PEDIATRIC DRUG CALCULATION.pptx

Pediatric Drug and Fluid Calculations for Nursing Students

1. Carver Christian University ELWA, RIA HIGHWAY MONROVIA, LIBERIA Pediatric Nursing One: WEEK 9 NOVEMBER 5,2022 PEDIATRIC DRUG CALCULATIONS: Presented b y: James V.T.Tuckolon RN/ASN,BSN,MSN/Pediatric Nurse Specialist

2. Learning objectives At the end of this session, student will be able to: Know the various formulas for drugs calculation in pediatric client work with other healthcare professionals in calculating correct pediatric drug dosages. Know the 24hrs maintenance fluid requirement and calculation

3. Fried's Rule 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 of average size and utilizes age rather than weight . It is important to note that because age does not necessarily indicate the patient's weight, medication adjustments may be necessary once the patient's response is determined. :

4. FRIED RULE Pediatric Dose= Age in months x normal adult dose 150 Examples: A doctor order 50mg of medication oral administration every 6 hours PRN for pediatric patient who admitted to the hospital. Calculate the dose for the four-year-old child using Fried’s rule?

5. 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. 1. Example : A seven-year-old pediatric patient is admitted to hospital. The dispenser is tasked with determining what dose of the medicine prescribed by the physician. If the adult dose is 100mg and the child weighs forty kilogram, what dose should the child is administered by using young’s rule ?

6. Clark's Rule Clark's Rule  is a medical term referring to a procedure used to calculate the amount of medicine to give to a child aged 2-17. The procedure is to take the child's weight in pounds, divide by 150lbs, and multiply the fractional result by the adult dose to find the equivalent child dosage. For examples:   1 . If an adult dose of medication calls for 30mg and the child weighs 30lbs. Divide the weight by 150 (30/150) to get 1/5. Multiply 1/5 times 30mg to get 6mg. 2. Using Clark’s rule, what is the dose for a twelve-year-old male who weighs 35kg, if the average adult dose is 500mg?

7. Clark's Rule Answer:1st convert kg to pounds; 1kg=2.2Ibs; 35kg=77Ibs; Child dose=77Ibs/150Ibs*500mg=257mg of drug. Clark's Rule is not used clinically, but it is a popular  dosage calculation  formula for pediatric nursing instructors.

8. Clark's Rule   Pediatric dose = weight in pound (lb.) x average adult dose 150lb   Pediatric dose = weight in (kg)x average x adult dose 70kg  

9. Nomogram Method   The  Nomogram method is utilized to determine the correct pediatric medication dosage based specifically on the patient's size . The patient's size is identified as  body surface area (BSA)  in meters squared (M 2 ). The average adult client (weighing 150 - 154 lbs.) will have a BSA of 1.73M 2 . The nomogram chart can be used to identify the patient's BSA based on their height and weight (in. and lbs. or cm and kg ). The surface area is determined where a straight line connecting the patient's height and weight crosses over the BSA column. Once the BSA of the patient is determined the following formula can be used to calculate the correct pediatric dosage:    

10. Nomogram Method     MEMORIZE THE BELOW FORMULAS 1. M 2 =√ Weight(kg) *height (cm) 36,000   2.M 2 =√ Weight ( lb ) *height (inch) 31,31   3. Pediatric dose = child’s BSA x adult dosage 1.73m 2      

11. Nomogram Method     1 . A pediatric patient is 65lbs and 4feet 5 inches. The physician orders an oral medication of Acetaminophen that has a normal adult dose of 1000mg. How many “mg” of this PCM will be administered? 2. A pediatric patient is 65lbs and 4feet 5 inches. The physician orders an oral medication of that has a normal adult dose of 250mg. How many “mg” of this PCM will be administered 3. A pediatric patient has BSA of .88m 2 .The doctor orders an IV medication that has a normal adult of 125mg. You are supplied with a vial that reads 30mg/ml. How many ml you administer to this patient? 4. You noticed that your patient weighed 27.2.kg and 91cm What is the patient’s BSA? The child has the body surface of 0. 52 M 2 and if the normal adult dose is 500mg. What is the child dose of the medication?   5. The child has the body surface of 0. 52 M 2 and if the normal adult dose is 500mg. What is the child dose of the medication?   s  

12. Pediatric Drug calculation per body weight per kg Most Pediatric Drug dosages are also based on body weight / kg/day: Examples:  For example: a four month old weighs 9kg presented at the clinic with fever of 38 degrees Celsius. The doctor orders PCM PO 10mg/kg prn. PCM labels 500mg/tab. How many “mg” the child is to take? How many tab that is required for the child?   A child weighs 30kg is to receive ampicillin 50mg/kg/day iv. a. How many mg of ampicillin is required for the child? b. What is the total daily dosage for this patient?

13. Pediatric Drug calculation in body weight per kg The 1.5year old child is prescribed an amoxicillin suspension. The dose prescribed is 40mg/kg divide into equal bid doses. The suspension is available in a 400ml/ml a. What is the dose in ml if the child weighs 22pounds?

14. Antimalarial drugs calculation Please read on the mg/kg for each of the anti-malaria use in Liberia. Our focus should be on pregnant women and children

15. Parkland's Burn Formula This formula was designed to help the healthcare provider determine the proper amount of fluids to administer to a patient following a burn.  Parkland's burn formula  is most useful during the first twenty four hours of  fluid resuscitation  with second degree or greater burns. Ringers lactate is the fluid of choice and should be administered at 4 mL/kg of body weight per percentage of burn using  total body surface area (TBSA)  as a guide . DETERMINING TBSA In order to determine the TBSA, the  Lund-Browder Chart  is one method that might be utilized. In a pediatric patient the head comprises a much larger portion of the BSA than with an adult. In accordance with the Lund-Browder Chart: The head of a pediatric patient = 18% Each arm = 9% The front torso = 18% The back torso = 18% Each leg = 14%

16. Parkland's Burn Formula Due to the increased surface area of the head, the pediatric patient's legs comprise a smaller portion of the BSA. Once the total volume of fluid is decided on, half of the volume is administered in the first eight hours’ post-burn and the remaining volume is administered over 16 hours . It is important to note that calculated volumes from this formula and many others is merely an estimate and may require adjustments in the amount of fluid being given based on the patient's response. FLUID REQUIREMENT= TBSA BURN (%)X Weight(kg) x4ml of RL 1kg Administer ½ of fluid requirements in 1st 8 hours, then administer the 2nd half of fluid requirements over the next 16 hours

17. IV PEDIATRIC MAINTENANCE FLUID REQUIREMENT ANDCALCULATION

18. 100ml of fluid for the 1 st 10kg of body weight 50ml of fluid for the 2 nd 10kg of body weight 20ml of fluid for the additional kg of body weight  

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