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
– Third spacing Volume Deficit: Volume Deficit: Dehydration
Mild Signs relate to severity of deficit Mod Severe alert
Restless Lethargic BP normal BP normal
to low Low Pulse
normal Pulse rapid Pulse rapid
to weak Urine
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
– 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?
– 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
2-month-old postop pyloric stenosis
admission to unit,
kicking both legs,
moving about in
crib, consolable. What is the FLACC
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
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
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
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
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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- Fall '11
- Nursing, pulse, safe dose, final concentration