1. CHAPTER 48: PEDIATRIC MEDICATION ADMINISTRATION AND CALCULATIONS
PYRAMID POINTS
CHAPTER 48:
PEDIATRIC MEDICATION ADMINISTRATION AND CALCULATIONS

2. PYRAMID POINTS I. Oral Medications
Most are liquid or suspension versus tablet
Solutions may be measured with oral syringe or other acceptable measurement or administration device
Mixing of suspensions required before pouring
Suspensions must be administered immediately after measurement
Administer with child seated upright or with head elevated
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3. PYRAMID POINTS I. Oral Medications (continued)
Never pinch child’s nostrils during administration
Unpleasant tasting medications should be directed toward back of infant’s mouth via syringe, slowly, allowing swallowing
Small child may be placed sideways on lap, closely held, medication administered via plastic spoon, cup, or syringe slowly
If tablet or capsule is administered, check child’s mouth to ensure it is swallowed; crush if pharmacologically appropriate
Follow generally accepted medication guidelines for children
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4. PYRAMID POINTS II. Ear Medications
Instill ear drops by pulling child’s earlobe down, back
If medication draining from ear canal, may insert cotton ball into ear to prevent leakage
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5. PYRAMID POINTS III. Parenteral Medications
Subcutaneous and intramuscular (IM) medications
Safe use of all injection sites based on normal muscle development, size of child
Preferred site in infant is vastus lateralis
Intravenous (IV) medications
Monitor site for signs of inflammation, infiltration, extravasation
Use agency policies for determination of volume of flush for peripheral and central lines
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

6. PYRAMID POINTS III. Parenteral Medications (continued)
Intermittent IV medication administration
May be administered through primary infusion tubing or via piggyback infusion set
Should be infused on pump or controller
Follow medication infusion with flush
Special IV administration sets: These administer gtt/mL
Retrograde IV injection
Medication mixed with diluent in syringe, then given into port in direction of burette
Syringe pump for IV medication administration
Syringe containing medication fitted into pump connected to IV tubing through Y connector
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7. PYRAMID POINTS IV. Calculation of Medication Dosage by Body Weight
Conversion of body weight: 1 kg = 2.2 lb
A child weighs 3.4 kg. How many lb does the child weigh? 3.4  2.2 = 7.48, or 7.5 lb
A child weighs 22 lb. How many kg does the child weigh? 22/2.2 = 10 kg
Calculation of daily dosages
Expressed as mg/kg per day or mg/lb per day or mg/kg per dose
Daily dosages usually divided into more than one dose throughout day
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8. PYRAMID POINTS continued …
Calculate daily dose, divide according to how many doses are to be given per day: If you are to give
220 mg/day, but doses are qid, divide 220 by 4 to get 55 mg/dose
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9. PYRAMID POINTS V. Calculation of Body Surface Area (BSA)
Determined by comparing body weight and height with averages or norms on nomogram
Not all children are same size for age; thus, nomogram is used
Height on left-hand side of nomogram, weight on right-hand side of nomogram
Use ruler on nomogram to line up height and weight, read BSA
Estimated surface area given in square meters (m2)
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10. PYRAMID POINTS VI. Calculation Based on BSA
Calculate with simple multiplication for dosage recommendations for children
When dosages are specified only for adults, formula is used to calculate child versus adult dosage
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11. PYRAMID POINTS
VII. Developmental Considerations for Administering Medications
Developmental age must be taken into consideration for safe, effective administration
General interventions
Be prepared with equipment
If child gets fussy when parent(s) present, consider asking parent to leave for administration of medications
Determine appropriate comfort measures pre- and postadministration of medications; institute appropriately
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

12. The nurse has an order to give ear drops to a 3-year-old child
The nurse has an order to give ear drops to a 3-year-old child. The nurse positions the child’s ear properly by pulling the pinna of the ear:
1. Downward and outward
2. Downward and backward
3. Upward and outward
4. Upward and backward
Answer: 2
Rationale: To administer ear drops to a child properly, the pinna of the ear should be pulled downward and backward. When giving ear drops to an adult, the pinna is pulled upward and outward (option 3). The other options are incorrect.
Test-Taking Strategy: Use basic principles of administering otic medications to answer this question. Note the age of the child to direct you to the correct option. Remember that to administer ear drops to a child properly, the pinna of the ear should be pulled downward and backward. If this question was difficult, review the fundamental principles of medication administration.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—implementation
Content Area: Child Health
Reference: Hockenberry, M., Wilson, D., & Winkelstein, M. (2005). Wong’s essentials of pediatric nursing (7th ed., pp ). St. Louis: Mosby.
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