N331 - Pediatric Nursing - Lecture 1 Fluid & Medication

Tofindthe percentageofdehydration

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Unformatted text preview: oncentration not to exceed 100mg/ml (per dosage handbook). Draw up 1.8 ml Can you “antegrade” this medicine? IV antegrade practice IV antegrade practice Metoclopramide 5mg IV q8h Final max concentration not to exceed 5mg/ml Available as injection solution 5mg/ml Infuse over 15­30 min How will you administer this drug? Syringe Pump Syringe Pump Slow programmed infusion of medication into primary IV line Fluid Volume Imbalances Fluid Volume Imbalances If fluid intake and output are not matched, fluid imbalance can occur rapidly. – Diarrhea – NG tube drain – Polyuria – Third spacing Volume Deficit: Volume Deficit: Dehydration Mild Signs relate to severity of deficit Mod Severe alert Thirsty Irritable Restless Lethargic BP normal BP normal to low Low Pulse normal Pulse rapid Pulse rapid to weak Urine normal <1cc/kg/hr dark minimal to absent output Lost 5% weight Lost 6-9% weight Lost 10% or more wt Dehydration Dehydration Calculate losses first – Original weight minus current weight. – Divide the loss by original wt. to find the percentage of dehydration Mild­moderate dehydration: replace estimated fluid deficit within 2­4 hr using 50­100 mL/kg by mouth plus replacement of ongoing losses. Use Oral Rehydration Solution Home Care: ORT Home Care: ORT Infants – Breast milk, lactose free formula or ½ strength lactose­free formula alternating with oral rehydration Children – No juice, soda, or plain water – ORT should contain glucose and electrolytes Extracellular Volume Extracellular Volume Excess Rapid weight gain is most sensitive index Intake and Output Daily Wts Monitor IV fluid closely! Interstitial fluid volume Interstitial fluid volume excess Edema – Inflammation – Local infection – Volume excess – Right heart failure – Leaking of albumin – burns Pain in Infants and Children Pain in Infants and Children Why is this an issue in pediatrics? Pain Assessment – Fifth Vital Sign Pain Management Nurse’s Role Nurse Verbal Report Observation – Grimace, irritable, restless… Physiologic response – HR, RR, diaphoresis Include parents in assessment Pain assessment tools Pain assessment tools Neonatal scale (FLACC) 3 years: Faces scale Older child: Scale from 1­ 10 FLACC FLACC 2-month-old postop pyloric stenosis repair. Crying steadily upon admission to unit, kicking both legs, moving about in crib, consolable. What is the FLACC score? What action will the RN take? Pain management Pain management Non­narcotics Opioids PCA/epidural analgesia Non­pharmacologic approaches U.S. Dept Health and U.S. Dept Health and Human Services Guidelines Use pain prevention with ATC analgesia Assess pain with other vital signs Pre­operative counseling of families and their role in communicating pain needs to nurses and physicians Your plan? Your plan? 15­kg child s/p appendectomy post­op day one on surgical floor. Order reads Morphine 1.5 mg IV Q3­4 prn pain. Pt. received dose 2 hours ago and is crying. Administering Morphine Administering Morphine 2mg/ml and 10mg/ml vials available Final concentration not to exceed _____mg/ml? Over _____ minutes? – How much will you draw up? – How will you administer this? Fever Fever Hyperthermia: set­point is normal, yet body temp exceeds set­point. Fever = elevation in set­point 1 degree of temp elevation raises RR by 4 breaths, oxygen demand by 7%, metabolic rate by 10%. Increases hydration and caloric requirements and HR Antipyretics Antipyretics Acetaminophen (10­15 mg/kg/dose) every 4 hours not to exceed 5 doses in 24 hrs. Ibuprofen (10 mg/kg/dose) every 6­8 hours When should a family call about a fever? 80 mg per 0.8ml 160mg per 5ml NCLEX review NCLEX review An order reads, “heparin 1300 units per hour IV.” An IV bag arrives labeled “heparin 20,000 units/250ml D5W.” How will the RN set the pump? ___________ ml/hr NCLEX review NCLEX review The doctor orders a single dose of 20mg/kg/dose of Amoxicillin oral suspension for a toddler who weighs 20lbs. What is the safe dose in milligrams? NCLEX review NCLEX review Order: Gentamicin sulfate 18mg IVPB q8h for a 9kg child. Supply: Gentamicin sulfate 20mg/2ml Recommended: Gentamicin 2mg/kg/dose IV q8h If safe, give____________________ml/dose THANK YOU...
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