Pharmacology: A Nursing Approach

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Pharmacology
Chapter 11
Pediatric Pharmacology
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1

I. DOSING

of pediatrics:

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a. Research related to pediatric clients is limited because of:

1. obtaining informed consent

2. parents and guardians are reluctant

3. fewer resources from pharmaceutical companies

4. perceived as unethical

3

b. Currently based on:

1. expert opinions

2. small clinical trials

3. personal experience with medications

off-label instructions

from adult dosing recommendations

4

II. Pharmacokinetics

the branch of pharmacology concerned with the movement of drugs within the body.

5

a. Absorption

i. Based on:

1. age

2. health state

3. weight

4. route

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ii. General guidelines:

1. Adolescents have a "slow" medication absorption due to "poor" nutrition habits, and changes in maturity and habits.

2. Gastric emptying is prolonged in "neonates" and "infants" causing decreased peak serum concentrations

3. Feeding methods impact absorption: "breastfed" vs. "formula-fed"

4. Skin of children is "thinner" and more "porous," so absorption is "enhanced" when topical route is used

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b. Distribution

i. General guidelines:

1. Until 2 years of age, requires higher doses of "water-soluble" medications to achieve therapeutic levels because higher percentage of "body fluid" composition

2. Less body fat requires "less" fat-soluble meds

Less albumin requires a "decrease" in dosage

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c. Metabolism

i. Children less than 2 years of age have "slower" metabolism of meds

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d. Excretion

ii. Infants excrete meds "slower"

10

III. Nursing Implications

in pediatric dosing

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a. Close monitoring of

"serum drug levels"

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b. Correct dosage calculation

i. most are ordered in patient's weight in "kg"

ii. dose per unit of weight

iii. body surface area (BSA)

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Further nursing implications:

c. Assess client's "developmental" age from the "chronological" age

d. Include "family" members or caregivers

e. Safety within minimum "restraint"

f. Providing "care"

g. Allowing some level of choice and control

h. Simple "explanations"

i. "Firm" approach

j. Addressing age-appropriate "explanations"

k. Use "syringes" for oral route

l. Do NOT mix drugs with "formula or food"

m. Never give injections to a "sleeping" child

n. Assess for self-administration and self-monitoring with "teens"

o. Educate that "OTC" products are NOT recommended in children