1. Medication Administration and Intravenous Therapy
Chapter 31:
Medication Administration and Intravenous Therapy

2. Medication Administration
Rights and guidelines
Six “rights”
Right patient
Right medication
Right dose
Right route
Right time
Right documentation

3. Medication Administration (cont.)
Administering medications to children is complex because of their immature body systems and varying sizes.
Age-related behaviors and developmental considerations should be kept in mind, and age-appropriate nursing actions should be used when administering medications to children.
Use your knowledge of growth and development to determine the best positive, age appropriate approach when giving medications.
See Box 31-1 Rules of Medication Administration in children page 647

5. Medication Administration Body Weight Method
To use the body weight method of pediatric dosage calculation, always calculate the child's weight in kilograms if the medication is ordered as a dose per kilogram.
Then calculate the safe low and high doses by using the child's body weight.
Always have another person check computations of drug dosage before administering medications to children.
As a Nurse , you are legally liable for errors of medication.

6. Medication Administration Body Surface Area Method
The body surface area (BSA) method can also be used to calculate pediatric dosages.
A West nomogram is used to determine the child's BSA based on his or her height and weight.
Then use the BSA and usual adult dosage of the medication to calculate the child's dose.

7. Question
It is often necessary to calculate pediatric dosages. One way of doing this is the body weight method. The order reads administer 100 mg/kg/day in divided doses. The child weighs 50 lb. What dosage would be given in each of the four doses/day you will administer?
a. 100 mg each dose
b mg each dose
c mg each dose
d mg each dose

8. Answer b. 567.5 mg each dose Rationale: 50 lb = 22.7 kg
100 mg x 22.7 kg = 2,270 mg/day
2,270 mg/day/4 doses daily = mg/dose

9. Medication Administration (cont.)
Routes of pediatric medication administration are oral, ophthalmic, otic, nasal, rectal, IM, subcutaneous, intradermal, and IV.
Oral is the most common route.

10. Medication Administration (cont.)
Ophthalmic, otic, nasal, and rectal administration
Ophthalmic administration: form pocket with lower eyelid
Otic administration
<3 years old: pull pinna down and back
≥3 years old: pull pinna up and back
Keep child with affected ear up for 5-10 min.
Nasal administration: hyperextend neck/head
Rectal administration: side-lying, left side easier, Lube small finger to insert suppository and hold buttocks tightly for 1-2 min until the urge to expel passes.

11. Medication Administration (cont.)
Ophthalmic -
To administer eye drops or ointment, place the child in a supine position.
To instill drops, pull the lower lid down to form a pocket, and drop the solution into the pocket.
Be careful not to touch the eye with the dropper to prevent contamination of the dropper or medication. Have the child hold the eye shut briefly, if possible, to help distribute the medication to the conjunctiva.
Apply gentle pressure to the inner canthus to decrease systemic absorption.
Ointment is applied from the inner to the outer canthus, with care not to touch the eye with the tip of the dropper or tube

12. Question Tell whether the following statement is true or false.
Because giving medication to children can be so complex, it is always an acceptable practice to place the medication in a favorite food.

13. Answer
False
Rationale: As a general rule, medications should not be given in food because if the child does not consume the entire amount of food, the dosage of medication will not be accurate. In addition, if given with food, the child may eventually associate the bad taste of the medication with food and may refuse to eat that food.

14. Medication Administration (cont.)
The muscle preferred for IM injections in the infant is the vastus lateralis.
To use the vastus lateralis muscle for an IM injection, locate the trochanter (hip joint) and knee as landmarks.
Divide the area between landmarks into thirds.
Using the middle section of the three sections, follow correct procedure for drawing up the medication and inject the needle into the lateral aspect of the leg at a 90-degree angle.

16. Intravenous Therapy
Maintaining fluid balance in the body tissues is essential to health.
Severe imbalance can occur rapidly in children because they dehydrate much faster than do adults.
Serious dehydration can result from diarrhea, vomiting, or loss of fluids in extensive burns.
Electrolytes help maintain the acid–base balance in the body, so the electrolyte balance in the body is also essential.

17. Intravenous Therapy (cont.)
Intracellular fluid is contained within the body cells and makes up 40% of body weight in children and adults.
Extracellular fluid is situated outside the cells and is either interstitial fluid (situated within the spaces or gaps of body tissue) or intravascular fluid (situated within the blood vessels or blood plasma).

18. Intravenous Therapy (cont.)
IV therapy might be administered to children to provide water, electrolytes, blood products, medications, or nutrients (TPN) the child needs.
IV fluid administration requires careful observation of the child's appearance, vital signs, intake and output, and the fluid's flow rate.
IV flow rate is regulated by the use of an infusion control device in order to closely monitor the rate of infusion.
A control chamber or Buretrol is used to deliver a controlled volume of fluid.
IV infusion sites must be monitored to avoid infiltration and tissue damage.

20. Question Tell whether the following statement is true or false.
Fluid and electrolyte balance is usually maintained in the body by a well-balanced diet.

21. Answer
True
Rationale: In normal health, the fluid and electrolyte balance is maintained through the intake of a well- balanced diet.