Pediatric Medication Calculations

Presentation Transcript

Pediatric Medication Calculations UNRS 314 Jan Bazner-Chandler CPNP, CNS, MSN, RN

Review 1 teaspoon = 5 mL/cc 1 tablespoon = 15 mL/cc 1 ounce = 30 mL/cc Remember the clock! grains to grams to milligrams. The most effective method to figure drug dosage utilizing apportion/extent. 16 oz = 1 pound (body weight)

IV Fluid Calculation Adult (Review) Step # 1 Total number of milliliters requested = ml/hr number of hours to run Step # 2 Milliliters for every hour x tubing trickle figure = gtt/min Minutes

Pounds to Kilograms Pounds to kilograms = pounds 2.2 In pediatrics you have to complete to the hundredths (don't round particularly in the baby or little kid)

Kilogram Example 20 pounds 5 ounces First need to change over 5 ounces to a small amount of a pound 5 separated by 16 = 0.31 20.31 pounds isolated by 2.2 = 9.23 kilograms Notes medicine would be computed in view of 9.23 kilograms. Try not to ROUND to 9.2

New Calculations Mg/kg dosing in view of weight (kg) Safe dosing ranges IV pediatric imbuement rates IV organization of meds per volutrol or syringe pump. 24 hour liquid figuring

Calculations of pounds to kilograms If a youngster weighs 84 lbs, what is the weight in kg? 84lb : x kg 84 separated by 2.2 = 39.18 kg If a kid weights 6 lbs 6 ounces what is the weight in kg? 6 ounces = 0.37 pounds 16 ounces 6.37 pounds isolated by 2.89 = kg

Medication measurements For a dose of solution to be protected, it must fall inside the sheltered range as recorded in a Drug Handbook, PDR or other solid medication reference.

Dosage in light of mg/kg and Body Surface Area The measurements of most pediatrics medications depends on mg/kg body weight or Body Surface Area (BSA) in meters squared. For testing purposed mg/kg will be utilized. BSA technique for computations might be found in NICU, ICU and high sharpness zones.

Safe Medication Dose Calculate day by day measurement requested (Physician orders) Calculate the low and high parameters of safe range (from medication book) Compare the patient's every day dosage to the sheltered range to check whether it falls inside the protected zone.

Calculation A tyke is 2 years and weighs 36 lbs is accepting Amoxicillin 215 mg po tid for a reciprocal otitis media (ear contamination). Quiet weight in kg = 16.36 kg Davis medicate direct: PO (youngsters) < 40 kg: 6.7 to 13.3 mg/kg q 8 hours. (low range)16.36 x 6.7 = 109.6 mg q 8hours (high range)16.36 x 13.3 = 217.5 mg q 8 hours Safe range: 109.6 to 217.5 mg of Amoxicillin Q 8 hours. Is the measurement safe? Yes, it falls inside the sheltered range.

How much medicine do you give? Doctor arrange Amoxicillin 215 mg at regular intervals. Suspension comes 250 mg for every 5 ml. 250 mg 215 mg 5 ml = x ml 1075 250x Give 4.3 mL/cc po at regular intervals

Safe Dose Ranges Read the medicine runs painstakingly dosage run for 24 hours measurements run for q 8 hours measurements extend for q 12 hours

Fluid Control Crucial in the pediatric populace Units frequently have strategies that kids under a specific age are on a liquid control pump.

Key ideas Fluid over-burden must be dodged Time over which a pharmaceutical ought to be regulated is basic data Minimal weakening (end grouping of medicine) is imperative for prescriptions, for example, aminoglycosides. Gathering helpful blood levels

Fluid over-burden Know what the IV rate is. Hourly recording of IV liquid admission. Try not to attempt and get up to speed with liquids. Compute liquids used to control IV meds into the hourly liquid computations.

Daily Fluid Needs Fluid needs ought to be ascertained on each patient to guarantee that the baby/tyke is accepting the right measure of liquids. Standard recipe for pediatrics should be remembered.

IV liquid estimations The upkeep measurements for organization of IV liquids depends on the accompanying equation: 100 ml of liquid for the 1 st 10 kg of weight 50 ml of liquid for the 2 nd 10 kg of weight 20 ml of liquid for and extra kg You have to remember this

Practice issue Jose measures 16 pounds Weight in kg = 7.27 kg Using the recipe gave what number of mls of liquid would he require in 24 hours.

Fluid Calculation 7.27 kilograms 100 mL x 7.27 kg = 727 mL 727 mL/24 hours or 30 mL every hour

Fluid Calculation 64 pound youngster Convert pounds to kilograms = 29.09 kg Fluid estimations: 100 mL x 10 kg = 1000 mL 50 ml x 10 kg = 500 mL 20 ml x 9.09 kg = 181 mL 1681 mL/24 hours or 70 mL/hour

Fluid Calculations Fluid computations can be adjusted. You can't oversee a small amount of a mL. In youngster #1 the figured hourly rate of 29.7 would be adjusted to 30 mL/hour. In tyke #2 the figured hourly rate of 70.04 would be adjusted to 70 mL/hour.

Fluid Calculations Since kids are in the doctor's facility for different sicknesses they will frequently have expanded liquid needs: drying out, fever, retching, the runs, failure to take po liquids. 24 hour liquid estimations might be 1 ½ to 2 times upkeep.

Fluid Calculations Child number #1 support liquid needs are 713 mL/24 hours. 1 ½ time upkeep would be 713 x 1 ½ = 1069 mL/24 hours or 45 mL/hour.

Fluid Calculation In tyke # 2 upkeep liquid needs are 1681 mL/24 hours. 1 ½ times upkeep would be 1681 x 1 ½ = 2522 mL/24 hours or 105 mL/hour.

IV bolus A 6 year old with lack of hydration is admitted to your unit. The alluding healing facility has a grown-up IV set-up. (dribble element of 15 gtt/ml) The doctor request is to implant 90 mL of typical saline more than 60 minutes. At what rate will you set the IV rate? (90 ml x 15 gtts) separated by a hour Hourly rate would be 23 gtts/minute

IV Buretrol

IV Buretrol A buretrol or volutrol is an inline repository between the customer's IV catheter set and the sack of liquids. Limit is 120 to 150 mL Rationale: the medical caretaker can fill the buretrol to a specific level and if the IV pump glitches, just the volume in the buretrol will stream to the customer.

Syringe Pump

Parenteral Pediatric Medications Step 1: Convert lb to kg Step 2: Determine the protected range in mg/kg Step 3: Decide whether the dosage is sheltered by contrasting the request and safe measurement run Step 4. Compute the measurements required Step 5. Check reference for diluent and span for organization.

Example #1 Child: 5 years: weight 44 lbs Order: famotidine (Pepcid) 5 mg IV offer Drug direct: 0.25 mg/kg q 12 hr IV up to 40 mg/day.

Example #1 Convert pounds to kg: 44 lb = 20 kg Determine safe measurements: 20 kg x 0.25 mg = 5 mg 5 mg is protected it meets mg/kg run and does not surpass 40 mg/day. 5 mg offer = aggregate of 10 mg/day

Example #1 Calculate the dosage Pepcid is given as 10 mg/mL 10 mg = 5 mg 1 mL x mL 5 = 10x 0.5 mL of Pepcid

Example #1 Drug manage: weaken with 5 or 10 mL and inject more than 2 minutes. The medicine would be infused specifically into the tubing of effectively running IV; infuse gradually more than 1 to 2 minutes.

Example #2 Child: 4 years: weight 17 kg Physician arrange: Fortaz (Ceftazidime) 280 mg IV q 8 hours Drug manage: Safe measurements 30 to 50 mg/kg/day 50 mg/mL more than 30 minutes Drug provided as 1 gram powder. Headings: Dilute with 10 mL of sterile water to measure up to 95 mg/mL.

Example #2 Safe dosage is 30 to 50 mg/kg/day Low range: 17 kg x 30 mg = 510 mg/day High range: 17 kg x 50 mg = 859 mg/day Safe range is 510 to 859 mg/day or 170 to 286 for every measurement. On the off chance that the request is to give the medication q 8 hours you would need to isolate the sheltered range by 3 or various the q 8 hour measurement x 3.

Example #2 Drawing up the solution: 1 gram/10 mL or 95 mg/1 mL 95 mg = 280 mg 280 1 mL x mL 95x = 2.94 mL

Example # 2 Adding drug to the volutrol Take the 2.94 mL of Ceftazidine – infuse it into the port on the volutrol and add extra IV liquid to = 10 mL.

Example # 2 The flush: prove based practice has exhibited that with an end goal to get the IV pharmaceutical from the volutrol to the patient the line should be flushed with 20 mL of IV liquid after the drug is into the IV line.

What about the flush? THE PHYSICIAN ORDER WILL NEVER STATE TO FLUSH THE LINE – YOU MUST DO THIS WITH EACH IV MEDICATION

Example #2 The medication control expresses that the medication can be securely manage more than 30 minutes. Recipe: 10 mL (pharmaceutical) + 20 mL flush after the prescription = 30 mL of liquid that necessities to mix more than 30 minutes. The pump would should be set at 60 mL for the pharmaceutical + the flush to be implanted over ½ hour.

NG – cc/cc substitution In and baby or youngster has a nasogastric tube in that is depleting liquid the doctor will regularly compose and arrange for: NG waste – cc/cc substitution What does this mean?

Nasogastric Output NG yield is measures q 4 hours. Toward the start of the move the night nurture reports that the seepage was 150 cc's throughout the previous 4 hours and you have to supplant this throughout the following four hours. Take note of: this is notwithstanding the IV hourly rate requested.

Sample issue IV hourly rate is 115 mL/hour NG yield to be supplanted throughout the following 4 hours is 150 cc's or 37 mL/hour. You IV would be set at 115 mL + 37 mL = 152 mL/hour for the following four hours.

Practice Problems Do the practice issues. Should be possible separately or in gatherings. Testing will be on like issues. You should accomplish 80% or better to have the capacity to securely regulate prescriptions in the clinical setting.

NG Fluid Replacement Order to supplant NG suction misfortune Often composed by MD to peruse Replace cc/cc NG yield at regular intervals

Practice Proble