CALCULATION OF ORAL AND PARENTAL MEDICATIONS

 

CALCULATION OF ORAL AND PARENTAL MEDICATIONS

Introduction:

            There are several methods for calculating pediatric medication dosage based on various combinations of age, height, weight, body surface area and adult dose.

            Due to variation above the concern about overdosing or under dosing medication for infants and children is of prime importance.

1. Calculations by body surface area

            The BSA method of calculation provides a method of converting an adult dose into a dose that is safe for pediatric administration.

            There are three steps to the calculation.

a.       Determine the child’s weight in kilograms.

b.      Calculate the BSa in square method

c.      Calculate the pediatric dose

 

2.  Clark’s Rule

          Clark’s rule is a medical term referring to a mathematical formula used to calculate the proper dosage of medicine for children aged 2-17.

          The procedure is to take the child’s weight in pounds, divide by 150lb, and multiply the fractional result by the adult dose to find the equivalent child dosage.

          Clark’s rule is not used clinically, but it is a popular dosage calculation formula for pediatric nursing instructors.

Child’s dose =

Adult dose x (Weight ¸ 150)

Example

11 year old girl / 70 lbs

500mg x (70¸150) = child’s dose

500mg x (0.47) = child’s dose

500mg x 0.47 = 235 mg

Childs dose = 235 mg

 

3. Fried’s Rule

Child’s dose = Adult dose x Age ¸ (age + 12))

          Fried’s rule is another method used to calculate the correct dose of medication for the pediatric patient when given only the adult dose.

          This method should not be considered as accurate as the nomogram method because it is based on the assumption that the child is average size and utilized age rather than weight.

          It is important to note that because age does not necessarily indicate the patients weight, medication adjustments may be necessary once the patient respondent is determined.

          Friends rule is a method of estimating the dose of medication for a child by dividing the child’s age in months by 150 and multiplying the result by the adult dose.

 

4. Young’s Rule

          Young’s Rule: Utilizes similar concepts as Fried’s rule except it is based on the child’s age in years. When given the adult dose of a medication it is possible to use this formula to find the correct pediatric dose.

         

Child’s dose = Adult dose x (Age ¸ (Age+12))

         

Example

11 year old girl / 70 lbs

500mg x (11 ¸ (11+12) = childs dose

500mg x (11 ¸23) = child’s dose

500mg x 0.48 = child’s dose

Child’s dose = 240mg

 

5. Nomogram method

          The nomogram method is utilized to determine the correct pediatric medication dosage based specifically on the patients size.

          The patients size of identified or body surface area (BSA) in meters squared (m²).  The average adult client (weighing 150-154 lbs) will have a BSA of 1.73m2.

          Once the BSA of the patient is determined the following formula can be used to calculate the correct pediatric dosage.

         

Administration of Oral and parenteral medications

          General considerations in administering oral and parenteral medications to children.

·        Positive identification – compare name tag

·        Double check, double check, double check

·        Maintaining security of drug.

·        Make sure child is awake before administrating any medication.

·        Talk their talk.

·        Maintain firm but friendly manner, gave praise, and comfort following administration.

·        Restrain child gently but firmly, ask for assistance if needed.

·        Some child are unable to swallow pills, crush and dissolve if allowable.

·        Administer liquid in a cup, spoon, dropper or syringe.

·        Check the 8 rights.

The ‘8’ Rights’

1.      Right patient

2.     Right medication

3.     Right reason

4.     Right dose

5.     Right route

6.     Right frequency

7.     Right time / day

8.     Right site

Common errors

·        Took medication twice

·        Wrong medication

·        Incorrect dose

·        Missed dose

Common causes

·        Not understanding medication label.

·        Not understanding how to give medication

·        Poor communication between parents / guardians and health care professional.

Before medication

·        Wash hands

·        Prepare work area

·        Take out the medication

·        Check the label and the items on the forms to see that they match.

·        Get proper measuring device

·        Check the time.

After medication

·        Praise the child

·        Check the label again

·        Return the medication to storage immediately – never leave medication unattended.

·        Record the medication, date, time, dose, route, and the signature on the medication log.

·        Clean the measuring device.

·        Wash the hands

·        Observe the child for side effects.

·        Allow the child opportunity to express his (or) her feelings.

·        Acknowledge that some medication is difficulty to take.

·        Encourage the child that next time will be easier offer to spend time with the child.

1. Oral Medication

Measuring oral medication

·        Dropper

·        Syringes, ½ tsp (or) less is most accurately measured with syringe (or) similar device.

·        Dosing spoon.

·        Medication cup.

 

Infants

·        Support the infant’s head

·        Hold the body semi-upright

·        An infant seat may be used.

·        Keep the infant’s arms and hands away from her face.

·        Gently press the chin to open the mouth.

·        Rock the baby before and after.

·        Syringe (or) dropper: Position on one side of the mouth along the gum, squirt slowly to allow time to swallow.

·        Special dosing nipples work best when the body is hungry.

·        Give oral medication before feeding unless instructed otherwise.

Toddlers

·        Ask parents what technique they are

·        Give toddlers some control, like sitting (or) standing but do not give vito power taking the medication.

·        Be honest about bad taste allow the child to drink afterward.

·        Use age – appropriate language to explain what you are doing.

·        Maintain an attitude that you expect cooperation.

·        Thank the child for their co-operation and praise them.

Pre-schoolers

·        May use chevable as well as suspensions or) elixier

·        Loose teeth may pose a problem.

·        Often can cooperate better with parents.

·        Letting parents give the medications is acceptable although nurse is still responsible to prepare the drug and assist parent in giving it

School aged children

·        Usually can take pills and capsules.

·        Need to be encouraged to swallow water immediately.

·        Ability to co-operate may vary and is often un-predictable be prepared to allow more time to giving medications to the pediatric patients.

Adolescents

·        Should be prepared to give explanations to adolescents specific to level of understanding.

·        Teach therapeutic effects as well as side effects to report.

·        Stay with the patient until medications are consumed

·        Expect that there may be mood swings.

·        Consider such adolescent issues as drug addictions (or) use of contraceptives which may cause drug interactions.

2. Other routes of administration

a)     Eye drops or ointment

·        Instill in lower conjuctival sac

·        Ointment from inner to outer canthus.

b)    Nose drops

·        With head tilted upward

·        Maintain position for 1 minute

c)     Ear drops

·        Warm first

·        Pull pinna down and back < 3 years.

·        Pull the pinna backward and upward > 3 years children.

·        Massage area in front of ear.

·        Maintain position with effect ear up 5 minutes

d)    Rectal medications

·        Use side lying position

·        Insert lubricated suppository upto first knuckle.

·        Hold buttocks together 1-2 minutes.

e)     Intramuscular medications

Fewer medications are given by this route due to potential for pain.  Common sites of IM injection in children are

1.      Deltoid muscle

2.     Ventrogluteal site

3.     Dorsogluteal site no recommended for < 3 years

4.     Vartus lateralis muscle

Find out the thigh injection site.  The site is located in the middle, outer sides of the thighs.  This site is usually used for infants and toddlers.

·         Find the groin.  One hand’s width below the grain becomes the upper border of the box.

·        Find the top of knee, one hands width above the top of the knee becomes the lower border of the box.

·        Stretch the skin to make it tight.

·        Insert the needle at a right angle on the skin (90⁰) straight.

 

The dorsogluteal site

·        Find the trochanter, (upper leg (femurs))

·        Draw an imaginary line between the two bones.

·        Find the posterior iliac crest.

·        After locating the center of the imaginary line. Find a point one inch toward the head

·        Stretch the skin tight.

·        Hold the syringe like a pencil (or) dart.  Insert the needle at a right angle to the skin.

The deltoid site

·        Find the acromion process

·        One method to locate this site is to place the palm of a hand centered on the persons shoulder.  The finger should be pointing toward the floor. The thumb and the other fingers are separated to make an upside down V shape.

·        Stretch the skin insert the needle at a right angle to the skin in the centre of the inverted triangle.

 

 

The ventrogluteal site

This site can be used for children age 7 months and older and adult.

·        Find the trochanter.

·        Find the anterior iliac crest

·        One month to locate site is to place the upper side of his (or) her leg.  The hand should be placed so the fingers are facing his (or) her head.

Intravenous injection

          Intravenous injection is the infusion of liquid substances directly into a vein.  Intravenous route is the fastest way to deliver fluids and medications throughout the body.

1.      Venous catheter

·        A needle is inserted into a vein, most often near the wrist.

·        Locate the vein using a tourniquet.

·        Insert that catheter at a slight angle (about 10 degrees).

·        Release the tourniquet when blood appears in the syringe (or) tubing.

·        Slowly inject the drug into the vein.

2.     Scalp vein

          The scalp vein provide a secondary option for peripheral intravascular access in small children and infants because  of minimal subcutaneous fat and less movement and the lack of a flexible joints, this reduces the likelihood of dislodging the catheter, which is common with intravenous catheters placed in the arms (or) legs.

SUMMARY

          Parenteral medications can be effective and safe when prepared and administered correctly.  However, because they are invasive and absorbed readily and quickly into the body, there are numerous risks associated with administering them.