PAEDIATRIC DRUG

COMPUTATION
PREPARED BY:
NURSING EDUCATION
AL RAYAN HOSPITAL
 OBJECTIVES:
 Age Group Guidelines
 Time of Administration
 Common Equivalent Used
 Computation of Peadiatric Doses
› CLARK’S RULE
› YOUNG’S RULE
› FRIEDMAN’S RULE
› BODY WEIGHT
› Drugs Measured in Units
› Medication in Powder Form
 
 Age Group Guidelines

 Infant: 1 month to one year

 Child: 1 - 12 years
› Toddler: 1 - 3 years
› Preschool: 4 - 5 years
› School aged: 6 - 12 years

 Adolescent: 13 - 18 years

 Adult: > 18 years

 TIME OF ADMINISTRATION
 

Abbreviation Derivation Meaning

A.c. ante cibum before meals

A.m. ante miridiem morning
B.i.d bis in die twice a day
H. hora hour
H.s. hora somni at sleeping time
O.d omni die daily
P.c. post cibum after meals
P.m. post miridiem afternoon
P.r.n pro re nata when required
Q.h quaque hora every hour
Q2h every 2 hours
Q3h every 3 hours
Q4h every 4 hours
Q.i.d or 4 i. d. quarter in die four times a day
Stat statim at once
T.i.d ter in die three times a day
 COMMON EQUIVALENT USED:

1 kg = 1000 grams 1 quart=2 pints

1 kg = 2.2 lbs or pounds 1 liter=1000 cc
1 gram= 1000 mg 1 pint =1/2 liter or 500 cc
1 grain= 60 mg 1 pint=16 fluid ounces
1 gm= 15 grains 1 ml = 15 gtts
1 gallon= 4 liters or 4000 cc 1 gtt = 4 megtts
1 gallon = 4 quarts 1 gm = 1 ml
1 quart = 1 liter 1 gm = 1 gtt
 HOUSEHOLD MEASURES:

1 table spoon = 15 ml or cc
1 tsp = 5 ml or cc
1 fluid ounce = 30 ml or cc
1 cup = 6 oz or 180 cc
1 fluid oz = 2 tbsp
1 glass = 8 oz or 240 cc
1 tbsp = 3 tps
Administering
Medications to
Children
 Administration of medication is traumatic for
children.

 Proper approach to administration can

facilitate the process and enhance the child’s
understanding of the importance of taking
medication.
 Important Consideration:
 The manner of approach should indicate that
the nurse firmly expects the child to take the
medication. Establishing a positive relationship
with the child will allow expression of feelings,
concerns and fantasies regarding medication.
 Explanation about the medication should appeal
to the child’s level of understanding (through
play or comparison to something familiar).
 The nurse must mask his or her own feelings
regarding the medication.
 Always be truthful when the asks.
 It is often necessary to mix distasteful medications or
crushed pills with a small amount of carbonated
prink, cherry syrup or applesauce.
 Never threaten a child with injection when refusing
oral medications.
 Medication should not be mixed with large quantities
of food or with any food that is taken regularly.
 Medications should be given at meal time unless
specifically prescribed.
 The nurse must know about the following about each
medication being administered: common usage and
dosages, contraindications, side effects and toxic
effects.
 Calculating the Paediatric Dose
 The nurse is responsible for knowing the medication being
given is within the safe dosage range for children.
1. Know what factors determine the amount of drug
prescribed.
a. Action of the drug, absorption, detoxification,
excretion are related to maturity and metabolic rate of
the child.
b. Neonates and premature infants require a reduced
dosage because:
Deficient or absent detoxifying agent
Decreased effective renal function
Altered blood-brain barrier and protein binding
capacity
 c. Dosage recommended for age group is not
satisfactory because a child may be much smaller
or larger than the average child in the age group.

2. Be alert of prescriptions that would be

inappropriate for the child.

3. Consult drug literature for the recommended

dosage and other information.
Oral Medications
 Infants
› Draw up medications in a plastic dropper or
disposable syringe
› Elevate infants head and shoulders and dispress
chin with thumb to open the mouth
› Place dropper or syringe in the middle of the tongue
and slowly drop the medication on the tongue
› Release thumb and allow the child to swallow.
› Once the correct amount of the medication is
measured, it can be placed in a nipple and the child
can suck the medication trough the nipple.
 Toddler
 Draw up medication in the syringe or medication
cup. Medicine can be placed in a spoon after
measuring accurately with a syringe.
 Elevate the child’s head and shoulders.
 Squeeze cup and put it in the child’s lips or place the
syringe in the buccal area and expel the medicine.
 Allow the child time to swallow
 Allow the child to hold the cup of able and to drink
it at own pace. Offer a favourite drink as a chaser if
not contraindicated.
 School-age Children
 Child is old enough to take medication as a pill
or capsule.
 Place the pill near the back of the tongue and
swallow with water or fruit juice.
 Always praise a child after taking a
medication.
 If the child finds it particularly difficult to
take oral medications, express understanding
of fear and displeasure and offer help.
Intramuscular
Injections
 General Consideration
 Draw up additional 0.2 -0.3 ml of air into the syringe –
this will clear the needle of medication and preventing
medication seepage from the site
 Use tuberculin syringe when injecting less than 1 ml of
medication.
 Cleanse site thoroughly using friction and let it dry.
 Alternate injection site and keep record at bedside.
 After injecting check for blood backflow.
 Massage site – this can prevent contracture and fibrosis of
the muscles. Can also do range of motion, warm soaks to
prevent scar tissues
 Infants
 Sites are rectus femoris (mid anterior thigh) vastus
lateralis ( middle third) or ventrogluteal
 Gluteous maximus and deltoid ca result to nerve
damage.
 A. Rectus Femoris

- place child in secure position to prevent movement

- Do not use neddle more than 1 inch
- Use proper quadrant of the thigh
Insert neddle in 45 degrees angle in downward
position, towards the knee.
 B. Vastus Lateralis

› Place child in supine or prone position

› Area is a narrow strip of muscle extended along a
line from the greater trochanter to lateral femoral
› Insert the needle perpendicular to skin 2-4 inch
deep – needle parallel to the floor.
 Toodler and school-age children
 A. Posterogluteal
› Upper outer quadrant
› Does not develop until the child begins to walk.
› Can be used when the child has been walking for 1
year or more.
› Complications my develop like sciatic nerve injury
or subcutaneous injury due to medication being
injected or poor absorption
 Administration:
 Do not use needle more than 2.5 cm or 1 inch
 Position the child in prone position
 Place thumb in the trochanter and middle
finger in the iliac crest let index finger drop at
a point midway between the thumb amd
middle finger to upper outer quadrant of the
buttock. This is the injection site
 B. Ventrogluteal
 This site provides a dense muscle mass tha tis
relatively free of danger of injuring the
nervous and vascular system.
 The disadvantage is that it is visible to the
child.
 Deltoid
 May be used for older larger children
 Determine site as with an adult
 Nursing Support
 Explain to the child where you are going to the
medication and why you are giving it
 Allow the child to express fear.
 Carry out procedure quickly and gently.
 Numb the site by rubbing firmly with
cleansing swab or with ice.
 Minimize pain by injecting the needle into the
muscle quickly in darting motion.
 Always secure the assistance of a second nurse to
help immobilize the child and divert attention as
well as to offer comfort and support.
 Praise the child for behaviour after the injection.
 Encourage activity that will use the muscle site of
the injection – to promote dispersal of medication
and prevent soreness. This can also be done by
massaging muscle after injection unless
contraindicated.
 Ensure proper site rotation.
Computation of
Pediatric Doses
 A. CLARK’S RULE

Average adult dose x weight of child in pounds = estimated safe dose

150
 CLARK’S RULE
 Example: How much Aspirin should a one-year-
old child weighing 21 lbs. receive if the average
adult dose is 10 grains?

10 grains x21 lbs = grain 1 2/5 or 1.4 grains

 150
B. YOUNG’S RULE

Adult Dose X (Age ÷ (Age+12)) = Childs Dose

 YOUNG’S RULE
 Example: How much Amoxicillin should an 11
year old child received if adult dose 500 mg?

500 Mg X (11 ÷ (11+12)) = Childs Dose

500 Mg X (11 ÷ 23) = Childs Dose

500 Mg X .48 = Childs Dose

Childs Dose = 240 Mg

 
 C. FRIEDMAN’S RULE

 
Average adult dose x age in months = estimated safe dose
150
 FRIEDMAN’S RULE
 Example : The adult dose of atropine sulfate is
0.6 mg. How much should a 2-month-old child
receive?

0.6 x 2 1.2
  0.008mg
150 150
 D. BODY WEIGHT

 The body weight method of calculating allows for

individualizing the drug dose and involves three steps
as follows:
  
 Convert pounds to kilograms if necessary.
 Determine drug dose per body weight by multiplying:
 Drug dose x body weight = client’s dose per day
 Follow the basic formula to calculate drug dosage:
  D q

H Q
 BODY WEIGHT
Example: order – Cefaclor (Ceclor) 20 mg/kg/day in three divided doses .
Child’s weight – 31 lbs
Drug label – Cefaclor (Ceclor) 125 mg / 5 ml
 
Convert pounds to kilograms
 
a. 31 divided by 2.2 = 14 kg.
 
b. drug dose x body weight
20 x 14 = 280 mg / day
280 mg divided by 3 divided doses in a day = 93 mg / dose
 
c. Calculate drug dosage
  93 mg x

125 mg 5 mlcross multiply

Answer: 3.7 ml is to be given per dose

 Drugs Measured in Units:

A. PENICILLIN

– some preparations penicillin come in units / ml,

whereas other come in milligrams / ml. you can
use the formula D/H = q/Q.
 Rule: To prepare Penicillin for injection, follow
these steps:
 
Read the medication order noting the number of units to be given.
For example, a patch is prescribed 300,000 units of Penicillin G
Procaine to be administered IVTT every 12 hours. Penicillin G
Procaine is available as 600,000/1.2 ml. Therefore, you would use
the formula: D/H =q/Q
 
300,000 units = x = cross multiply
600,000 units 1.2 ml
 
600,000 units (x) = 300,000 units (1.2 ml)
600,000 units 600,000 units
 
x = 0.6 ml of the drug will be given IVTT
every 12 hours
B. INSULIN
– Frequently, you will it necessary to mix two types of
insulin, usually regular insulin and NPH insulin. When
you have to mix insulin, there are two important
guidelines that you must remember:

 Do no contaminate the contents of one vial with the

contente of the other vial.
 Always draw up the NPH insulin, which is a turbid
preparation, last because chemically, it has a protein
substance in it that the clear Regular insulin does not
have. Drawing up the NPH insulin last helps prevent
contamination of the regular insulin.
 INSULIN
Example: The doctor’s order reads as follow:
Urine sugar q 6 hours (6 AM – 12 NN – 6 PM – 12 MN)

Give Regular insulin subcutaneously for the following urine

sugar result.
 
0 - none
Trace - none
1+ - 5 units
2+ - 10 units
3+ - 15 units
4+ - 20 units
Stock: Regular insulin 40 units / ml.

At 6 AM, the Regular insulin result was 2+.

 How many units will you give using a ) u-100 insulin
syringe?

10 units= x cross multiply

40 units100 units

40 units (x) = 10 units (100 units)

40 units = 40 units

x = 25 units
 Medication in Powder Form

The available amount of drug is in a solute form (dry powder) and

needs to be reconstituted by adding a diluent (solvent). The label
on the available drug well give directions for adding the diluent.
There are three common diluents that must always be sterile
when added to the drug powder. Use either one of the three.
 
 Bacteriostatic water
 Sodium chloride (0.9%)
 Sterile distilled water for injection

Read the directions for reconstitution at the label for the:

 
 recommended diluent
 quantity of diluent
 ratio of solute to solvent after reconstitution
Use the usual formula to calculate drug dosage required.
 
Example: The physician prescribed 250 mg of Amoxycillin IM
q 8h. The medication was available as a powder in a 1 gram
vial.
 
Directions for reconstitution: Reconstitute with 2.5 ml of
sterile water for injection. Shake well unit dissolved.
Solution concentration ---------- equal 330 mg/ml. fluid
volume will equal 3.0 ml.
 
250 mg
________ X 3ml
1000 mg

= 0.75 ml will be given IM every 8 hours