PYRAMID POINTS
 Most are liquid or suspension versus tablet
 Solutions may be measured with oral syringe or other acceptable measurement or administration device
 Mixing of suspensions required before pouring
 Suspensions must be administered immediately after measurement
 Administer with child seated upright or with head elevated
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-2

PYRAMID POINTS
I. Oral Medications (continued)
 Never pinch child’s nostrils during administration
 Unpleasant tasting medications should be directed toward back of infant’s mouth via syringe, slowly, allowing swallowing


Small child may be placed sideways on lap, closely held, medication administered via plastic spoon, cup, or syringe slowly
If tablet or capsule is administered, check child’s mouth to ensure it is swallowed; crush if pharmacologically appropriate
 Follow generally accepted medication guidelines for children
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-3

PYRAMID POINTS
 Instill ear drops by pulling child’s earlobe down, back
 If medication draining from ear canal, may insert cotton ball into ear to prevent leakage
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-4

PYRAMID POINTS
 Subcutaneous and intramuscular (IM) medications
•
Safe use of all injection sites based on normal muscle development, size of child
•
Preferred site in infant is vastus lateralis
 Intravenous (IV) medications
•
Monitor site for signs of inflammation, infiltration, extravasation
•
Use agency policies for determination of volume of flush for peripheral and central lines
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-5

PYRAMID POINTS
III. Parenteral Medications (continued)




Intermittent IV medication administration
•
May be administered through primary infusion tubing or via piggyback infusion set
•
Should be infused on pump or controller
•
Follow medication infusion with flush
Special IV administration sets: These administer 60 gtt/mL
Retrograde IV injection
•
Medication mixed with diluent in syringe, then given into port in direction of burette
Syringe pump for IV medication administration
•
Syringe containing medication fitted into pump connected to IV tubing through Y connector
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-6

PYRAMID POINTS
 Conversion of body weight: 1 kg = 2.2 lb
 A child weighs 3.4 kg. How many lb does the child weigh?
3.4

2.2 = 7.48, or 7.5 lb
 A child weighs 22 lb. How many kg does the child weigh?
22/2.2 = 10 kg
 Calculation of daily dosages
•
Expressed as mg/kg per day or mg/lb per day or mg/kg per dose
•
Daily dosages usually divided into more than one dose throughout day
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-7

PYRAMID POINTS continued …
 Calculate daily dose, divide according to how many doses are to be given per day: If you are to give
220 mg/day, but doses are qid, divide 220 by 4 to get 55 mg/dose
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-8

PYRAMID POINTS
 Determined by comparing body weight and height with averages or norms on nomogram
 Not all children are same size for age; thus, nomogram is used
 Height on left-hand side of nomogram, weight on right-hand side of nomogram
 Use ruler on nomogram to line up height and weight, read BSA
 Estimated surface area given in square meters
(m 2 )
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-9

PYRAMID POINTS
 Calculate with simple multiplication for dosage recommendations for children
 When dosages are specified only for adults, formula is used to calculate child versus adult dosage
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-10

PYRAMID POINTS
 Developmental age must be taken into consideration for safe, effective administration
 General interventions
•
Be prepared with equipment
•
If child gets fussy when parent(s) present, consider asking parent to leave for administration of medications
•
Determine appropriate comfort measures pre- and postadministration of medications; institute appropriately
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-11

The nurse has an order to give ear drops to a 3-year-old child.
The nurse positions the child’s ear properly by pulling the pinna of the ear:
1. Downward and outward
2. Downward and backward
3. Upward and outward
4. Upward and backward
PEDIATRIC NURSING:
Pediatric Medication Administration and Calculations
Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 48-12