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Pediatric Pharmacokinetics
Absorption
Influencing factors
Childs age, health status, underlying disease,
hydration, route of administration
Route of administration
Gastric acidity, emptying, motility, surface area,
enzyme levels, intestinal flora
IM/SubQ
Peripheral perfusion
Efectiveness of circulation
Topical
Childrens skin is thin and porous
Pediatric Pharmacokinetics
(contd)
Distribution
Influencing factors
Body fluid composition
Neonates and infants are 70% water
Body tissue composition
Neonates and infants have less body fat
Protein-binding capability
Neonates and infants have less albumin
Efectiveness of barriers
Skin
Blood-brain barrier
Pediatric Pharmacokinetics
(contd)
Metabolism
Influencing factors
Maturational level of child
First-pass efect
Higher metabolic rate
Pediatric Pharmacokinetics
(contd)
Excretion
Areas of occurrence
Kidneys
Infants have decreased
Renal blood flow
Glomerular filtration rate
Renal tubular function
Intestines, salivary glands
Lungs
Sweat glands, mammary glands
Principles of
Medication Administration
Standardized dosage ranges have not been
established for children.
Children respond diferently to medications
than adults.
The nurse must incorporate principles of
growth and development when
administering medications.
The margin of safety is narrow.
Medication Administration
Procedures
Based upon child's developmental level
Oral medications
Injections
Alternative routes
Rectal
Ophthalmic
Optic
Topical
Nasal
Inhalation therapy
Question
deltoid
dorsogluteal
rectus femoris
vastus lateralis
Nursing Implications
Client identification
Considering developmental and cognitive
diferences
Diferentiating developmental from chronologic age
Adolescent Considerations
Considerations
for adolescents
Developmental age
Age, weight, height
Health status
History of drug use
Nutritional/hydration status
Cognitive level
Family/child understanding
Nursing Diagnoses
Potential
nursing diagnoses
Practice Question #1
Children have higher metabolic rates than adults.
The nurse realizes that this afects administration of
medication for pain in children in all of the following
ways except
A. higher requirement for medication
B. increased dosage
C. decreased frequency
D. increased frequency
Practice Question #2
Although adolescents have physical appearance
and organ structure and function similar to that of
adults, the nurse knows that their bodies continue
to grow and require increased vigilance in
monitoring
A. therapeutic and toxic drug levels.
B. side efects of medications.
C. route of medication administration.
D. frequency of medication administration.
Converting LB to
KG
Example 1
Example
2
Practice problems
Converting KG to LB
Example 1
Example 2
Practice problems
Two-step process.
Example 1
13
Calculate the
recommended daily
dosage range first.
Lower daily dosage = 20 mg/kg
20 mg x 18.2 kg = 364 mg/day
Upper dosage:
728 mg / 3 = 243 mg per dose
1.
37
Intramuscular and
Subcutaneous
Medications
Insulin and immunizations
Dosage calculations are
done
the same way as with
adults,
but dosages are
sometimes
calculated to the
nearest
hundredth and
measured using
a tuberculin syringe.
Pediatric IV Medications
Methods of IV Medication
Administration
Administration of
Intravenous Medications
Site selection
Infusion pumps
Close monitoring
Immediate onset of action
Example 1
A dosage of 125 mg in 1 mL of D5 NS is to be diluted in 20
mL of D5 NS and infused in 30 minutes. It is to be
followed with a 5 mL D5 NS flush. A pump will be used
and the tubing is a micro drip burette.
Add 19 mL of D5 NS to the
= 60 gtt/min
Practice problem
The volume of a 10 mg
dosage of medication is 1
mL. Dilute to 40 mL and
administer over 50 min.
Dilution volume
Gtt/min_
mL/hr
Practice problem
Example 2
A child with a body weight of 18.4 kg is to receive a medication
with a dosage range of 100-150 mg/kg/day. The order is for 600 mg
in 75 mL of D5W every 6 hours. Determine if the dosage is within
normal range.
Calculate the normal daily dosage range.
Example 3
Practice problem
Practice problem
Practice problem
Emergency Medications
Use the Broselow tape to determine color of
drawer to open
Look for Code cart on Pediatric unit.