Module 10

West Nomogram

Chart used to identify body surface area to calculate pediatric dosages * Normal height/weight (2nd from left) --> In order to use the normal column on the West nomogram, you must be familiar with the normal height and weight standards for children * For abnormal height/weight, use far left and far right on nomogram (Use rigid straight edge to span the two) --> Stretch between the height and weight to see where the ruler crosses the surface area mark

Determining if an order for a child is safe

Compare the ordered dose to the recommended dose range and determine if the dosage is safe >> If safe, calculate the amount and administer >> If unsafe, notify the prescriber Example: An order is written for Narcan 1.2 mg IV stat for a child who weighs 12 kg > Recommended dosage is 0.1 mg/kg/dose Is this dose safe? YES. This dose ordered is 1.2 mg

Calculating gtt/min

gtt/min = total volume (mL) x drop factor (gtt/mL) / time in minutes ** gtt/min = mL/hr ** gtt/min MUST be rounded to a WHOLE NUMBER. You cannot administer part of a drop!

Two methods to calculate pediatric dosages

Body weight (BW) Body surface area (BSA) based on height and weight

Neonates are weighed in grams

1 kg = 1,000 g Example: Infants weighs 3,000 g OR 3 kg

Things to remember for pediatric medication

1) Dosages for children are smaller than those for adults 2) Most medications for children are liquid 3) Oral route is preferred to parenteral 4) No more than 1 mL IM for small children and older infants; small infants should receive not more than 0.5 mL IM 5) Parenteral doses are usually given with tuberculin (TB) syringes

Calculating BSA from Kilograms (Weight) and Centimeters (Height)

1) Multiply weight in kilograms by height in centimeters 2) Divide the product obtained in Step 1 by 3,600 3) Enter the square root sign into the calculator 4) Round the final BSA in square meters (m2) to nearest hundredth

Formula for Calculating BSA from Pounds (Weight) and Inches (Height)

1) Multiply weight in pounds by height in inches 2) Divide the product obtained in Step 1 by 3,131 3) Enter the square root sign into the calculator 4) Round the final BSA in square meters (m2) to nearest hundredth

Calculating BSA for Child Dosing Using Adult Dosing

1) Take BSA of child (in m2) 2) Divide by 1.7 m2 3) Multiply by the adult dosage amount (in mg)

Rules of pediatric medication calculation

1) Use same methods (R&P, DA, Formula) 2) Pediatric doses are smaller (in mcg) 3) IM dosages rarely exceed 1 mL; for small infants, 0.5 mL 4) Subcut dosages are not to exceed 0.5 mL 5) For dosages less than 1 mL, use TB syringe 6) Pediatric doses are rarely rounded to tenths; use TB so hundredths can be given

Converting weight: pounds and kilograms

2.2 lbs = 1 kg ** When converting child's weight from lbs to kg- round to the nearest 10th