3. Pharmacological Care in Pediatrics.pptx

Drug dosage calculation for the Pediatric drugs
Common Pediatric drug dilutions
Standard precaution during administering drug
Common Pediatric concerns/complications during drug therapy
Caring for children receiving Chemotherapy, antimicrobial therapy and long-term Insulin therapy
Managing pain in children by using pharmacological and non- pharmacological approaches
Allergies reaction

1. Pharmacological Care in Pediatric

2. Objectives After this lecture, students will be able to: Drug dosage calculation for the Pediatric drugs Common Pediatric drug dilutions Standard precaution during administering drug Common Pediatric concerns/complications during drug therapy Caring for children receiving Chemotherapy, antimicrobial therapy and long-term Insulin therapy Managing pain in children by using pharmacological and non- pharmacological approaches Allergies reaction

3. General Guidelines The responsibility of giving medications to children is a se r io u s o n e . Children are smaller than adults and medication dosag e m us t be adjusted. Child r en r eact mo r e v iol e nt l y . Drug reactions are not predictable . The impact on growth and development must be consi d e r ed when g ivi n g d r ug s to c hild r en Dou b l e c he c king is a l w a ys best Must d ou b l e c he c k these me d s: Digoxin, Insulin, Heparin

4. Pediatric Drug Administration Pediatric drug therapy should be guided by the child’s age, weight and level of growth and development. The nurse’s approach to the child should convey the impression that he or she expects the child to take the medication Explanation regarding the medications should be based on the child’s level of understanding

5. Pediatric Drug Administration The nurse must be honest with the child regarding the procedure It may be necessary to mix distasteful medication or crushed tablets with a small amount of honey or gelatin Never threaten a child with an injection if he refuses an oral medication All medications should be kept out of the reach of children and medications should never be referred to as candy

6. Routes Of Drug Administration Time OD: once a day BD: 9-9 TDS: 9-3-9 HS: at night SOS: as per need NPO: not per oral 8 hrly : 6-2-10 6 hrly : 6-12-6-12 Routes IV IM S/C Inhalation Oral Instillation(drops) Insertion(suppositories)

7. Drug Dosage Calculation V x DD x Wt DA DD: Desired Dose DA : Dose Available V : Volume Wt : Weight Example: Physician ordered for inj. Lasix 0.5mg/kg stat, Patient wt is 10 kg. Available ampule is 20mg / 2ml. DD = 0.5mg / kg DA = 20 mg Wt = 10 kg V = 2 ml 2 x 0.5 x10 = 0.5 ml 20

8. Maintenance Fluid Requirements Fluid calculations are based on weight in kilograms . Rule of 4-2-1

9. Example 16 kg Child Calculate: 10 x 4=40 6 x 2=12 Total maintenance fluid requirements = 52 ml/ hr

10. IV drugs Formula Formula: Required dose x Dilution Vial dose Vail Calculation: The doctors advise for I nj I nocef 600 mg IV/ TDS for eight years old child, but I nj Inocef available in 1000 mg dilution in 10ml in Vail. How you will calculate the dose? Data: Vial dose = 1000 mg Req dose = 600 mg Dilution = 10 ml. Solve: = 600/1000 x 10 = 6/1 x 1 = 6 x 1 = 6ml Ans .

11. Drops Factor 1. Drop factor for drip set is 15 1ml = 15 drops. 2. Drop factor for chamber is 60 1ml = 60drops . Formula: volume x drop factor hours x minutes

12. Drop Rate Calculation Formula: Total amount of fluid x Drops factor Total time in minutes The doctor advised for injection D/W 5 % 1000 ml through drip set in 24 hrs. Calculate the drop rate factor?  Data: Total amount = 1000 ml Total time = 24 hrs. (24 x 60= 1440) Drop factor = 15 drops/60sec Drop rate = ? Formula: Total amount of fluid x Drops factor Total time in minutes = 1000 x 15 /24 x60 = 15000/1440 = 10 drops/minutes Ans .

13. I/v Chamber Calculation The Doctor advice for injection D/W 5 % 500 ml through I/V chamber in 24 hrs. Calculate the drop ? Data: Total amount of fluid = 500 ml Total time = 24 hrs. (24x60 = 1440) Drop factor = 60 drops / 60sec Drop rate = ? Formula: Total amount of fluid x Drops factor Total time in minutes = 500 x 60 / 24x60 = 30000/1440 = 21 micro drops/min Ans

14. Types of Fluid and amount of N/S

15. Standard Precaution During Administering Drugs Don’t use the drug without label Always look for expiry date Handle the drug very consciously Ask the patient for any type of drug sensitivity Don’t touch the needle & prevent contamination Select the appropriate site of drug administration Don’t administer the drug in case of No Order in file Keep in mind don’t reuse the syringe for another patient Documents the name, time, amount to be administered .

16. Complication of Drug Therapy Every drug have different side effect with continues drug therapy in different individuals. The side effect and complication may involve all system of body. Drug therapy should be given in very carefully.

17. Common Side Effects of Chemotherapy Bruising and Bleeding: Destruction of blood platelets can result in bruising and bleeding, known as Thrombocytopenia, Nausea and Vomiting: Affecting both the gastrointestinal tract and the message center in the brain responsible for nausea and vomiting. Diarrhea or Constipation: Proper diet and nutrition can help avoid or reduce these symptoms. Anemia: Low red blood cells count

18. Conti… Fever: Chemotherapy often temporarily destroys white blood cells, which are the body's primary defense against infection. Hair Loss: Some chemotherapy causes hair loss or thinning of the hair. Mouth and Throat Sores: Rapidly growing cells that line the mouth, throat and digestive tract can be temporarily destroyed by chemotherapy medicines. Organ Damage: Chemotherapy drugs may affect organs.

19. Long Term Insulin T herapy Insulin infusion need proper attention in order to maintain blood glucose. Patient with long term insulin therapy may cause very serious complication. If insulin therapy is not properly manage it cause life threating issue. Insulin administrative technique and home measurement should be educate to patient or his/her parents.

20. Anti-Microbial Therapy Care: All types of antibacterial therapy have some side effect as well as complication , so before administration of antibiotic: Right Patient Right Dose Test Dose Proper Dilution Time Accuracy Proper Interval

21. Allergic reactions Some drugs may produce undesirable effects The body tissue doesn’t accept the drug. It acts as foreign body and causes the allergic reaction It may be minor or severe sometimes even leading to death

22. No single method of drug administration is ideal for all drugs in all circumstances Very Important Info!

23. Managing pain in children by using non- pharmacological approaches: Patient Education t o improve health care outcomes. Music Therapy may help lift your child's energy levels and mood. Massage may help relax your child's muscles and decrease pain. Mind-Body T herapies  focus on the relationships among the brain, mind, body, and behavior. Art Therapy is an integrative mental health and human services profession that improves the lives of individuals, families.

24. Conti… Heat  helps decrease pain and muscle spasms. Ice  helps decrease swelling and pain. Ice may also help prevent tissue damage. Relaxation Exercises  teach your child to breathe in deeply until his or her stomach rises a bit and then breathe out slowly.  Guided Imagery  teaches your child to imagine a picture in his or her mind. Your child learns to focus on the picture instead of his or her pain.

25. Managing Pain in Children by u sing Pharmacological Approaches: Use analgesic and antipyretic as per severity of pain. Medication should be provided with regular interval. Avoid from high dose, it may cause complication. Safe and effective administration of medicines Calculations Errors.

26. References Smith , S.F., Duell , D.J., Martin, B.C. (2004) Clinical Nursing Skills, Basic to Advanced, 6 th Ed. New Jersey: Prentice Hill Timby , B.K. (2003) Fundamental Skills and Concepts in Patient Care, 7 th Ed. Philadelphia: Lippinco tt

27. Thank You

28. Home work The doctor ordered for injection Amoxil 50 mg IV BID, but injection Amoxil available in 250mg dilution in 5 ml Vail . Calculate the dose? For a one years old child the doctor advise injection Maxalon 5mg IV OD, injection Maxalon is available in 10mg / 2ml in ampule. calculate the right dose? Injection D/W 5 % 1000 ml give in 4 hrs. Calculate the drop rate factor? Injection D/W 5 % 1000 ml give in 6 hrs. Calculate the drop rate factor? Injection N/S 0.9 % 200 ml through IV chamber in 12 hrs. Calculate the drops?