Pharmacological Care Aspects While Dealing With Paediatric Patients-1

Unit3
Pharmacological care
aspects while dealing with
paediatric patients
Nursing Instructor
Shabaz Emmanuel
BSN RN
Thursday, February 29, 2024 1

Learning Objectives
• Drug dosage calculations for pediatric patients.
• Calculate pediatric dosages based on body weight.
• Find a patient’s body surface area (BSA).
• Calculate patient dosages based on a patient’s BSA.
• 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.
Introduction
• Dosages for medication administration to pediatric
patients are almost always determined by the
patient's size (height and weight). However, most
reference manuals for medications focus primarily
on the adult dosages. Therefore, the healthcare
provider must be able to determine the appropriate
dosage for the pediatric patient when given the
adult dosage. Several different methods may be
used to determine the correct dosage of medication
for a pediatric patient.
• Because the administration of medication is a
nursing responsibility, nurses need to have not
only knowledge of drug action and patient
responses but also resources for estimating
safe dosages for children. Children’s dosages
are most often expressed in units of measure
per body weight (mg/kg). Some medications,
such as chemotherapy, are more precisely
dosed using BSA.
– Nomogram Method (Using a Child's Body Surface
Area)
– Fried's Rule (Using the Child's Age in Months)
– Young's Rule (Using the Child's Age in Years)
– Clark's Rule (Child's Weight in Pounds)
– Parkland's Burn Formula

• Fried's Rule
Child dose= Age in months x Adult dose
150
• Young's Rule
[Age / (Age + 12)] x Adult Dose = Pediatric Dose

• Clark's Rule
Clark's rule equation is defined as the weight
of the patient in pounds divided by the average
standard weight of 150 pounds (68 kg)
multiplied by the adult dose of a drug equals
the pediatric medication dose, as is
demonstrated below:
Pediatric Dosage = (Weight/150 lbs.) x Adult
Dose.
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.
Calculating BSA Using a
Formula
• To determine a patient’s Body Surface Area
(BSA):
If you know the height in cm and weight in kg,
calculate
BSA= Height(cm) x weight(kg)

3600

DETERMINING TBSA
• In a pediatric patient the head comprises a

much larger portion of the BSA than with an
adult.
• The head of a pediatric patient = 18%
• Each arm = 9%
• The front torso = 18%
• The back torso = 18%
• Each leg = 14%
• 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 Requirements = TBSA burned (%) x
Weight (kg) x4 mL (RL)/1 kg
• Administer ½ of fluid requirements in 1st 8
hours, then administer the 2nd half of fluid
requirements over the next 16 hours.

Pharmacokinetics
Study of how drugs are used by the body
• Absorption
• Distribution
• Biotransformation
• Elimination

Absorption
Process that moves a drug from the site where it is

given into the bloodstream
• IV medications bypass the absorption process by

going directly into the bloodstream
• Oral medications absorbed in digestive system
• Topical absorbed through the skin

Biotransformation
• Process that chemically changes the drug in

the body
• Occurs primarily in the liver
• Helps to protect the body from foreign
chemicals including drugs

Distribution
• Process that moves the drug from the

bloodstream to other body tissues and fluids
• Target site is where the drug product produces
its desired effect
• Each drug affects drug target sites

Elimination
Process where the drug leaves the body

Main way of eliminating is in the
• Urine
Other ways
• Exhalation
• Sweat
• Feces
• Breast milk
• Other body secretions
Drug Adjustment
• Factors related to growth and maturation

significantly alter an individual’s capacity to
metabolize and excrete drugs. Immaturity or
defects in any of the important processes of
absorption, distribution, biotransformation, or
excretion can significantly alter the effects of a
drug.

Newborn and premature infants with immature enzyme
systems in the liver (where most drugs are broken down
and detoxified), lower plasma concentrations of protein
for binding with drugs, and immaturely functioning
kidneys (where most drugs are excreted) are particularly
vulnerable to the harmful effects of drugs. Beyond the
newborn period, many drugs are metabolized more
rapidly by the liver, necessitating larger doses or more
frequent administration. This is particularly important in
pain control, when the dosage of analgesics may need to
be increased or the interval between doses decreased.
Routes of drug administration
• Oral administration
• Intramuscular administration
• Subcutaneous and intradermal administration
• Intravenous administration
• Nasogastric, orogastric, and gastrostomy
administration
• Rectal administration
• Optic, otic, and nasal administration
• Aerosol therapy
NURSING CARE FOR CHILDREN RECEIVING
CHEMOTHERAPY
Nursing care involves the same objectives as for

patients with other types of cancer, specifically:
(1)Preparation for diagnostic and operative procedures
(2)Explanation of treatment side effects
(3)Child and family support
Because this is most often a disease of adolescents
and young adults, the nurse must have an
appreciation of their psychologic needs and
reactions during the diagnostic and treatment
phases.
• The most common side effect of irradiation is fatigue.
This is particularly difficult for active, outgoing school-
age children and adolescents because it prevents them
from keeping up with their peers. Sometimes
adolescents will push themselves to the point of
physical exhaustion rather than admit and succumb to
the decreased activity tolerance. The nurse cautions
parents to observe for behavior such as extreme fatigue
at the end of the day, falling asleep at the dinner table,
inability to concentrate on homework, or an increased
susceptibility to infection.
• A regular bedtime and scheduled rest periods
are important for these children, especially
during chemotherapy, when myelosuppression
increases the risk of infection and debilitation.
Before discharge, the nurse should discuss a
feasible school schedule with the parents and
child. An area of concern for adolescents is the
high risk of sterility from irradiation and
chemotherapy.
Nursing care for children receiving
Insulin therapy
• Insulin replacement is the cornerstone of management of
type 1 DM. Insulin dosage is tailored to each child based on
home blood glucose monitoring. The goal of insulin therapy
is maintaining near-normal blood glucose values while
avoiding too frequent episodes of hypoglycemia. The goals
of treatment are to maintain near-normal glucose levels of
less than 126 mg/dl and glycosylated hemoglobin
(hemoglobin A1c) of 7% or less. Glycemic control decreases
the likelihood of long-term complications in patients with.
Insulin is administered as two or more injections per day or
as continuous subcutaneous infusion using a portable insulin
pump.
• No matter which method of insulin
replacement is used, normal pattern cannot be
duplicated. Subcutaneous injection results in
absorption of the drug into the general
circulation, thus reducing the concentrations of
insulin to which the liver is exposed.

Insulin Preparations
• Insulin is available in highly purified pork preparations

and in human insulin biosynthesized by and extracted
from bacterial or yeast cultures. Most clinicians suggest
human insulin as the treatment of choice. Insulin is
available in rapid-, intermediate-, and long-acting
preparations, and all are packaged in the strength of 100
units/ml. Some insulins are available as premixed
insulins, such as 70/30 and 50/50 ratios, the first number
indicating the percentage of intermediate-acting insulin
and the second number the percentage of rapid-acting
insulin.
Dosage
• Conventional management has consisted of a

twice-daily insulin regimen of a combination of
rapid-acting and intermediate acting insulin drawn
up into the same syringe and injected before
breakfast and before the evening meal. The amount
of morning regular insulin is determined by
patterns in the late morning and lunchtime blood
glucose values. The morning intermediate-acting
dosage is determined by patterns in the late
afternoon and supper blood glucose values.
Dosage
• Fasting blood glucose patterns at breakfast

help determine the evening dose of
intermediate insulin, and the blood glucose
patterns at bedtime help determine the evening
dose of rapid-acting (regular) insulin. For
some children, better morning glucose control
is achieved by a later (bedtime) injection of
intermediate-acting insulin.

Dosage
• Regular insulin is best administered at least 30 minutes

before meals. This allows sufficient time for absorption
and results in a significantly greater reduction in the
postprandial rise in blood glucose than if the meal were
eaten immediately after the insulin injection. Intensive
therapy consists of multiple injections throughout the day
with a once- or twice-daily dose of long-acting insulin to
simulate the basal insulin secretion and injections of
rapid-acting insulin before each meal. A multiple daily
injection program reduces microvascular complications of
diabetes in young, healthy patients who have type 1 DM.
Methods of Administration.
• Daily insulin is administered subcutaneously by

twice-daily injections, by multiple-dose injections, or
by means of an insulin infusion pump. The insulin
pump is an electromechanical device designed to
deliver fixed amounts of regular or lispro insulin
continuously (basal rate), thereby more closely
imitating the release of the hormone by the islet cells.
Although the pump delivers a programmed amount
of basal insulin, the child or parent must program a
dose for the pump to deliver before each meal.

• The system consists of a syringe to hold the
insulin, a plunger, and a computerized mechanism
to drive the plunger. The insulin flows from the
syringe through a catheter to a needle inserted into
subcutaneous tissue (the abdomen or thigh), and
the lightweight device is worn on a belt or a
shoulder holster. The needle and catheter are
changed every 48 to 72 hours by the child or
parent using aseptic technique and then taped in
place.
• Although the pump provides more consistent insulin
delivery, it has certain disadvantages. Pump therapy is
expensive and requires commitment from the parent and
child. A certain level of math skills is required to
calculate infusion rates. It should also not be removed for
more than 1 hour at a time, which may limit some
activities. Skin infections are common, and as with any
other mechanical device, it is subject to malfunction.
However, the pumps are equipped with alarms that signal
problems, such as a depleted battery, an occluded needle
or tubing, or a microprocessor malfunction.
TYPES OF INSULIN
• There are four types of insulin, based on the

following criteria:
• How soon the insulin starts working (onset)
• When the insulin works the hardest (peak time)
• How long the insulin lasts in the body (duration).
However, each person responds to insulin in his or
her own way. That is why onset, peak time, and
duration are given as ranges.

• Rapid-acting insulin (e.g., NovoLog) reaches
the blood within 15 minutes after injection.
The insulin peaks 30 to 90 minutes later and
may last as long as 5 hours.
• Short-acting (regular) insulin (e.g., Novolin
R) usually reaches the blood within 30 minutes
after injection. The insulin peaks 2 to 4 hours
later and stays in the blood for about 4 to 8
hours.
• Intermediate-acting insulins (e.g., Novolin
N) reach the blood 2 to 6 hours after injection.
The insulins peak 4 to 14 hours later and stay
in the blood for about 14 to 20 hours.
• Long-acting insulin (e.g., Lantus) takes 6 to
14 hours to start working. It has no peak or a
very small peak 10 to 16 hours after injection.
The insulin stays in the blood between 20 and
24 hours
Monitoring
• Daily monitoring of blood glucose levels is an essential

aspect of appropriate DM management.
Blood Glucose. Self-monitoring of blood glucose
(SMBG) has improved diabetes management and is
used successfully by children from the onset of their
diabetes. By testing their own blood, children are able
to change their insulin regimen to maintain their
glucose level in the euglycemic (normal) range of 80 to
120 mg/dl. Diabetes management depends to a great
extent on SMBG. In general, children tolerate the
testing well
Monitoring
• Glycosylated Hemoglobin. The measurement of glycosylated

hemoglobin (Hb A1c) levels is a satisfactory method for
assessing control of the diabetes. As red blood cells circulate
in the bloodstream, glucose molecules gradually attach to the
hemoglobin A molecules and remain there for the lifetime of
the red blood cell, approximately 120 days. The attachment is
not reversible; therefore, this glycosylated hemoglobin
reflects the average blood glucose levels over the previous 2
to 3 months. The test is a satisfactory method for assessing
control, detecting incorrect testing, monitoring the
effectiveness of changes in treatment, defining patients’ goals,
and detecting nonadherence.
Pain
• Pain in primary care

• Painful and invasive procedures
• Postoperative pain
• Burn pain
• Recurrent headaches
• Recurrent abdominal pain
• Pain with sickle cell disease
• Cancer pain
Pain management in children
• Unrelieved pain may lead to potential long-

term physiologic, psychosocial, and behavioral
consequences. Management of pain should be
a priority for all clinicians.
• Oftentimes medications such as non-steroidal

anti-inflammatory drugs (NSAIDs),
acetaminophen, or opiates are used to manage
the pain.
• PHARMACOLOGIC MANAGEMENT
 For mild pain or moderate pain (Tylenol,
paracetamol) and (NSAIDs) are suitable.
 For moderate (5 to 6) to severe pain (7 to 10 on 0
to 10 scale), opioids are needed. A combination
(acetaminophen with codeine) works better in some
cases because nonopioids act at the peripheral
nervous system, and opioids act at the CNS
 Morphine is considered the gold standard for the
management of severe pain
• PHARMACOLOGIC MANAGEMENT
Patient-Controlled Analgesia
Epidural Analgesia
Transmucosal and Transdermal Analgesia

• Non Pharmacological approaches

o Distracting the child
o Massages
o Heat/Cold Therapy
o Exercise
o Quality Sleep

Common concern/complications of drug therapy
• Digestive system disturbance

• Allergic reactions
• Severe aches and pains
• Heart problems

Conversions:
• 1 liter (L) = 1000 ml (milliters)
• 1 kg (kilogram) = 2.2 lbs
• 1 gram (g) = 1000 mgs (pounds)
(milligrams) • 16 ounces (ozs) = 1 lb (pound)
• 1 mg (milligrams) = 1000 mcgs • 1 cup = 8 ounces (ozs)

(micrograms)
• 1 ml (milliter) = 20 drops
• 1 ounce (oz) = 30 ml (milliters)
• 1 drop (gtt) = 0.05ml
• 1 tsp (teaspoon) = 5 ml (milliters)
• 1 inch = 2.54 cm (centimeters)
• 1 tbs (tablespoon) = 15 ml
(milliters)

Pharmacological Care Aspects While Dealing With Paediatric Patients-1

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pharmacological Care Aspects While Dealing With Paediatric Patients-1

Uploaded by

Copyright:

Available Formats

Unit3

Thursday, February 29, 2024 1

Thursday, February 29, 2024 5

Thursday, February 29, 2024 6

This formula was designed to help the healthcare

BSA= Height(cm) x weight(kg)

Thursday, February 29, 2024 9

• In a pediatric patient the head comprises a

Thursday, February 29, 2024 12

Thursday, February 29, 2024 13

Process that moves a drug from the site where it is

• IV medications bypass the absorption process by

• Oral medications absorbed in digestive system

• Topical absorbed through the skin

• Process that chemically changes the drug in

Thursday, February 29, 2024 15

• Process that moves the drug from the

Thursday, February 29, 2024 16

Process where the drug leaves the body

• Factors related to growth and maturation

Thursday, February 29, 2024 18

Nursing care involves the same objectives as for

Thursday, February 29, 2024 25

• Insulin is available in highly purified pork preparations

• Conventional management has consisted of a

• Fasting blood glucose patterns at breakfast

Thursday, February 29, 2024 28

• Regular insulin is best administered at least 30 minutes

• Daily insulin is administered subcutaneously by

Thursday, February 29, 2024 30

• There are four types of insulin, based on the

Thursday, February 29, 2024 35

• Daily monitoring of blood glucose levels is an essential

• Glycosylated Hemoglobin. The measurement of glycosylated

• Pain in primary care

• Unrelieved pain may lead to potential long-

• Oftentimes medications such as non-steroidal

Thursday, February 29, 2024 44

• Non Pharmacological approaches

Thursday, February 29, 2024 45

• Digestive system disturbance

Thursday, February 29, 2024 46

• 1 mg (milligrams) = 1000 mcgs • 1 cup = 8 ounces (ozs)

You might also like