ATI Pediatric Nurse 210- Chapter 8 Safe Administration of Medication

How to Administer Oral Medication to children: 9 tips)

1. Determine the child's ability to swallow pills 2. Use the smallest measuring device for doses of liquid medication. Use an oral medication syringe for smaller amounts and a med cup for bigger amounts. 3. Avoid measuring a liquid medication in a teaspoon or tablespoon. 4. Use rigid plastic cups instead of paper cups for liquid meds. 5. Only use the droppers that come with the medication for measurement. 6. Administer the medication in the side of the mouth in small amounts. This allows the infant or child to swallow. 7. Stroke the infant under the chin to promote swallowing while holding the cheeks together. 8. Hold the infant in a semi- reclining position similar to a feeding position. 9. Hold infant upright to prevent aspiration.

How to administer transdermal/topical medications:

1. Ensure that the skin is dry and intact. 2. Apply to the body or major muscle ( try to hide from smaller children) 3. Assess the skin site of administration regularly. 4. Rotate sites frequently.

How to inject via Deltoid Muscle: (4)

1. Explain the procedure to the child and guardians. 2. Position the child sitting or standing. 3. Inject up to 1 mL 4. Provide atraumatic care

How to administer subcutaneous medications: (5)

1. Give anywhere where there is adequate subq tissue. 2. Inject volumes of less than 0.5 mL. 3. Use a 1 mL syringe with a 26- to 30- gauge needle. 4. Insert at a 90 degree angle. Use a 45 degree angle for children who are thin. 5. Check policy for aspiration practices.

Atraumatic care for Optic Eye Medication Administration: (3)

1. If infants clench their eyes closed, place the drops in the nasal corner. When the infant opens his eyes, the medication will enter his eye. 2. Apply light pressure to the lacrimal conjunctiva of the eye for 1 minute to prevent unpleasant taste. 3. Play games with younger children

How to provide atraumatic care for Nasal medications:

1. Insert the tip into the naris vertically, then angle it prior to administration. 2. Play games with younger children.

What are the common subcutaneous inject sites? (3)

1. Lateral aspect of the upper arm 2. Abdomen 3. Anterior thigh

What should be included in the assessment ? (6)

1. Medication & Food Allergies 2. Appropriateness of medication dose for the child's age and weight 3. Child's Developmental Age 4. Child's physiological and psychological condition 5. Tissue and skin integrity when administering intramuscular ( IM), subcutaneous, and topical medications 6. IV patency when administering IV medications

When selecting sites for injection medications, consider the following: (4)

1. Medication amount, viscosity, and type. 2. Muscle mass, condition, access of site, and potential for contamination. 3. Treatment course and number of injections. 4. Age and size of child.

How to provide atraumatic care for oral medication administration? (5)

1. Mix the medication in a small amount of sweet nonessential food ( applesauce or sherbet). 2. Offer juice, a soft drink, or snack after Administration. 3. Add flavoring to medications as available. 4. Use a nipple to allow the infant to suck the medication. 5. Reward each child with a prize or sticker afterwards .

How to administer ear medications/otic for pediatric population: (3)

1. Place the child in a prone or supine position with the affected ear upward. 2. Children younger than 3 years old: pull the pinna downward and straight back. 3. Children older than 3 years: pull the pinna upward and straight back

How to provide rectal medication: (5)

1. Provide lubrication to the medication by using warm water or other lubricant, if the med is not prelubricated. 2. Insert beyond both rectal sphincters ( small child less than 0.5 inches, older child 1 inch) 3. Hold the buttocks gently together for 5-10 minutes. 4. If necessary to half the dose, cut the medication lengthwise. 5. Try to perform the procedure quickly and use distractions.

How to administer nasal medication: (3)

1. Remove mucus prior to administration. 2. Position the child with the head hyperextended. 3. Use a football hold for infants.

Intraosseous medication administration tips: (5)

1. Temporary route of administration for use in an emergent situation in which venous access cannot be obtained. 2. Use an intraosseous or large bore needle that is inserted into the tibia. 3. Monitor site for infection, leakage of fluid. 4. Monitor distal pulses, temperature of leg, and color frequently. 5. Risk for compartment syndrome

Intramuscular injection tips: (5)

1. Use a 22- to 25- gauge, 1/2 to 1 inch needle. 2. Vastus Lateralis is the recommended site in infants and small children. 3. Position the child supine, side-lying, or sitting. 4. Inject up to 0.5 mL for infants. 5. Inject up to 2 mL for children.

Peripheral Venous Access Devices administration tips : (3)

1. Use a 24- to 22- gauge catheter. 2. Use for continuous and intermittent IV medication administration. 3. Short term IV therapy can be completed at home with the assistance of a home health nurse.

How to provide Aerosol medications for children and atraumatic care:

1. Use a mask for younger children. 2. Atraumatic care: - Insert the tip into the naris vertically, then angle it prior to administration. - Play games with younger children.

A nurse is preparing to administer medication to a toddler. Which of the following actions should the nurse take? ( SATA) A) Identify the toddler by asking the caregiver. B) Tell the caregiver to administer the medication. C) Calculate the safe dosage. D) Ask the toddler to pick a toy to hold during administration. E) Offer juice after administration.

Correct Answers- C, D, and E

A nurse is preparing to administer an intramuscular ( IM ) injection to a child. Which of the following muscle groups is contraindicated? A) Deltoid B) Ventrogluteal C) Vastus Lateralis D) Dorsogluteal

D) Contains major nerves and blood vessels and is not recommended for children.

A nurse is planning to administer the influenza vaccine to a toddler. Which of the following actions should the nurse take? A) Administer subcutaneously in the abdomen. B) Use a 20- gauge needle. C) Divide the medication into the two injections. D) Place the child in the supine position.

D) The vastus lateralis is recommended for administering IM medications. Supine position is an appropriate action to take.

True or False: Avoid mixing medication with formula or putting it in an bottle of formula because the infant might not take the entire feeding , and the medication can alter the taste of the formula .

True

True or false : Central Venous Access Devices ( CVADS) can be short term or long term.

True

True or false: Assess venipuncture sites per facility protocol and prior to administration of medications.

True

True or false: For otic medications for children ages 3 and younger, you would pull the pinna downward and back.

True

True or false: the Deltoid muscle can be used in children for medication containing up to 1 mL

True

What is required for Long term use of CVADS?

Tunneled catheter or implanted infusion ports

What does intraosseous mean?

Intraosseous infusion is the process of injecting medications, fluids, or blood products directly into the marrow of a bone; this provides a non-collapsible entry point into the systemic venous system.

How to administer medications via a feeding tube : (4)

1. Confirm placement 2. Use liquid formulation 3. Do not add medication to the formula bag 4. If administering several medications, flush tubing with water after the administration of each medication.

What is required for non-tunneled catheters or peripherally inserted central catheters ( PICC) to verify placement prior to use?

- An x-ray

What are the identifiers for prior to medication administration?

1) Name, DOB, and/or Hospital Identification number 2) Use guardian(s) for verification of infants or nonverbal children

Optic Medication Administration tips for children: (5)

1) Place the child in a supine or sitting position 2) Extend the child's head and ask the child to look up 3) Pull the lower eyelid downward and apply the medication in the conjunctiva pocket. 4) Administer ointments from the inner to outer canthus of the eye preferably before nap or bedtime.

How to administer intradermal medications: (4)

1. Administer on the inside surface of the forearm. 2. Use a TB syringe with 26- to 30- gauge needle with an intradermal bevel. 3. Insert needle at 15 degree angle. 4. Do not aspirate

How to provide atraumatic care for otic medications: (4)

1. Allow refrigerated medications to warm to room temperature prior to administration. 2. Massage the outer area for a few minutes following administration. 3. Play games with younger children. 4. Praise child after procedure.

How to provide atraumatic care for Deltoid Injections: (10)

1. Apply lidocaine and prilocaine topical ointments to the site for 60 minutes prior to injection. 2. Change needle after puncturing a rubber stopper. 3. Use the smallest gauge of needle as possible. 4. Use therapeutic hugging. 5. Secure the child firmly to decrease movement of the needle while injecting 6. Use distraction. 7. Encourage guardians ot hold the child after. 8. Offer praise. 9. Use play therapy 10. Offer sucrose pacifiers to infants.

Pediatric dosages are based on : (3)

1. Body Surface Area 2. Age 3. Weight

Medication Administration Tips: (7)

1. Calculate the safe dosage for medication. 2. Notify the provider if medication dosage is determined to be outside the safe dosage rate, and for any questions about medication preparation or route. 3. Double check high risk or facility medications with another nurse. 4. Use two client identifiers prior to administration. 5. Determine parental involvement with administration. 6. Allow the child to make appropriate choices regarding administration ( choosing the right or left leg, whether the guardian or nurse will administer the medication). 7. Prepare the child according to age and developmental stage

How to administer Injection medications to pediatric population: (4)

1. Change the needle if it pieced a rubber stopper or vial. 2. Secure the infant or child prior to injections. 3. Assess the need for assistance. 4. Avoid tracking of medication.

Atraumatic care for Long Term CVAD placement: (16)

1.Insert a PICC before multiple peripheral attempts. 2. Use a transilluminator to assist in vein location. 3. Avoid terminology such as " bee sting" or " stick" 4. Attach an extension tubing to decrease movement of the catheter. 5. Use play therapy. 6. Apply lidocaine and prilocaine topical ointment to the site for 60 minutes prior to an attempt. 7. Keep equipment out of site until procedure begins. 8. Perform procedure in a treatment room. 9. Use nonpharmacological therapies. 10. Allow guardians to stay if they prefer. 11. Use therapeutic holding. 12. Avoid using the dominant or sucking hand. 13. Cover the site with a protective cover that allows for visibility of the IV site. 14. Swaddle infants. 15. Offer nonnutritive sucking to infants before, during, and after the procedure. 16. Teach guardians how to properly care for device.

The ventrogluteal muscle can be used for IM injections in children for medications containing up to _____ mL of fluid.

2 mL

What is the maximum amount of medication that can be inserted in the Vastus Lateralis IM for children?

2 mL

A nurse is teaching the guardian of an infant about administration of oral medications. Which of the following should the nurse include in the teaching? ( SATA) A) Use a universal dropper for medication administration. B) Ask the pharmacy to add flavoring to the medication. C) Add the medication to a formula bottle before feeding. D) Use the nipple of a bottle to administer the medication. E) Hold the infant in a semi-reclining position.

Correct Answers- B, D, and E

A nurse is caring for an infant who needs otic medication. Which of the following is an appropriate action for the nurse to take? A) Hold the infant in an upright position. B) Pull the pinna downward and straight back. C) Hyperextended the infant's neck D) Ensure that the medication is cool.

Correct Answer- B

How should you teach a child to swallow tablets that aren't available in liquid form and can't be crushed?

Teach in short sessions using verbal instruction, demonstration, and positive reinforcement.

Peripheral Venous Access Devices are also called __________

They are also called: 1. Intermittent infusion devices 2. Peripheral/ saline/heparin locks