Drug Therapy in Pediatric Patients PDF

SLIDES Ms.Virgina Varghese PREPARED BY Ms. Reshma P S PRESENTER COLLEGE / COHS CENTRE NURSING PROGRAM SEMESTER FALL 2024-2025 Drug therapy in Pediatric patient 1 Course Outcomes (From Course Specifications) A1...

SLIDES Ms.Virgina Varghese PREPARED BY Ms. Reshma P S PRESENTER COLLEGE / COHS CENTRE NURSING PROGRAM SEMESTER FALL 2024-2025 Drug therapy in Pediatric patient 1 Course Outcomes (From Course Specifications) A1 Describe the general principles of pharmacotherapeutic, pharmacokinetics, and pharmacodynamics in wellness promotion and illness prevention and treatment. A2 Explain principles of safe administration of medications B1 Demonstrate proficiency in applying the 10 rights of medication administration during the preparation and administration of medication therapy. B2 Apply the methods of healthcare documentation and professional communication related to medication therapy C1 Analyze the legal and ethical parameters of medication administration √ C2 Utilize the nursing process and teaching-learning principles in health promotion, self-care and management to assess, plan, set goals and administer medications to diverse individuals across the lifespan with basic pharmacological needs. D1 Demonstrate continued ability to calculate drug dosages safely and use of terminology associated with pharmacology D2 Generate a positive and flexible approach to lifelong learning 2 Drug therapy in Pediatric patient Introduction Pediatrics covers all patients up to the age of 16. Because of ongoing growth and development, pediatric patients in different age groups present different therapeutic challenges. Traditionally, the pediatric population is subdivided into six groups: Premature infants (less than 36 weeks' gestational age) Full-term infants (36 to 40 weeks' gestational age) Neonates (first 4 postnatal weeks) Infants (weeks 5 to 52 postnatal) Children (1 to 12 years) Adolescents (12 to 16 years) Pharmacokinetic Differences in the Pediatric Client ABSORPTION Reduced gastric acidity because the gastric acid-producing cells in the stomach are immature until the age of 3. As a result, medications, such as enteric-coated tablets, may pass through the digestive tract unchanged. Gastric emptying is slower, because peristalsis is irregular. The gastrointestinal tract is longer proportionately to total body size. Topical absorption is faster because of thinner skin and disproportionate skin surface area. Intramuscular absorption is more difficult to anticipate, this can lead to variations in vasodilation and vasoconstriction, resulting in altered absorption. DISTRIBUTION Total body water (TBW) content is much greater therefore, children require higher doses per kilogram of weight of water- soluble medications than do older clients. Total body fat content is less, fat-soluble medications must be varied to achieve desired effects. Protein binding is decreased because of liver immaturity, resulting in reduced production of protein. The blood-brain barrier is immature, leading more drugs to enter the brain. BIOTRANSFORMATION (METABOLISM) The levels of enzymes are decreased because of the immaturity of the liver. Children (aged 2–6 years) have higher metabolic rates and, thus, may require higher levels of medication, especially older children, whose livers have established microsomal enzymes. Many variables affect metabolism of drugs, including the status of the liver enzymes used to break down chemicals, genetic differences, and maternal exposure to potentially harmful substances during pregnancy. ELIMINATION Glomerular filtration rate is approximately 30%–50% less than an adult because of immaturity of the kidneys. Tubular secretion and reabsorption are decreased, due to renal immaturity. Perfusion to the kidneys is decreased, resulting in immature glomeruli, immature renal tubules, and a shorter loop of Henle. Urine pH is lower and the capacity to concentrate urine is less, which results in medications circulating longer and having the potential of reaching toxic blood levels Pediatric Drug Sensitivity Neonates and infants, are more sensitive to the effects of drugs because of the immaturity of their organ systems. For example, many drugs that affect the central nervous system (barbiturates and morphine) produce exaggerated depressant effects in neonates and infants. Body temperature control also may be disrupted by many drugs in infants and young children, because of the immaturity of the temperature regulatory system. Salicylates and acetaminophen reduce fever when administered at therapeutic doses, but may cause hyperthermia when an overdose is given General anesthetics, diuretics, and antihypertensive drugs may adversely affect the immature cardiovascular system. DOSAGE DETERMINATION The method of conversion employed most commonly is based on body surface area: Approximate child's dose = Body surface area of the child × Adults dose 1.73 m2 ADVERSE DRUG REACTIONS Pediatric patients are subject to adverse reactions when drug levels rise too high related to organ system immaturity and to ongoing growth and development ex:discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides) should be avoided in patients whose age puts them at risk. PROMOTING ADHERENCE Selecting the most convenient dosage form and dosing schedule, Suggesting mixing oral drugs with food or juice (when allowed) to improve palatability, Providing a calibrated medicine spoon or syringe for measuring liquid formulations, and Taking extra time with young or disadvantaged parents to help ensure conscientious and skilled participation. NURSING CARE FOR CHILDREN RECEIVING MEDICATIONS Assessment Obtain baseline data on vital signs, height in centimeters, and weight in kilograms. Take a medication history from the caregiver including any history of allergy. Nursing Diagnoses Including but not limited to: Risk of injury related to administration of medications Risk of injury related to adverse effects of medications Risk of injury related to idiosyncratic reactions due to altered metabolism and excretion secondary to young age Risk of poisoning related to medicines stored in unlocked cabinets accessible to children Risk of altered nutrition related to medication therapy Deficient knowledge related to medications, safe doses, adverse effects of medications Planning/Goals Client takes or receives medications safely without injury or poisoning. Client is free of complications associated with the adverse effects of medications. Client does not experience nausea, vomiting, weight loss, or decrease in food or fluid intake during medications Client (or parents) verbalize understanding of precautions, medication administration, adverse effects, and when to contact physician Implementation Administration of Oral Medications to Children 1. The child’s developmental stage and the type of medication are important factors to consider in administering oral medications. 2. With some exceptions, tablets may be crushed and capsules opened and the powder mixed with a sweet syrup. 3. The use of ice before taking bitter medication or using a straw may decrease taste sensation. 4. Liquid medications may be administered using a small spoon, dropper, or syringe without a needle. Administration of Parenteral Medications to Children 1. Always explain the procedure well and have parents provide support when possible. 2. Provide sufficient, appropriate restraint to ensure the child’s safety. 3. In children under 3 years, the preferred site is the vastus lateralis muscle. 4. The deltoid muscle is not fully developed until adolescence and is not used as a site in children under 18 months. 5. The length of needle selected for a subcutaneous injection ranges from 3⁄8 to 5⁄8 inch, depending on the child’s age and subcutaneous tissue. 6. Intravenous sites should be selected so that the child’s activity is not limited. 7. Electronic infusion devices are often used to ensure accurate administration of intravenous fluids. Keep the controls away from the child. 8. Rectal medications are usually administered by suppository Guidelines for the Administration of Medications to Children Consent must be obtained from caregiver(s) before medication administration Establish a trusting relationship with the child. Praise children for their cooperation Obtain information from the caregiver(s) about family and personal history of allergy, how the child usually takes medications, liquids the child likes, and the child’s preferred name. Never tell children the medication is candy or deceive them about what they are taking Use a kind but firm approach to the child Teaching Children About Drug Therapy 1. Readiness to learn is a critical factor in initiating teaching. 2. Teaching must be geared to the developmental level of the child. This requires that the nurse gauge the child’s mastery of language and ability to deal with ideas conceptually. 3. Find out what the child knows and believes about his/her illness and its treatment. Correct misconceptions. 4. Children generally have short attention spans, 1 to 5 minutes per year of development, so instruction and explanations must be provided in brief segments. 5. Make use of role playing and visual aids the child can handle. 6. Instructional booklets geared to the child’s level of understanding may be useful teaching tools. Always remember to review these booklets with the child. Evaluation The nurse should discuss evidence of therapeutic effectiveness (e.g., decrease in body temperature, side effects, and adverse effects) with the prescriber such as: no injury related to medication administration. improvement in condition related to successful medication therapy. no evidence of complications associated with the adverse effects of medications. experienced no weight loss or decrease in food or fluid intake during medications. Client (or parents) could repeat the importance of taking medications as prescribed, an understanding of precautions, medication administration, adverse effects, and when to contact physician Accidental Poisonings 1. Nurses should provide instruction in the prevention and immediate treatment of common poisonings. 2. Syrup of ipecac should be available in all homes where children spend time. 3. After ingesting a poison, vomiting is not induced if the child is comatose, if the poison is a corrosive, or if it is a petroleum product  References Broyles, B., Reiss, B., & Evans, M. (2012). Pharmacological aspects of nursing care. Nelson Education. Berman, A., Snyder, S. J., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., & Park, T. (2010). Kozier and Erb's fundamentals of nursing (Vol. 1). Pearson Australia. Lehne, R. A. (2013). Pharmacology for nursing care. Elsevier Health Sciences. Thank You 21 21