Sherpath Med Admin

Do not allow the parents to hold the child. The parents should be allowed to therapeutically hold the child during the IV insertion if they are comfortable with the position and the procedure. Reduce pain using topical pharmacological agents. The use of EMLA cream will reduce the pain associated with the insertion of an IV catheter and encourage more cooperation from the child helping to prevent injury. Obtain help from a colleague to hold the child and the extremity. Therapeutic holding of a child may be a necessary step for the insertion of an IV catheter. Insertion of an IV catheter can be a traumatic event for a child. Restraint of the child will reduce the length of time the child is in the stressful situation. Tell the child to imagine his or her favorite activity while guiding the catheter. The nurse should help the child imagine positive images when preparing them for the insertion of an IV catheter. This imagery will help the child feel in control of the situation and improve cooperation.

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?

Release the tissue and inject the medication. Releasing the tissue before injecting the medication will remove pressure from the tissue allowing the medication to be safely injected. Gently pinch the subcutaneous tissue from the muscle. The nurse should pinch the child's skin to raise the subcutaneous tissue from the muscle underneath. This will help prevent the needle from being inserted too deeply into the patient. Insert the needle at a 45-degree angle with the bevel up using a dart motion. Inserting the needle at a 45-degree angle with the bevel up is used for subcutaneous injections in most cases. The nurse would use a dart-like motion to decrease the time of skin penetration, thereby reducing the pain felt by the patient with a subcutaneous injection. Apply gentle pressure to the site using dry gauze after removing the needle. Applying gentle pressure will help stimulate clotting and prevent the medication from leaking out of the needle site.

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?

Determine the shortest length needle according to the selected muscle. The nurse should choose the shortest-length needle for the administering of an IM injection based upon the selected muscle for administration. This will help prevent the injection from penetrating too deeply. Choose the needle length by taking into account the amount of body fat on the child. The amount of body fat on the child would influence the correct needle choice by requiring a longer needle when the child is carrying a higher amount of body fat. Determine the appropriate gauge needle for the type of medication to be administered. The nurse should choose the smallest-gauge needle, based on the site and viscosity of the medication, when administering an IM injection. Using the smallest-gauge needle will help reduce the pain associated with intramuscular injection and increase the child's cooperation during the procedure.

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?

Notify the health care provider. The nurse should notify the ordering provider and request the medication be changed to a different form. Medication that is enteric-coated cannot be crushed or chewed without hindering the effectiveness of the medication.

A pediatric patient cannot swallow pills. The medication order is for an enteric-coated medication. How should the nurse proceed?

"This may sting a bit but should not last very long." Preparing the child for what to expect will help him process the situation and encourage his involvement in the process. "This medication is necessary to help your body function properly." The nurse should explain the reason for the injection and help the child understand that the medication will help with her illness. This will help the child remain calm if she understands that it is for her benefit. "This medication is going to help you and you did not do anything wrong." Helping the child to understand that the injection will help her feel better is an important aspect of increasing the child's confidence in the procedure. The nurse should help the child understand that the injection in NOT a punishment. "You may feel a warm sensation at the injection site, but it is normal and will only last a few minutes." The nurse should explain the length of time sensations associated with the injection should last when preparing the child for an injection. If the child knows what to expect then he or she is more likely to be cooperative.

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?

Cleanse the skin allow it to dry. In preparing the skin for the application of a topical medication the skin should be cleansed to remove exudates, scales, and other residue. This preparation will allow proper penetration of the topical medication. Examine the skin for abnormalities. The presence of bruises, abrasion, and irritation would affect the absorption of topical medications and, therefore, should not be present at the site of application. Teach the child to not touch treated areas. The child should avoid manipulating the treated area once the topical medication has been applied. Manipulation of the treated area could alter the perfusion of the area, which would change the absorption characteristics of the medication. Assist the child in applying the medication. Children should be involved in their own care as much as is appropriate for the child's development.

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?

Use a calm voice to help the infant relax. Using a calm voice helps the baby know how to react to a disturbing event and can increase the likelihood that the infant remains still during administration. Obtain assistance in restraining the child. The restraining of a child is not always necessary, but may be necessary if efforts getting the child to cooperate fail. Remove any excess mucus with a bulb syringe. The removal of excess mucus from the nares is essential for preparing an infant to receive nasal medication because it will allow the medication access to the mucus membranes.

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?

Deliver the nebulized medication with supplemental oxygen. Using oxygen with the nebulizer allows both the medication and oxygen to be delivered to the lungs. The delivery of oxygen is independent of the nebulized medication because oxygen transfer occurs in the alveoli and nebulized medication will not travel into the alveoli.

The nurse is caring for a child who is experiencing an acute asthma attack. What approach should the nurse use to administer a bronchodilator?

Double check the prescribed rate. The nurse should verify the ordered rate of the IV medication. If it was administered incorrectly, stop the infusion and notify the health care provider. Check the infusion site for edema. The nurse should check the IV site for signs of edema, infection, and infiltration, a medication instilled at an incorrect higher rate may cause edema or infiltration at the IV site. Disconnect the infusion and flush the site. The nurse should stop the infusion and flush the site if the rate prescribed is not the same as the rate that is set on the infusion pump. This will prevent a continuing medication error. Stop the infusion and contact the health care provider. After stopping the infusion, the nurse contacts the health care provider to inform him or her of the increased rate of medication administration and to receive further orders.

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?

"IV medications will begin to take effect immediately." IV medications have a rapid onset of action, and this is a stat medication. This would be the preferred method, and the most accurate and best response by the nurse to the parent's query.

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?

Using a nipple, wait for the infant to begin sucking before adding the medication. The infant should be encouraged to begin sucking the empty nipple and only afterward should the medication be added. By waiting until the infant is sucking the nurse can ensure that the infant is able to feed.

The nurse is preparing to administer prescribed oral medication to a 3-month-old patient. How should the nurse administer this medication?

Calculate the dose based on the number of mg/mL in the suspension. Prescriptions will often state the dosage in mg—and not mL—for liquids; care must be given to calculate the correct liquid dose.

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?