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# Pediatric Medications

This presentation is to aid in learning about how to calculate pediatric medications
by

## Tracy Blair

on 10 September 2018

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#### Transcript of Pediatric Medications

NURS 4401
Tracy Blair MSN RN

Pediatric Medications
Come and Discover
the world of
Pediatric Medicine

Fluid Management
Calculate the Weight
Safe Dose Range
Medications
PO IM IV
Calculate the
Dilution Range
1 teaspoon = 5 ml
1 tablespoon = 15 ml
1 liter = 1000 ml
1 ounce = 30 ml
1 kg = 2.2 pounds
mcg to mg to grams
Remember the Basics
The maintenance dose for administration of IV fluids is
based on the following formula (24hr):

0-10 kg = 100ml/kg
10-20 kg = 50ml/kg (child's wt - 10) + 1000ml
>20 kg = 20ml/kg (child's wt - 20) + 1500ml

4:2:1 Replacement (hourly rate):
0-10 kg = 4 x kg
10-20 kg = 40 + 2 x kg (-10)
>20 kg = 60 + 1 x kg (-20)

Fluid Bolus Urine Output
20 ml/ kg 1-2 ml/kg/hr

You need to memorize this
Fluid Maintenance
Timmy weighs 9 kg, how much fluid does he need in a hour? In a day?
100 x 9 = 900 ml/day or 37.5 ml/hr
4:2:1= 36 ml/hr

Susie weighs 15 kg, how much fluid does she need in a hour? In a day?
(50 x 5 (child's wt-10) + 1000= 1250 ml/day or 52.1 ml/day
4:2:1= 50 ml/hr

Joey weighs 28 kg, how much fluid does he need in a hour? In a day?
(20 x 8 (child's wt- 20) + 1500= 1660 ml/day or 69.2 ml/day
4:2:1= 68ml/hr
Calculations
Know what the IV rate is.

Hourly recording of IV fluid intake

Don’t try and catch up on fluids

Calculate fluids used to administer IV medications into the hourly fluid calculations.
Fluid Control is critical in the pediatric population

Units often have policies that children under certain ages with IV fluids / IV medication be placed on an infusion pump.
Fluid Control
A 6 year old with dehydration is admitted to your unit. The physician order is to infuse 90 mL of NS over 2 hour. Then added another order for 90 ml NS in 30 mins. At what rate will you set the IV rate?
90 ml/2hr= 45ml/hr
90ml/30min= 180ml/hr
Calculations
Time over which a medication should be administered is critical information
Minimal dilution (end concentration of medication) is important for medications such as aminoglycosides
Collecting therapeutic blood levels for vancomycin levels
Key concepts
Oral IM IV
Medications
Remember to make sure it’s RIGHT
First Calculate the Weight
Step by Step Guide
In Pediatrics, medications are calculated out by kilograms, patients are often weighed in pounds:

2.2 lbs = 1 kg

To convert pounds to kg
___wt in lbs/2.2 = ___kg

To convert kg to pounds _____kg x 2.2 = ____lbs
Pediatric dosages calculated by weight
If a child weighs 88 lbs,
what is the weight in kg?
88lb = ? kg 88 divided by 2.2 = 40 kg

If a child weights 6 lbs
what is the weight in kg?
6 lb divided by 2.2 = 2.72 kg
Calculation
For a dosage of medication to be safe, it must fall within the safe range as listed in a Pediatric Drug Handbook, PDR or other reliable drug reference.
Medication dosage
Calculate daily dose ordered (Physician orders)
Calculate the low and high parameters of safe range (from drug book)
Compare the patient’s daily dose to the safe range to see if it falls within the safe zone
Safe Medication Dose
Donna is 2 years and weighs 36 lbs is receiving Amoxicillin
215 mg
po tid
for a bilateral otitis media (ear infection)

Donna’s wt= 36 lb /2.2 = 16.4 kg

Safe Dose range is:
20-40
mg/kg/day
Take the weight (kg) x dose range.
16.4 x
20
= 328 mg/kg/day to
16.4 x
40
= 656 mg/kg/day

Remember to calculate the dose
(TID (three times a day) = /3)
328 mg /3 = 109 mg/dose
656 mg /3 = 219 mg/dose

The drug dose is SAFE, since
215 mg
falls within the safe dose range of 109-219 mg per dose
Calculation
Terry weighs 22 kg. He is to receive
200 mg
of Ancef Q 6 hours. Safe dose range is
25 – 50
mg/kg/day. Is this dose safe?

Take the weight (kg) x dose range
22 x
25
= 550 mg/kg/day to
22 x
50
= 1100 mg/kg/day

Remember to calculate the dose
(Q 6 hr = /4)
550 mg /4 = 137.5 mg/dose
1100 mg /4 = 275 mg/dose

The drug dose is SAFE, since
200 mg
falls within the safe dose range of 137.5-275 mg per dose
Calculation

Some are the dose range for a day
Some are the dose range for q 8 hours
Some are the dose range for q 12 hours

You should always figure it according to the order administration
Safe Dose Ranges
PO Medications
The preferred injection site for infants and toddlers is the Vastus Lateralis. The Rectus Femoris is also an acceptable site and may be used as an alternative or to rotate injection sites. The Ventrogluteal muscle may be used for children older than 3 years of age who have been walking for several years. The Deltoid muscle is generally used only in children over 4-5 years of age du to the small muscle mass.

Potts and Mandleco. Pediatric Nursing; Caring for Children and Their Families. 3rd ed. pg. 619.
IM Medications
Infants:
Vastus Lateralis or Rectus Femoris: 0.5 – 1 ml

Toddlers:
Vastus Lateralis or Rectus Femoris: 1 ml
Dorsogluteal: 1 ml
Ventrogluteal: 1ml
Deltoid: 0.5 ml

Preschoolers:
Vastus Lateralis or Rectus Femoris: 1.5 ml
Dorsogluteal: 1.5 ml
Ventrogluteal: 1.5 ml
Deltoid: 0.5 ml

School-age Child:
Vastus Lateralis or Rectus Femoris: 1.5-2.0 ml
Dorsogluteal: 1.5-2.0 ml
Ventrogluteal: 1.5- 2.0 ml
Deltoid: 0.5 ml

Vastus Lateralis or Rectus Femoris: 2.0- 2.5 ml
Dorsogluteal: 2.0- 2.5 ml
Ventrogluteal: 2.0- 2.5 ml
Deltoid: 1.0 ml

Potts and Mandleco. Pediatric Nursing; Caring for Children and Their Families. 3rd ed. pg. 619.
IM Medications
Check for Compatibility of solutions
Be aware of potential contraindications for medications.
Be aware how medications are eliminated.
Check the IV site before giving the medication to ensure the IV is patent without swelling, redness, or tenderness at the site
The preferred injection site for infants and toddlers is the Vastus Lateralis. The Rectus Femoris is also an acceptable site and may be used as an alternative or to rotate injection sites. The Ventrogluteal muscle may be used for children older than 3 years of age who have been walking for several years. The Deltoid muscle is generally used only in children over 4-5 years of age du to the small muscle mass.

Potts and Mandleco. Pediatric Nursing; Caring for Children and Their Families. 3rd ed. pg. 619.
IM Medications
Infants:
Vastus Lateralis or Rectus Femoris: 0.5 – 1 ml

Toddlers:
Vastus Lateralis or Rectus Femoris: 1 ml
Dorsogluteal: 1 ml
Ventrogluteal: 1ml
Deltoid: 0.5 ml

Preschoolers:
Vastus Lateralis or Rectus Femoris: 1.5 ml
Dorsogluteal: 1.5 ml
Ventrogluteal: 1.5 ml
Deltoid: 0.5 ml

School-age Child:
Vastus Lateralis or Rectus Femoris: 1.5-2.0 ml
Dorsogluteal: 1.5-2.0 ml
Ventrogluteal: 1.5- 2.0 ml
Deltoid: 0.5 ml

Vastus Lateralis or Rectus Femoris: 2.0- 2.5 ml
Dorsogluteal: 2.0- 2.5 ml
Ventrogluteal: 2.0- 2.5 ml
Deltoid: 1.0 ml

Potts and Mandleco. Pediatric Nursing; Caring for Children and Their Families. 3rd ed. pg. 619.
IM Medications
Check for Compatibility of solutions
Be aware of potential contraindications for medications
Be aware how medications are eliminated.
Check the IV site before giving the medication to ensure the IV is patent without swelling, redness, or tenderness at the site
IV Infiltrates and Extravasations
IV Infiltrates and Extravasations
IV Buretrol
A Buretrol is an inline receptacle between the client’s IV catheter set and the bag of fluids.
Capacity is 150 ml, but usually you fill it for 1-2 hours of fluid maintenance
In the OR the Buretrols are always filled to 100 ml
Rationale: the nurse can fill the Buretrol to a certain level and if the IV pump malfunctions, only the volume in the Buretrol will flow to the patient.
IV Buretrols are only being used in the OR
The ml/hour is calculated by the MD order and the amount to be infuse is entered into the IV infusion pump.

The amount of fluid in the Buretrol is the amount to be infused.
The Infusion Pump
Concentrations
Kyisha is a 16 year old admitted to the unit with Osteomyelitis. She weighs 60 kg. She is to receive Ampicillin 900 mg IV Q6 hr.

The dilution is
5- 8.3
mg/ml.

Take the DRUG amount divide by the DILUTION amount.

900 /
8.3
=
Minimal amount (Max Concentration): 108 ml
900 /
5
=
Maximum amount (Min Concentration): 180 ml
Calculations are only used in Ampicillin
Martha is in with pneumonia. She weighs 62 kg. She is to receive Cefazolin 1250 mg IV Q6 hr.

The dilution is 20- 40 mg/ml.

Take the DRUG amount divide by the DILUTION amount.

1250 / 40 =
Minimal amount (Max Concentration): 32.3 ml
1250 / 20 =
Maximum amount (Min Concentration): 62.5 ml
Calculations
Formula:

1 hour= the amount multiple by 1
30 mins= the amount multiple by 2
20 mins= the amount multiple by 3
15 mins= the amount multiple by 4
10 mins= the amount multiple by 6
IV Rates for Medications
You have 40 ml to give over 30 minutes.
40 x 2= Set your IV Delivery System at 80 ml/hr.

You have 60 ml to give over 20 minutes.
60 x 3= Set your IV Delivery System at 180 ml/hr.

You have 80 ml to give over 15 minutes.
80 x 4= Set your IV Delivery System at 320 ml/hr.
Calculations
When processing IV medication questions-
1. Find out the patient weight= change to kg Take weight divide by 2.2
2. Find the safe dose range within the question= this is usually based on
weight. What can the patient receive safely?
3. Figure out the safe dose range
by day
.
This is a range- high/low
Take the patient’s weight and
multiply
it by the safe dose range
4. Figure out how often they are receiving the medication, Q 4H, Q6H, etc.
5. Figure out the safe dose range
by dose. This is a range- high/low
Divide
the day amount by how often they are getting the medication
6. Find what was ordered in the question, Figure out if the order is safe.
7. Figure out what you need to set the pump rate at by taking the amount and
multiplying
it by the time (either x2= 30mins, x3= 20mins, x4= 15 mins, etc). Sometimes this can be a range and you might have two numbers.
If you need to dilute the medication, find the dilution range and
divide
it into the ordered medication amount to get your dilution amount.

Review
Jose is a 15 year old who weighs 165 lbs. to
receive 1750 mg of Ancef (Cefazolin) for an
osteomyelitis Q 8 hours. The safe dose range is 50 to 100 mg/kg/day. The medication comes in a 50 ml bag. And should be given over 30 minutes.
Calculations
Jose’s weight 165 lbs.
Convert to kg. 165 / 2.2 = 75 kg

Safe Dose Range
50- 100
mg/kg/day
75 x
50
= 3750 mg/day to
75 x
100
= 7500 mg/day Must divide it by 3 since he’s receiving it Q 8 hours to get the safe dose
3750 /3 = 1250 mg/dose to
7500 / 3 = 2500 mg/ dose

Dose is 1750 mg which is safe, since 1750 mg is within 1250-2500 mg per dose.

The Medication comes in a 50 ml pre-filled bag

Given over 30 minutes
Set IV Delivery System at:
50 ml x 2 = 100 ml/hr
Calculations
Mary is a 11 months with fevers. She weighs 15 lbs. She is to receive 40 mg of Gentamycin Q 6 hours.

The safe dose range is 20 to 40 mg/kg/day.
The medication comes in a 30 ml syringe. And should be given over 20 minutes
Calculations
Mary’s weight 15 lbs.
Convert to kg. 15/ 2.2 = 6.8 kg

Safe Dose Range
20- 40
mg/kg/day
6.8 x
20
= 136 mg/day to
6.8 x
40
= 272 mg/day Must divide it by 4 since he’s receiving it Q 6 hours to get the safe dose
136/4 = 34 mg/dose to
272 /4 = 68 mg/ dose

Dose is 40 mg which is safe, since 40 mg is within 34-68 mg per dose

The Medication comes in a 30 ml pre-filled syringe

Given over 20 minutes
Set the syringe pump at:
30 ml x 3 = 90 ml/hr
Calculations
Congratulations!
You have solved the problem
of understanding Pediatric Medications
Now go out and investigate!
Calculate the IV Delivery System's Rate
Ampicillin needs to be diluted just prior to giving the medication to the patient.
Full transcript