Pediatric Medication Administration - PowerPoint PPT Presentation

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Dosage based on mg/kg and Body Surface Area ... BSA method of calculations may be seen in NICU, ICU and high acuity areas. Safe Medication Dose ... – PowerPoint PPT presentation

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1
• UNRS 314
• Jan Bazner-Chandler
• CPNP, CNS, MSN, RN

2
Review
• 1 teaspoon 5 mL / cc
• 1 tablespoon 15 mL / cc
• 1 ounce 30 mL /cc
• Remember the clock! grains to grams to
milligrams.
• How to calculate medication dose using ration /
proportion.
• 16 oz 1 pound (body weight)

3
• Step 1
• Total number of milliliters ordered ml / hr
• number of hours to run
• Step 2
• Milliliters per hour x tubing drip factor
gtt/min
• Minutes

4
Pounds to Kilograms
• Pounds to kilograms pounds
• 2.2
• In pediatrics you need to carry out to the
hundredths (do not round especially in the infant
or small child)

5
Kilogram Example
• 20 pounds 5 ounces
• First need to convert 5 ounces to a fraction of a
pound 5 divided by 16 0.31
• 20.31 pounds divided by 2.2 9.23 kilograms
• Notes medication would be calculated based on
9.23 kilograms. DO NOT ROUND to 9.2

6
New Calculations
• Mg / kg dosing based on weight (kg)
• Safe dosing ranges
• IV pediatric infusion rates
• IV administration of meds per volutrol or syringe
pump.
• 24 hour fluid calculation

7
Calculations of pounds to kilograms
• If a child weighs 84 lbs, what is the weight in
kg?
• 84lb x kg
• 84 divided by 2.2 39.18 kg
• If a child weights 6 lbs 6 ounces what is the
weight in kg?
• 6 ounces 0.37 pounds
• 16 ounces
• 6.37 pounds divided by 2.89 kg

8
Medication dosage
• For a dosage of medication to be safe, it must
fall within the safe range as listed in a Drug
Handbook, PDR or other reliable drug reference.

9
Dosage based on mg/kg and Body Surface Area
• The dose of most pediatrics drugs is based on
mg/kg body weight or Body Surface Area (BSA) in
meters squared.
• For testing purposed mg / kg will be used.
• BSA method of calculations may be seen in NICU,
ICU and high acuity areas.

10
Safe Medication Dose
• Calculate daily dose ordered (Physician orders)
• Calculate the low and high parameters of safe
range (from drug book)
• Compare the patients daily dose to the safe
range to see if it falls within the safe zone.

11
Calculation
• A child is 2 years and weighs 36 lbs is receiving
Amoxicillin 215 mg po tid for a bilateral otitis
media (ear infection).
• Patient weight in kg 16.36 kg
• Davis drug guide PO (children) lt 40 kg 6.7 to
13.3 mg / kg q 8 hours.
• (low range)16.36 x 6.7 109.6 mg q 8hours
• (high range)16.36 x 13.3 217.5 mg q 8 hours
• Safe range 109.6 to 217.5 mg of Amoxicillin Q 8
hours.
• Is the dose safe? Yes, it falls within the safe
range.

12
How much medication do you give?
• Physician order Amoxicillin 215 mg every 8 hours.
• Suspension comes 250 mg per 5 ml.
• 250 mg 215 mg
• 5 ml x ml
• 1075
• 250x
• Give 4.3 mL / cc po every 8 hours

13
Safe Dose Ranges
• Read the medication ranges carefully
• Some are the dose range for 24 hours
• Some are the dose range for q 8 hours
• Some are the dose range for q 12 hours

14
Fluid Control
• Crucial in the pediatric population
• Units often have policies that children under a
certain age are on a fluid control pump.

15
Key concepts
• Fluid overload must be avoided
• Time over which a medication should be
• Minimal dilution (end concentration of
medication) is important for medications such as
aminoglycosides.
• Collecting therapeutic blood levels

16
• Know what the IV rate is.
• Hourly recording of IV fluid intake.
• Dont try and catch up on fluids.
• Calculate fluids used to administer IV
medications into the hourly fluid calculations.

17
Daily Fluid Needs
• Fluid needs should be calculated on every patient
to assure that the infant / child is receiving
the correct amount of fluids.
• Standard formula for pediatrics needs to be
memorized.

18
IV fluid calculations
• The maintenance dose for administration of IV
fluids is based on the following formula
• 100 ml of fluid for the 1st 10 kg of weight
• 50 ml of fluid for the 2nd 10 kg of weight
• 20 ml of fluid for and additional kg
• You need to memorize this

19
Practice problem
• Jose weighs 16 pounds
• Weight in kg 7.27 kg
• Using the formula provided how many mls of fluid
would he need in 24 hours.

20
Fluid Calculation
• 7.27 kilograms
• 100 mL x 7.27 kg 727 mL
• 727 mL / 24 hours or 30 mL per hour

21
Fluid Calculation
• 64 pound child
• Convert pounds to kilograms 29.09 kg
• Fluid calculations
• 100 mL x 10 kg 1000 mL
• 50 ml x 10 kg 500 mL
• 20 ml x 9.09 kg 181 mL
• 1681 mL / 24 hours or 70 mL / hour

22
Fluid Calculations
• Fluid calculations can be rounded. You cannot
administer a fraction of a mL.
• In child 1 the calculated hourly rate of 29.7
would be rounded to 30 mL / hour.
• In child 2 the calculated hourly rate of 70.04
would be rounded to 70 mL / hour.

23
Fluid Calculations
• Since children are in the hospital for various
illnesses they will often have increased fluid
needs dehydration, fever, vomiting, diarrhea,
inability to take po fluids.
• 24 hour fluid calculations may be 1 ½ to 2 times
maintenance.

24
Fluid Calculations
• Child number 1 maintenance fluid needs are 713
mL / 24 hours.
• 1 ½ time maintenance would be 713 x 1 ½ 1069 mL
/ 24 hours or 45 mL / hour.

25
Fluid Calculation
• In child 2 maintenance fluid needs are 1681 mL
/ 24 hours.
• 1 ½ times maintenance would be 1681 x 1 ½ 2522
mL / 24 hours or 105 mL / hour.

26
IV bolus
• A 6 year old with dehydration is admitted to your
unit. The referring hospital has an adult IV
set-up. (drip factor of 15 gtt/ml) The physician
order is to infuse 90 mL of normal saline over 1
hour. At what rate will you set the IV rate?
• (90 ml x 15 gtts) divided by 60 minutes
• Hourly rate would be 23 gtts/minute

27
IV Buretrol
28
IV Buretrol
• A buretrol or volutrol is an inline receptacle
between the clients IV catheter set and the bag
of fluids.
• Capacity is 120 to 150 mL
• Rationale the nurse can fill the buretrol to a
certain level and if the IV pump malfunctions,
only the volume in the buretrol will flow to the
client.

29
Syringe Pump
30
Parenteral Pediatric Medications
• Step 1 Convert lb to kg
• Step 2 Determine the safe range in mg/kg
• Step 3 Decide whether the dose is safe by
comparing the order with safe dose range
• Step 4. Calculate the dose needed
• Step 5. Check reference for diluent and duration

31
Example 1
• Child 5 years weight 44 lbs
• Order famotidine (Pepcid) 5 mg IV bid
• Drug guide 0.25 mg / kg q 12 hr IV up to 40
mg/day.

32
Example 1
• Convert pounds to kg 44 lb 20 kg
• Determine safe dose
• 20 kg x 0.25 mg 5 mg
• 5 mg is safe it meets mg / kg rule and does not
• exceed 40 mg/day.
• 5 mg bid total of 10 mg/day

33
Example 1
• Calculate the dose
• Pepcid is provided as 10 mg/mL
• 10 mg 5 mg
• 1 mL x mL
• 5
• 10x 0.5 mL of Pepcid

34
Example 1
• Drug guide dilute with 5 or 10 mL and infuse
over 2 minutes.
• The medication would be injected directly into
the tubing of actively running IV inject slowly
over 1 to 2 minutes.

35
Example 2
• Child 4 years weight 17 kg
• Physician order Fortaz (Ceftazidime) 280 mg IV q
8 hours
• Drug guide
• Safe dose 30 to 50 mg/kg/day
• 50 mg/mL over 30 minutes
• Drug supplied as 1 gram powder. Directions
Dilute with 10 mL of sterile water to equal 95
mg/mL.

36
Example 2
• Safe dose is 30 to 50 mg/kg/day
• Low range 17 kg x 30 mg 510 mg/day
• High range 17 kg x 50 mg 859 mg/day
• Safe range is 510 to 859 mg/day or 170 to 286 per
dose.
• If the order is to give the drug q 8 hours you
would need to divide the safe range by 3 or
multiple the q 8 hour dose x 3.

37
Example 2
• Drawing up the medication
• 1 gram / 10 mL or 95 mg / 1 mL
• 95 mg 280 mg 280
• 1 mL x mL 95x 2.94 mL

38
Example 2
• Adding medication to the volutrol
• Take the 2.94 mL of Ceftazidine inject it into
fluid to 10 mL.

39
Example 2
• The flush evidence based practice has
demonstrated that in an effort to get the IV
medication from the volutrol to the patient the
line needs to be flushed with 20 mL of IV fluid
after the medication is into the IV line.

40
• THE PHYSICIAN ORDER WILL NEVER STATE TO FLUSH THE
LINE YOU MUST DO THIS WITH EACH IV MEDICATION

41
Example 2
• The drug guide states that the drug can be safely
• Formula
• 10 mL (medication) 20 mL flush following the
medication 30 mL of fluid that needs to infuse
over 30 minutes.
• The pump would need to be set at 60 mL for the
medication the flush to be infused over ½ hour.

42
NG cc/cc replacement
• In and infant or child has a nasogastric tube in
that is draining fluid the physician will often
write and order for
• NG drainage cc/cc replacement
• What does this mean?

43
Nasogastric Output
• NG output is measures q 4 hours.
• At the beginning of the shift the night nurse
reports that the drainage was 150 ccs for the
last 4 hours and you need to replace this over
the next four hours.
• Note this is in addition to the IV hourly rate
ordered.

44
Sample problem
• IV hourly rate is 115 mL/hour
• NG output to be replaced over the next 4 hours is
150 ccs or 37 mL/hour.
• You IV would be set at 115 mL 37 mL 152 mL /
hour for the next four hours.

45
Practice Problems
• Do the practice problems.
• Can be done individually or in groups.
• Testing will be on like problems.
• You must achieve 80 or better to be able to
safely administer medications in the clinical
setting.