Pediatric Basics

Question 1

Ten Rights of Medication Administration

Answer 1

• right patient
• right drug
• right dose
• right time
• right route
• right documentation
• right assessment
• right evaluation
• right education
• right to refuse medication

Question 2

what is the most reliable source for administering medications to child?

Answer 2

parents

Question 3

what is the preferred route for administering medications to children?

Answer 3

• oral
  
  • most meds are dissolved and suspended in liquid preparations

Question 4

caution regarding oral medication administration

Answer 4

• many peds meds are given by drops or dropper
  
  • many droppers are marked in tenths of mLs
  • a good way to avoid error is to demonstrate the technique and mark device for administration

Question 5

what to be cautious of with a G button?

Answer 5

have to watch for granulation/scar tissue is not forming/blocking the stoma

Question 6

what type of water should be used to flush a gastrostomy tube?

Answer 6

tap water

Question 7

what are the drug dosage usually calculated in?

Answer 7

mg/kg

Question 8

what difference with a safe dose range is okay with pediatrics?

Answer 8

+/- 10%

Question 9

body water content for:

premature infant

newborn infant

one year old

>2 yo

Answer 9

90%

70-80%

64%

60%

Question 10

what are the ratios of % of ECF to % cellular premature infants?

Answer 10

65% to 25%

Question 11

what are the ratios of % of ECF to % cellular for newborns?

Answer 11

40-45% vs 30-35%

Question 12

what are the ratios of % of ECF to % cellular for 1 yo?

Answer 12

24% vs 40%

Question 13

what are the ratios of % of ECF to % cellular for >2 yo?

Answer 13

20% vs 40%

Question 14

what are infants and small children more vulnerable to rapid fluid and electrolyte imbalance?

Answer 14

• greater body surface area
• inc metabolic rate: so inc RR, inc HR
• proportionately infants have a smaller body water reserve
• body surface area is greater so insensible loss is greater
• b/c of higher metabolic rate, there are more waste products ot excrete

Question 15

fluid maintenance requirements

Answer 15

• 0-10 kg: 100 mL/kg/24 hr
• 11-20 kg: 1000 mL + (50 * kg >10 kg)
• 21-70 kg: 1500 mL + (20 * kg >20 kg)

Question 16

what are the reasons for the majority of fluid and electrolyte imbalances in children?

Answer 16

• secondary to vomiting and diarrhea

Question 17

dehydration

Answer 17

• occurs when body fluids are lost in excess of gains
  
  • most worried about sodium levels
• common alterations due to:
  
  • GI tract
  • skin–burns
  • metabolism
  • lungs

Question 18

isotonic dehydration

Answer 18

• proportional losses of fluid and electrolytes
  
  • Na is b/w 130-150
  • observable losses may bot be isotonic, but other avenues make adjustments
  • net loss is isotonic
  • greatest loss from ECF–>shock is greatest concern

Question 19

hypotonic dehydration

Answer 19

• losses of electrolytes exceed fluid
  
  • Na < 130
  • ICF is more concentrated than the ECF, so water moves in and cells expand
  • greater loss from ECF–>shock is a problem–>inc HR and dec BP

Question 20

hypertonic dehydration

Answer 20

• losses of fluids excess electrolytes
  
  • Na > 150
  • most dangerous and requires more specific tx
  • ECF is more concentrated, so water moves there from ICF and cells shrink
    
    • so shock less apparent, b/c water moving to ECF and wouldn’t see a drop in BP
  • seizures are more likely b/c of the shrinking cells

Question 21

assessment of level of dehydration

Answer 21

• assess systemic perfusion
  
  • S/S of poor perfusion include:
    
    • HR inc initially then dec
    • cool extremities
    • cap refill >2 sec
    • weak peripheral pulses
    • mucous membranes pale and dry
    • urine output dec
    • BP normal then postural dec

Question 22

what are significant weight changes for:

infants?

children?

adolescents?

Answer 22

• infants: 50 g in 24 hr
• child: 200 g in 24 hr
• adolescent: 500 g in 24 hr
  
  • concerned about both inc and dec in weight

Question 23

what age can you start using tears as an indication of hydration status?

Answer 23

2-3 mos

Question 24

where is the best place to assess skin turgor on an infant?

Answer 24

thigh or abdomen

Question 25

when do the fontanels close?

Answer 25

* posterior: 2 mos * anterior: 18 mos

Question 26

what are the appropriate urine volume parameters for pediatrics?

Answer 26

1 mL/kg/hour

Question 27

what is normal urine specific gravity in children?

Answer 27

1.005-1.020

Question 28

what are the normal serum carbon dioxide balance in: premies? newborns? infant/child?

Answer 28

* premie: 14-27 * newborn: 13-22 * infant/child: 20-28

Question 29

what can you assess to determine hydration status and fluid/electrolyte balance?

Answer 29

* ask about vomiting, diarrhea * type, freq, amt of food given * urinating pattern * any weight loss or gain * fever? evidence of infection? * V/S: temp, HR, RR, BP * skin assessment * anterior fontanel and eyes * I&O * urine specific gravity * labs: urine and serum electrolytes, SG, ABGs, EKG

Question 30

weight loss indicating mild dehydration in infants and children

Answer 30

* infants: 3-5% weight loss * children: 3-4% weight loss

Question 31

weight loss indicating moderate dehydration in infants and children

Answer 31

* infants: 6-9% weight loss * children: 6-8% weight loss

Question 32

weight loss indicating severe dehydration in infants and children

Answer 32

* infants: \> or equal to 10% weight loss * children: 10% or greater weight loss

Question 33

how to assess how much weight loss the child experienced due to dehydration?

Answer 33

* pre illness weight minus post illness = difference * (difference divided by preillness weight)\*100=percent weight loss

Question 34

goals of rehydration

Answer 34

* maintain intravascular volume and systemic perfusion * replace volume deficit and ongoing losses * continue to provide maintenance fluid requirements * IV fluids for children with severe fluid volume deficit is initiated to restore first--\>will expand extracellular volume

Question 35

what route will we use to give meds/fluids if the child is extremely dehydrated or if veins are non-accessible?

Answer 35

intra-osseous route

Question 36

fluid replacement in hypotonic vs isotonic vs hypertonic dehydration

Answer 36

* fluid replacement is RAPID during isotonic or hypotonic dehydration * b/c of the signs of shock and low BP with high HR * rapid replacement is CONTRAINDICATED in hypertonic dehydration b/c of the risk of water intoxication

Question 37

oral rehydration solution (ORS)

Answer 37

* used for children who have intact suck and swallow, no change in LOC, and not in shock * pedialyte is most often used * mild dehydration: give 50 mL/kg of the ORS over 4 hours * moderate dehydration: give 100 mL/kg of the ORS over 6 hours

Question 38

can we allow breast feeding to continue if a child is dehydrated?

Answer 38

* as long as suck and swallow is intact and LOC is unchanged * breast feeding can continue ad lib

Question 39

what body system are we concerned about if the child is experiencing fluid volume excess or deficit?

Answer 39

CNS

Question 40

if question asks: if a newborn weighs 2.6 kg and is admitted to the hospital, and the doctor orders similac with iron at 20 cal/oz, and the infant requires 120 cal/kg to grow, how many oz oc the similac ordered will the infant need to ingest in order to maintain his weight?

Answer 40

* newborn's weight in kg \* required cal/kg * 2.6 kg \* 120 cal/kg=312 cal/24 hours * (1 oz/20 cal)\*312 cal=15.6 or 16 oz/day