Pharmacology: A Nursing Approach
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
b. Currently based on:
1. expert opinions
2. small clinical trials
3. personal experience with medications
from adult dosing recommendations
the branch of pharmacology concerned with the movement of drugs within the body.
i. Based on:
2. health state
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
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
i. Children less than 2 years of age have "slower" metabolism of meds
ii. Infants excrete meds "slower"
III. Nursing Implications
in pediatric dosing
a. Close monitoring of
"serum drug levels"
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)
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