chapter 31 medication administration and iv therapy
TRANSCRIPT
Chapter 31Chapter 31
Medication Administration and Medication Administration and Intravenous TherapyIntravenous Therapy
The Six “Rights” of The Six “Rights” of Medication Medication AdministrationAdministration
The right medicationThe right medication The right patientThe right patient The right doseThe right dose The right routeThe right route The right timeThe right time The right documentationThe right documentation
Role of the Nurse in Role of the Nurse in Medication Medication AdministrationAdministration
Understand the factors that influence or alter Understand the factors that influence or alter how the child absorbs, metabolizes, and how the child absorbs, metabolizes, and excretes the medicationexcretes the medication
Be aware of any allergies the child may haveBe aware of any allergies the child may have Administer the medications properlyAdminister the medications properly Teach the patient and the family caregivers Teach the patient and the family caregivers
about the effects and possible side effects of about the effects and possible side effects of medications givenmedications given
Guidelines for Medication Guidelines for Medication Administration in ChildrenAdministration in Children
Do not give the child a choice whether or not to take Do not give the child a choice whether or not to take the medicinethe medicine
Do give choices that allow the child some controlDo give choices that allow the child some control Do not tell the child the injection will not hurtDo not tell the child the injection will not hurt Give simple and brief explanationsGive simple and brief explanations Assure child that it is okay to be afraid and/or cryAssure child that it is okay to be afraid and/or cry Do not talk in front of the child as if he or she were Do not talk in front of the child as if he or she were
not therenot there Be positive in approaching the childBe positive in approaching the child
Guidelines for Medication Guidelines for Medication Administration in Administration in Children (cont.)Children (cont.)
Keep time between explanation and Keep time between explanation and administration briefadministration brief
Do preparation for administration out of Do preparation for administration out of sight of the childsight of the child
Obtain cooperation from family Obtain cooperation from family caregiverscaregivers
Computing DosagesComputing Dosages
Pounds to kilograms:Pounds to kilograms: 2.2 lbs2.2 lbs = = 42lbs42lbs 1 kg x kg1 kg x kg2.2 lb x X kg = 1 kg x 42 lb2.2 lb x X kg = 1 kg x 42 lb2.2 lb x X kg2.2 lb x X kg = = 1 kg x 42 lb1 kg x 42 lb 2.2 lb 2.2 lb2.2 lb 2.2 lb
X = X = 4242 2.22.2X = 19.kgX = 19.kg
Computing DosesComputing Doses
Calculating dose using body weightCalculating dose using body weight Dosage range 10-30 mg/kg is safeDosage range 10-30 mg/kg is safe Child weighs 20 kgChild weighs 20 kg
10 mg10 mg = = X mgX mg 1 kg 20 kg1 kg 20 kg10 mg x 20 kg10 mg x 20 kg = = 1 kg x X kg1 kg x X kg 1kg 1 kg1kg 1 kg200 x 1 = 1 X 200 = X200 x 1 = 1 X 200 = X200 mg is the safe low dose200 mg is the safe low dose
Computing dosesComputing doses
Now calculate for the high doseNow calculate for the high dose 30 mg30 mg = = X mgX mg 1 kg 20 kg1 kg 20 kg30 mg x 20 kg = 1 kg x Xmg30 mg x 20 kg = 1 kg x Xmg30 mg x 20 mg = 30 mg x 20 mg = 1 kg x X mg1 kg x X mg 1 kg1 kg600 x 1 = 1X 600 = X600 x 1 = 1X 600 = XThe high safe dose is 600 mgThe high safe dose is 600 mgRange is 200-600 mg for a child of 20 kgRange is 200-600 mg for a child of 20 kg
Computing DosesComputing Doses
Body surface area (BSA) methodBody surface area (BSA) method The The West nomogramWest nomogram A graph with several A graph with several
scales arranged When two values are scales arranged When two values are known, the third can be plotted by drawing a known, the third can be plotted by drawing a line with a straight edgeline with a straight edge
Draw a line between the point representing Draw a line between the point representing the child’s height on the left and the chil’d the child’s height on the left and the chil’d height on the right. The intersecting point is height on the right. The intersecting point is the body surfacethe body surface
Routes of Medication Routes of Medication AdministrationAdministration
OralOral IntramuscularIntramuscular Eye, ear, and nose dropsEye, ear, and nose drops Rectal medicationsRectal medications Intravenous therapyIntravenous therapy
Medication Medication AdministrationAdministration Children vary in age, weight, body Children vary in age, weight, body
surface, ability to absorb. Metabolize surface, ability to absorb. Metabolize and excrete medsand excrete meds
Determination of drug dosageDetermination of drug dosage Checking dosageChecking dosage Identification Identification Family aspectsFamily aspects
AdministrationAdministration OralOral Intramuscular (see table 45-5)Intramuscular (see table 45-5) Subcutaneous and intradermalSubcutaneous and intradermal IntravenousIntravenous
Parenteral Fluid TherapyParenteral Fluid Therapy Site selection (accessibility)Site selection (accessibility) Scalp vein IVsScalp vein IVs Intraosseous infusionIntraosseous infusion
Rapid, safe and lifesaving alternate route Rapid, safe and lifesaving alternate route of administrationof administration
Surgical cutdownSurgical cutdown
Equipment for Fluid Equipment for Fluid TherapyTherapy CathetersCatheters Needleless systemsNeedleless systems
Prevent accidental needle stick injuries Prevent accidental needle stick injuries during administration of IVP or piggyback during administration of IVP or piggyback medsmeds
Rely on prepierced boresRely on prepierced bores
Infusion pumpsInfusion pumps
Equipment Collected in Equipment Collected in Preparation for Starting Preparation for Starting an IV Linean IV Line
IV tubingIV tubing Any necessary extension tubingAny necessary extension tubing The container of solutionThe container of solution The equipment to stabilize the siteThe equipment to stabilize the site A tourniquetA tourniquet Cleansing supplies used by the institution Cleansing supplies used by the institution
Equipment Collected in Equipment Collected in Preparation for Starting Preparation for Starting an IV Line (cont.)an IV Line (cont.)
Sterile gauze, adhesive tape, cling roll Sterile gauze, adhesive tape, cling roll gauzegauze
An IV poleAn IV pole An infusion pump or controllerAn infusion pump or controller A plastic cannula or winged small-vein A plastic cannula or winged small-vein
needle, usually between 21-gauge and needle, usually between 21-gauge and 25-gauge (depending on the child25-gauge (depending on the child’’s size)s size)
Management of Peripheral Management of Peripheral Intravenous Lines (PIVs)Intravenous Lines (PIVs)
Securing PIVsSecuring PIVs Transparent dressings preferred because Transparent dressings preferred because
the insertion site can be visualizedthe insertion site can be visualized
Removal of PIVsRemoval of PIVs ComplicationsComplications
InfiltrationInfiltration ExtravasationExtravasation
Reasons for Reasons for Administering IV Therapy Administering IV Therapy to the Pediatric Patientto the Pediatric Patient
Maintain fluid and electrolyte balanceMaintain fluid and electrolyte balance Administer antibiotic therapyAdminister antibiotic therapy Provide nutritional supportProvide nutritional support Administer chemotherapy or anticancer Administer chemotherapy or anticancer
drugsdrugs Administer pain medicationAdminister pain medication Administer blood productsAdminister blood products
Candidates for IV Candidates for IV TherapyTherapy
Children who have poor gastrointestinal Children who have poor gastrointestinal absorption caused by diarrhea, vomiting, and absorption caused by diarrhea, vomiting, and dehydrationdehydration
Children who need a high serum concentration Children who need a high serum concentration of a drugof a drug
Children who have resistant infections that Children who have resistant infections that require IV medicationsrequire IV medications
Children with emergency problemsChildren with emergency problems Children who need continuous pain reliefChildren who need continuous pain relief
Fundamental Concepts of Fundamental Concepts of Fluid BalanceFluid Balance
WaterWater Intracellular fluidIntracellular fluid Extracellular fluidExtracellular fluid
ElectrolytesElectrolytes Maintain acid-base balanceMaintain acid-base balance
Acid-base balanceAcid-base balance AcidosisAcidosis Alkalosis Alkalosis
Complications Associated Complications Associated With the Use of Central With the Use of Central Venous Lines Venous Lines
ContaminationContamination ThrombosisThrombosis Dislodgement of the catheterDislodgement of the catheter Extravasation (fluid escaping into Extravasation (fluid escaping into
surrounding tissue)surrounding tissue)
Selection of IV SitesSelection of IV Sites Varies with the child’s ageVaries with the child’s age The best choice is the one that least restricts the The best choice is the one that least restricts the
child’s movementschild’s movements Sites used include the hand, the wrist, the forearm, Sites used include the hand, the wrist, the forearm,
the foot, and the anklethe foot, and the ankle The antecubital fossa, which restricts movement, is The antecubital fossa, which restricts movement, is
sometimes used, only if other sites are not availablesometimes used, only if other sites are not available The scalp vein may be used if no other site can be The scalp vein may be used if no other site can be
accessedaccessed
Observations of the IV Observations of the IV SiteSite
RednessRedness PainPain Induration (hardness)Induration (hardness) Flow rateFlow rate Moisture at the siteMoisture at the site SwellingSwelling