NURSING CARE OF THE CHILD UNDERGOING MEDICATION,

ADMINISTRATION AND INTRAVENOUS THERAPY

SUBMITTED BY:
JAYSON KING CRUZ

NURSING PROCESS
OVERVIEW

For the Child needing

Medication/Intravenous Therapy

Include the assessment of the childs past

experience w/ taking medicine to help predict
what his or her response to medicine
administration might be.
Assess the childs chronological age and
cognitive level to aid in planning the most
appropriate level of explanation that will be
needed.
Inquire about the familys cultural beliefs and
attitudes toward medication, including using
use of herbal or folk remedies.

ASSESSMENT
Because children vary so greatly in size and
individual need, medication administration
to children begins w/ assessment of the
childs height and weight so that a correct
dose of medicine can be calculated based
on the childs development age.
Important to determine the childs ability to
swallow oral medicine or plan the best site
for an intramuscular or intravenous
injection.

NURSING DIAGNOSIS

Disturbed sleep pattern related to timing of

medication administration.
Deficient knowledge related to action and
side effects of medicine.
Fear related to intravenous administration of
medicine.
Rash related to side effect of medicine.
Health seeking behavior by parent related
to desire to learn more about different types
of medicine available for childs illness.

OUTCOME IDENTIFICATION
AND PLANNING

Planning for medicine administration for

children involves the same safe rule s of
administration as those for adults.
Extra consideration is necessary at each step.
Establishing that a dose is accurate for that size
child can involve recalculating the dose using a
nomogram that shows body surface area.
The schedule for administration must be not
only one that is effective for the drugs action.
Explain to the child the effects that can be
expected from the medicine.

IMPLEMENTATION

Medicine and IV interventions with children include

both administering medicine to ill children and
teaching parents and children how to continue to
take medicine when at home or at school.
As long as a child is uncomfortable or has definite
disease symptoms, parents tend to give medicine
conscientiously.
Helping parents fill out administration schedules to
post in readily visible location, such as on the
refrigerator or a bathroom mirror can be as
important an act as explaining the drugs action to
ensure all doses of medicine will be given.

OUTCOME
IDENTIFICATION

Expected outcomes associated with medication

administration should ensure that a child
received the medicine as prescribed and that
the medicine had all the desired effect.
Specific examples suggesting outcome
achievement are:
Child states she understands she must continue
to take thyroid hormone for a lifetime.
Parents list the adverse effect ot the drug and
state the telephone number they will call if
adverse symptoms occur.

MEDICATION
ADMINISTRATION

Medication in children are given by a variety of routes.

Orally
Intranasaly
Topically
Transdermaly
Rectally
Via injection(Subcutaneous, IM, IV, Intraosseous, or
epidural)
Inhalation
Pharmacokinetics- the way a drug is absorbed,
distributed throughout the body, metabolized,
inactivated, and excreted.

PHARMACOKINETICS IN
CHILDREN

Absorption- drug absorption (transfer of the drug from

its point of entry in the body into the bloodstream) is
influenced by the route of administration as well as by the
concentration and acidity of the drug.
Distribution- refers to the movement of the drug
through to bloodstream to specific site of action.
Metabolism- involves the conversion of the drug into an
active form (biotransformation) or an inactive form
(inactivation).
Excretion- elimination of raw drug or drug matabolites, a
process that largely prevents properly administered drugs
from becoming toxic, of drugs potentially limited until
about 12mos. Of age, when kidney becomes mature.

ADVERSE DRUG EFFECT

Children respond to drugs in much the

same way as adults but they may
experienced unique or exaggerated side
effects because of immature liver
function or rapid metabolism during
periods of rapid growth.
The newborn may suffer adverse effects
from drugs taken by the mother
prenatally or from drugs taken by a
breast-feeding mother.

SAFE STORAGE OF
DRUGS

Since young children do not appreciate the

overdoses of medicine can be serious and
even fatal, they may help themselves to
additional medicine and poison
themselves.
Adolescents can deliberately take extra
doses of drugs such as steroids or pain
medicine.
Used lock medicine cabinet or drawer
above the height their children could reach.

SAFE ADMINISTER OF
DRUGS

Administering drugs safely to children

requires that you first determined that
you are giving the right drug to the
right child, in the right dosage, and the
right route at the right time.
Ensure that the parents or child have
the right information about the
medicine.

Right
Right
Right
Right
Right

medicine
child
dosage
route and time
information

ORAL ADMINISTRATION

Children younger than 9years old often have

difficulty swallowing tablets.
For Children younger than 3 years of age, it is
virtually impossible.
Most oral medications for young children, therefore
is furnished in liquid form.
In infants oral medication can be given with a
medicine dropper or a unit dose syringe (without a
needle).
Also may be given fluid form a small glass or spoon.
Never give medicine with the child lying completely
flat, otherwise, the child may Choke or Aspirate.

INTRANASAL
ADMINISRATION

Having someone drop medicine into the nose

can be very uncomfortable.
Tell the child you to understand this, but that
the medicine is important because it will help
him or her get better.
Place the child on his or her back. A schoolage child could extend the head over the side
of the bed so that it is lower than the trunk.
Instill the appropriate number of drops into
one nostril.

OPHTHALMIC
ADMINISTRATION

Eye medications are the most often administered by

being dropped into the conjunctival sac of the eye.
This type of administrations, like nose drops, is
frightening, for children because they have been
warned may times never to put any into their eyes.
Instil the correct number of drops into the conjunctiva
of the lower lid.
Allow the eyelid to close. Avoid placing the drops,
directly on the cornea, because that can be painful.
To instil an Ophthalmic ointment, apply a fine line of
the ointment along the inside rim of the conjunctival
sac, working from the inner to the outer eye canthus.

Otic administration refers to the administering medicine, primarily

drops, into the ear canal.
Like other forms of medicines, this is difficult for children to accept
because they have been told not to put anything into their ears.
Also because ear drops, are generally administer for earache,
which is sharp, excruciating pain, a child may worry that having
medicine put into the ear will the pain even worse.
Place the child on the back, in a mummy restraint if necessary. Turn
the head into one side.
Children younger than 3years,
Straighten the external ear canal by pulling the pinna down and
back.
If the children older than 3years, pull the pinna of the ear up and
back.
Instill the specified number of drops into the ear canal.

RECTAL
ADMINISTRATION

A good route for administering medication to children is by rectal

insertion, because this allows the drug to be absorbed across the
mucous membrane of the intestine.
Some medications are given by rectal suppository, a few are
given by retention of enema.
Most suppositories are supplied lubricated. If not add a drop of
water based lubricant such as K-Y jelly to the tip.
Use glove and insert the suppository gently but quickly beyond
the rectal sphincters.
If the medication is to be administered by enema to a young
children, use usual enema technique, but with as small an
amount of fluid as possible to the child can it retain.
Press the childs buttocks firmly together for appropriately 15sec.
After administering the enema or a child will expel the solution
and the medicine will be lost

TRANSDERMAL/ TOPICAL
ADMINISTRATION

Children who have skin irritation or

need medicine to relieve itching or
dryness may have topical creams or
lotions prescribed.
A number of childrens medicines are
available by transdermal patch,
because absorption of drugs through
the skin can be yet another effective
and pain-free route for administration.

INTRAMUSCULAR AND
SUBCUTANEOUS
ADMINISTRATION

Intramuscular (IM) injections are rarely

prescribes for children because children do
not have sufficient muscle mass for easy
deposition of medication, and they are often
painful.
For IM injections in infants, the mandatory
site for administration is the Vastus lateralis
muscle of the anterior thigh.
Use the lateral aspect rather than the medial
portion, where an injection would cause more
pain.

CONTINUOUS SUBCUTANEOUS
PUMP INFUSION

Administration of a medication by the constant infusion of

medication into the subcutaneous tissue using a medication
pump.
Supply a constant level of medicine to sustain consistent
blood levels.
The disadvantage is that the child must be careful to protect
the pump from damage.
With an infusion pump, the drug is instilled into the
subcutaneous tissue by the constant forward movement of a
lunger of the medicine filled-syringe.
The site usually chosen is the abdomen, as this both protect
the pump and allows it to be out of sight.
Insulin and heparin are two drugs often prescribed for use
with infusion pumps.

INTRAVENOUS THERAPY

IV Therapy is the quickest and most

effective means of administering fluid or
medicine to an ill infant or child, it is
relatively common pediatric therapy.
It can be used to maintain fluid and
electrolyte balance, to promote therapeutic
levels of drugs in the body quickly, and to
provide rehydration and nutritional support.
Blood or blood product replacement is
another common therapy.

DETERMINING FLUID AND

CALORIC NEEDS OF THE CHILD

IV fluid administered to children and infants must be

isotonic(exerts the same osmotic pressure as their bloodstream) to
prevent destruction of RBC or water intoxication.
Using isotonic fluids prevents a pressure gradient that would lead
to fluid shifting into the interstitial tissue (as would happen if the IV
fluid were hypotonic) or fluid shifting from interstitial tissue into the
bloodstream (as would happen if the IV fluid is hypertonic).
Lactated ringers and 0.9% normal saline are the two isotonic IV
fluids commonly used in children.
Normal saline 0.45% is hypotonic sol. That may be used with
children who are dehydrated to restore blood volume quickly.
Dextrose 10% in 0.9% sodium chloride is an example of hypertonic
sol. That might be used to cause fluid to shift into the bloodstream
to relieve cerebral edema for a child with a head injury.

OBTAINING VENOUS
ACCESS

The needle size for IV Therapy varies depending on

the solution and the rate at which it will be
administered.
Sites frequently used for IV insertion in young
children or infants include the veins on the dorsal
surface of the hand or on the flexor surface of the
wrist.
Leg or foot veins also may be used.
Scalp vein over the temporal area.
An infusion placed in a scalp vein can be frightening
to parents because it seems a much more serious
procedure than an infusion administered into a hand.

DETERMINING RATE AND AMOUNT OF

FLUID ADMINISTRATIONH

Because childrens hearts and

circulatory systems are smaller than
those in adults, iv Fluids must be
infused at a smaller rate.
Mini dropper- a device that reduces
the size of the drop in the control
chamber to 60 drops per ml.

Intravenous medication
administration

To administer medicine by:

Bolus technique- clamp the IV tubing above the
medicine port in the IV line; clean the port with alcohol.
Insert the syringe and needle filled with the prescribed
medicine into the port and inject the medicine slowly
and gently based on the manufacturers instruction.
Piggyback- infusion of medicine, medication is
provided by the pharmacy and prepared and diluted in
small fluid filled plastic bag.
To begin with piggyback infusion, hang the piggyback
bag, clean the medicine port on the IV line, insert the
piggyback system into the port.

USING INTERMITTENT
INFUSION DEVICES

Still sometimes called heparin locks, are devices that

maintain open venous access for medicine
administration while allowing children to be free of IV
tubing so that they can be out of be and more active.
The vessels of the back of the hand are generally
chosen as the IV site.
Scalp vein tubing is used and capped at the end with a
specially designed rubber stopper or a commercial trap
-the tubing is filled with a dilute solution of heparin and
normal saline through the rubber stopper and flushed
again with solution every 2 to 8hrs (depending on
hospital policy) to keep it patent

USING CENTRAL VENOUS ACCESS

CATHETERS AND DEVICES

Venous access for long term IV therapy can be

obtained using catheter inserted into the vena
cava just outside the right atrium; the
catheters used in this way include Broviac,
Hickman, and Goshong catheters.
Vascular access ports (VAPs; infusion ports
that can be implied) are smaller plastic devices
that are implanted under the skin, usually on
the anterior chest just under the clavicle, for
long term fluid or medication administration
via bolus or continouos administration.

ADMINISTERING AN
INTRAOSSEOUS INFUSION

Infusion of fluid into the bone marrow cavity of a long bone, usually
the distal or proximal tibia, the distal femur, or the iliac crest
The following are steps used to initiate an intraosseous infusion:
1. The skin over the chosen site is clean.
2. A small incision is made into the skin with a scalpel blade.
3. A large hypodermic or bone marrow needle is inserted through
the incision into the cavity of the bone.
4. To ensure that the needle tip has reached the bone marrow
cavity.
5. If bone marrow is obtained, the syringe is removed and IV tubing.
6. a dressing with additional iodine is then applied over the needle
site.
7. a restraint is applied to the leg to help the child hold the leg still.

ADMINISTERING A SUBCUTANEOUS
(HYPODERMOCLYSIS) INFUSION

The technique is still used for children with blood

disorders who receive a medication to remove
stored iron from their body.
Sites used for hypodermoclysis generally include
the pectoral region, the back, and the antero
lateral aspects of the thighs.
The IV needle is inserted into the subcutaneous
layer of the skin and infusion apparatus is opened.
The rate is governed by the rate of absorption by
the subcutaneous layer of skin; it is not a set rate.