Pediatric

Considerations

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Pediatric Pharmacology
 Limited research
 Research risk
 Obtaining informed consent
 Drug labeling and dosing instructions
 Pediatric Research Equity Act in 2012
• Requires study of pediatric drug use

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Pediatric Pharmacokinetics
 Absorption
 Influencing factors
• Child’s age, health status, weight, route of administration
• Nutritional habits, physical maturity, hormonal differences
• Hydration, underlying disease, GI disorders
 Route of administration
• Gastric acidity, emptying, motility, surface area, enzyme
levels, intestinal flora
 IM/subQ
• Peripheral perfusion
• Effectiveness of circulation
 Topical
• Children’s skin is thin and porous.

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Pediatric Pharmacokinetics (Cont.)

 Distribution
 Influencing factors
• Body fluid composition
• Body tissue composition
• Protein-binding capability
• Effectiveness of barriers

 Metabolism
 Influencing factors
• Maturational level of child
• Liver metabolism
• Higher metabolic rate

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Pediatric Pharmacokinetics (Cont.)

 Excretion
 Kidneys
• Infants have decreased
 renal blood flow.
 glomerular filtration rate.
 renal tubular function.

Pediatric Pharmacodynamics
 Mechanisms of action and effect of a drug on
the body
 Includes the onset, peak, and duration of effect
of a medication.
 Intensity of therapeutic effects and adverse
effects
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Nursing Implications
 Pediatric drug dosing and monitoring
 Monitoring for therapeutic effects and adverse reactions
 Side effects may be difficult to evaluate.
 Calculations

 Pediatric drug administration

 Considering developmental and cognitive differences
• Differentiating developmental from chronologic age
 Maintaining safety while ensuring comfort
 Family-centered care

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 Nursing Implications (Cont.) 7

Pediatric drug administration

 Atraumatic care
 Oral administration
 Subcutaneous, intramuscular, and intravenous
 Ex. Eutectic mixture of local anesthetics
 Decreasing pain and anxiety -
• Distraction, diversion, relaxation
• Creative imagery
 Intravenous sites
 Basic principles

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 Adolescent Considerations 8

 Considerations for adolescents –

 Need individualized care specific to
developmental stage
• Physical changes
• Cognitive level and Social, reasoning, and
decision-making skill development
• Emotional factors
• Independence from parents
• Increases Self-care behaviors
• Impact of chronic illness

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 Nursing Process: Family-Centered 9

Collaborative Care

 Assessment
 Age, weight, height
 Developmental age
 Health status
 Nutritional and hydration status
 Allergy history
 Family/child understanding
 History of drug use

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 Nursing Process: Family-Centered 10

Collaborative Care (Cont.)

 Potential nursing diagnoses

Knowledge, deficient
Health maintenance, ineffective
Knowledge, readiness
Injury, risk for

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 Nursing Process: Family-Centered 11

Collaborative Care (Cont.)

 Planning
 Child, family members, and caregivers will recognize
the need for drug administration.
 Family members and caregivers, as well as the
pediatric patient if appropriate, will describe the
rationale for drug therapy
 Child, family members, and caregivers will incorporate
the drug treatment regimen into their lifestyle.
 Child, family members, and caregivers will demonstrate
safe drug administration practices.
 The pediatric patient will remain free of drug-related
injuries.

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 Nursing Process: Family-Centered 12

Collaborative Care (Cont.)

 Nursing interventions
 Assist patient, family, and caregivers to use
appropriate follow-up resources and support.
 Follow all rights of safe drug administration.
 Help patient, family, and caregivers to
manage complex drug schedules.
 Use educational strategies that are
interactive and engaging for the pediatric
patient.

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 Nursing Process: Family-Centered 13

Collaborative Care (Cont.)

 Evaluation
 Evaluate the child’s physiologic and psychological
response to treatment –

 Evaluate the family member’s knowledge concerning

drug, dose, administration schedule, and side effects.

 Evaluate the therapeutic and adverse effects of drug(s).

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Pediatric Drug calculation

 The basic formula is easy to recall and is most frequently used in
calculating drug dosages. The basic formula is the following:
 (D / H) x V = A
 where D is the desired dose (i.e., drug dose ordered by the health careprovider),
 H is the on-hand dose (i.e., drug dose on label of container [bottle, vial]),
 V is the vehicle (i.e., drug form in which the drug comes [tablet, capsule, liquid]),
 A is the amount calculated to be given to the patient.
 Ex. Order: cefaclor (Ceclor) 50mg/kg/day PO b.i.d.
 BW 10kg
 50mg x 10kg= 500mg/kg/day Available on hand
500mg/2 doses = 250mg desired dose
 (250mg / 250mg) X 1
 = 1 x 1 =1capsule each dose 2x a day

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