mL
Toddler (13-36 mo) Ventrogluteal max amount
1 mL
Types of IV Infusions
IV medications can be administered as a continuous infusion or intermittently (bolus and intermittent infusion). The appropriate method is chosen to meet the needs of the child and to accommodate any restrictions posed by the medication and the volume of fluid.
Intradermal Injection
Intradermal injections enter the dermis layer of skin, which is just below the epidermis, and usually on the inner aspect of the forearm or on the upper back. They are most often used for allergy testing or tuberculosis (TB) screening (PPD). The needle used is 25 or 27 gauge and ⅜- to ⅝-inches in length. The maximum volume injected is 0.1 mL.
Positioning to Administer Oral Medication
It may be necessary to hold an infant or young child in order to safely administer an oral medication. The nurse cradles the child's head between the nurse's non-dominant arm and body, holds the child's hand with the nurse's non-dominant hand, and then administers the oral medication using the dominant hand.
The nurse is preparing medication for an 8-month-old infant by mixing it with applesauce. The infant's parent asks why the medication should not be mixed into the infant's breast milk, since that is what the infant prefers. What is the appropriate response from the nurse?
It may result in the child refusing to drink breast milk, an essential food for an 8-month-old.
Rectal Medication Administration
Medications given rectally can have a localized effect on the GI tract such as prompting defecation. They also can have a systemic effect such as decreasing fever, although absorption of medication administered by the rectal route is not as reliable as the oral route.
Procedure
Place the child supine with the head in the midline position and the neck slightly hyperextended. After hand hygiene and putting on gloves, instill the number of drops ordered into each naris. Keep the child's head in this same position for 1 minute. Instruct the child not to blow the medication out the nose. Praise all efforts at cooperation.
Selecting Needle Size and Length
Selection of the appropriate needle size and length will depend on the child's size, the amount of body fat, the site to be used, and the muscle mass at the IM site. Always use the smallest-size needle (22-25 gauge) and the shortest length (½-1½ inches) that will safely and comfortably administer the medication. For viscous medication, a larger-gauge needle may be indicated.
An infant is prescribed nasal drops by the primary health care provider. Which actions should the nurse take to ensure proper delivery of the medication?
Use a calm voice to help the infant relax. Obtain assistance in restraining the child. Remove any excess mucus with a bulb syringe.
The nurse is preparing to administer a subcutaneous injection to a pediatric patient. Which skin abnormality would cause the nurse to avoid that site?
scarring ecchymosis- bruising an open wound
The nurse is preparing to administer an intramuscular injection to a pediatric patient. What information does the nurse require to accurately determine which site is best to administer the injection?
the child's age the child's weight the volume of medication
When preparing a suspension or elixir that specifies dosage in milligrams (mg), what should the nurse do to ensure the patient receives the correct amount of the medication?
Calculate the dose based on the number of mg/mL in the suspension.
Older child (6-14 yr) Vastus Lateralis max amount
1.5-2 mL
Older child (6-14 yr) Ventrogluteal max amount
1.5-2 mL
Young child (3-6 yr) Vastus lateralis max amount
1.5-2 mL
Topical Medication Administration
A variety of prescription and over-the-counter creams, lotions, and ointments are used to treat skin irritation, dryness, or infection. Once the procedure has been explained to the child, perform hand hygiene, don gloves, cleanse the skin to remove any exudates, scales, or other residue, and allow the skin to dry. Don a new pair of gloves, and apply the ointment or cream per orders or instructions. Children should be included in this process as much as appropriate for their ages. Encourage the child to avoid touching the treated areas.
Before an IV catheter is inserted, the nurse explains the procedure to the child and parent, which includes:
All available information about why the catheter is being placed. What the child will see and feel during each step of the procedure. Where it will be inserted. How long it will be in place. What function(s) it will perform. If additional equipment (eg, an infusion pump) will be used.
Nursing Care Pearl
Always use a new needle for every planned injection. Using the same needle to give an injection that was used to draw up a medication from a vial or IV bag will make it more difficult to complete the injection, since the needle will be dulled. Tis can also increase discomfort for the patient.
The nurse is preparing to administer an oral medication to a child who is reporting nausea and frequent vomiting. Which action should the nurse take to ensure successful delivery of the medication?
Ask the health care provider to prescribe the medication rectally or by injection. An alternative administration route such as rectal, intravenous, or intramuscular, should be requested so the patient doesn't go without the needed medication.
Drug Alert Box: Using EMLA Anesthetic Cream
Choose appropriate site. Clean and dry area. Wash hands, don gloves. Place EMLA cream (2.5 g) on the site and cover with an occlusive, transparent dressing. Do not rub it into the skin. Leave EMLA in place for a minimum of 1 hour and maximum of 4 hours. Wash hands, don gloves, remove dressing and EMLA cream. Begin venipuncture. Anesthetic effect lasts 1 hour-2 hours. For IV therapy in an ambulatory care setting, provide prescription for EMLA and directions for use to parents. Use with caution in infants younger than 12 months. Do not apply to mucous membranes. Prevent accidental ingestion by older infants and young children. Do not administer EMLA to any child with methemoglobinemia.
Ophthalmic Medication Administration
For children, most ophthalmic medications come in the form of drops or ointment. If these preparations are refrigerated, allow them to warm to room temperature before instillation. After hand hygiene and putting on gloves, gently remove any exudates by wiping the child's eye with a sterile gauze pad (move from inner to outer canthus) using a different pad for each eye. Shake all suspensions well before instillation. Eye drops are instilled into the conjunctival sac. Eye ointment is applied along the inside edge of the lower eyelid from the inner to the outer canthus.
Preferred Sites IM
For infants and toddlers: vastus lateralis (Rishovd, 2014; Jackson et al, 2013) For children 3 years of age to 18 years of age: deltoid (Rishovd, 2014; Jackson et al, 2013) Not Recommended: the dorsogluteal site (possible injury to the sciatic nerve) and the rectus femoris (Rishovd, 2014)
Intermittent infusion administration- intravenous intermittent infusion administration- programmable infusion pumps
Frequently used to deliver intermittent infusion of IV medications via the "piggyback" method. Pumps have dual-programming capabilities that allow a secondary line attached to an IV bag containing medication, diluted to the correct concentration, to run concurrently or sequentially with a primary infusion of IV fluids. Must verify medication compatibility with IV solution being used.
The nurse is caring for a child who is experiencing an acute asthma attack. What approach should the nurse use to administer a bronchodilator?
Deliver the nebulized medication with supplemental oxygen.
Toddlers (<36 months of age), children, and adults
Densest portion of deltoid muscle—above armpit and below acromion1″ to 2″ needle, 23-25 gauge
Otic Medication Administration
When instilling medications into the ear (otic), the child is positioned supine with the head turned to allow access to the appropriate side. If drainage is present, which may occur if the tympanic membrane is ruptured, gloves must be worn—following hand hygiene—to instill eardrops. First, gently clean any exudates from the outer ear with a sterile gauze pad. Never attempt to clean the ear canal by placing any item such as a cotton-tipped applicator inside the ear. To avoid pain, otic solutions should be allowed to warm to room temperature before administration.
Intravenous (IV) therapy is widely used for children. Fluids and electrolytes, total parenteral nutrition (TPN), blood products, and medications can be delivered by the IV route. When used to administer medications, IV therapy produces consistent therapeutic blood levels. Some medications can only be given via the IV route. IV medications have a nearly immediate onset of action. The risks of IV therapy include:
fluid overload. Adverse drug reactions. Septicemia. Extravasation. Inflammation or infection at the IV catheter insertion site
Oral administration is the
most widely used method of medication administration. However, it is also one of the least reliable methods of administration because of spillage, leakage, and the spitting out the medication. Additionally, absorption of oral medication is affected by the presence or absence of food in the stomach, gastric emptying time, gastrointestinal (GI) motility, and stomach acidity.
It is not recommended to crush
time-release medications (eg, extended-release [XR], controlled-release [CR], sustained-release [SR]), as well as enteric-coated tablets because their safety is reduced. Time-release medications are designed to be slowly dissolved and by crushing these pills the medication will be released all at once. Enteric-coated tablets are designed to prevent contact of the medication with the stomach lining, because the medication may cause adverse effects such as ulcer formation; by crushing enteric-coated tablet the medication will have direct contact with the stomach lining.
Preparing the Child for Injections
Injected medications are rapidly absorbed and result in more reliable absorption than the oral route. However, injections are stressful and threatening to children; therefore, they are not a preferred method of pediatric medication administration. Preparing the child for an injection can reduce emotional and anticipatory concerns. Depending on the child's developmental level, explain:The reason for the injection.Any sensations the child might experience and the length of time they are anticipated to last.That an injection is not punishment. Practice distraction techniques such as squeezing their hand, deep breathing, listening to music, or talking about something of interest. Offer parents the option to stay with their child or leave if they feel unable to cope with the stress.
Intramuscular (IM) Injection
Intramuscular (IM) Injection Intramuscular (IM) injections deposit medication deeply into vascular muscle tissue, thus allowing rapid absorption. Examples of IM medications include penicillin, vitamin B12, and several different immunizations. Determine the accurate injection site before initiating the injection procedure; this will help avoid injecting an IM medication into subcutaneous tissue or puncturing a blood vessel, nerve, or bone. The site should be soft and well vascularized with healthy, intact skin. The child's age, size, and muscle mass along with the volume and properties of the medication to be injected will influence the choice of the IM injection site to be used.
Needle and Site Selection Iv
Over-the-needle IV catheters, 22 to 26 gauge, are used for children's peripheral IV lines. Vein size and the kind of fluid to be infused guide catheter selection. Generally, the smallest catheter through which fluids and medications can be safely infused should be used. The rate and type of fluid to be infused, the projected length of time the IV catheter will be needed, and the availability of veins often determine site selection. The nurse also considers the child's developmental level. The hand, forearm, and antecubital sites are often used. Scalp veins can be used for infant IV lines.
Rectal Medication procedure
Perform hand hygiene and don gloves. Place water-soluble lubricant on the suppository. Advise the child to take a deep breath or bear down, if possible, to relax the sphincter. Then, depending on the size of the child's anus, use either the index finger or little finger to gently insert the suppository through the anus and past the internal sphincter (approximately 1.5 cm to 2.5 cm). After insertion, hold the infant or young child's buttocks together for at least 5 minutes. Instruct older children and adolescents not to expel the suppository for 5 minutes to 10 minutes.
Reduce Pain Iv
Pharmacologic interventions are essential to reduce or eliminate pain from IV catheter insertion. Topical anesthetic agents such as EMLA or other devices such as the J-Tip, which delivers buffered lidocaine to the skin, must be used. Nonpharmacologic interventions including guided imagery (eg, putting on an imaginary "magic glove" that keeps the hand from hurting) and distraction (eg, music, videos, books) should be used as well.
The nurse is preparing to insert an IV catheter in a pediatric patient. What actions should the nurse take when applying eutectic mixture of local anesthetics (EMLA) cream?
Place on the skin site and cover with a transparent dressing. Leave in place for a minimum of 1 hour prior to catheter insertion.
Respiratory Medication Administration
Respiratory medications, used frequently in children, are delivered by a nebulizer or a metered-dose inhaler, a hand-held device that delivers "puffs" of medication for inhalation. Although many inhaled medications have an unpleasant taste or smell, this route is a relatively nonthreatening form of medication delivery. Monitoring for desired therapeutic effects as well as systemic side effects is essential.
The nurse is providing patient teaching to the family of a young child with asthma. The nurse would instruct the parents on the correct use of which piece of equipment to increase the effectiveness of a metered-dose inhaler?
Spacer The use of a spacer can increase the effectiveness of administration with a metered dose inhaler because it allows the child time to deeply inhale the medication.
Sprinkle, Powder, and Tablets
The nurse mixes a sprinkle, powder, or crushed tablet with a small amount (eg, 1 to 3 teaspoons) of a nonessential food such as applesauce or pudding, or with a liquid. Mixing medications with necessary foods, such as breast milk or formula, is avoided because this can alter the food's taste causing the child to refuse that food. The medication's compatibility with food must be determined before mixing and administration.
Preventing Injury Iv
The nurse must determine if the child will be able to hold the arm (or foot) still during the procedure. This is of major importance to prevent injury and to successfully insert the IV catheter. In most cases with young children, the nurse will need another health care provider to restrain the child and the extremity, using the "hug" technique, during the insertion procedure and until the IV catheter is completely secured. The parent or guardian should not be asked to help restrain the child during the placement of an IV catheter.
Intravenous Monitoring
The nurse should assess and document the IV catheter site of a child at least every hour (Tofani et al, 2012), looking specifically for signs and symptoms of infiltration, phlebitis, and/or infection. Observations are made for any redness, blanching, swelling, and/or exudates. If there is pain at the site, the nurse assesses the quality of the pain (sharp or dull) as well as the degree of pain using a pain scale. The nurse documents IV site assessment findings in the medical record. If signs and symptoms of complications (eg, edema, erythema, pain, blanching, coolness, purulent drainage, or red streaking of the skin above the vein) are noted, the IV infusion is discontinued and the health care provider is notified.
Preparation of Oral Medication
The nurse should evaluate the pediatric patient to determine the swallowing ability of the patient before choosing the type of medication. Additionally, it is important that the correct dose is prepared when administering an elixir or suspension because prescriptions often specify doses in milligrams (mg) and not milliliters (mL).
Patches
For application of any topical medication, avoid areas of bruises, abrasion, and irritation, as these can affect the absorption of the medication.
the nurse is ordered to administer a stat IV medication to a 3-month-old patient. The parent asks, "Why can't you just give this medication by mouth; it'll take some time to start working anyway?" What is the best response by the nurse?
"IV medications will begin to take effect immediately."
An 8-year-old child is prescribed a medication that must be delivered by injection. Which statements should the nurse make to prepare the child for administration of this medication?
"This may sting a bit but should not last very long." "This medication is necessary to help your body function properly." This medication is going to help you and you did not do anything wrong." "You may feel a warm sensation at the injection site, but it is normal and will only last a few minutes."
Subcutaneous Injection
A subcutaneous injection is administered into the connective tissue that lies just below the dermis layer of the skin. Subcutaneous injections should be given only into healthy tissue free from infection, bruising, and scarring. If circulation is impaired because of conditions such as shock or vascular disease, a subcutaneous injection should not be used because absorption will be altered. This type of administration is used for medications that provide a sustained effect (eg, heparin, insulin) or for certain immunizations.
intermittent infusion administration- intravenous intravenous intermittent infusion administration- syringe pumps
A syringe containing medication that has been mixed and diluted by the pharmacist, along with primed, low-volume tubing, is placed into the pump. After connecting the tubing to the IV line, pump is programmed to deliver the volume in the syringe over a specified time period.
Toddler (13-36 mo) Vastus Lateralis max amount
1-1.5 mL
Adolescent (15 yr- adult) Ventrogluteal max amount
2-3 mL
Procedure
After performing hand hygiene, don gloves and clean the site in a circular pattern with an antiseptic swab and allow the skin to dry. Gently pinch the tissue to raise the subcutaneous tissue from the muscle. The angle of needle insertion is usually 45 degrees; some nurses use a 90-degree angle with a ½-inch needle. A 90-degree angle should only be used if the nurse is able to grasp 2 inches of skin. Insert the needle with the bevel up using a dart-like motion. Release the tissue and inject the medication. After removing the needle, gentle pressure can be applied to the site using a dry gauze pad; do not massage.
Procedure intradermal injection
After performing hand hygiene, don gloves and clean the site in a circular pattern with an antiseptic swab and allow the skin to dry. Turn the bevel of the needle up and insert gently at a 5-degree to 15-degree angle, barely penetrating the skin. Inject the medication slowly to form a bleb or wheal. The injection site should not be massaged.
The nurse is teaching the parent of an infant how to administer medication using an oral syringe. In what order does the nurse describe the appropriate steps?
Assess the child's gag reflex and ability to swallow. Seat the infant in an upright or semi-upright position. Open the infant's mouth using gentle pressure to the chin or cheeks. Place the syringe along the side of the cheek. Gently dispense medication as the infant begins to suck.
Nursing Care Pearl
Attempt to use the most distal anatomic sites on your patient for intravenous access first, as this will allow for more proximal sites to be used if the initial insertion attempts are unsuccessful.
Changing Sites, Bags, and Tubing
Because of the fragility of children's veins, the difficulty of finding new sites, and the stress of insertion, children's IV sites are to be changed only when clinically indicated (O'Grady et al, 2011). IVs such as TPN and lipids are changed every 24 hours. Clear fluids should be changed every 72 hours-96 hours. It is now recommended to change IV tubing no more frequently than every 96 hours but at least every 7 days (O'Grady et al, 2011) to minimize risk of intravascular infection. IV bags and tubing should be changed more frequently (eg, every 24 hours) when TPN, lipids, or blood products are administered (O'Grady et al, 2011).
Preparation
Before administering nose drops to an infant, the nurse removes any excess mucus by gently suctioning the nares with a bulb syringe. To make eating more comfortable for a congested infant, saline nose drops are given followed by gentle suction, 20 minutes to 30 minutes before feedings. Nose drops can cause an uncomfortable sensation when administered, which can be stressful for young children. Provide a thorough explanation of what the child will feel, how the medication will make it easier to breathe through the nose, and what the child needs to do to help. Assistance with holding may be necessary for young children.
Determining Oral Medication Form
Before administering, the nurse assesses the child's gag reflex and ability to swallow. The specific form of oral medication used should be tailored to the child's developmental level and ability to take a particular form. Determining how the child takes medications at home will help choosing the best form to use. The oral route can be less predictable because of medication loss to spillage, leaking, or spitting out.
The nurse must consider the:
Compatibility of the medication with IV solutions. Type of IV tubing to be used. Recommended concentration for IV administration. Volume of the diluted medication. Suggested administration rate. Amount of flush needed. Information about administration of specific IV medications can be obtained from pharmacists or hospital formulary. Medications delivered by IV bolus (push) are given over a defined period of time (a few minutes), directly into the IV catheter through the port closest to the child's insertion site. Intermittent infusion administration can be performed using either a programmable infusion pump or a syringe pump.
A 7-year-old child is admitted to the hospital to receive an intravenous antibiotic. The child's parent is concerned about injury to the child's arm because this is the child's first IV infusion. How does the nurse ensure patient safety while placing the IV catheter?
Do not allow the parents to hold the child. Reduce pain using topical pharmacological agents. Obtain help from a colleague to hold the child and the extremity. Tell the child to imagine his or her favorite activity while guiding the catheter.
The nurse is caring for a pediatric patient and is implementing orders to infuse an IV medication at a rate of 50 mL/hr. The nurse returns to the room 15 minutes after initiating the IV medication and finds the pump set to 75 ml/hr. What action should the nurse take?
Double check the prescribed rate. Check the infusion site for edema. Disconnect the infusion and flush the site. Stop the infusion and contact the health care provider.
Administering otic drops for a child older than 3 years.
For a child older than 3 years, pull pinna up and back.
The nurse is caring for a pediatric patient who is to receive oral pain medication. The patient's parents indicate that the patient has had trouble swallowing capsules in the past. Which forms of medication may the nurse request?
Elixir Suspension Chewable tablet Sprinkle (powder)
Elixir or Suspension
Ensure that the correct dose is prepared when administering an elixir or a suspension. Health care providers' orders often specify the dosage in milligrams (mg), not milliliters (mL), for liquid medications. It is important to calculate the mL dose properly on the basis of the number of mg/mL for the available liquid medication.
Administering otic drops for a child younger than 3 years.
For an infant or a child younger than 3 years, grasp the pinna at the lobe, and pull down and back.
Nasal Medication Administration
Generally, nose drops and sprays are used for localized treatment of the nasal passages. However, the mucous membranes inside the nose allow for fairly rapid systemic absorption of medications. A wide range of medications can be given to children intranasally, including antidiuretic hormone (deamino-d-arginine-vasopressin [DDAVP]), fentanyl, ketamine, midazolam (Versed), and lorazepam
Oral Administration in Infants
Infants usually receive elixir or suspension forms that are administered using an empty nipple or oral syringe. The infant is placed in an upright or semi-upright position, similar to the position used for feeding. The nurse opens the infant's mouth by applying gentle pressure to the chin or cheeks. If using a nipple, the nipple is placed in the infant's mouth and the medication added to the empty nipple when the baby begins to suck. If using an oral syringe, the syringe is gently placed in the infant's mouth along the side of the cheek, and the nurse pushes the medication in slowly as the infant sucks.
Rectal Medication Administration indications
Medication administration via the rectal route is usually reserved for times when a child cannot eat or drink, or is unable to tolerate oral intake because of nausea and vomiting. There is a risk of injury to the anal and rectal tissues. This route should not be used if the rectum is full of stool. Rectal medication is contraindicated in children with rectal disease or those who have had rectal surgery.
Metered-dose Inhalers
Metered-dose inhalers offer a portable means of delivering inhaled medications. Many people, particularly children, have difficulty using a metered-dose inhaler correctly. The effectiveness of these medications is increased with the use of a spacer device. A spacer is a cylindrical piece of hard or expandable plastic that attaches to the inhaler on one side, and a mouthpiece or face mask on the other side. The child depresses the inhaler, and the medication enters the spacer, allowing the child time to deeply inhale the medication that is now mixed with air.
Nebulized Medications
Nebulized medications are diluted in normal saline solution and administered with a hand-held, small-volume nebulizer. The nebulizer aerosolizes the medication for inhalation. Medication can be delivered through a face mask or plastic mouthpiece held between the lips or close to the face. Encourage the child to breathe deeply and slowly. Can be delivered with supplemental oxygen to a child with an acute episode of respiratory distress. Can be delivered to an unconscious or intubated child by inserting the aerosol administration device in-line between the child and a bag-valve-mask device or ventilator.
Fear and Anxiety Iv
The nurse assesses the child's level of fear and anxiety, and has the child practice coping strategies in advance. The parents are reassured that once the IV catheter is inserted and secured in place, they will be able to hold their child. It is explained to the child how participating in play activities and self-care is still possible.
Preferred Subcutaneous Sites
Preferred subcutaneous injection sites for children are: Outer posterior aspects of the upper arms. Anterior aspects of the thighs. The abdomen, excluding a 2-inch radius around the umbilicus, is another site that is often used for children who require frequent subcutaneous injections (eg, type 1 children with diabetes). Systematically rotating sites can facilitate consistent drug absorption. The site of each subcutaneous injection must be recorded in order to properly rotate sites.
rectal medication preparation
Rectal administration is stressful for children because they fear intrusive procedures. Carefully prepare the child and explain the reason the medication is being given via this route, the steps of the procedure, and what the child can do to help. Position the child on the left side with the right leg slightly flexed, exposing the anal area sufficiently for visibility. Adequate draping is essential for preschool and older children. Distraction and deep-breathing exercises can help the child relax the external sphincter.
A child is brought to the allergist's office for frequent congestion and watery eyes. The health care provider orders a series of allergens to be administered subcutaneously to determine the child's allergies. When the nurse administers these subcutaneous injections, which steps should be taken?
Release the tissue and inject the medication. Gently pinch the subcutaneous tissue from the muscle. Insert the needle at a 45-degree angle with the bevel up using a dart motion. Apply gentle pressure to the site using dry gauze after removing the needle.
Milliliter-only Systems
The AAP recommends using milliliter only systems with oral dosing to avoid dosing errors (Yin et al, 2014). Oral syringe for volumes 5 mL or less. Calibrated plastic medicine cups for 5 mL to 30 mL (1 oz).
Summary
The knowledge and skills to appropriately administer medication is vital in the pediatric setting. The nurse must be able to assess each patient, and allay the fears and anxiety that many children have when it comes to taking medication. This is particularly true with medications that must be delivered via injection. Appropriate methods of selected medication administration include the following: Intradermal injections enter the dermis layer of skin, which is just below the epidermis, and usually on the inner aspect of the forearm or on the upper back. A subcutaneous injection is given into the connective tissue that lies just below the dermis layer of the skin. IV medications can be administered as a continuous infusion or intermittently (bolus and intermittent infusion). The appropriate method is chosen to meet the needs of the child and to accommodate any restrictions posed by the medication and the volume of fluid. Eye drops should be instilled into the conjunctival sac. Use of a spacer increases effectiveness of respiratory medication delivery via inhaler by allowing the child time to deeply inhale.
Introduction
The pediatric patient offers many challenges to the nurse in administration of medications. Thorough study of this unit will provide the student with the knowledge of several different strategies to administer oral and injectable medications. These approaches will be used for oral, intramuscular, subcutaneous, intravenous, rectal, ophthalmic, otic, nasal, inhalation, and topical administration of medications.
Intravenous Infusion Rate Monitoring
To accurately control the infusion rate for IV fluid or medication administration, infusion pumps that deliver a preset volume at a set rate are used for infants and children. Infusion pumps are programmed with IV fluid limits to prevent accidental fluid overload. Many hospitals have policies that require a child's IV pump be set to infuse no more than a 2-hour fluid volume. If the infusion rate must be changed, the nurse should verify this with the health care provider, disconnect the infusion, flush the site, and reconnect at the correct rate.
The nurse is preparing to administer prescribed oral medication to a 3-month-old patient. How should the nurse administer this medication?
Using a nipple, wait for the infant to begin sucking before adding the medication.
Toddlers months of age (12 to 36 months of age)
Vastus lateralis muscle preferred until the deltoid muscle has developed adequate mass (approximately age 36 months)7/8″ to 1″ needle, 23-25 gauge
Intermittent infusion administration- intravenous bolus administration
Volume of medication infused is small, usually 5 mL or less, and the effects can be seen immediately. It is imperative that the nurse verify the administration rate for an ordered medication to ensure that it can be safely given IV push. It is recommended to use needleless systems to access IV tubing (O'Grady et al, 2011).
The nurse receives orders to administer eye drops to a young patient. What is the correct order for the steps involved?
Wash hands and don gloves. Gently wipe the child's eye with a sterile gauze pad. Shake the medication. Instill drops into the conjunctival sac.
if the child cannot swallow tablets or capsules, the nurse should determine if the medication is available in
a liquid form or as a chewable tablet. If not, the nurse determines if the tablet can be crushed or if the contents of a capsule can be emptied.
The nurse is performing patient teaching prior to discharge for a child with type I diabetes. What information should the nurse provide the child regarding administration of a subcutaneous insulin injection?
change the site of injection track the location of injection sites administer the insulin injection in their abdomen - is the preferred location for children who require frequent subcutaneous injections
