Oral Medications

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Drug Ad ministrati on I

The admi nistration of medicines has always been an integral part of nursing care, but when caring for
children it involves several problem areas. The responsibility of the child nurse in ensuring that the
correct medication is safely and appropriately administered to the correct child is a huge undertaking
which requires many different skills. Children are particularly risk from medication for a number of
reasons. Their immature bodies systems make them less able to absorb metabolize and excrete drugs.
Their age, weight and surface area varies widely making standardize dosages impossible. In addition,
many children dislike taking medication, so th e nurse has to be able to find an acceptable method of
administration for ec;Jch individual child to promote compliance. This may be further aided by the nurse's
knowledge of alternative preparations available for each medication. Although it is mostly the doctor's
responsibility to prescribe appropriate medication, the nurse who will be administering the prescription
should have an understanding of the appropri at e dosage, route of administration, desired action,
possible side effects and contraindications of each medication to be given. The nurse will also need
to be able to explain most of these aspects to th e child and family and ensure continued acceptance
of the regimen . This chapter contains oral, intravenous medications, intramuscular medications, fluid
calculations for IV infusions, exchange transfusion, total parenteral nutrition.
Key words: Drug administration to children, five rights, young's rule, clark's rule, ventrogluteal site,
vastus lateral is, dorsogluteal, exchange transfusion, total parenteral nutrition.

OR AL AD MINISTRATION OF MEDICATIONS TO CH ILDREN


Administering to pediatric patients is more specialized ski ll, they ne ed for accuracy in p reparing
and giving drugs to childre n is even greater than with adult p atients. Since, the pediatric dose
is often relatively small in comparison with the adult dose, a slight increase in the amount of
a drug administered represents a greater proportional error, as there exist a narrow margin
be tvveen therapeutic level and toxic level in some drugs.
The responsibility of a nurse is important because the child is unable to communicate
verbally any signs of distress that indicate over dosage, side effects or allergic reaction.
~ a Pe dia tric Nursing Procedure Ma
nua l

Safet y Measures _
up
bef ore adm ini stra tio n of me dic ati on to the ped iatr ic gro
It is ess ent ial to revise the five rig hts
the y are :
i. Th e rig ht pat ien t
ii. Th e rig ht dru g
iii. Th e rig ht dose
iv. Th e rig h t ro ute
v. Th e rig ht tim e. w "th e dru g
t add ed re cen tly is the rig ht of the par en ts and chi ldren to kno
Th e sixth righ as the y wo uld
its ac tion and sid e effe ct, thu s red u dn g th e ch anc es of m isu se
th ey a re rec eiv ing
we re not given th e inf orm a tion .
be like ly to use it uns afe ly if th ey r had n ot
chi ld wa s re ce ivin g tab l e t ept oin for con vul sion an d th e mo the
For exa mpl e, if the m ay find ~
n whi ch h er chi ld wa s J-ia ving as the y we re a mil d n ature. She
not ice d the con vu lsio the bab y
ticu lar me di cat ion th e ba by slee ps and sh e m ay adm in iste r it wh en
tha t a fte r th is par sle ep and this ;:-
ing to ma ke th e chi ld sle e p thin kjn g th e bab y will h ave peace ful
is irri tab l e or cry
itse lf can be harmful. ·-

nis tra tio n


Po ssible Errors in Drug Ad mi
err ors in adm inis teri ng dru gs:
Th ere can be various rea son s for
n by the pre scr ibe r.
i. Po or com mu nic atio n of inte ntio y.
rou tin e wh en adm ini ste rin g the rap
ii. Fai lur e to keep an est abl ish ed
obj ect ive s of the rap y.
iii. Lac k of und ers tan din g of the me nts ma y
nur se to rec ogn ize tha t the me dic al officers and pha rm a cy dep art
iv. Fai lur e of the
ma ke errors. (\_
Poo r con cen trat ion or con sta nt inte rru ptio n. dos e,
v. ck the dru g, the
erie nce d per son to dou ble che
vi. Ign oring the need for an exp ~
tio n of the pat ien t and any pre vio usl y adm ini ste red pre par atio n.
ide ntifica
vii. Failur e to calculate to one 's ow
n satisfaction. ~
riat e ped iatr ic dos es of com mo nly use d me dic ations.
viii. Failure to learn app rop
ix. La ck of knowle dge reg ard ing
dru g int era ctio n and sid e effects. 0------..
rag e.
x. In ade qua te sec urity of dru g sto
inistere d dos es. ~
XI. Failu re to record adm r, no me dic atio n sho uld be omitted
m edicat ion , how eve
If you are in doubt, do not give the ~~
wit h ou t the me dic al offi cer 's ord er.
~~
Oral Ro ute f~ _
, pow der s.
P edi atric medications are pre pared as tablets . . . s
l.
It is earlier to persua de old er chi
ldr en to sw allo w ~apsules. m ed1 cat10n
!: It is ess ent ial to rem em ber tha t
if they are assured of a reward in the
ch ildr en can be easily p ers uad ed to ~ave b1t~
fo rm of a cho col ate or swe ets, 1f p
er
erm 1tted.

4l '
Drug Adm ini stration fi)
·l. 'I hey ca n be made accepta ble if given along with fr uits flavored syrups but
sho uld not be
mixed with fo od as th e child may d evelop aversion to p articula r fo od, if mixed with
th e

m edici n e.
5. Caps ul es sh ould not be open ed and a d ministe red as the powder is un palata
bl e.
sugar and
6. If the child cannot swallow open the capsule and mix the powder with honey or
other sweeten ed syrups.

Purpos es
_To safely and effe ctively ad ministe r th e drugs to th e patient by mout h.

Points to Rem ember


Q Liquid forms are safer to swall ow to avoid aspirati o n.
ounts.
G When m L-x.ing drug with palatable Oavoring and such as syrup/h oney, use on ly sma ll am
0 Ca lcu late th e p edi atric dos ~ (or) amount .n eeded carefull y.
Do n o t u se dru g which is discove red or
Q Do no t admini ste r contam inated drugs (dru gs fall e n on the floor).
by
Nurses sh ould try to be aware of a m edicin e taste as that th ey ca n answer questio ning
the child .
. So
8 Cau tion must b e exercise d to prevent aspiratio n when giving medicat ion to ch ildren
give t o infa nts in small amount s to avoid choking .
0 If chi ldren are placed in a sitting position th ey are learn likely to aspirate the medica tions
th an if lying on their b acks.

Admin ist ration of Medicine by Mouth


For In fants
Take the m ed icin e in a dropp er syringes or in a tea spoon.
s Hold the in fa nt in her mothers lap.
ren
e Medicin es are generall y adminis tered before feeding unless contrain dicated. Child
open
h ead a nd shou lder sh ould be rais ed and the chin should be depress ed with thu mb to
the mouth.
slowly
fj The d ro pper (o r) the spoon should be placed on the middle of the tongue and
dro pped in the tongue.
0 The thumb be released and the child sh ould b e allowed to swallow .

For Toddlers
hea d and
The med icine should be taken in a m easuri ng cup (or) in a teaspoon. 'foe chil d
should be released
.
shoulde r be raised medicin e cup sh ould be h eld to th e m outh and m edicine
slowly.
l
Procedure M an ua
{i - Pediatric N ur si ng
et at th e
Pre-sc ho ol A ge
C hi ld re n
ou ld be ta ug ht to pl ac e th e ta bl
gh to ta ke a ta bl
et th ey sh
dr en ar e ol d en ou
W he n ch il w in g th e
th e to ng ue . ui ds w it h th e ta bl et . A ft er sw al lo
ba ck of
ld be gi ve n on
sw al lo w in g fl
E m ph as is sh ou .
Th e be al w ay s ra is ed
en 's ch in sh ou ld
e, ch il dr
m ed ic in

ist ra tio n
o ral dr u g ad m in
f ig . 7. 1: In fa nt s

. .
,=·•g . 7 .2 : To dd le r or al d ru 9 a d m in is tr at io n
Drug Admin istratio n

Equipments
® Medicines card
0 Medication tray
@ Disposable medication cups
0 Oral medication, e.g. tablets, syrup, etc.
® Medicine measures
e Glass of water, juice or preferred fluid
@ Milliliter measure~
@ 1 mL syringe
e 5 mL spoon, plastic droper
0 Motor and piston
® Paper towels
® Toy appropriate to the age.

Steps of Procedure
. . , '~
Assess fo r any contraindication s to client receiving oral medications. Is oJf t able to swallow,
is client suffering from nausea (or) vomiting, is client has current gastfoTntestinal surgery.
® Does client need gastric suction?
® D etermine client's preference for fluids
@ Prep are the needed equipment
® Ch eck accuracy and completeness of each medication card form of printout with
p hysicians written medication and time for administration.

Prepare Drug
a. Wash hands.
b. Arrange m edication tray and cups in medicine room . Prepare medication for one client at
a time. Keep medication cards for each client together.
c. Select stock supply. Compare label of medication card.
d . Calculate current drug dosage, time, double check calculation .
e. To prepare tablet (or) capsules from bottle, pour required number into bottle cap and
transfer medications to medication cup. Do not touch medicines with fi nger. Extra
capsules may be removed to bottle.
ei All tablets given to child at one time may be placed in one cup except for those requi ring
pre-administratio n assessment.
Ci) If the client has difficulty in swallowing, grind tablet in motor and piston . J~©O/.~
.·'.•. /~
.,.- ?
Z~\\
Prepare Liquids
.-(I/ l
~--✓
e Remove b ottle cap from container.and place cap upside down
Hold bottle with lab le against palm pf hand while pouring. '
i) i m
I! )·~
,; '

Had medication cup at eye level and fill to derived levels/sca le. -----·--·-
(B Pediatric Nursing Procedure Manual
Administrating Medication
a. Take med icat ion to clients at corr ect time .
b. Iden tify clie nt by com pari ng nam e on card
prin tout frmn (or) with nam e (or) pati en
iden tific atio n bracelet. Ask pati ent to state his full
nam e.
c. Perf orm nece ssar y pre-adm inis trati on for specific
med icat ion.
d. Explain purp ose of each med icat ion and its acti
on to client (or) pare nts. Allo w them to as.
any que stions. i
i.
e. Assist pati ent to sitting/ later al posi tion .
f. Afte r full glass of water (or) juic e drugs to b e swa
llow ed .
g. For su blin gu al adm inist ratio n drug s cli en t have
1 to plac e med icat ion und er tong ue an d
allow it diss olve .
h. Reco rd actual time, each dru g adm i n is te red on
med i catio n reco rd (or) com pute r inclu de
initials and sign ature.

Afte r Care of Equ ipme nt


@ Disp ose all solid supp lies.
.. Cup s, spoo ns, drop pers shou ld be wash ed with
so ap and wate r an d m ake th em dry an d
repl ace in cupb o ard .
e Ke ep the clien t unit neat and tidy.
e Retu rn in 30 minu tes to eval u ate the clien t's resp
onse to med icati o ns.

Calc ulation for Adm inist ratio n of Med icati on


Man y for m u las are us ed to dete rmin e a dose of a
drug to be give n to a chil d.
1. You ng's Rule :
Whi ch applies to children 1-12 years of age

Chil d1s dose = _Chil


_ d__:;:_
age_(in
_year
__s) x Ad u 1t d ose
Child age + 12
Exam ple: A child aged 10 years, suffe ring from tube
rculo sis requires to be give n injec tion
strep tomy cin intra mus cularly. Calc ulate the dose .
·
Chil d's dose = -10- x 1000 m g
10+1 2
n
10
= - x l00O mg
22
1000 0
=
22
= 454m g
,r
2. Clar ks rule: Uses th e child re n weig ht to rnlcu
' late the appr opri ate do
th e a dult dose is base d o n 150 lb pers on. se an d assu mes t 1ia ,,
Drug Adm inistra tion

Ch 1.Id d ose = -wigh t of child (pou nds) inlb


--=---- -~-- ~--- ..:.. ..:.. x Ad ult dose
150 poun ds
llb = 454 g
1 kg = 2.2 lb
1000 gm = 2.2 lb

Example: A child weig hing 20 lbs requ ires IM strep tomy


cin .
Adult dose is 1000 mg.
20
=-x l00 0mg
150
2
= lS X 1000 mg
=133 mg
3 . Surfa ce area: Surfa ce area is d et ermi ne d. with a
n anog ram
.Id d surfa ce are a in squa re m et er
Ch 1 ose = - - - -- - ~ - - - - x Adul t dos e
1.-73
4. Friod's Rule: Appl ies to a child youn ger than 1 year old
age. The rule assum es that an adult
dose shou ld be appr opria te for a child who is 12 years
.
.ld
Chl dose __ -
Infan t age (in mont hs)
- - = - ---'- ----- ..:- x Adul t close
150 .

INT RAM USC ULA R DRU G ADM INIS TRA TIO N

Defin ition
It is a proc ess of inj ectio n of medi catio n into the musc
le tissu e of th e b ody with syrin ge and
nee dle .

Purp ose
0 To admi niste r d rugs w hen q u ick actio n is req uired.
0 To admi niste r drugs when patie nt is not able to swall
ow and retain as in psych iatric or
unco nscio us pati ents.
e To admi n ister drugs whic h are inact ivate d by gastri c
en zyme s or which irrita tes the gastric
muco sa .
© To· admi niste r oil suspe nded drugs , e.g. parac etam ol.
Poin ts to be reme mber while sele cting the IM Injec
tions
Be ve ry caref ul when selec ting IM injec tio n s ites.
Chi ldren ca n b e unpr ed ictabl e and unco opera ti
ve .
Di strac ting the c: hild wi th conv erc;atio11 or a toy may
0 redu ce pain 1wrcc pticrn .
Give injl'c: tion qui ckly and do nol (iglt t wit h the
e;l
cliilcJ .
(I) (J se str i ct c1s1~p ti c tcchn iq11c s.

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