NURS 4055 Child Health Competencies
1
Spring 2023 – Workbook (1 3 weeks of class/lab)
st
Table of Contents:
1/18/23: Class: Pediatric Assessment & Readings/Preparation
(this is an 8 hour day)
2-5
1/25/23: Lab: Pediatric Assessment & Skills, Medication Administration
Schedule & Readings/Preparation (this is a 2 hour day)_________
6-13
1/23/23: Lab Day: Growth & Development
Schedule & Readings/Preparation (this is a 3 hour day)
14-20
1/28/23-2/6/23: Medication Calculation & Administration Simulation Lab
Instructions ______________________________________________
Med Lab Rubric __________________________________________
Medication Chart ___________________________
21
22-23
24-26
Revised 1/6/23
NURS 4055 Child Health Competencies
2
Child Health Class Day – Spring 2023
Wednesday, Jan 18, 2023
Room 1010
0900 – 1100
1100 – 1200
1300 - 1600
Welcome to Child Health & Team Based Learning
Discussion/Explanation/Example
Pediatric Assessment
Communication TBL (including pre and post test)
Readings/Preparation:
Review the course syllabus and bring questions to class. We will not be reviewing the entire syllabus in
class.
TO DO LIST:
€ Text your clinical faculty with your name and cell number.
€ Complete Syllabus Acknowledgement Statement (on Canvas under Syllabus & Schedule tab)
€ Complete Confidentiality Statement Acknowledgement (on Canvas under Syllabus & Schedule
tab)
€ Complete TWU CON Clinical Evaluation Tools Verification (on Canvas under Clinical
Documents tab)
Readings: Preparation material listed in Canvas, Review handout on Team Based Learning.
Revised 1/6/23
NURS 4055 Child Health Competencies
3
NURS 4055 Child Health Competencies
Pediatric Assessment – Spring 2023
Assessment Review – Your Job: Be a Detective
● Doorway/bedside assessment
o What can you see? What do those findings tell you? What would you do next?
Pediatric Assessment Age-Specific Approaches (w/Parent and Child)
● Infant
o Auscultate heart/lungs/abdomen while infant is asleep/quiet
o Allow parent to nurture/comfort vs. assisting
o Explain to caregiver each step as you do it
● Toddler
o Concrete thinking – use appropriate language
o Allow freedom of movement when possible
o Perform most invasive parts last
● Preschooler – Fears body invasion and mutilation
o Concrete thinking – use appropriate language
o Give simple choices to sit or stand, etc.
o Medical play appropriate to explain or elicit cooperation – allow to touch equipment
● School-Age
o Increased language skills – explain in simple, realistic terms
o Include the child in the examination
● Adolescent
o Respect privacy/Emphasize confidentiality
o Use mature language and appropriate terminology – clarify slang terms, but don’t use
o Allow for time to ask/answer questions without parent/caregiver present
Revised 1/6/23
NURS 4055 Child Health Competencies
4
Pediatric Assessment Checklist
General Approach
● Consider the age and developmental stage of the child.
o Implement language and communication techniques consistent with a child's developmental
level and family’s needs.
● Introduce yourself to the child and family and establish rapport. Use play techniques for infants and
young children.
● Gather as much information as possible by observation first
● Use a systematic approach; but be flexible to accommodate a child's behavior.
o Examine least intrusive areas first (i.e. hands, arms, feet) and painful and sensitive assessment
last (i.e. ears, nose, mouth)
o Determine what parts of the exam is to be completed before possible crying or lack of
cooperation (i.e. heart, lungs & abdomen)
o Where possible, assessments should be clustered with other care at a time when the child is
relaxed and compliant.
General Appearance: Lethargic or active, agitated or calm, compliant or combative, posture and movement
Systems Assessment
❖ Neuro: Development, orientation, PERRLA, sleep, pain, vision, hearing
❖ Integumentary: Pigmentation, turgor, lesions, bruising, wounds, scars, mucosa, body temperature
❖ Respiratory: Noises, secretions, cough, respiratory rate, rhythm, air movement, breath sounds, work of
breathing (accessory muscles, retractions, nasal flaring), oxygen requirement and delivery mode
❖ Cardiovascular: Heart rate and rhythm, heart sounds, perfusion (CPETC - color, pulses, edema,
temperature, capillary refill), neurovascular (perfusion, movement and sensation), Checks, 5 P’s
(pulselessness, pallor, pain, paresthesia, paralysis) when applicable
❖ Abdominal/GI/GU: Bowel sound, soft/firm/distended, GI/GU, I&O, nutrition, feedings, puberty
❖ Musculoskeletal: Hand grasp, range of motion, movement of extremities, gait, symmetry
❖ Focused assessment: Assessment of presenting problem
❖ Other: IV/lines, tubes/drains, dressings, casts, monitors, labs, isolation
❖ Safety: Oxygen set up at the bedside, suction set up at the bedside, side rails (up to right height), bed
(low and locked), call light, ID bands (on patient)
❖ Risk assessment: Pressure, fall, abuse
❖ Psychosocial: Well-being, family needs
Pediatric Vital Signs
Age
1 - 12 months
(Infants)
Revised 1/6/23
Temperature*
35.5-37.5C*
Pulse
Respiratory Rate
80 – 140
20 - 30
Systolic Blood
Pressure**
70 - 100
NURS 4055 Child Health Competencies
5
1 - 3 years
(Toddlers)
35.5-37.5C*
80 – 130
20 - 30
80 - 110
3 - 5 years
(Preschool)
35.5-37.5C*
80 – 120
20 – 30
80 – 110
>6 – 12 years
(School-Age)
35.5-37.5C*
70 – 110
20 - 30
(RR↓ with ↑age)
80 - 120
Temperature:
● *35.5-37.5 C oral (95.9-99.5 F) - May vary by source/method*. Always consistently use the same
source/method and note in documentation.
● Temperature > 38.5 C (101.5 F) is considered to be elevated/febrile and should be treated.
● Temperature < 35.5 C (95.9 F) is considered abnormal and should be rechecked.
Blood Pressure:
● **Hypotension: Systolic BP < 70 + (2 x age) up to 10 years of age**
● **Hypertension: Normal blood pressure varies by age/gender/height. Elevated systolic/diastolic
pressures or wide pulse pressures should be rechecked and further evaluated.
Height & Weight:
● Doubles birth weight by 6 months; Triples birth weight by 1 year; Quadruples birth weight by 2 years
● Body mass index (BMI) is age- and gender-specific based on height & weight.
● Underweight is defined as a BMI under the 5th percentile.
● Overweight is defined as a BMI between the 85th and 94th.
● Obesity is defined as a BMI at or above the 95th percentile.
References:
● American Heart Association. (2020). PALS guidelines. Retrieved from
https://www.pedscases.com/pediatric-vital-signs-reference-chart
● Bartlett, D., & Tortorice, J. (2020). Age specific practice. Retrieved from https://ceufast.com/course/agespecific-practice
Revised 1/6/23
NURS 4055 Child Health Competencies
6
Skills Lab Day
Wednesday, Jan. 25, 2023
room 4104 (Med Admin) & 4600 (Clinical Reasoning)
Attire: This is a clinical day, follow clinical dress code. Please do not change groups as they are balanced.
Supplies: pen/pencil, calculator, copy of workbook with completed prep work
**When in lab areas (4600), all backpacks, purses and other personal items should be stored in lockers
and out of the way. Nothing can be left in the hallways on the 4th floor**
Readings/Preparation: Skills Guide readings posted in this workbook and information on Canvas.
Watch the following videos clips:
o https://www.youtube.com/watch?v=awy-AfmVyc0 (how to set up suction 6 min)
o https://www.youtube.com/watch?v=XwuMD1ORmN8 (how to set up a nebulizer 3:16)
o https://www.youtube.com/watch?v=LGxV9mHqXP0 (oxygen delivery devices 4:19 min)
o https://nhcps.com/lesson/bls-rescue-breathing/ (rescue breathing 1:02)
Pediatric Skills: Review pediatric skills prep questions/answers.
Skills Guide: Breakout session will focus on application of pediatric skills content.
Revised 1/6/23
NURS 4055 Child Health Competencies
7
Complete the medication reference chart on workbook pg. 22-25. This will be your drug guide for the skills
breakout session.
Watch Medication Lab demo video on Canvas located in the Medication Lab folder.
Pediatric Medication Calculations: Review Ch. 25 in Calculate with Confidence – Pediatric Dosage
Calculations based on body weight NOT body surface area (BSA). See workbook for fluid maintenance
calculation formula for daily fluid requirements (Note: daily oral fluid requirements are the same as IV daily
maintenance requirements). Skills breakout session will focus on application of pediatric medication
calculation content. Skills Guide: Administering Medications and Irrigations; Skills Guide: Intravenous Access
**Participation in Lab Day is mandatory and counts towards clinical hours. Make sure to sign-in at all
stations to receive credit.**
Sim Lab: Assessment Practice – (REVIEW PRIOR TO Skills Day)
Oxygen Delivery Systems
Liters/min
F
i
0
2
Nasal Cannula**
1
2
4
%
Nasal Cannula**
2
2
8
%
Nasal Cannula**
3
3
1
%
Nasal Cannula**
4
3
4
%
*Too high a flow for small
children
5*
** each liter = approx. 4%
02
6*
3
7
%
4
0
%
Other Oxygen Delivery Systems
Simple Face Mask
> 5 liters
4
0
6
0
%
Venturi Mask
Variable
2
4
6
Revised 1/6/23
NURS 4055 Child Health Competencies
8
0
%
Non-Rebreather
reservoir mask
> 10 liters
High Flow nasal
cannula
Up to 60 liters
>
6
0
%
2
1
8
0
%
ROOM 4607: Assessment Practice (TO BE COMPLETED IN LAB ON 1/25/23
Practice setting up and connecting oxygen and suction into the headwall to create a safe patient environment.
You will be checking this in the hospital as part of your daily safety check. Once you have set everything up,
disconnect everything and reset for the next group.
Oxygen:
● Locate the oxygen flowmeter in the headwall.
● Connect the christmas tree to the oxygen gauge on the headwall.
● Connect the oxygen tubing to gauge.
● Turn on/off to make sure connected properly and oxygen is flowing.
● Discuss when each type of oxygen delivery device would be most appropriate and the amount of oxygen
delivered by each (nasal cannula, simple face mask, non-rebreather mask, bag-valve mask,)
● Demonstrate proper bag-valve mask ventilation
Suction:
● Locate the suction gauge in the headwall.
● Place the suction canister in the holder.
● Attach the canister to the suction gauge.
● Attach the suction tubing to the suction canister and attach the Yankauer.
● Turn on/off to make sure connected properly and suction is working.
● Consider when use of different suction settings would be most appropriate (intermittent vs. continuous)
and when different suction devices would be used
BREAKOUT 2: Pediatric Skills Practice – TO BE COMPLETED PRIOR TO LAB ON 1/25/23
For the pediatric medication calculation skills rotation, use the drug reference guide you prepared on p. 24-26 of
the workbook and the fluid maintenance calculation reference to complete the two (2) scenarios.
Pediatric Medication Calculation & Administration: Fluid Maintenance Calculation Reference
Daily Fluid Requirement (24 hour period)
Weight (kg)
Fluid
0 - 10 kg (first 10 kg)
100 ml/kg
11 - 20 kg (second 10 kg)
1000 ml + 50 ml/kg
21 - 70 kg (above 20 kg)
1500 ml + 20 ml/kg
Example: Jeff weighs 33 kg, so
100 x 10 = 1000, 50 x 10 = 500, 20 x 13 = 260
Revised 1/6/23
NURS 4055 Child Health Competencies
9
1000 + 500 + 260 = 1760 ml/day (24 hours)
To calculate hourly rate: 1760 ml/day ÷ 24 hours/day = 73.33 ml/hr rounded to 73 ml/hr
Hourly Fluid Requirement (“4-2-1 Method”)
**This is the formula you will be expected to know**
Weight (kg)
0-10 kg (1st 10kg) x 4
11-20 kg (2nd 10kg) x 2
21+ kg (above 21 kg) x 1
Example: Jeff is 33kg, so:
4 x 10 = 40, 2 x 10 = 20, 1 x 13 = 13
40 + 20 + 13 = 73 ml/hr
This method can be used to calculate approximate hourly rate. Note: This # may vary slightly from the other
method.
Notes:
1. Daily fluid requirements are the same whether oral intake or intravenous fluid replacement.
2. In what populations or disorders might you expect to see decreased (¼ or ½ maintenance) or increased
(2 times maintenance) fluids ordered?
3. **Note: For Intake/Output measurements, the weight in grams is considered equal to mLs (ex. 20gms =
20mLs). It is important to make sure the scale is zeroed correctly so that the dry weight of the diaper is
already taken into account so the output measurement is accurate.**
PEDIATRIC SKILLS OVERVIEW
(To be reviewed PRIOR to skills day).
Medication Administration:
View this short YouTube: https://www.youtube.com/watch?v=9JEAnm5rgwo
8. What techniques would you employ to administer an oral medication to the following?
a. Infant – use a syringe and place into the inside corner of the mouth and administer slowly. Stop if signs
of choking to prevent aspiration. Enlist parent to assist if it helps with child cooperation. It is ok for the
parent to administer the medication with the nurse observing.
b. Toddler - give choices when available, enlist parent to assist if it helps with child cooperation. It is ok
for the parent to administer the medication with the nurse observing.
c. Preschooler – give choices when available, give them a job or allow them to help.
d. School-Age child – explain what medication is for in simple terms.
9. What is the important to know about syrups and suspension?
Answer: There is a high sugar content in syrups. Sugar = carbs – important to know for diabetics or people
who are on carbohydrate sensitive diets (ex. Ketogenic diet). Suspensions need to be shaken to mix
thoroughly prior to administration.
10. What methods could you use to secure a peripheral IV in a child?
Answer: IV house, arm board – no coban, large amounts of tape, etc.
Revised 1/6/23
NURS 4055 Child Health Competencies
10
11. What is the difference between a peripheral IV and a peripherally inserted central catheter (PICC)?
Answer: A peripheral IV is a short catheter inserted for short term IV therapy/medications. A PICC is a
peripherally inserted central catheter; it is a central line that is used for long term IV therapy/medications.
The current practice of most facilities is to saline-lock peripheral IVs when not in use/in between uses. PICC
lines are heparin locked when not in use/between uses.
12. How do you prepare the hub of an IV catheter or primary tubing prior to access?
Answer: Scrub the hub for minimum of 20 seconds with alcohol wipe or CHG. For clinical practice, always
check agency policy as some may require you to scrub for longer than 20 seconds or may have a specific
cleaner to use (alcohol vs. CHG, etc.)
Tip: When administering an IV medication remember “SASH”. Flush with saline 1st, administer antibiotic
or other medication 2nd, flush with saline 3rd, flush with heparin 4th. The diameter of the PICC line is
narrow and increased resistance can cause the tube to collapse. Always use a syringe with a minimum
diameter of at least 5 mL when flushing the line/administering medications. Note: prefilled saline flush
syringes have a 5-10 mL diameter even though they generally only contain 3-5 mL of saline.
13. How do you know how long to infuse your IV medication over in minutes? (Hint: The MD does not
order it)
Answer: Look up the medication a drug reference resource and you will find infusion rate/time under
administration details (intermittent infusion).
14. What are syringe pumps and why are they used in pediatrics?
Answer: A syringe pump is an infusion pump used to gradually administer small amounts of a medication or
IV solution (with or without medication) to a pediatric patient. It can be programmed to deliver small
volumes of medication (1-60 mL) over a period of time allowing for more consistent delivery. The design
and settings may vary by manufacturer, but all use the same type of tubing called microbore tubing. The
entire length of tubing can be flushed with less than 1 mL of fluid. It can be connected directly to the
patient’s IV if only receiving intermittent infusions. If patient is receiving a continuous IV infusion, the
microbore tubing should be attached to the port in the primary tubing that is closest to the patient. Tubing
should be flushed with 1 mL of normal saline or compatible IV fluid between medications and should be
changed every 24 hours.
Notes:
Revised 1/6/23
NURS 4055 Child Health Competencies
11
SKILLS LAB – SCENARIO #1 – TO BE COMPLETED PRIOR TO SKILLS DAY 8/31/22
Grace is a 5-month-old with a congenital heart defect who has nasogastric tube for supplementary feedings.
Mom reports that she has been fussy and pulling at her ear for several days. She has been diagnosed with acute
otitis media (AOM). Grace weighs 12 pounds.
1. How many kg does Grace weigh (round to the nearest hundredth)?_5.45 kg__
2. Grace has an order for Amoxicillin suspension 240 mg NG every 12 hours for acute otitis media.
a. Calculate the safe dose range. _436-490.5 mg_ _218-245.25mg_
b. Is this dose safe? (Yes/No)
3. Amoxicillin suspension is available in a multi-dose bottle with a concentration of 250 mg/5 mL. How
much will you prepare to administer for one dose? _4.8mL_
4. What fluid will you use to flush the ng-tube following Amoxicillin administration? How much fluid
will you draw up to flush the ng-tube __Draw up 5 to 10 ml of water.__
5. How will you check placement of the ng-tube prior to medication administration? _xray_
6. Practice drawing up the medication in the syringe and administering via nasogastric tube.
7. Practice flushing the nasogastric tube following medication administration.
8. Grace has an order for IV fluids of 0.9% normal saline to run at maintenance rate. What will you set the
pump to run at in mL/hr? 22 mL/hr
9. Grace also has another antibiotic ordered. The order reads: Vancomycin 325 mg IV every 6 hours.
a. Calculate the safe dose range. _245.25-327mg_ _61.31-81.75mg_
b. Is this dose safe? (Yes/No)
c. How long should you infuse the Vancomycin dose over in minutes? _0.9mg/min_
d. The drug is available in a syringe with 325 mg/50 mL. What rate would you set the pump at to
infuse the dose in mL/hr? _8.33-8mL/hr_
10. Document medication given using the Medication Administration Record (MAR) below.
Medication Administration Record
Grace Wyatt
Medical Record: 123453
DOB: August 1, 2022
Allergies: NKDA
Physician: Dr. Healthy
Diagnosis: Otitis Media; Congenital Heart Defect
R
o
Medication
Dosage
u Frequency
Time
t
e
Amoxicillin
N
240 mg
Q12h
0900
2100
suspension
G
Normal saline
Maint. Rate
I
(0.9% Sodium
CONTINUOUS
_______
__23mL/hr___
V
Chloride) solution
I
Vancomycin
V
0300 0900
325 mg
Q6h
solution
P
1500 2100
B
Initials
Signature
Date
NN
Nancy Nurse, RN
1/25/23
Revised 1/6/23
NURS 4055 Child Health Competencies
12
SKILLS LAB – SCENARIO #2 – TO BE COMPLETED PRIOR TO SKILLS DAY
Scott is a 4-year-old with cerebral palsy who has been admitted with febrile seizures. Scott weighs 35 pounds.
Upon assessment, he has a temperature of 102.2F.
1. How many kg does Scott weight (round to the nearest hundredth)?_15.91kg_
2. Scott has an order for Acetaminophen 162.5 mg GT PRN for a temp of >38.5C.
a. What is Scott’s actual temperature in Celsius? 39c
b. Is Acetaminophen indicated at this time? yes
c. Calculate the safe dose range. _159.1 -238.65 mg/dose_
d. Is this dose safe? (Yes/No)
3. Acetaminophen is available in 325mg tablets. How many tablets will you administer? 0.5 tab
4. Practice preparing the tablet if indicated.
5. Scott also has an antibiotic ordered. The order reads: Cefazolin 500 mg IV every 8 hours.
a. Calculate the safe dose range. _397.75-596.63mg_
b. Is this dose safe? (Yes/No)
c. How long should you infuse the Cefazolin dose over in minutes? 1.53 mg/min
d. The drug is available in a syringe with 500 mg/35 mL. What rate would you set the pump at to
infuse the dose in mL/hr? 5.83-6mL/hr
6. Document medication given using the Medication Administration Record (MAR) below.
Medication Administration Record
Scott Walker Medical Record: 123456
DOB: January 1, 2019
Allergies: NKDA
Physician: Dr. Healthy
Diagnosis: Febrile Seizures; Cerebral Palsy
R
Medication
Dosage
Acetaminophen
tablets
162.5 mg
Cefazolin solution
500 mg
Initials
NN
o
u Frequency
t
e
PRN Q4-6
N
HOURS FOR
G
TEMP >38.5 C
I
V
Q8h
P
B
Signature
Nancy Nurse, RN
Growth and Development
Revised 1/6/23
Time
_______
0800 1600
2400
Date
1/25/23
NURS 4055 Child Health Competencies
13
Sensori Motor
●
●
●
●
Paolo imitates his brother. For instance he smiles whenever Tony smiles.
Holly chews on the block to explore it
Tommy took the plastic ball and put it in his mouth to feel the shape…
Peek a boo → obj permanence
○ Object permanence will always have it, egocentrism goes away
Pre Operational
● Alexis puts her clothes in her closet whether they are dirty or clean. Her mother has told her to put her
clothes in the drawers or hangers after wearing them so they'll last longer.
(the problem is she wasn't able to follow her mothers instruction → “mom is telling her what to do'')
● After watching a show about animals, Bree tells her mother that lions are extra big cats. → black and
white → cat is cat → “sorting”
● Rose likes to drink grape juice from the tall iced tea glasses even though she has more trouble handling
the glass. She thinks there's more juice in the tall glass. →Lack of Conservation
● As Kwana counted, he held up a finger for each number he said. → needs fingers (concrete would say
im six)
● When soo nams sister was crying, he tried to give her his own fave stuffed animal
○ Egocentrism, if it makes me feel better it will make her feel better
Concrete Operations
● After watching a show about animals, Bree tells her mother that lions are extra big cats. → black and
white → cat is cat (if she's looking at it “can physically see” = concrete)
● Nina was able to sort out the large, red marbles from the rest. (ex: sorting by size and color or sorting 3
at the same time; if it was sorted by one thing → preoperational ex: silver/brown)
● When she was called on, Leah answered: “If ⅓ is more than 1/6 , and ⅙ is more than 1/8 , then ⅓ is
more than 1/8 “ (school aged kid → “straight math” → can physically see it; formal → theoretical
conclusion “x, ab, etc)
● Brook sorted his cards by teams. Then he put the players on each team in alphabetical order.
○ This team v this tem (Concrete- different teams, preop- its baseball cards)
Formal Operations
● Gavin answered the question that included a hypothetical situation
○ Abstract thinking is involved
● Brittany can use abstract thinking to solve problems
● Drew talks to his father about why his science experiment didn't work → they come up w the
conclusion/theory → trying to understand the why
○ Hypothesizing (Why did it not work? There is no known cause as of right now)
Revised 1/6/23
NURS 4055 Child Health Competencies
14
● Ona is puzzled by the problems she's having at school. She can remember things better but she just
doesn't seem to be able to concentrate as well → self awareness.
○ Concentration is a higher-level adolescent
● Shemika said to her friend Danielle “Suppose the guy was going out with your best friend asked you
out? What would you do then?”
Milestones:
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
4-5 months: Lifts head 90 degrees from prone position
5 months: Reaches for objects with an open hand
6 months: Tripod sitting
7-8 months: Transfers object hand to hand (before they have to sit upright without help at 8 months)
→ uses 2 hands is after 8 months
7-10 months: Crawling
8 months: sits indep w no support
8-12 months: Develops the concept of object permanence
Most below actual age
○ Primitive reflexes → 3 months
○ Crude (gross) pincer grasp dev → 6 months (wrong)
Select wrong age group
○ Stacking toys appropriate → 6 months (wrong)
○ Kicks ball in forward motion → 4 years
○ Engages in parallel play → 2 years
5 years: able to dress themselves independently
3 years: Build a tower of 9-10 cubes
Associative play → 4 years
Babinski becomes negative → 1 year/when you begin to walk
Starts holding furniture → 10 months
Kicks a ball→ 2 years
Pick a pair
Use scissors well → 4 years
Walks independently → 12 months
Draws a person with 4 parts → 4 years
Dev fine pincer → 10 months
Select wrong age group
Engages in cooperative play → 7 years
Goes up and down stairs → 2 years (wrong)
Ties shoelaces → 5 years
Below actual age
Revised 1/6/23
NURS 4055 Child Health Competencies
15
Hops and skips on one foot → 2 years (wrong)
Throws a ball overhand → 3 years
● Stranger anxiety begins →6-8 months
Rides a tricycle → 3 years
Enjoys banging on pots and pans → 9 months
Head lag should be gone → 4 months
● Pick a pair
Understand the concept of conservation → 7 years
Per group is the major influence → 15 years
Uses past and future tense; tells creative stories → 5 years
Imaginary playmates are common → 5 years
Rules:
● If it can fit in a toilet paper tube → 3 up for safety reasons
● Hospitalized pts → needs to be wiped down
Toys:
● Barbie/doll → toddler (doll)/preschool (barbie)→ Preoperational → storytelling, dolls, imagination
(look out for small pieces → older than 3y)
● Rattle → 3-4 months/infant → sensorimotor
● Boardgame → school age, → follow steps → concrete
● Tube w yellow things → preschooler → preoperational
● ABC’s book → toddler/preschool age → preoperational
● Drums → 9 months → sensorimotor
● Red hard ball → toddler →sensorimotor/ preoperational
● Bowling pins → toddlers→ sensorimotor/ preoperational
● Stacking cups → toddlers (3)/ Preschooler (stacks higher, pouring) → preoperational
● Card games (go fish) → school age→concrete
● Finger puppets → toddler (is parent is using them)/ preschool →preoperational
● Pots and pans → Toddler/ preschool → sensorimotor/ preoperational
● lights ??? pincher toy → Preschooler → preoperational
● Rattling ball → Toddler → sensorimotor → good distraction
● Monopoly → School age (older 7-8)/adolescent→ Concrete operational/formal
● Shapes box (sorting)→ Toddler/ preschool → preoperational
● Soft book → Toddler/ preschool→ sensorimotor/preoperational
● Coloring book → Preschool (grasp concept of coloring)/ school age (with activities) → preoperational
● Elmo medical box → Preschool → preoperational → fear of mutilation
● Doll house → Preschooler (5) → preoperational
● Deck of cards → adolescents →Formal
● Mobile → infants → sensorimotor
Revised 1/6/23
NURS 4055 Child Health Competencies
16
● Stuffed animal → toddler/preschool → preoperational (if it has pieces that can come off, only older
preschoolers)
● Mirror → infants (4mo-9mo → they can lift their head, sit) → sensorimotor
● Soccer ball → preschool → preoperational
● Board book that makes noise → infants/ toddler → sensorimotor
● Fabric book with noise and teething corners→ infant → sensorimotor
● Abacus → toddler/preschool → preoperational
● Outfit princess → preschool → preoperational
● Lawnmower → Toddler → preoperational?
● Soft ball → toddler/preschool → sensorimotor/preoperational
● Bucket and shovel → toddler → preoperational (can determine if right/left handed)
● Play phone → infants → sensorimotor (copying mom and dad)
● Stacking rings that make noise → infant (6-8mo → can sit and play)/ toddler → sensorimotor/
preoperational
● Word search → school age → concrete operational
● Walkie talkie → infant/ toddler → sensorimotor
○ If real → preschool/school age → concrete/formal
● Book with mirror → toddler → sensorimotor/ preoperational
● Hat → preschool / school age → preoperational
● 20 question challenge → school age / adolescents → concrete/formal
Revised 1/6/23
NURS 4055 Child Health Competencies
17
Growth & Development Day – Spring 2023
Monday, Jan 23, 2023
Room 2702 & 4104
Attire: this is a clinical day, follow clinical dress code.
Please do not change groups, they are balanced.
Supplies: Print and bring a copy of the Growth and Development Lab Workbook with you. Bring your
textbook if desired to use as a reference throughout the day.
Readings/Preparation:
In preparation for Growth and Development lab day, review the growth & development readings, paying
particular attention to developmental milestones. Be prepared to discuss and put this information into action
during class. You are expected to participate fully in class; your learning will depend on your active
participation. Faculty will be serving as facilitators in your learning process.
Developmental Milestones: Pay particular attention to developmental milestones tables, anticipatory
guidance, safety and injury prevention, and developmental theorists (focus on Erikson & Piaget) as related to
the developmental progression of infants, toddlers, preschoolers, school-age children and adolescents.
Play & Toys: Review psychosocial, play and toys for infants, toddlers, preschoolers, school-age, and
adolescents.
**Growth & Development Day activities count as clinical time and attendance is mandatory.**
Revised 1/6/23
NURS 4055 Child Health Competencies
18
N4055 Child Health Competencies – Growth & Development Day
BREAKOUT: Growth & Development Theory Application
Age Group
Infant
(birth to 1
year)
Theorist/
Developmental
Stage
Erikson: Trust vs.
Mistrust
Piaget: Sensorimotor
Toddler
(1-3 years)
Erikson: Autonomy
vs. Shame and
Doubt
Piaget: Sensorimotor
(end); Preoperational
(beginning)
Preschoole
r (3-6
years)
Erikson: Initiative
vs. Guilt
Piaget:
Preoperational
School age Erikson: Industry vs.
(6-12 years) Inferiority
Revised 1/6/23
Characteristics of
Stage
Nursing Applications
The baby established a Hold the hospitalized baby often. Offer
sense of trust when
comfort after painful procedures. Meet the
basic needs are met.
baby’s needs for food and hygiene.
Encourage parents to room in. Manage pain
effectively with the use of pain meds and
other measures.
The baby learns from
Use crib mobiles, manipulative toys, wall
movement and
murals, and bright colors to provide
sensory input.
interesting stimuli and comfort. Use toys to
distract the baby during procedures and
assessments.
The child is
Allow self-feeding opportunities. Encourage
increasingly
child to remove and put on own clothes,
independent in many
brush teeth, or assist with hygiene. If
spheres of life.
immobilization for a procedure is necessary,
proceed quickly, providing explanations and
comfort.
The child shows
Ensure safe surroundings to allow
increasing curiosity
opportunities to manipulate objects. Name
and explorative
objects and give simple explanations.
behavior. Language
skills improve.
The child likes to
Offer medical equipment for play to lessen
initiate play activities. anxiety about strange objects. Assess
children’s concerns as expressed through
their drawings. Accept the child’s choices
and expression of feelings.
The child is
Offer explanations about all procedures and
increasingly verbal
treatments. Clearly explain that the child is
but has some
not responsible for causing an illness in self
limitations in thought or family member.
processes. Causality is
often confused, so the
child may feel
responsible for
causing an illness.
The child gains a
Encourage the child to continue schoolwork
sense of self-worth
while hospitalized. Encourage the child to
NURS 4055 Child Health Competencies
19
from involvement in
activities.
Age Group
Adolescent
(12-18
years)
Piaget: Concrete
Operational
The child is capable of
mature thought when
allowed to manipulate
and see objects.
Theorist/
Developmental
Stage
Erikson: Identity
vs. Role Confusion
Characteristics of
Stage
Piaget: Formal
Operational
Age
3 months
*2-4 months:
posterior
fontanelle
closes
The adolescent’s
search for selfidentity leads to
independence from
parents and reliance
on peers.
The adolescent is
capable of mature,
abstract thought.
bring favorite pastimes to the hospital. Help
the child adjust to limitations on favorite
activities.
Give clear instructions about details of
treatment. Show the child equipment that will
be used in treatment.
Nursing Applications
Provide a separate recreation room for teens
who are hospitalized. Take health history and
perform exams without parents present.
Introduce adolescent to other teens with same
health problem.
Give clear and complete info about healthcare
and treatments. Offer both written and verbal
instructions. Continue to provide education
about the disease to the adolescent with a
chronic illness, as mature thought now leads to
greater understanding.
BREAKOUT: Developmental Milestones & Theory Matching
Developmental Milestones
Gross Motor Skills
Fine Motor Skills
Language Skills
Toys
Raises head 45
Holds hands in
Coos
Mobile; contrasting colors
degrees from prone
front of face; hands
and patterns; mirror;
open
music; rattle
4-5 months
Lifts head and looks
around; rolls over
Bats at objects;
grasps rattles; holds
bottle & carries
objects to mouth
6 months
Tripod sits; rakes
objects
Releases objects to
take another; rakes
objects
*6 months:
teeth begin
erupting
Revised 1/6/23
Laughs,
raspberries,
vocalizes in
response to others;
responds to name
Squealing
Fabric or board books;
easy-to-hold toys that
make noise;
floating/squirting bath
toys; soft dolls or animals
NURS 4055 Child Health Competencies
20
8 months
Sits unsupported
9 months
Crawls
10 months
Pulls to stand; cruises
holding to furniture
12 months
Sits from standing;
walks independently
*12-18
months:
anterior
fontanelle
closes
Gross (crude)
pincer grasp
Bangs objects
together; drinks
from cup with
assistance
Fine pincer grasp;
puts objects into
container and takes
out; feed self with
fingers
Feeds self with cup
and spoon; pokes
with finger; holds
crayon and mark on
paper
Babbling; follows
simple commands
Gives meaning to
names; mama and
dada; recognizes
objects by name;
imitates animal
sounds
Understands "no;"
uses 5-20 words;
knows 200 words;
sometimes answers
"what's this?"
40-50 words; 2-3
word sentences;
points to body parts
and pictures; uses
my or mine
18 months
Climbs stairs with
assistance
Turns multiple
book pages;
removes shoes;
stacks 4 cubes
2 years
Runs; kicks ball;
stand on tiptoe;
carries objects while
walking; climbs
without assistance
3 years
Climbs; pedals
tricycle; walks up
and down stairs with
alternate feet
Builds tower of 6
or 7 cubes; right or
left handed;
scribbles; turns
knobs; puts round
pegs into holes
Undresses self;
copies circle; builds
tower of 9-10
cubes; holds pencil
in writing position;
screws/unscrews
lids; turns book
pages one at a time
*33 months:
deciduous
teeth eruption
complete – 20
teeth
Revised 1/6/23
Plastic cups, bowls; mirror;
building blocks; stacking
toys; busy boxes; balls;
dolls; board books; toy
telephone; push-pull toys
(at 12 months)
Uses 2-3
recognizable words
with meaning
Understands
prepositions;
follows 3-part
commands; half
speech understood
by people outside
family; 3-4 word
sentences;
vocabulary of 1,000
words; can say
name, age, and
gender; uses
pronouns and
plurals
Push-pull toys
Household items (plastic
bowls, cups, utensils, etc.);
child-size household items
(kitchen, broom, etc.);
blocks; dolls; cars;
manipulative toys with
buttons, knobs; puzzles;
stacking toys; beads to
string; blocks; push-pull
toys; tricycle; music;
chalk, paint, crayons;
buckets, shovel; bath toys
NURS 4055 Child Health Competencies
21
4 years
Throws ball
overhand; kicks ball
forward; hops on one
foot; stands on one
foot 5 seconds
Uses scissors well;
copies capital
letters; draws circle
and square; draws a
person with 4 body
parts
5 years
Skip; somersaults;
may skate and swim
Prints some letters;
draws person with
at least 6 body
parts; dresses and
undresses without
help; ties shoelaces;
uses fork, spoon,
and knife with
supervision; copies
triangle; cares for
own toileting
Revised 1/6/23
Tells stories;
understands same
and different; asks
many questions;
knows at least one
color; can count a
few numbers
Long, detailed
conversations; uses
past, future, and
imaginary; answers
questions using
why and when; can
count to 10; recalls
parts of a story;
speech completely
intelligible; speech
is grammatically
correct; says name
and address
Jigsaw puzzles; creative
supplies (crayons, paint,
scissors, paint, glue);
puppets, dress-up clothes,
props; play kitchen and
pretend food; sandbox;
dolls and accessories;
swing sets; driving toys;
blocks, Legos; simple
board games; dollhouse
with accessories
NURS 4055 Child Health Competencies
22
BREAKOUT: Toys & Play
A Developmental Perspective on Play
Play is the primary means that children, of all ages, learn. Play also provides comfort and distraction in
uncomfortable situations. Therefore, fostering opportunities to play and incorporating play into interventions
will help make interactions with children more successful. Using play can also help to stimulate developmental
growth.
Infants – In the early months, babies explore their new world with their eyes. They then progress to use not
only their eyes and ears, but also their hands and mouth to explore objects. By the end of the first year, babies
are fully active in exploring their world. They may be crawling, creeping, or walking. They enjoy dropping,
throwing, squeezing, and “making things happen.”
Toddlers – They take joy in experimenting in movement. There is intense exploration of toys and objects, as
well as their quality and adaptive use in play. Piling up blocks and knocking them over is very enjoyable as a
toddler. The first pretend play is “as if” doing daily activities. They pretend to sleep, eat, or bathe. Toddlers
enjoy playing near each other (parallel play) but are not likely to share. This is very much the “mine” stage.
Preschoolers – They are some of the most playful children. The preschooler’s movement abilities continue to
develop alone with the refinement of manipulative activities. Preschoolers usually pretend or dramatize events
with other children. This sociodramatic play usually represents more roles, events, and object substitution. Real
and pretend are not firmly separated in younger preschoolers; therefore, they “become” rather than “pretend to
be.” Preschoolers also love to construct and build.
School-age – They are more involved in playing games with other children rather than a specific interest in
toys. This is a very social time where they may develop elaborate themes in their sociodramatic play. Many of
the themes may represent blood and thunder melodramas. There is an interest in games with rules and following
the standards. Older school-age children become more creative and inventive in their arts and crafts and the
types of choices they make for play. They prefer to play with same-sex peers; they enjoy “fooling around” with
friends as well as sitting and talking with adults.
Adolescents – “Play activities” are almost all peer directed. Interests may involve reading, music, sports, or
movies. This is a time when privacy is very important. Adolescents may not be very interested in taking to
adults they do not know.
Revised 1/6/23
NURS 4055 Child Health Competencies
23
Examples of Play
● Solitary - individual play
● Parallel - individual but side-by-side with another child. no interaction or sharing of toys
● Associative - Associative play is when children play together, but have different ideas and goals.
For example, talking to each other and playing with the same toys, but doing different things. This
usually happens between 3 and 5 years old. You can encourage associative play by taking your
child to a playgroup
● Cooperative - Treasure Hunt, Puzzles, Building Dens, Relay Races, Team Games, Makie, Up a
Dance, Board Games.
● Collaborative - Collaborative play is a type of play that involves taking turns, sharing, following
rules, negotiating, and compromising. Children who engage in collaborative play work together on
projects to reach a common goal.
● Medical - The use of games, toys, books, art, and role playing, sometimes with real or pretend
medical equipment, to help children understand and become more comfortable with medical tests,
procedures, treatments, and their illness.
Toy Match
(Write down which toy(s), from the toy table, you would provide for each child and the rationale for your
choice.) (SCROLL UP)
5-month-old
6-month-old
9-month-old
12-month-old
18-month-old
Revised 1/6/23
NURS 4055 Child Health Competencies
24
3-year-old
6-year-old
9-year-old in isolation
10-year-old
16-year-old:
What is important to remember when selecting toys for children who are in isolation?
TOY MEMORY AID
“Most People Can Get This”
M = Music/Mobiles (Infants)
P = Push/Pull/Pound toys (Toddler)
C = Colors, Coloring, Characters (Preschool)
G = Games (School Age)
T = Themselves (Adolescents)
**Note: Toy/play needs may vary based on developmental age vs. actual age, disease processes/treatment therapies (isolation,
casts, etc.)
N4055 CHILD HEALTH COMPETENCIES: MEDICATION SIMULATION LAB PREPARATION
Medication Simulation Lab Instructions
Prior to the simulation:
Complete assigned preparation work PRIOR to your scheduled simulation day and bring with you to the
simulation. You must wear your TWU uniform and ID badge. You may work in groups on the prep, however,
on the day of simulation all work will be done individually.
On the day of simulation, you will have 90 minutes to complete the medication simulation lab. Review the
rubric and watch the video for lab expectations.
Following the simulation, complete the medication lab reflection questions from Canvas and submit to canvas.
Note: If you are unable to complete the simulation successfully, you must complete remediation with your
clinical faculty until successful in order to pass the clinical portion of this course.
Medication Calculation and Administration Preparation Must be completed PRIOR to scheduled lab.
Review:
● Medication Lab Rubric and Medication Lab Instructions.
● Watch the Medication Lab videos and all Medication Lab materials in order to prepare for the skills lab and
simulation.
Revised 1/6/23
NURS 4055 Child Health Competencies
25
● Fluid maintenance calculations.
● Calculation of medication doses based on weight, safe-dose range calculations and recognition of whether
ordered dose is within range or not (especially divided dose calculations; ex. Child is 20 kg. Give 500 mg Med
every 6 hrs with safe dose range of 50-100mg/kg/day in divided doses q6-8hrs.
● Administration of medication via oral route.
Resources:
● Skills Guides: Administering Medications and Irrigations, Intravenous Access
● Medication Administration and Fluid Maintenance in Pediatrics Module
● Calculate with Confidence, 5th ed.: Ch. 25 – Pediatric Calculations (per Body weight)
●
●
●
●
●
●
Right patient
Right medication
Right dose
Right time .
Right route
Right documentation
N4055 Child Health Competencies: (see Canvas for schedule)
N4055 Child Health Competencies
Medication Simulation Lab Rubric
Name: ___________________________________________
Faculty:
________________________________
Med Admin Sim Rubric Spring 2023
C
Ratings
P
riteria
Introduction
Enters patient room,
performs AIDET and hand
hygiene.
Safe Dose Calculation
Identifies and calculates
safe and accurate doses
of medications due to be
administered**
Revised 1/6/23
1 pts
Competent
Introduces self to patient and or
family as dictated by the
situation. Completes hand
hygiene. Score this as done or
not done (this is not counted
as an error for study
purposes)
1 pts Competent
Without prompting: (**faculty do
NOT ask/review with student
med calculations prior to med
preparation or
administration) Student
verbalizes correct doses to be
administered
0 pts
Error
Does not introduce self-and/or does not
perform hand hygiene (this is not
considered an error for study purposes).
0 pts Error
Student verbalizes incorrect
doses to be
administered; or does
not identify that the
medication is unsafe or
is not due.
NURS 4055 Child Health Competencies
26
Retrieves medication
from cart/drawer
Retrieves medication
from the cart/drawer and
compares to the eMAR
2 Patient Identifiers
Allergy Identification
Appropriate
Administration
Recognizes embedded
errors
Revised 1/6/23
1 pts Competent
Student uses the eMAR (not paper
prep work or scratch paper)
to retrieve the medications
for administration. Student
verbalizes and demonstrates
comparing the medication
package to the eMAR and
states the name, dose, route,
and (expiration). Student
checks the medication name
as the students closes the
med cart/drawer.
1 pts Competent
Without Prompting: Student
scanned and verified 2 patient
identifiers compared to eMAR
prior to medication
administration (if they forgot
and remembered later and
self-corrected; still document
as an error for study
purposes, but discuss in
debrief).
1 pts
Competent
Without Prompting: Student asks
and identifies, from the
allergy bracelet, patient
allergies compared to eMAR
prior to medication
administration (if student
forgets and self-corrects, still
mark as error for study
purposes, but discuss in
debrief).
1 pts Competent
Without prompting: Verbalizes
pertinent patient assessment
data prior to medication
administration (i.e. digoxin =
HR & potassium), pain score
with appropriate pain scale.
1 pts Competent
Without prompting: Student holds
or states they will notify the
provider prior to giving
medications outside the safe
dosage range, outside correct
time span, patient has an
0 pts Error
Student does not use the
eMAR or does not
demonstrate checks.
Student does not
verbalize or
demonstrate
comparing the
medication package to
the eMAR or state the
name, dose, route, and
(expiration). Student
does not check the
medication name as
the student closes the
med cart/drawer.
0 pts Error
Student did NOT scan and
verify 2 identifiers prior
to medication
administration (if they
ID, but do not scan, it is
still an error).
0 pts Error
Student did not ask and/or
compare allergy
bracelet to eMAR prior
to medication
administration.
0 pts Error
Student did NOT verbalize
or assess pertinent
data prior to
medication
administration.
0 pts Error
Student administers
medications that
should not be given.
NURS 4055 Child Health Competencies
27
Oral Medication
Administration Follows 6
Rights
IV Maintenance Fluid
Rate Follows
6 Rights
IV Medication Follows 6
Rights
Medication Teaching
Patient/Family teaching is
appropriate for
medication and
developmental level
Faculty Notes/Comments:
Faculty feedback:
Revised 1/6/23
allergy, or patient has order
for 2 similar drugs.
1 pts Competent
Without Prompting: Selects the
appropriate oral medications
and compares med to eMAR
at the bedside for 3rd check
(for pediatric patient,
accurately indicates on the
syringe how much medication
will be administered). Scans
medication and documents.
1 pts Competent
Without prompting: Student
selects the appropriate IV
fluid. Scans fluid and
documents the correct hourly
rate. Student should assess IV
site (does not count as an
error is site is not assessed
but discuss in debriefing).
1 pts Competent
Without prompting: Student
selects the appropriate IV
medication with the
appropriate amount. Student
scans the medication and
documents the dose and
appropriate infusion rate.
1 pts Competent
Without prompting: Student
performs appropriate
teaching to the patient/family
appropriate for the
medication and the
developmental level (this is
not scored for the study).
0 pts Error
Student does NOT: Select
the appropriate oral
medication and
compare to the eMAR
at the bedside for 3rd
check. Does not
indicate how much
medication will be
administered via
syringe (or indicates
wrong amount). Does
not scan the
medication or does not
document.
0 pts Error
Student does NOT do any
one of the following:
Select the correct IV
fluid or does not scan
fluid or document the
hourly rate.
0 pts Error
Student does NOT do any
one of the following:
Select the appropriate
IV medication, or does
not scan the
medication, or does
not document the dose
or the correct infusion
rate.
0 pts Error
Student does NOT provide
teaching, or teaching is
inaccurate, or
inappropriate for
developmental level
(this is not considered
an error for the study).
Total Points: 11
NURS 4055 Child Health Competencies
28
Revised 1/6/23
NURS 4055 Child Health Competencies
29
Medications – COMPLETE PRIOR TO MedLab
Look up the following medications using Lexicomp to complete the chart using the Children’s Health Formulary. Website: online.lexi.com
Login: CHIDFW2021 & Password: DFW2021 (case sensitive). You must use this site for preparation as other resources may have different
ranges causing your calculations to be incorrect during the simulation.
Name of Drug
Generic/Trade
EXAMPLE:
Vancomycin (for
general dosing
I.V., mild to
moderate
infection)
Classification
Safe Dosage Range
List the Most Common Side Effects
Action of Medication
Antibiotic,
Miscellaneous
45-60 mg/kg/day divided every 6-8
hours; dose and frequency should be
individualized based on serum
concentrations; usual maximum
daily dose: 2000 mg/day
Injection:
Cardiovascular: Hypotension
accompanied by flushing
Central nervous system: Chills,
drug fever
Dermatologic: Erythematous
rash on face and upper body
(red neck or red man
syndrome)
Hematologic: Eosinophilia,
reversible neutropenia
Local: Phlebitis
Inhibits bacterial cell wall
synthesis; alters bacterial-cellmembrane permeability
10-15 mg/kg/dose every 4-6 hours.
Do not exceed 5 doses in 24 hours,
75 mg/kg/day, or 4,000 mg/day.
Angioedema, disorientation,
dizziness, rash, nausea,
vomiting. HA, insomnia,
constipation, Steven-Johnson
syndrome, nephrotoxicity,
hepatotoxicity
Pain: works peripherally to block
pain impulse generation; may also
inhibit prostaglandin synthesis in
the CNS
**Note: Dosing
indications in
bold text will
direct you to the
dosage range
needed for use in
lab/sim.**
Acetaminophen
liquid or tab:
based on usual
oral dose for
infants/ children
Pain/Fever AND
adult Pain/Fever
Analgesic,
antipyretic
Revised 1/6/23
Adult: 325 to 600 mg every 4 to 6
hours as needed or 1 g every 6 hours
as needed; maximum dose: 4g/day
Fever: acts on the hypothalamus
to produce antipyresis
NURS 4055 Child Health Competencies
30
Nice reference
table: OIP.Ka5k9JVFDLu_fnbBOhmgHaDp
(474×233)
(bing.com)
Acetaminophen
and Codeine 30 mg
(Tylenol #3) Adult:
Pain: Oral: Initial
Analgesic,
opioid
combination
Solution/suspension: 120mg/codeine
12 mg/5mL, 15 mL q 4 hrs PRN,
max: 4,000mg/24hrs
Constipation, drowsiness,
hypotension, confusion, dizziness,
HA, malaise, rash, nausea, vomiting,
dyspnea, pruritic maculopapular rash
Acetaminophen: may work
peripherally to block pain
impulses; acts on hypothalamus to
produce antipyresis
Tablets: 300-1,000 mg/dose/codeine
(15-60mg/dose) q 4 hrs PRN, max:
4,000mg/360mg per 24 hrs
Amoxicillin, (1) oral:
based on General
Pediatric dosing,
susceptible infection,
mild to moderate
infection
(2) for skills day: otitis
media treatment
AND (3) General Adult
dosing (immediate
release)
Antibiotic,
penicillin
Revised 1/6/23
3 dosages should be listed
1. Oral:
Pediatric: 25 to 50 mg/kg/day in
divided doses every 8 hours;
maximum dose: 500 mg/dose.
2. Skills day (otitis media):
Oral: 80 to 90 mg/kg/day in divided
doses every 12 hours
3. General Adult:
Immediate release: Oral: 500 mg to
1 g every 8 to 12 hours.
Codeine: blocks pain impulse
generation and inhibits ascending
pain pathways, thus altering the
perception and response to pain;
causes CNS depression
Gastrointestinal: Diarrhea,
Nausea
Genitourinary: Vulvovaginal
infection
Nervous system: Headache
Inhibits bacterial cell wall
synthesis by binding to one or
more of the penicillin-binding
proteins (PBPs) which in turn
inhibits the final transpeptidation
step of peptidoglycan synthesis in
bacterial cell walls, thus inhibiting
cell wall biosynthesis. Bacteria
eventually lyse due to ongoing
activity of cell wall autolytic
enzymes (autolysins and murein
hydrolases) while cell wall
assembly is arrested.
NURS 4055 Child Health Competencies
31
Cefazolin Sodium
IV based on IV
general dose for
infants/children/adol,
susceptible infection,
mild to moderate
Antibiotic,
Cephalosporin
(First
Generation)
Cefuroxime IV:
based on IV/IM
general dose for
infants/children/adol.
susceptible infection,
mild to moderate
Antibiotic,
Cephalosporin
(second
generation)
Revised 1/6/23
Infants, Children, and Adolescents:
IM, IV:
Mild to moderate infections: 25 to
100 mg/kg/day divided every 8
hours; maximum daily dose: 6
g/day
Hypotension, Syncope,
Pruritus, abdominal cramps,
Clostridioides difficile diarrhea,
flatulence, heartburn, nausea,
vaginitis, confusion, dizziness,
drowsiness, fatigue, increased
blood urea nitrogen, increased
serum creatinine, renal failure
syndrome
Treatment of susceptible
infections involving the
respiratory tract, skin and skin
structure, urinary tract, biliary
tract, bone and joint, genitals,
and septicemia , perioperative
prophylaxis, treatment of
bacterial endocarditis. Inhibits
bacterial cell wall synthesis by
binding to one or more of the
penicillin-binding proteins
(PBPs) which in turn inhibits the
final transpeptidation step of
peptidoglycan synthesis in
bacterial cell walls, thus
inhibiting cell wall biosynthesis.
Bacteria eventually lyse due to
ongoing activity of cell wall
autolytic enzymes (autolysins
and murein hydrolases) while
cell wall assembly is arrested.
Infants, Children, and Adolescents:
Mild to moderate infection: IM, IV:
75 to 100 mg/kg/day divided in 3
doses; maximum dose: 1,500
mg/dose
Diarrhea, local
thrombophlebitis, diaper rash in
children, N/V, unpleasant taste,
vaginitis, decreased
hematocrit, decreased
hemoglobin, eosinophilia,
Jarisch-Herxheimer reaction
Treatment susceptible infections
involving the lower respiratory
tract, urinary tract, skin and skin
structure, sepsis, uncomplicated
and disseminated gonorrhea,
and bone and joint, meningitis,
and surgical prophylaxis.
Inhibits bacterial cell wall
synthesis by binding to one or
more of the penicillin-binding
proteins (PBPs) which in turn
inhibits the final transpeptidation
step of peptidoglycan synthesis
NURS 4055 Child Health Competencies
32
Cetirizine PO: based on
Urticaria, chronic
spontaneous
(Children 6-11 years
Antihistamine
Urticaria acute: Infants ≥6
months and Children <2 years:
2.5 mg once daily, Children 2 to 5
Drowsiness, headache,
Abdominal pain, nausea,
xerostomia, insomnia, malaise,
bronchospasm, pharyngitis,
fatigue
years: 2.5 to 5 mg once daily,
Children >5 years and
Adolescents: 5 to 10 mg once
in bacterial cell walls, thus
inhibiting cell wall biosynthesis.
Bacteria eventually lyse due to
ongoing activity of cell wall
autolytic enzymes (autolysins
and murein hydrolases) while
cell wall assembly is arrested.
Relief of symptoms of hay fever or
other respiratory allergies, relief of
symptoms of common cold, relief
of symptoms associated with
perennial allergic rhinitis,
treatment of acute urticaria, has
also been used as adjunct
therapy in management of
cutaneous symptoms of
anaphylaxis
daily.
Urticaria, chronic spontaneous:
Children 6 to 11 years: Oral: 5 mg
once daily or twice daily
Clindamycin IVPB
Pediatric: General
dosing susceptible
infection
Antibiotic,
Miscellaneous
Revised 1/6/23
Pediatric: 20 to 40 mg/kg/day
divided every 6 to 8 hours;
maximum daily dose: 2,700
mg/day
Dermatologic: Urticaria,
vesiculobullous dermatitis
Gastrointestinal: Abdominal
pain, nausea, vomiting
inhibits bacterial protein
synthesis; bacteriostatic or
bactericidal depending on drug
concentration, infection site, and
organism
NURS 4055 Child Health Competencies
33
Dexamethasone IVP
Usual ADULT dosage
range
Digoxin elixir PO: daily
maintenance for 1
month – 24 months
AND Adult Heart
Failure with reduced
ejection fraction
Maintenance dose
Diphenhydramine PO:
Allergies,
antihistamine
(Children 6 - < 12
years) fixed dosing
Adrenal
Corticosteroid;
Antiinflammatory
Agent;
Antiemetic;
Corticosteroid,
Systemic;
Glucocorticoid
Antiarrhythmic
Agent,
Miscellaneous;
Cardiac
Glycoside
Ethanolamine
Derivative;
Histamine H1
Antagonist;
Histamine H1
Antagonist, First
Generation
Revised 1/6/23
Adult: 4 to 20 mg/day given in a
single daily dose or in 2 to 4
divided doses; High dose: 0.4 to
0.8 mg/kg/day (usually not to
exceed 40 mg/day).
Adrenal suppression: May
cause hypercortisolism or
suppression of
hypothalamic-pituitaryadrenal axis, particularly in
younger children.
Bradycardia, cardiac
arrhythmia, tachycardia,
diaphoresis, Hiccups,
increased appetite, nausea
Long-acting corticosteroid with
minimal sodium-retaining
potential. It decreases
inflammation by suppression of
neutrophil migration, decreased
production of inflammatory
mediators, and reversal of
increased capillary permeability;
suppresses normal immune
response. Dexamethasone
induces apoptosis in multiple
myeloma cells.
Dexamethasone's mechanism of
antiemetic activity is unknown.
1 to 24 months:10 to 15 (mcg/kg/day)
Heart failure with reduced ejection
fraction: Maintenance dose Oral:
0.125 to 0.25 mg once daily; higher
daily doses are rarely necessary. If
patient is >70 years of age, has
impaired renal function, or has a low
lean body mass, low doses (eg,
0.125 mg daily or every other day)
should be used initially
Infants and Children: Oral: 5
mg/kg/day in equally divided doses
administered every 6 to 8 hours as
needed; usual dose: 12.5 to 25
mg/dose; maximum dose: 50
mg/dose.
*Be aware of Digoxin toxicity*
Accelerated atrioventricular
junctional rhythm, asystole,
atrial
tachycardia,maculopapular
[most common skin rash],
Abdominal pain, diarrhea,
Heart failure: Inhibition of the
sodium/potassium ATPase pump
in myocardial cells results in a
transient increase of intracellular
sodium, which in turn promotes
calcium influx via the sodiumcalcium exchange pump leading
to increased contractility. May
improve baroreflex sensitivity
Chest tightness, hypotension,
palpitations, tachycardia
Diaphoresis, skin
photosensitivity, skin rash,
constipation, diarrhea, dry
mucous membranes, epigastric
discomfort, nausea, vomiting,
chills,dizziness, drowsiness
fatigue headache, sedated
state, Nasal congestion,
thickening of bronchial
secretions, wheezing
Competes with histamine for H1receptor sites on effector cells in
the gastrointestinal tract, blood
vessels, and respiratory tract;
anticholinergic and sedative
effects are also seen
NURS 4055 Child Health Competencies
34
Docusate PO: Stool
softener, weight
directed dosing,
infants and children
Stool Softener
Weight-directed dosing: Infants and
Children: 5 mg/kg/day in 1 to 4
divided doses
Throat irritation (liquid)
Furosemide: based on
oral dose for
infants/children
Antihypertensive
Diuretic, Loop
Intermittent dosing (acute): Initial: 2
mg/kg as a single dose; if
ineffective, may increase in 6 to 8
hours in increments of 1 to 2
mg/kg/dose; maximum dose: 6
mg/kg/dose.
orthostatic hypotension,
hyperglycemia, hyperuricemia,
hypocalcemia, hypokalemia,
hypomagnesemia,
hypovolemia, increased serum
cholesterol, Abdominal cramps,
constipation, diarrhea, gastric
irritation, nausea, oral irritation,
vomiting
Hydrocodone/Acetami
nophen: <50 kg:
Oral: Usual initial
dose
Analgesic
Combination
(Opioid);
Analgesic,
Opioid
Revised 1/6/23
Maintenance dosing (chronic):
Limited data available: Initial: 0.5 to
2 mg/kg/dose every 6 to 24 hours; if
initial dose ineffective, may increase
dose in increments of 1 to 2
mg/kg/dose; maximum daily dose: 6
mg/kg/day not to exceed maximum;
adjust dose to minimal effective
dose for maintenance
Patient weight:
<50 kg: Oral: Usual initial dose:
Hydrocodone 0.1 to 0.2 mg/kg/dose
every 4 to 6 hours; in infants,
reduced doses and close monitoring
should be considered due to
possible increased sensitivity to
respiratory depressant effects; use
with caution in infants.
Bradycardia, cardiac arrest,
hypotension, dizziness,
drowsiness, drug dependence,
lethargy, sedation, Cold and
clammy skin, diaphoresis,
Abdominal pain, constipation,
gastric distress, heartburn,
nausea, respiratory depression
Reduces surface tension of the
oil-water interface of the stool
resulting in enhanced
incorporation of water and fat
allowing for stool softening
Primarily inhibits reabsorption of
sodium and chloride in the
ascending loop of Henle and
proximal and distal renal tubules,
interfering with the chloridebinding cotransport system, thus
causing its natriuretic effect
Hydrocodone: Binds to opiate
receptors in the CNS, altering the
perception of and response to
pain; suppresses cough in
medullary center; produces
generalized CNS depression.
Acetaminophen: Although not fully
elucidated, the analgesic effects
are believed to be due to
activation of descending
serotonergic inhibitory pathways
in the CNS. Interactions with other
nociceptive systems may be
involved as well (Smith 2009).
Antipyresis is produced from
NURS 4055 Child Health Competencies
35
Ibuprofen: Oral
Analgesic, children <
50 kg
Analgesic,
Nonopioid;
Nonsteroidal
Antiinflammatory
Drug (NSAID),
Oral;
Nonsteroidal
Antiinflammatory
Drug (NSAID),
Parenteral
Weight-directed dosing:
5.4 to 8.1kg:
50mg
>10%: Hematologic &
oncologic: Decreased
hemoglobin (17% to 23%)
8.2 to 10.8kg:
75 to 80mg
inhibition of the hypothalamic
heat-regulating center.
Reversibly inhibits
cyclooxygenase-1 and 2 (COX-1
and 2) enzymes, which results in
decreased formation of
prostaglandin precursors; has
antipyretic, analgesic, and antiinflammatory properties
10.9 to 16.3kg:
100mg
16.4 to 21.7kg:
150mg
21.8 to 27.2kg:
200mg
27.3 to 32.6kg:
200 to 250mg
Regular Insulin IVP
and IV drip: Adult:
DKA- IV initial
Insulin, ShortActing
32.7 to 43.2kg:
300mg
IV: Initial: 0.1 units/kg IV bolus,
followed by 0.1 units/kg/hour via IV
infusion, or 0.14 units/kg/hour via IV
infusion (no bolus) (Kitabchi 2009).
Dosage adjustment: Increase the IV
infusion rate (eg, by double) each
hour if serum glucose does not
decrease by ~50 to 75 mg/dL in the
first hour. Once serum glucose
approaches 200 to 250 mg/dL (DKA)
or 250 to 300 mg/dL (HHS), may
decrease IV infusion (eg, to 0.02 to
0.05 units/kg/hour) and administer
Revised 1/6/23
Peripheral edema, Injection site
pruritus, Amyloidosis (localized
at injection site), hypoglycemia,
hypokalemia, weight gain,
Anaphylaxis, hypersensitivity
reaction, Immunogenicity,
Erythema at injection site,
hypertrophy at injection site,
lipoatrophy at injection site,
swelling at injection site
Insulin acts via specific
membrane-bound receptors on
target tissues to regulate
metabolism of carbohydrate,
protein, and fats. Target organs
for insulin include the liver,
skeletal muscle, and adipose
tissue.
Within the liver, insulin stimulates
hepatic glycogen synthesis.
Insulin promotes hepatic
synthesis of fatty acids, which are
released into the circulation as
lipoproteins. Skeletal muscle
effects of insulin include
NURS 4055 Child Health Competencies
36
dextrose-containing IV fluids until
DKA or HHS has resolved
increased protein synthesis and
increased glycogen synthesis.
Insulin stimulates lipoprotein
lipase synthesis and activity; this
results in hydrolysis of
triglycerides into free fatty acids
and storage of free fatty acids in
adipocytes, thereby reducing
circulating triglyceride levels
If insulin is required prior to the
availability of the insulin drip, regular
insulin should be administered by IV
push injection.
Labetalol IV drip: Adult:
for chest pain or
HTN 0.050.1mg/kg/min and
titrate for effect.
Antihypertensive
; Beta-Blocker
With AlphaBlocking Activity
Intermittent IV: Initial: 5 to 20 mg
over 2 minutes; repeat dose
every 10 minutes until target
blood pressure is reached;
manufacturer's labeling).
Although manufacturer's labeling
recommends against exceeding a
cumulative IV dose of 300 mg, it
may be reasonable to exceed this
dose in selected patients, while
monitoring for accumulation.
>10%:
Cardiovascular: Orthostatic
hypotension (intravenous:
58%; tablet: 1%)
Central nervous system:
Dizziness (1% to 20%),
fatigue (1% to 11%)
Blocks alpha1-, beta1-, and
beta2-adrenergic receptor
sites; elevated renins are
reduced. The ratios of alpha- to
beta-blockade differ depending
on the route of administration
estimated to be 1:3 (oral) and
1:7 (IV)
Gastrointestinal: Nausea
(≤19%)
Levetiracetam PO:
Partial onset (focal)
seizures (infant > 6
mo < 4 yr)
Lorazepam IV: Status
epilepticus
Methylprednisolone
IV: General dosing;
anti-inflammatory or
Antiseizure,
Miscellaneous
Benzodiazepine
Antiseizure,
Sedative
Antianxiety,
Antiemetic
Adrenal
Corticosteroid
Revised 1/6/23
Initial: 10 mg/kg/ dose twice daily;
increase dosage every 2 weeks by 10
mg/kg/ dose daily based on response
and tolerability to the recommended
dose of 25 mg/kg/ dose twice daily
Diarrhea, stuffy nose, runny nose,
trouble sleeping, N/V, abdominal
pain
0.1 mg/kg slow IV; may repeat dose
once in 5 to 10 minutes; maximum
dose of 4mg/dose
Dizziness, tiredness, weakness,
irritation at IV site
IV (sodium succinate):
0.11 to 1.6 mg/kg/day in 3 to 4 divided
doses.
insomnia, heartburn, nervousness,
abdominal distention, diaphoresis,
acne, mood swings, decreased
appetite, facial flushing, delayed
The precise mechanism is unknown,
however, studies suggest that it may
involve one or more central
pharmacologic effects, such as
binding to synaptic proteins which
modulate neurotransmitter release
Binds to benzodiazepine receptors
on the GABA neuron and results in
hyperpolarization (a less excitable
state) and stabilization
Regulate gene expression
subsequent to binding specific
intracellular receptors and
translocation into the nucleus.
NURS 4055 Child Health Competencies
37
Prednisone PO:
Adult: 16 to 64 mg/day once daily or in
divided doses.
immunosuppressive;
IV usual range
Prednisone PO: Adult:
usual dose range
Montelukast PO:
Children ≥6 years
and Adolescents
Leukotriene
receptor
antagonist
<15 years
AND Adult: asthma,
persistent,
maintenance
Morphine IV: Acute
pain, moderate to
severe; IV
intermittent dosing <
50 kg AND Adult
dosing: Acute
coronary syndrome,
refractory ischemic
chest pain IV
Kids >6: Oral: 5 mg once daily in the
evening.
wound healing, increased
susceptibility to infection, diarrhea,
constipation.
Cough, headache, diarrhea,
common cold symptoms,
abdominal pain
Adolescents <15: 10 mg once daily in
the evening.
modulate carbohydrate, protein, and
lipid metabolism and maintenance of
fluid and electrolyte homeostasis.
Controls or prevents inflammation by
controlling rate of protein synthesis,
suppressing migration of
polymorphonuclear leukocytes
(PMNs) and fibroblasts, reversing
capillary permeability, and stabilizing
lysosomes at cellular level
Leukotriene receptor antagonist so
prevent leukotriene from bidining
which stops airway edema smooth
muscle contraction, and inflammatory
process caused by asthma
Adult:10 mg once daily in the evening.
Some experts suggest waiting 1 to 2
months before assessing efficacy
Analgesic, opioid
Acute pain, moderate to severe:
0.025-0.03 mg/kg/dose q 2-4 hrs
Pediatric (<6mo): 0.025-0.3
mg/kg/dose q 2-4 hrs
Pediatric (>6mo and <50kg): 0.05
mg/kg/dose
ACS, refractory ischemic chest pain:
initially= 2-4mg, then= 2-8mg q 5-15
min PRN
OR
initially= 1-5mg, then= 1-5mg q 530min PRN
Revised 1/6/23
GI: constipation, N/V
Cardiovascular: vasodilation,
chest pain, palpitations
Nervous system: drowsiness,
dizziness, confusion
Binds to opioid receptors in CNS=
inhibition of ascending pain
pathways= altered perception and
response to pain
NURS 4055 Child Health Competencies
38
Nitroglycerin SL: Adult:
Acute angina
translingual 0.4mg
spray
Antianginal agent,
vasodilator
Initial: 1 or 2 sprays at onset; repeat
every 5 minutes if angina persists; may
administer up to 3 sprays in a 15-minute
period
Headache, or burning tingling of
mouth
Nitroglycerin forms nitric oxide which
activates a certain enzyme that
causes smooth muscle (artery walls
made of it ) to relax and vasodilator
effect on veins and arteries , reduces
cardiac oxygen demand by
decreasing preload, reduce afterload
Potassium Chloride
PO: Adult:
hypokalemia oral
electrolyte
supplement
mild to mod:
10-20 meq 2-4 times a day; max single
dose is 40meq
abdominal pain, nausea, vomiting,
has diarrhea
replenishes intracellular potassium
Cardiovascular: flushing
CNS: dizziness, HA, insomnia,
paresthesia
Inhibits phosphodiesterase type 5 in
Severe 40meq 3 -4 times daily or 20
meq every 2-3 hours
Sildenafil PO:
Pulmonary hypertension
(oral) Infants: Initial
(up to maximum
dosing)
Phosphodiesteras
e inhibitor
Vasodilator
Pulmonary hypertension:
Infants: initial: 0.25 mg/kg/dose every 6
hours or 0.5 mg/kg/dose every 8 hours;
titrate as needed; max reported dose
range: 1 to 2 mg/kg/dose every 6-8
hours.
Children and adolescents < 18 years:
8-20 kg: 10 mg 3 times daily
>20 kg to 45 kg: 20 mg 3 times daily
>45 kg: 40 mg 3 times daily
Derm: erythema, skin rash
GI: diarrhea, dyspepsia, gastritis,
nausea
smooth pulmonary vasculature →
pulmonary vasculature relaxation;
vasodilation in pulmonary bed and
systemic circulation (to a lesser
degree) may occur
GU: UTI
Hepatic: inc liver enzymes
Neuromuscular & skeletal: back
pain, myalgia
Ophthalmic: visual disturbance
(including vision color changes,
blurred vision, and photophobia)
Sulfamethoxazole &
Trimethoprim PO:
Antibiotic,
Sulfonamide
Derivative
Dosage recommendations are based on
the trimethoprim (TMP) component:
8 to 12 mg TMP/kg/day in divided doses
Revised 1/6/23
Respiratory: epistaxis,
exacerbation of dyspnea, nasal
congestion, rhinitis, sinusitis
Diarrhea, upset stomach,
vomiting, loss of appetite
Interferes with bacterial folic acid
synthesis and growth via inhibition of
dihydrofolic acid formation
NURS 4055 Child Health Competencies
39
every 12 hours; maximum dose of 160
mg TMP/dose
General dosing,
susceptible infection
Valproic Acid PO:
Seizure disorders
(general dosing)
Initial
Antiseizure Agent,
Miscellaneous,
Infantile Spasms
Baclofen
Cannabidiol solution
Cetirizine
Cholecalciferol
Clonazepam
Clonidine
Cyproheptadine
Divalproex
Duloxetine
Gabapentin
Lamotrigine
Lanzoprazole
Levetiracetam
Revised 1/6/23
10 to 15 mg/kg/day in 1 to 3 divided
doses; increase by 5 to 10 mg/kg/day at
weekly intervals until seizures are
controlled or side effects preclude further
increases
Headache, n/v, dizziness, fatigue.
constipation
Causes increased availability of
GABA to brain neurons or may
enhance the action of GABA or mimic
its action at postsynaptic receptor
sites. Also blocks voltage-dependent
sodium channels, which results in
suppression of high-frequency
repetitive firing
NURS 4055 Child Health Competencies
40
Metoclopraminde
Methocarbamol
Oxcarbazepine
Pregabalin
Tizanidine
that
similar
1.6
Ref).
mg/kg/day;
theNote:
tofollowing
adult Pharmacokinetic
doses
experiential
age-dependent
of 30 to
data
150
analysis
are
pediatric
mg/day:
needed
based
Children
doses
to on
fully
resulted
simulation
assess
2 to 6 in
years:
(Ref
exposures
reported
0.35 to
Trazodone
Antidepressant,
Serotonin
Reuptake
Inhibitor/Antag
onist
Children
2Oral:
dose:
at
increments
daily
(maximum
mg/kg/dose
2-week
at
Immediate
25bedtime,
mg/dose;
18
intervals
dose:
up
months
attobedtime;
100
release:
3not
may
mg/kg/dose
into
mg/dose
to12.5
<3
increase
exceed
Initial:
maximum
years:
to 25aonce
dose
1mg
to
• Fatigue
• Constipation
• Diarrhea
• Dry mouth
• Abdominal pain
• Nausea
• Vomiting
• Anxiety
• Tremors
• Loss of strength and
energy
• Muscle pain
• Runny nose
• Weight gain
• Weight loss
Revised 1/6/23
NURS 4055 Child Health Competencies
41
Valproate Depacon
[DSC];
Depakene [DSC]; Depakote;
Depakote ER; Depakote
Sprinkles
Antiseizure
Agent,
Miscellaneous; I
nfantile Spasms,
Treatment
Headache
• Nausea
• Vomiting
• Dizziness
• Fatigue
• Constipation
• Diarrhea
• Abdominal pain
• Trouble sleeping
• Loss of strength and
energy
• Lack of appetite
• Increased hunger,
Weight gain, Weight
loss, Anxiety, Flu-like
signs, Hair loss
Zonisamide (Zonegran;
Zonisade)
Antiseizure
Agent,
Miscellaneous
Excipient information
presented
when
available
(limited,
particularly
for
generics);
consult
Revised 1/6/23
Children <5 years: Limited
data available: Oral: Initial:
1 to 2 mg/kg/day in 2
divided doses; increase
dose in increments of 0.5
to 1 mg/kg/day once or
twice daily every 2 weeks;
usual dose: 5 to 8
• Loss of strength and
energy
• Dizziness
• Fatigue
• Nausea
• Abdominal pain
Stabilizes neuronal membranes
and suppresses neuronal
hypersynchronization through
action at sodium and calcium
channels; does not affect GABA
activity.
NURS 4055 Child Health Competencies
42
specific
labeling.
product
Capsule, oral: 25 mg,
100 mg
Suspension, oral: 10
mg/mL, extemp
oraneously
prepared
by
pharmarcy
Revised 1/6/23
mg/kg/day (Cross 2014;
Glauser 2002; Wallander
2014).
Children ≥5 years and
Adolescents <16 years:
Limited data available:
Oral: Initial: 0.5 to 1
mg/kg/day in 1 to 2
divided doses; increase
dose in increments of 0.5
to 1 mg/kg/day in 2
divided doses every 2
weeks; if patients require
more rapid titration, dose
may be increased in 1.5
mg/kg/day increments; if
concomitant CYP3A4
inducing agent, may
increase at weekly
intervals. Reported usual
dose: 5 to 8 mg/kg/day in
1 or 2 divided doses,
although some patients
may require up to 12
mg/kg/day or a
maximum daily dose of
500 mg/day once daily or
in 2 divided doses,
whichever is less
(Balabanova 2020;
• Headache
• Lack of appetite
• Diarrhea
• Trouble sleeping
NURS 4055 Child Health Competencies
43
Guerrini 2013; Wallander
2014; Zonegran European
Medicines Agency 2021).
Adolescents ≥16 years: Oral:
Initial: 100 mg once daily;
dose may be increased to
200 mg/day after 2
weeks; further increases in
dose should be made in
increments of 100
mg/day and only after a
minimum of 2 weeks
between adjustments;
usual effective dose: 100
to 600 mg/day
(manufacturer's
labeling). Note: There is
no evidence of increased
benefit with doses >400
mg/day. Steady-state
serum concentrations
fluctuate 27% with oncedaily dosing, and 14%
with twice-daily dosing;
patients may benefit from
divided doses given twice
daily (Leppik 1999).
Revised 1/6/23