4Intake and Output charted in mL If an infant consumes 3 ½ ounces of formula how many mL was consumed?
5grains (gr) to milligrams (mg) gr 1 = 60 mggr ¾ = 45 mggr ½ = 30 mggr ¼ = 15 mg
6Calculations Pounds to kilograms Safe Dosing How to calculate medication dose using ration / proportionIV medicaitions24 hour fluid calculationsNaso-gastric drainage replacement
7Pounds to Kilograms Pounds to kilograms = pounds 2.2 Nursing Alert: In pediatrics you need to carry out to the hundredths (do not round)
8Kilogram Example 20 pounds 5 ounces First need to convert 5 ounces to a fraction of a pound 5 divided by 16 = 0.3120.31 pounds divided by 2.2 = 9.23 kilogramsNote medication would be calculated based on 9.23 kilograms. DO NOT ROUND
9Calculations of pounds to kilograms If a child weighs 84 lbs, what is the weight in kg?84lb = ____ kg84 divided by 2.2 = kg
10Pounds to kilogramsIf a child weights 6 lbs 6 ounces what is the weight in kg?6 ounces = pounds16 ounces6.37 pounds divided by 2.2 kg = kg
11Calculations mg / kg dosing based on weight Safe dosing ranges IV pediatric infusion ratesIV administration of meds per volutrol or syringe pump.24 hour fluid calculationNasogastric fluid replacement
12Medication dosageFor 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.
13Dosage 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.
14Safe Medication Dose Calculate daily dose ordered (Physician orders) Calculate the low and high parameters of safe range (from drug book)Compare the patient’s daily dose to see if it falls within the safe range.
15DosingHow to calculate pediatric medication amount per day and per dose:Video can be accessed through under medication link
16Calculation A child is 2 years and weighs 36 lbs Physician order: Amoxicillin 215 mg po tid for a bilateral otitis media (ear infection)First you would need to change 36 lbs to kg36 divided by 2.2Patient weight in kg = kg
17Calculating Safe Range Davis drug guide: PO (children) < 40 kg: Amoxacillin 6.7 to 13.3 mg / kg q 8 hours.(low range)16.36 x 6.7 = mg q 8hours(high range)16.36 x 13.3 = mg q 8 hours
18Safe Range 109.6 mg to 217.5 mg of Amoxicillin Q 8 hours. Is the 215 mg dose ordered by the MD safe? Yes (it falls within the safe range)
19How much medication do you give? Amoxicillin Suspension comes:250 mg per 5 mL you want to give 215 mg250 mg mg5 ml = x ml1075250xGive 4.3 mL po every 8 hours
20Administration of mL / pediatric mL can be administered up to the tenthsPO medication via oral syringe
21Safe Dose RangesRead the medication ranges carefully: dosing can be for:dose range for 24 hoursdose range for q 8 hoursdose range for q 12 hours
22Fluid Control Crucial in the pediatric population Units often have policies that children under a certain age are on a fluid control pump.
23Key concepts Fluid overload must be avoided Time over which a medication should be administered is critical informationMinimal dilution (end concentration of medication) is important for medications such as aminoglycosides.Collecting therapeutic blood levels
24Fluid overload Know what the IV rate is. Hourly recording of IV fluid intake.Don’t try and catch up on fluids.Calculate fluids used to administer IV medications into the hourly fluid calculations.
25Daily Fluid NeedsFluid 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.
26IV fluid calculationsThe maintenance dose for administration of IV fluids is based on the following formula100 mL of fluid for the 1st 10 kg of weight50 mL of fluid for the 2nd 10 kg of weight20 mL of fluid for and additional kgYou need to memorize this
27Practice problem Jose weighs 16 pounds Weight in kg = 7.27 kg Using the formula provided how many ml of fluid would he need in 24 hours.
28Fluid Calculation 7.27 kilograms 100 mL x 7.27 kg = 727 mL 727 mL / 24 hours or mL per hour
29Fluid Calculation 64 pound child Convert pounds to kilograms = kgFluid calculations:100 mL x 10 kg = 1000 mL50 ml x 10 kg = mL20 ml x 9.09 kg = 181 mL1681 mL / 24 hours or mL / hour
30Fluid CalculationsFluid 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 would be rounded to 70 mL / hour.
31Fluid CalculationsSince 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.
32Fluid CalculationsChild number #1 maintenance fluid needs are 713 mL / 24 hours.1 ½ time maintenance would be 713 x 1.5 = 1069 mL / 24 hours or 45 mL / hour.
33Fluid CalculationIn child # 2 maintenance fluid needs are 1681 mL / 24 hours.1 ½ times maintenance would be 1681 x 1.5 = 2522 mL / 24 hours or 105 mL / hour.
35IV BuretrolA buretrol or volutrol is an inline receptacle between the client’s IV catheter set and the bag of fluids.Capacity is 120 to 150 mLRationale: 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.
36Flushing buretrols / solusets Two great articles that explain the concept of “flushing” the line after giving an IV medication
39Parenteral Pediatric Medications Step 1: Convert lb to kgStep 2: Determine the safe range in mg/kgStep 3: Decide whether the dose is safe by comparing the order with safe dose rangeStep 4. Calculate the dose neededStep 5. Check reference for diluent and duration for administration.
41Drug Guide Information Usual Dosage:0.5 mg / kg / day divided twice daily (maximum 40 mg / day)Administration: May be administered IV push over a period not less than 2 minutes or as an intermittent infusion over 15 to 30 minutes; final concentration not to exceed 4 mg/mL.
42Example #1 Convert pounds to kg: 44 lb = 20 kg Determine safe dose: 20 kg x 0.5 mg = 100 mg100 mg divided by 2 (drug is given twice a day)5 mg is safe it meets mg / kg rule and does not exceed 40 mg/day.5 mg bid = total of 10 mg/day
43Example #1 Calculate the dose Pepcid is provided as 10 mg/mL 10 mg = 5 mg1 mL x mL5 =10x mL of Pepcid
44Example #2 Child: 4 years: weight 17 kg Physician order: Fortaz (Ceftazidime) 280 mg IV q 8 hours
45Drug Guide Information Dosing:Safe dose 30 to 50 mg/kg/dayDrug supplied as 1 gram powder. Directions: Dilute with 10 mL of sterile water to equal 95 mg/mL.Administration: intravenous infusion over 15 to 30 minutes; may be given IV over 3-5 minutes at final concentration of 100 mg/mL
46Example #2 Safe dose is 30 to 50 mg/kg/day Low range: 17 kg x 30 mg = 510 mg/dayHigh range: 17 kg x 50 mg = 859 mg/daySafe 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.
47Example #2 Drawing up the medication: 1 gram / 10 mL or 95 mg / 1 mL 95 mg = 280 mg1 mL x mL x = 2.94 mL or 2.9 mLDO NOT ROUND UP TO 3 mL
48Example # 2 Adding medication to the volutrol Take the 2.9 mL of Ceftazidine – inject it into the port on the volutrol and add additional IV fluid to = 10 mL.
49Example # 2The 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.
50What about the flush?THE PHYSICIAN ORDER WILL NEVER STATE TO FLUSH THE LINE – YOU MUST DO THIS WITH EACH IV MEDICATION
51Example #2The drug guide states that the drug can be safely administer over 30 minutes.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.
52NG – cc/cc replacementIf a child has a nasogastric tube that is draining fluid the physician will often write and order for:NG drainage – cc/cc replacement q 4 hoursWhat does this mean?
53Nasogastric Output NG output is measures q 4 hours. At the beginning of the shift the night nurse reports that the drainage was 150 mL 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.
54Sample problem IV hourly rate is 115 mL/hour NG output to be replaced over the next 4 hours is 150 cc’s or 37 mL/hour.IV would be set at 115 mL + 37 mL = You would run the IV at 152 mL / hour for the next four hours.
55Practice Problems Do the practice problems. Can be done individually or in groups.Testing will be on like problems.You must achieve 90% or better to be able to safely administer medications in the clinical setting.