January 26, 2022 • 13 mins
Things nurses should consider when administering medications to pediatric populations.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:05):
Hey, and welcome to nursing with Dr. Hobbick. It's
Wednesday night, and I amthinking about medications and
special populations for nursesto take care of I'm thinking
about pediatric populations. Solet's talk about some of the
considerations that we have forthese folks, as nurses. Last
(00:26):
week, we talked aboutpharmacokinetics
pharmacodynamics. And when we'rethinking about pediatrics, we
need to think about theseconcepts. These can be different
for children, the younger theyare, the more different they
might be processes that canaffect the absorption,
distribution, metabolism andexcretion of medications. The
(00:47):
first thing I want to talk aboutis the fact that for pediatric
medications, there's verylimited research. Now, as you
imagine, part of that is becauseparents may be reluctant to go
ahead and give informed consentfor their child to participate
in a medication trial. Anotherreason is because well, frankly,
(01:08):
there's not a very big marketshare for pediatric medications.
As a result, only about half ofall medications carry FDA
approval. This really limits theknowledge that we have about
pediatric medications andsometimes medications may be
prescribed based on smallstudies based on adult studies,
(01:30):
or based on studies done withhealthy children rather than
children with the condition thatis being treated. Of course, we
have drug dosages that could bedifferent for children than they
are for adults. Something elsewe need to make sure that we
have educated on his units ofmeasure, it's best to use a very
(01:50):
accurate unit of measure, wewant to make sure that parents
or caregivers are able toaccurately measure medications,
things like educating them onusing a oral syringe, or how to
use the medicine cup that comeswith a medication, educating
them on units of measureconversions. So understanding
(02:11):
that we should use millilitersinstead of teaspoons or
tablespoons. We always want tomake sure that we use the
smallest size syringe. Typicallywhen we are fearing dosage
calculations for adults, we willround our response are answers
to the nearest 10th. Forpediatrics, we typically round
to the nearest 100. Forpediatric patients, we may need
(02:34):
to rely on other measures ofverifying identification.
Children very young children whoaren't able to speak may not be
able to verify their name, dateof birth, they may not many
children may not know theirmedications or allergies. And
the most important thing aboutpediatric medications is that we
monitor for therapeutic effectand adverse effects. We really
(02:59):
want to monitor closely for thatbecause with the differences in
organ function in body surfacearea in digestion, excetera we
may not have exact dosing, andso the dosing is based on what
we think might be the safest,but that may not get us over
(03:20):
that minimum effectiveconcentration. And we want to
make sure that we're monitoringfor those adverse effects. It
may be very difficult as a nurseto monitor for adverse effects,
we may not see the child veryoften. And so we need to lean on
the caregivers or parents tonotify us of anything that seems
different any behavioral changesthat may have resulted from a
(03:44):
subjective symptoms such asnausea, or tinnitus, we won't
necessarily be able to see thosethings and a child who's not
able to make their needs known,won't be able to tell us
thinking about absorption as faras our pharmacokinetics and
children. Obviously their age issomething we need to think
about. newborns have some organfunctions that are not mature.
(04:07):
And this can change the way thatthey absorb medications, their
health status. Obviously, theroute of administration that we
choose oral is still thepreferred route whenever we can
nutritional habits, hormonaldifferences when thinking about
adolescents at this point canalter the way medications are
absorbed, hydration status, anykind of Gi disorders. Gastric
(04:30):
acidity is lower in newborns andinfants than in adults and so
may lend itself more to theabsorption of alkaline or basic
medications versus acidicmedications. gastric emptying,
and motility is a little bitslower in infants and chest fed
infants have a little bit fastergastric emptying than formula
(04:53):
fed infants the lack ofintestinal flora in newborns,
enzyme levels are low in newnewborns, there is a smaller
amount of surface area in theintestines for absorption. The
younger the child is very youngchildren, especially newborns
and infants have higher bodywater than adults do, which can
(05:15):
affect water solublemedications. They have less body
fat, which will affect lipidsoluble medications. neonates
and infants have less proteinand they have fewer protein
binding sites. If the child hasjaundice, that means they have
more bilirubin in theirbloodstream and that bilirubin
can actually bind to thoseprotein sites, meaning there's
(05:37):
even fewer protein sites. And ifyou remember from last week,
that means that there may bemore free medication available
that can have an effect on thepatient. Rather than being bound
to that protein. The blood brainbarrier is also immature and
medications may be able to passacross that barrier and into the
(05:57):
central nervous system, hepaticblood flow and drug metabolizing
enzymes are low in infants,which means that they may not be
able to metabolize medicationsas quickly, this might lead to a
longer half life or a longerduration of those medications.
And infants have immaturekidneys, they may have a lower
(06:19):
rate of excretion, than adultsdo. Now, these changes, these
differences get less as thechildren age. But it's something
to consider this will affect theonset, peak and duration of the
medication. Careful monitoringof that therapeutic effect and
adverse effects is vital for thepediatric population.
(06:42):
Medications for children aretypically dosed based on weight
or body surface area, when we docalculations, they need to be
checked with another RN. Thatdoesn't mean you go to the other
RN and you say, Here's mycalculation, here's my answer.
You give them the sameinformation and allow them to
come to their own conclusion.
And then you compare theresponses, your answers to make
(07:04):
sure that you're both on thesame page. When we're
administering medications tochildren, you're obviously going
to think about how old the childis how developed they are, how
you're going to be able toexplain to them what you're
going to do. It's important toalways be honest, to always
include that child in thediscussion. Unless they're a
(07:26):
newborn, you want to engage themin what's going to happen. If
it's a toddler, considerimaginative play if they have a
lovey or a stuffed animal, youmight show them how you're going
to administer the medication ona stuffed animal, preschool aged
children, it's good to give themchoices if you can. So would you
(07:47):
like your shot on this side orthis side, we're not going to
offer them the choice of gettingthe medication or not, but we
might give them some form ofcontrol. With school age,
children may have some fears ofbodily injury, so you'll want to
be honest with them. Never lieto a child, never try to
administer an injection orsomething while they're
(08:08):
sleeping. We really want to tryto make them as comfortable as
possible. Make them feel as safeas we can. If we can involve the
caregiver or the parent in thatmedication administration.
That's great. If the parentdoesn't want to be a part of it.
That's okay too. Sometimes wecan alleviate some of the
(08:29):
anxiety though by having thechild sitting on the parent's
lap. Distraction can be helpfulwith children, especially school
aged children, my my owndaughter when she got her COVID
vaccine, I had her tell theperson who was administering it
her favorite joke, which is didyou hear the joke about the
(08:49):
water buffalo with no ears?
Well, neither did he. That's herjob. We can use relaxation,
creative imagery, evenimaginative play to distract
children from pain or anxiety.
When we're giving oralmedications, it may be
appropriate to crush themedication and put it in
something. Remember from ourprevious talks that you can't
(09:11):
crush something that is entericcoated, or extended release or
delayed release. You always wantto check with your pharmacist if
you have one available to see ifyou can mix a crushed medication
with certain foods. If it'sappropriate, you could mix it
with chocolate syrup with jam orjelly with applesauce with
pudding. Again, making sure thatit's compatible before you do so
(09:35):
that it's something that you cancrush and you could use honey
but make sure that you avoidthat in children under one year
of age or who may beimmunocompromised, intravenous
sites we have to protect becausechildren may be curious or they
may, you know want to removethis thing that is bothering
them. Or in the case ofnewborns, they move around a lot
(09:56):
we want to make sure that weprotect that IV site, so it can
be hard to access IVs on them,we want to make sure that we
keep that one safe. We may evenhave some numbing spray or vapor
coolant spray that we can applybefore we give an injection to
decrease pain stimulus when wedo the actual medication
(10:18):
administration. I know I saidthis before, but the most
important thing is to berespectful, to be honest, to
explain as best you can at anappropriate level for the child
and to use the least amount ofrestraint possible. Now,
adolescents may still be in aconcrete thought process, they
may not really think aboutfuture consequences as much. So
(10:43):
when we're thinking abouttalking to them about medication
regimens, and the importance ofthem, telling them avoiding a
future health problem is notgoing to be something that sits
well in their mind, they'rereally not going to think about
it, they still have that kind ofsuperhero complex, nothing bad
is going to happen to me. Wewant to make sure that we
address their if they have achronic condition in the
(11:06):
dementia medication regimen inan every day act that they enjoy
something like keeping on normalblood sugar in order to be able
to participate in sports.
Finally, the last importantpiece is to always involve the
family or caregiver. Childrencannot administer their own
(11:26):
medications all of the time. Sowe want to make sure that that
parent, caregiver, whoever it isthat's with the child is going
to be taken care of them,understands the medication
administration understands thedosing the frequency,
understands how to safelyadminister the medication, and
is able to help the child withit knows what to report to the
(11:48):
provider as far as adverseeffects and what kind of
therapeutic effects to look for.
That's all there is for today onnursing with Dr. Hobbick. Thanks
for joining me here and nexttime we'll talk about geriatric
considerations and medicationadministration for nurses
Hey, and welcome to nursing with Dr. Hobbick. It's
Wednesday night, and I amthinking about medications and
special populations for nursesto take care of I'm thinking
about pediatric populations. Solet's talk about some of the
considerations that we have forthese folks, as nurses. Last
(00:26):
week, we talked aboutpharmacokinetics
pharmacodynamics. And when we'rethinking about pediatrics, we
need to think about theseconcepts. These can be different
for children, the younger theyare, the more different they
might be processes that canaffect the absorption,
distribution, metabolism andexcretion of medications. The
(00:47):
first thing I want to talk aboutis the fact that for pediatric
medications, there's verylimited research. Now, as you
imagine, part of that is becauseparents may be reluctant to go
ahead and give informed consentfor their child to participate
in a medication trial. Anotherreason is because well, frankly,
(01:08):
there's not a very big marketshare for pediatric medications.
As a result, only about half ofall medications carry FDA
approval. This really limits theknowledge that we have about
pediatric medications andsometimes medications may be
prescribed based on smallstudies based on adult studies,
(01:30):
or based on studies done withhealthy children rather than
children with the condition thatis being treated. Of course, we
have drug dosages that could bedifferent for children than they
are for adults. Something elsewe need to make sure that we
have educated on his units ofmeasure, it's best to use a very
(01:50):
accurate unit of measure, wewant to make sure that parents
or caregivers are able toaccurately measure medications,
things like educating them onusing a oral syringe, or how to
use the medicine cup that comeswith a medication, educating
them on units of measureconversions. So understanding
(02:11):
that we should use millilitersinstead of teaspoons or
tablespoons. We always want tomake sure that we use the
smallest size syringe. Typicallywhen we are fearing dosage
calculations for adults, we willround our response are answers
to the nearest 10th. Forpediatrics, we typically round
to the nearest 100. Forpediatric patients, we may need
(02:34):
to rely on other measures ofverifying identification.
Children very young children whoaren't able to speak may not be
able to verify their name, dateof birth, they may not many
children may not know theirmedications or allergies. And
the most important thing aboutpediatric medications is that we
monitor for therapeutic effectand adverse effects. We really
(02:59):
want to monitor closely for thatbecause with the differences in
organ function in body surfacearea in digestion, excetera we
may not have exact dosing, andso the dosing is based on what
we think might be the safest,but that may not get us over
(03:20):
that minimum effectiveconcentration. And we want to
make sure that we're monitoringfor those adverse effects. It
may be very difficult as a nurseto monitor for adverse effects,
we may not see the child veryoften. And so we need to lean on
the caregivers or parents tonotify us of anything that seems
different any behavioral changesthat may have resulted from a
(03:44):
subjective symptoms such asnausea, or tinnitus, we won't
necessarily be able to see thosethings and a child who's not
able to make their needs known,won't be able to tell us
thinking about absorption as faras our pharmacokinetics and
children. Obviously their age issomething we need to think
about. newborns have some organfunctions that are not mature.
(04:07):
And this can change the way thatthey absorb medications, their
health status. Obviously, theroute of administration that we
choose oral is still thepreferred route whenever we can
nutritional habits, hormonaldifferences when thinking about
adolescents at this point canalter the way medications are
absorbed, hydration status, anykind of Gi disorders. Gastric
(04:30):
acidity is lower in newborns andinfants than in adults and so
may lend itself more to theabsorption of alkaline or basic
medications versus acidicmedications. gastric emptying,
and motility is a little bitslower in infants and chest fed
infants have a little bit fastergastric emptying than formula
(04:53):
fed infants the lack ofintestinal flora in newborns,
enzyme levels are low in newnewborns, there is a smaller
amount of surface area in theintestines for absorption. The
younger the child is very youngchildren, especially newborns
and infants have higher bodywater than adults do, which can
(05:15):
affect water solublemedications. They have less body
fat, which will affect lipidsoluble medications. neonates
and infants have less proteinand they have fewer protein
binding sites. If the child hasjaundice, that means they have
more bilirubin in theirbloodstream and that bilirubin
can actually bind to thoseprotein sites, meaning there's
(05:37):
even fewer protein sites. And ifyou remember from last week,
that means that there may bemore free medication available
that can have an effect on thepatient. Rather than being bound
to that protein. The blood brainbarrier is also immature and
medications may be able to passacross that barrier and into the
(05:57):
central nervous system, hepaticblood flow and drug metabolizing
enzymes are low in infants,which means that they may not be
able to metabolize medicationsas quickly, this might lead to a
longer half life or a longerduration of those medications.
And infants have immaturekidneys, they may have a lower
(06:19):
rate of excretion, than adultsdo. Now, these changes, these
differences get less as thechildren age. But it's something
to consider this will affect theonset, peak and duration of the
medication. Careful monitoringof that therapeutic effect and
adverse effects is vital for thepediatric population.
(06:42):
Medications for children aretypically dosed based on weight
or body surface area, when we docalculations, they need to be
checked with another RN. Thatdoesn't mean you go to the other
RN and you say, Here's mycalculation, here's my answer.
You give them the sameinformation and allow them to
come to their own conclusion.
And then you compare theresponses, your answers to make
(07:04):
sure that you're both on thesame page. When we're
administering medications tochildren, you're obviously going
to think about how old the childis how developed they are, how
you're going to be able toexplain to them what you're
going to do. It's important toalways be honest, to always
include that child in thediscussion. Unless they're a
(07:26):
newborn, you want to engage themin what's going to happen. If
it's a toddler, considerimaginative play if they have a
lovey or a stuffed animal, youmight show them how you're going
to administer the medication ona stuffed animal, preschool aged
children, it's good to give themchoices if you can. So would you
(07:47):
like your shot on this side orthis side, we're not going to
offer them the choice of gettingthe medication or not, but we
might give them some form ofcontrol. With school age,
children may have some fears ofbodily injury, so you'll want to
be honest with them. Never lieto a child, never try to
administer an injection orsomething while they're
(08:08):
sleeping. We really want to tryto make them as comfortable as
possible. Make them feel as safeas we can. If we can involve the
caregiver or the parent in thatmedication administration.
That's great. If the parentdoesn't want to be a part of it.
That's okay too. Sometimes wecan alleviate some of the
(08:29):
anxiety though by having thechild sitting on the parent's
lap. Distraction can be helpfulwith children, especially school
aged children, my my owndaughter when she got her COVID
vaccine, I had her tell theperson who was administering it
her favorite joke, which is didyou hear the joke about the
(08:49):
water buffalo with no ears?
Well, neither did he. That's herjob. We can use relaxation,
creative imagery, evenimaginative play to distract
children from pain or anxiety.
When we're giving oralmedications, it may be
appropriate to crush themedication and put it in
something. Remember from ourprevious talks that you can't
(09:11):
crush something that is entericcoated, or extended release or
delayed release. You always wantto check with your pharmacist if
you have one available to see ifyou can mix a crushed medication
with certain foods. If it'sappropriate, you could mix it
with chocolate syrup with jam orjelly with applesauce with
pudding. Again, making sure thatit's compatible before you do so
(09:35):
that it's something that you cancrush and you could use honey
but make sure that you avoidthat in children under one year
of age or who may beimmunocompromised, intravenous
sites we have to protect becausechildren may be curious or they
may, you know want to removethis thing that is bothering
them. Or in the case ofnewborns, they move around a lot
(09:56):
we want to make sure that weprotect that IV site, so it can
be hard to access IVs on them,we want to make sure that we
keep that one safe. We may evenhave some numbing spray or vapor
coolant spray that we can applybefore we give an injection to
decrease pain stimulus when wedo the actual medication
(10:18):
administration. I know I saidthis before, but the most
important thing is to berespectful, to be honest, to
explain as best you can at anappropriate level for the child
and to use the least amount ofrestraint possible. Now,
adolescents may still be in aconcrete thought process, they
may not really think aboutfuture consequences as much. So
(10:43):
when we're thinking abouttalking to them about medication
regimens, and the importance ofthem, telling them avoiding a
future health problem is notgoing to be something that sits
well in their mind, they'rereally not going to think about
it, they still have that kind ofsuperhero complex, nothing bad
is going to happen to me. Wewant to make sure that we
address their if they have achronic condition in the
(11:06):
dementia medication regimen inan every day act that they enjoy
something like keeping on normalblood sugar in order to be able
to participate in sports.
Finally, the last importantpiece is to always involve the
family or caregiver. Childrencannot administer their own
(11:26):
medications all of the time. Sowe want to make sure that that
parent, caregiver, whoever it isthat's with the child is going
to be taken care of them,understands the medication
administration understands thedosing the frequency,
understands how to safelyadminister the medication, and
is able to help the child withit knows what to report to the
(11:48):
provider as far as adverseeffects and what kind of
therapeutic effects to look for.
That's all there is for today onnursing with Dr. Hobbick. Thanks
for joining me here and nexttime we'll talk about geriatric
considerations and medicationadministration for nurses
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