Ch 38 Medication Administration and Safety for Infants and Children

Calculation: What is the 24-hour maintenance fluid requirement for a child weighing 8.5 kg?

850 ml - The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kilogram between 10 & 20. To determine an hourly rate, divide total milliliters per day by 24: 8.5 kg ´ 100 mL = 850 mL/24 hr.

1. A student nurse on pediatric unit is preparing gentamicin to administer intravenously. Student understands she must apply the "five rights" when administering medications. Is this T/F?

False - student must adhere to the "six rights" of med administration: right patient, rights drug, right dose, right time, right route & right documentation.

SATA A nurse should routinely ask a colleague to double-check a medication calculation and the actual medication before administering which medications?

Insulin, Anticoagulants, Narcotics - Nurse should ask another nurse to check dosage calculation & med before administering the following: insulin, narcotics, chemotherapy, digoxin or other inotropic drugs, anticoagulants, and K+ and Ca++ salts. Institutions may require two nurses to check other medications also to prevent med error.

2. The mucous membranes inside nose allow for fairly rapid systemic absorption of overriding of a variety of meds. Antidiuretic hormone (DDAVP) is an appropriate med to administer intranasally. Is this T/F?

True - Other medications that can be given by this route include fentanyl, ketamine, versed, and lorazepam. Otherwise, nose drops and sprays are used for localized treatment of the nasal passages.

13. When liquid medication is given to a crying 10-month-old infant, which approach minimizes possibility of aspiration?

a. Administer med with a syringe (without needle) placed along side of infant's tongue - The contents are administered slowly in small amounts, allowing the child to swallow between deposits.

1. What should nurse use to prepare liquid med in volumes less than 5 mL?

a. Calibrated syringe - To ensure accuracy, a calibrated syringe without a needle should be used to prepare a liquid dosage less than 5 mL.

9. What parameter should guide nurse when giving a subcutaneous injection to school-age child with cellulitis?

a. Do not to give injections in edematous areas - Subcutaneous injections should never be given in areas of edema because absorption is unreliable.

17. A child is receiving intravenous fluids. How often should nurse assess and document the condition of the child's intravenous site?

a. Every hour - The nurse assesses & documents an IV site at least every hour for signs and symptoms of infiltration and phlebitis.

21. When teaching a mother how to administer eye drops, where should the nurse tell her to place them?

a. In the conjunctival sac that is formed when the lower lid is pulled down - The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area.

11. What is main purpose for using a volume-control device, such as a Buretrol or an infusion pump, to administer intravenous fluids to children?

a. To avoid fluid overload - A volume-control device such as a Buretrol or an infusion pump allows nurse to set a specific volume of fluid to be given in a specific period of time (usually 1 hour) & decreases risk of inadvertently administering a large amount of fluid.

8. The nurse administering an IV piggyback medication to a preschool child should

a. Use a "Smart" pump if available - Programmable infusion pumps are frequently used to facilitate safe intermittent infusion of IV meds for children via piggyback method. Some hospitals use previously used "Smart" pumps with pre programmed drug libraries to assist in prevention of medication errors.

5. What is appropriate response to a parent who asks "What should I do if my child can't take a tablet?"

b. "Find out if the med is available in a liquid form." - A tablet should not be crushed without knowing whether it will alter absorption, effectiveness, release time, or taste. Therefore telling parent to find out whether the medication is available in liquid form is the most appropriate response.

6. What is maximum safe volume that a neonate can receive in an intramuscular injection?

b. 1.0 mL - The maximum volume of medication for an intramuscular injection to a neonate is 1.0 mL.

18. What is the hourly maintenance fluid rate for an intravenous infusion in a child weighing 19.5 kg?

b. 61 mL - The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24. Calculations: Child weighs 19.5 kg. Therefore child requires 1000 mL; plus 50 mL ´ 9.5 kg = 475 mL. Next add calculated amounts: 1000 + 475 = 1475 mL and divide by 24 hours to equal 61.45 mL per hour. This rounds down to 61 mL/hr.

2. Which food is appropriate to mix with medication?

b. Applesauce - To prevent child from developing a negative association with an essential food, a nonessential food such as applesauce is best for mixing with medications.

4. Which factor should nurse remember when administering topical med to an infant as compared with an adolescent?

b. Infants have a thinner stratum corneum that absorbs more medication. - Infants & young kids have a thinner outer skin layer (stratum corneum), which increases absorption of topical medication.

14. Guidelines for intramuscular administration of medication in school-age children include:

b. Insert needle quickly, using a dart-like motion - Needle should be inserted quickly in a dart-like motion at 90-degree angle unless contraindicated.

SATA What nursing actions are correct when giving heparin subcutaneously?

b. Insert the needle at a 45- to 90-degree angle. d. Insert the needle into the abdominal tissue For this subcutaneous injection, the nurse inserts the needle at a 45- to 90-degree angle and injects into the subcutaneous abdominal tissue.

10. What action is correct when administering eardrops to a 2-year-old child?

b. Pull the pinna of the ear back and down - For children younger than 3 years, the pinna, or lower lobe, of the ear should be pulled back and down to straighten the ear canal.

19. What nursing action is indicated when a child receiving a unit of packed red blood cells complains of chills, headache, and nausea?

b. Stop infusion immediately & notify HCP

20. What is the best action for the nurse to take when giving medications to a 3-year-old child?

c. Allow child to choose fruit punch or apple juice when giving the medication - Realistic choices allow the child to feel some control.

16. What action is appropriate when using an EMLA cream before intravenous catheter insertion?

c. Leave cream on skin for 1 to 2 hours before the procedure - The cream should be left in place for a minimum of 1 hour and no more than 2 hours.

12. What is the most important nursing action before discharge for a mother who is apprehensive about giving her child insulin?

c. Observe mother while she administers insulin injection - It is important the nurse evaluate mother's ability to give insulin injection before discharge. Watching her give injection to child will give nurse an opportunity to offer assistance and correct any errors.

15. What action indicates a school-age child is using a metered-dose inhaler correctly?

c. The child holds his breath for 10 seconds after the first puff - After a puff, child should hold breath for about 10 seconds or until he counts slowly to 5.

3. Which physiologic difference affects the absorption of oral medications administered to a 3-mo-old infant?

d. Variable pancreatic enzyme activity - Pancreatic enzyme activity is variable in infants for first 3 mos of life as GI system matures. Meds that require specific enzymes for dissolution & absorption might not be digested to a form suitable for intestinal action.

7. In which muscle should the nurse select to give a 6-month-old infant an intramuscular injection?

d. Vastus lateralis - The vastus lateralis is not located near any vital nerves or blood vessels. It is the best choice for intramuscular injections for children younger than 3.