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PEDIATRIC MATH CALCULATIONS

Pediatric Medication Administration


The 6 Rs to drug administration: the right patient the right medication the right dosage the right time the right route

Pediatric Medication Administration


THE FOUR FACTORS AFFECTING DRUG THERAPY IN CHILDREN: Metabolism o In certain neonates and children, metabolism may be underdeveloped and prevent the child from getting the total dose until the age of 1. o Some older children can metabolize drugs at a faster rate due to increased metabolic rates. Example: theophylline. Absorption o The ph of neonatal gastric fluid is neutral or slightly acidic and becomes more acidic as the infant matures. o Infant ph increases with formulas, therefore, give medications on empty stomachs. o Nafcillin and Penicillin G are better absorbed by an infant than adults. (Gastric acid greater in adult) o Topical drugs have increased absorption in children due to thin epidermis.

Pediatric Medication Administration


THE FOUR FACTORS AFFECTING DRUG THERAPY IN CHILDREN: Distribution
o Changes in body weight and physiology can influence drug distribution. Children have less fat and lean muscle mass. They also have more body fluid than adults.

Excretion
o Most medications are excreted through the renal system. If renal development is impaired or renal function is decreased, or if the child has only one functioning kidney, that will affect the dosage that the child receives. This will also affect the types of medications given to the child.

Pediatric Medication Administration


GROWTH & DEVELOPMENTAL FACTORS AFFECTING DRUG ADMINISTRATION:
Infants:
o With oral medications, direct medication into the inside of the cheek to prevent aspiration. Lift the head during administration. Give small amounts at a time. Can use nipple for infant to suck medication. o Give medication in the strength as ordered. Do not dilute. o With IM injections, the vastus lateralis is the preferred site in children under the age of two (thigh muscle) o Treat child as individual. Assess the childs cooperation ability and personality. o Administration of a drug to a child requires tact and skill. You should proceed as if a protest is not expected. Persuasion before administration set the scene for struggle.

Toddler to School Age:

Pediatric Medication Administration


GROWTH & DEVELOPMENTAL FACTORS AFFECTING DRUG ADMINISTRATION-cont:
Allow the child some controlcup or spoon. Always do the same in the hospital as in the home. Enlist the child to cooperate. Toddlers have a fear of mutilation-using a band-aid after an injection takes care of that fear. Reassure at any difficult or painful act. They need to know they are not being punished. Explain the procedure honestly. Have the child help if possible. School age children are usually cooperative. They like to please people. Playrooms are for play and are safe. Insulin instructions for a school age child or adolescent can be a peer with the same problem. Answer the child as if you are explaining what they need to tell the peer to fix the issue.

Pediatric Medication Administration


1 kilogram=1000 grams=2.2 pounds 1 gram=1000 milligrams 1 milligrams=1000 micrograms 1 cm=10 mm Macro drip is 10 or 15 drops Micro drip is 60 drops 1 liter=1000 ml 1 ounce =30 ml 1 tsp=5 ml 1 Tbsp=3 tsp 1 gr=60 mg 1 in=2.5 cm

FORMULAS FOR VOLUME


V (Volume to be administered) = DO (Dosage ordered) x V (volume dosage on hand is in) DOH (Dosage on hand) Practice Question: Amoxil 350 mg PO every 6 hours x 10 days. Available is Amoxil 500 mg in 10ml. How many mLs should be administered?

VOLUME
V (Volume to be administered) = DO (Dosage ordered) x V (volume dosage on hand is in) DOH (Dosage on hand) Amoxil 350 mg PO every 6 hours x 10 days. Available is Amoxil 500 mg in 10ml. How many mLs should be administered? 350mg X 10ml V=0.7 X 10 Administer 7 ml 500

VOLUME
V (Volume to be administered) = DO (Dosage ordered) x V (volume dosage on hand is in) DOH (Dosage on hand)
Physician orders Tylenol 800 mg PO now X 1. You have 180mg/5 ml. What is the dose you will give?

VOLUME
V (Volume to be administered) = DO (Dosage ordered) x V (volume dosage on hand is in) DOH (Dosage on hand) Physician orders Tylenol 800 mg PO now X 1. You have 180mg/5 ml. What is the dose you will give? 800mg X 5 = 4.44 X 5 22.2 ml 180mg

VOLUME
V (Volume to be administered) = DO (Dosage ordered) x V (volume dosage on hand is in) DOH (Dosage on hand)
Order reads: Pediaphrophen (ibuprophen) 10 mg/kg PO q 4 hours. The label reads 100 mg/2.5 ml. The child weighs 35 pounds. How many milliliters will you administer?

VOLUME
Order reads: Pediaphrophen (ibuprophen) 10 mg/kg PO q 4 hours. The label reads 100 mg/2.5 ml. The child weighs 35 pounds. How many milliliters will you administer? 35lbs/2.2=15.9 kg 10 x 15.9=159 159 x 2.5=1.59 x 2.5 = 3.97ml = 4.0 ml 100

Pediatric Fluid Facts


IV pumps are used for fluid administration accuracy. The time frame medications are given is critical. Dilution depends on drugs being administered and IV site. Make sure to know IV rate. If unsure, double check. Record input and output hourly if ordered, usually it is every 2-4 hours. Do not try to catch up on fluids if administration is off. Make sure to include all fluid intake and output such as:
o IV Fluids o IV piggybacks o IV push meds All fluids consumed Drains/NG Suctioning Diapers/Voiding Stool Vomit

60 gtt/mL set- micro set 60 gtt/min = 1 cc 10 gtt/mL set- macro set 10 gtts/min = 1cc 15 gtt/mL set-macro set 15 gtts/min = 1 cc 20 gtt/mL set-macro set 20 gtts/min = 1 cc

Micro & Macro Drip Sets

If large volumes of fluid must be administered (125 ml/hour or more) a macro drip set is usually used. Micro drip sets are unable to deliver large volumes per hour because their drop size is so small. If the IV volume is <50ml/hour, then a micro drip set is to be used.

FORMULA FOR IV RATE


DO (Dosage ordered) x V (volume dosage on hand is in) DOH (Dosage on hand)
This formula will give you the volume in ml/hour that an IV should be run. A child is receiving Zosyn 285 mg over 1 hour. Available is Zosyn 1000 mg in 500 ml. Calculate the infusion rate in ml/hr. 285 x 500 = .285 x 500 = 142.5 ml in 1 hour 1000

FORMULA FOR IV RATE


V(Volume) X [Drip Factor]=Rate in gtts/min T (Time) Ordered: l Liter NS to be infused over 12 hours using a macro drip tubing calibrated at 15gtt/ml. Calculate the rate in gtt/min 1000 ml x 15=1000 x 15=1.38 X 15=20.83gtt/min 12 x 60 720

FORMULA FOR IV RATE


V(Volume) X [Drip Factor]=Rate in gtts/min T (Time) Ordered: 1000 ml of dextrose 5% in water (D5W) is ordered to be infused over 5 hours. The drop factor is 10gtt/ml. How many drops per minute should be given to infuse the 1000ml over 5 hours? 1000 ml x 10= 1000 x 10=3.33 X 10 =33.3 gtt/min 300 300

PRACTICE QUESTIONS FOR IV RATE


The physician orders cefuroxime 1 g in 50 ml of NS to be infused over 30 minutes. The tubing drop factor is 60gtt/ml. How many drops per minute should be given to infuse the total amount of cefuroxime over 30 minutes? The physician orders gentamicin 80 mg in 100 ml D5W to be infused over 1 hour. The tubing drop factor is 60 gtt/ml. How many drops per minute should be given to infuse the gentamicin over 1 hour?

FORMULA FOR IV RATE


V(Volume) X [Drip Factor]=Rate in gtts/min T (Time) The physician orders cefuroxime 1 g in 50 ml of NS to be infused over 30 minutes. The tubing drop factor is 60gtt/ml. How many drops per minute should be given to infuse the total amount of cefuroxime over 30 minutes? 50 ml x 60 = 50ml x 60 gtt/ml (cxl with 30 and get 2) 30 30 (Cancel with the 60 and get 1) 50 X 2 =100 gtt/min 1

FORMULA FOR IV RATE


V(Volume) X [Drip Factor]=Rate in gtts/min T (Time) The physician orders gentamicin 80 mg in 100 ml D5W to be infused over 1 hour. The tubing drop factor is 60 gtt/ml. How many drops per minute should be given to infuse the gentamicin over 1 hour? 100ml x 60 = 100 x 60= 100 gtt/min 60 60

FORMULA FOR MAINTENANCE FLUIDS


IV Fluid requirements of Children: This is for fluid
maintenance o 1st 10 kg = 100ml/kg o 2nd 10 kg = 50 ml/kg o each additional kg of body weight = 20 ml/kg Pt weighs: 15 kg which equals 100x10=1000 50x 5= 250 Total Maintenance IV fluid1250 divided by 24 (hours) to obtain the IV rate per hour for the child. 42 kg which equals 100x10=1000 50x10= 500 20x22= 440 Total IV fluid is 1940 divided by 24 (hours) to obtain the IV rate per hour for the child.

FORMULA FOR MAINTENANCE FLUIDS


Practice Problems: Calculate the Fluid Needs Below for a 24 hour period: Pt weighs: A 6 kg infant needing maintenance fluids A 37 kg child needing 1 times maintenance fluids An 18 kg child needing times maintenance fluids A 48.5 kg teen needing maintenance fluids

FORMULA FOR MAINTENANCE FLUIDS


Practice Problems: Calculate the Fluid Needs Below for a 24 hour period: Pt weighs: A 6 kg infant needing maintenance fluids 6x100=600ml divided by 24 =25 ml/hour A 37 kg child needing 1 times maintenance fluids 10 X 100=1000 10 X 50= 500 17 X 20= 340 1840 is maintenance 1840/2=920 (1/2 X) 920 +1840=2760 divided by 24 =115ml/hr

FORMULA FOR MAINTENANCE FLUIDS


Practice Problems: Calculate the Fluid Needs Below for a 24 hour period: Pt weighs: An 18 kg child needing times maintenance fluids 10X100=1000 8X 50= 400 1400/2 = 700ml in 24 hours A 48.5 kg teen needing maintenance fluids 10x100=1000 10x 50= 500 28.5x20= 570 2070 mls per 24 hours

FORMULA FOR CALCULATING OUTPUT


Pediatric output is always discussed in ml/kg/hour. Normal pediatric output is 1-3 ml/kg/hr. FORMULA: # ML DIVIDED BY WEIGHT IN KG DIVIDED BY #HOURS = OUTPUT IN ML/KG/HR Example: A 25 kg child has had a total of 589 ml in 12 hours. What is the output per hour. Is this output within normal range? 589 ml/ 25 kg/ 12 hours = 1.96 ml/kg/hr

FORMULA FOR CALCULATING OUTPUT


Normal pediatric output is 1-3 ml/kg/hr. Diaper weights are 1 gram = 1 ml (THIS IS JUST A FYI) Practice Questions: A child weighs 6.2 kg. Her output is 92 ml in 24 hours. Is this childs output within normal range? Steven weighs 44 kg. His output in the last 24 hours is 1865 ml. Is this output within normal range? Mary weighs 19.7 kg. Her output is 436 ml in the last 18 hours. Is this output within normal range?

FORMULA FOR CALCULATING OUTPUT


Practice Questions: A child weighs 6.2 kg. Her output is 92 ml in 24 hours. Is this childs output within normal range? 92 ml/ 6.2 kg/ 24 hours = 0.618 ml/kg/hr-UNDER Steven weighs 44 kg. His output in the last 24 hours is 1865 ml. Is this output within normal range? 1865 ml/ 44 kg/ 24 hours = 1.766 ml/kg/hrNORMAL Mary weighs 19.7 kg. Her output is 436 ml in the last 18 hours. Is this output within normal range? 436 ml/ 19.7 kg/ 18 hours = 1.23 ml/kg/hr-NORMAL

STEPS FOR CALCULATING SAFE DOSAGES


Safe dose range is based on the childs weight in kg.
The doctor has ordered 210 mg of acetaminophen q4-6 hours for pain and fever for a postoperative child. The child weighs 39 pounds. The recommended dose range for acetaminophen is 10-15mg/kg/dose q4-5 h. Acetaminophen is supplied as 160mg/5ml. Calculate the dose. Is the ordered dose safe to administer? Weight: 39 lbs / 2.2 = 17.7 kg Drug 10-15mg/kg/dose 10 x 17.7 = 177.7 THE DOSE, 210 MG, FALLS BETWEEN THE 15 X 17.7 = 265.5 CALCULATED DOSES OF 177.7 & 265.5. THEREFORE, THE DOSE IS SAFE & THERAPEUTIC Dose: 210 x 5 = 6.56 ml or 6.6 rounded to the nearest 10th 160

STEPS FOR CALCULATING SAFE DOSAGES


Practice Questions: A child weighs 22 lb. The physician prescribes Ampicillin 650 mg q 6 hours PO. The recommended dose is100-200 mg/kg/24 hour divided q 6 hour. Calculate the individual dose for Ampicillin. Did the Dr. order a safe dose? Is it therapeutic? A child weighs 60 lb. The physician orders Cefuroxime 750 mg q8 PO. The recommended dose is 75-100 mg/kg/day q 8 hours. Did the physician order a safe dose? Is it therapeutic?

STEPS FOR CALCULATING SAFE DOSAGES


A child weighs 22 lb. The physician prescribes Ampicillin 650 mg q 6 hours PO. The recommended dose is100200 mg/kg/24 hour divided q 6 hour. Calculate the individual dose for Ampicillin. Did the Dr. order a safe dose? Is it therapeutic? Weight: 22 lb = 10 kg Recommended: 100-200 mg/kg/day divided q 6 hours Calculation 10 kg x 100 mg/kg/day = 1000 mg/day 10 kg x 200 mg/kg/day = 2000 mg/day Divided q6 1000 mg/day 2000 mg/day (4 doses/day) 4 doses/day 4 doses/day Single dose range: 250 to 500 mg/dose Physician ordered an unsafe dose.

Practice Questions:

STEPS FOR CALCULATING SAFE DOSAGES


A child weighs 60 lb. The physician orders Cefuroxime 750 mg q8 PO. The recommended dose is 75-100 mg/kg/day q 8 hours. Did the physician order a safe dose? Is it therapeutic?

Weight: 60 lb = 27.3 kg Recommended: 75-100 mg/kg/day divided q 8 hours Calculation 27.3 kg x 75 mg/kg/day = 2047.5 mg/day 27.3 kg x 100 mg/kg/day = 2730 mg/day Divided q8 2047.5 mg/day 2730 mg/day (3 doses/day) 3 doses/day 3 doses/day Single dose range: 682.5 to 910 mg/dose q 8 hours Dose is safe AND therapeutic.