Medication Administration

Learning Outcomes
By the end of this lab session student will be
able to:
1. Calculate pediatric medications .
2. Demonstrate (OR,IM,SC ,ID ,Inhalation &
suppositories .).
3. Calculate IV infusion rate and fluid maintenance .
4 .Apply eye ,ear and nose drops.
Pediatric dose calculation

1-Milligrams/kilograms/body weight
This is the most common method used for alculating
pediatric dosage ,It is based on the client’s weight
l Care must be taken to properly convert body
weight from pounds to kilograms (1 kg= 2.2 lb).
l Pediatric dosages are usually expressed as
mg/kg/day or mg/kg/dose.
Dosage calculations

Dosage per Milligrams/kilograms/body weight

l Care must be taken to properly convert body
weight from pounds to kilograms
(1 kg= 2.2 lb).
l Pediatric dosages are usually expressed as
mg/kg/day or mg/kg/dose.
 Example 1:

Calculate the dose of amoxicillin suspension in

mLs for otitis media for a 1-year-old child
weighing 22 lb, The dose required is 40
mg/kg/day divided BID and the amoxicillin
suspension is available as 400 mg/5 mL.
Example 1 : Cont….

Dosage per milligrams/kilograms/body weight

Step 1. Convert the pounds to kg :22/2.2=10 kg

Step2. Calculate the dose in mg :40 x 10 =400 mg/day
Step 3 .divide the dose by frequency :400mg /2 (BID)
= 200mg /dose .
Step 4. Convert the mg dose to ml : D x V
200 X 5 =2.5 ml . H
400
Example 2:

Solumedrol 5 mg/kg is ordered for a child

weighing 40 kg. Solumedrol is available as 150
mg / 2 mL .
How many mL must the nurse administer?
Dosage per milligrams/kilograms/body weight
Measuring oral Medications
Oral Medication Administration
Hold the infant in the cradle
position and stabilize the
head against your body.
Hold infant's arm with your
free arm. Press on the
infant's chin to open mouth.
Squirt the medication to the
back and side of the mouth
in small amount.
Administering Intramuscular Injection

Definition:- a form of parenteral administration

of medication, where a drug is injected into a
deep muscle tissue.
IM Injection Sites:
l Vastus Lateralis
l Rectus femoris
l Deltoid
l Dorsogluteal
Vastus Lateralis:
Vastus lateralis:
Vastus lateralis cont…

Largest muscle in infant / small child.

Ø Appropriate age:
• Infants
• Toddlers

Ø Recommended maximum amount

• Give 1 ml or less to infants.
• Give 2 ml or less to toddlers.
•Use 1 inch (2.5 cm) needle
•Needle is inserted at a 90-degree angle.
 Points to be recognized when giving injection

l Pressure at the site for 10 to 15 seconds immediately

before giving the injection to decrease discomfort
l In different extremities; have two or more nurses
assist (and provide manual restraint, if needed) during
the procedures.
l (The child has only one painful experience when
multiple injections are given at one time; this is
believed to be less traumatic than receiving painful
injections one after the other.)
 IM Injection technique
vKeep needle outside of child’s visual field
vSecure child before giving IM
vSelect the outer middle third of the thigh
Inspect injection site before injection
for tenderness or firmness.
Grasp and pinch the area
surrounding the injection site about
10 seconds. Hold the syringe
between the thumb and forefinger in
a pen- and inject at a 90 degree
angle , Aspirate and pulling the
medication . Whaley & Wong
l IM medication
Dorsogluteal
 Dorsogluteal site cont…
Gluteal muscle does not develop until a child
begins to walk
Should not be used in children under 2 years.
Appropriate age:
• Toddlers
• Preschool , school age and adolescents.
Recommended maximum amount:
• Give 2 ml or less to toddlers.
• Give 3 ml or less to preschool and older
children.
• Give 5 ml or less to adolescents.
Dorsogluteal injection site

• Select upper outer quadrant site

• Clean site with alcohol swab.
• Stretch skin; quickly plunge needle
into the skin at 90 degree.
• Aspirate , if no blood is aspirated,
push drug 1 ml every 10 second
slowly.
• If blood appears, withdraw the
needle completely and begin
again.
Deltoid muscle site

Appropriate age
l Toddlers
l Preschool and older children
l Adolescents
Recommended maximum amount
Ø Give 1 ml or less in toddlers& preschool.
Ø Give 1 to 2 ml in older children
adolescents.
Illustration of insulin sites inject

l Insulin injection sites in

children.
l Use these illustrations to
instruct the child and his
parents about the
injection sites for insulin
administration that are
recommended
l SC injection video
Points to be followed regarding storage and
injection of insulin

l Insulin should be store in room temperature

or refrigerator(middle ) until expiry date.
l Insulin vial will expired after 28 days when it
open if it stored in room temperature.
l In case of exercise; insulin should be injected
in periumblical.
l The drug is injected at 45 - 90 degree angle
careful.
Cont…

l The sites of injection, upper arm, upper back

of arm( between shoulder and elbow).
l , upper buttocks, upper thigh, and around
umbilicus.
l Systemic rotation of injection sites is
necessary to enhance absorption, in each
sites 10 times.
l Each injection should be separated from the
previous with 2.5cm.
Intradermal injection

Definition:-
l Intradermal injection is administration of
medication into the dermal layer of skin.
l Purposes:-
l To perform sensitivity test.
l To perform tuberculin test.
l To administer vaccination.
l 10- to 15-degree angle
l Site: inner forearm
Intradermal injection cont…
ID videos
Inhalation therapy

• Aerosol medications are commonly used in treating

respiratory illnesses such as asthma or bronchiolitis.
Advantages of using this route include delivering the
medication directly to the site of action, a faster
onset of action, and less systemic side effects.
• the medication, releasing it into a small mask that’s
placed over the child’s face.
• The child can then breathe in the medication through
his mouth by taking deep, slow breaths.
Definition of inhalation
therapy

l Nebulizer video
Intravenous medications sites
Calculating pediatric fluid needs

l Children weighing under 10 kg require 100

ml of fluid per kilogram of body weight per
day.
l Children weighing 10 to 20 kg require 1,000
ml of fluid per day for the first 10 kg plus 50
ml for every kilogram over 10.
l Children weighing more than 20 kg require
1,500 ml of fluid for the first 20 kg plus 20 ml
for each additional kilogram.
Daily Fluid Requirements

l 100/50/20 rule : more common in

pediatric .

l Weight in Kg Amount of Fluid/Day

l 0-10 100cc /kg
l > 10-20 1000+50cc/kg for each kg >10kg
l > 20 1500 +20cc/kg for each kg >20kg
Examples

l A 6 kg child needs 600 ml/day, which equals

25 ml/hr.

l A 35 kg child needs 1800 ml/day, which

equals 75 ml/hr

l A 14 kg child needs 1200 ml/day, which

equals 50ml/hr
Calculation of infusion rate:

Total volume = gtts/ hr

Time /hours
e.g:
1000 ml need to be infused over 8hours
What is infusion rate should the nurse regulate
V = gtts/min 1000 = 125 gtts/hr(pump)
T/H 8
N.B. Most of IV delivery system(infusion pump.)
Calculation of infusion rate cont…

Then (if used infusion set)

Total volume x drop factor = gtts/ min
Time /minutes
e.g :800 ml Ns to be infused over 5 hours
What is infusion rate in drop per minute (drop
factor 15)
800x 15 = 40 drop/ min
5x60
Question 1

Calculate the IV flow rate for 300 ml of NS to

be infused in 3 hours.
The infusion set is calibrated for a drop factor
of 20 gtts/mL.
What is the IV flow rate in gtts/min?
Question 2

l Doctor order 500ml D10w to be infuse over 5

hours
l Calculate the infusion rate for IV pump.
I.V complications

l Infiltration
l Catheter occlusion
l Air embolism
l Phlebitis
l Infection
Eye drops
• Wash hands.
• Instruct patient to look up.
• Pull the lower lid down
• Rest hand holding the dropper
with the medication on the
Client’s forehead to reduce risk
of trauma to the eye.
• Instill in conjunctival pouch.
• Removed and disposed
equipment
 Ear drops

* Position infants & toddlers on their

sides.
*The pinna of the ear is to be pulled
down and back.
* Instill warm drops into the external
canal and gently massage the area
anterior to the ear
* For children over 3 years , pull the
pinna upwards and back
* After instillation, the child should
maintain the position for 5minutes.
l Ear drops video
Nose drops

Ø Hold the infant in the

cradle position, stabilizing
the head with your arm ,
and tilting it back slightly
Ø Squeeze the drops into
each nostril as you try to
comfort & hold the infant
in this position for at least
1 minute
Ø Place a toddler's head
over a pillow squeeze the
drops into each nostril
 Rectal medication
* Place the child in aside –lying or
prone position.
* Lubricate the suppository with a
water soluble gel
* Using a finger cot , gently insert
the suppository into the rectum
* Do not insert your finger more
than 1/2 inch
* The buttocks should be held
tightly together for 5-10 minutes.
Suppositories video
THANK FULL