Administration of medication

    • Administration of medication
      • Determination of drug dosage
        • Few standardized doses ranges
        • Body surface area
      • Checking dosage
      • Identification
        • Two identifiers
      • Preparing the parents
      • Preparing the child
      • Oral administration
        • Preparation
        • administration
      • Intramuscular administration
        • Apply EMLA (a eutectic mix of lidocaine and prilocaine) or LMX cream (lidocaine) topically over site if time permits.
        • Prepare medication
          • Selecting the syringe and needle
          • If withdrawing medication from an ampule, use a needle equipped with a filter that removes glass particles; then use a new, nonfilter needle for injection.
          • The maximum volume to be administered in a single site is 1 mL for older infants and small children.
          • Have medication at room temperature before injection.
        • Determining the site
          • For infants and small or debilitated children, use the vastus lateralis or ventrogluteal muscles; the dorsogluteal muscle is insufficiently developed to be a safe site for infants and small children.
            • Ventrogluteal: On side with upper leg flexed and placed in front of lower leg
            • Vastus lateralis: Supine, lying on side, or sitting
          • Obtain sufficient help in restraining child.
          • Explain briefly what is to be done and, if appropriate, what child can do to help.
          • Expose injection area for unobstructed view of landmarks.
          • Select a site where skin is free of irritation and danger of infection; palpate for and avoid sensitive or hardened areas.
          • With multiple injections, rotate sites.
          • Place child in a lying or sitting position; child is not allowed to stand because landmarks are more difficult to assess, restraint is more difficult, and the child may faint and fall.
          • Use a new, sharp needle (not one that has pierced rubber stopper on vial) with smallest diameter that permits free flow of the medication.
          • Grasp muscle firmly between thumb and fingers to isolate and stabilize muscle for deposition of drug in its deepest part; in obese children, spread skin with thumb and index finger to displace subcutaneous tissue, and grasp muscle deeply on each side.
          • Allow skin preparation to dry completely before penetrating skin
        • Administration
          • Decrease perception of pain.
            • Distract child with conversation.
            • Give child something on which to concentrate (e.g., squeezing a hand or side rail, pinching own nose, humming, counting, yelling “Ouch!”).
            • Spray vapo-coolant (e.g., ethyl chloride or fluoromethane) on site before injection, place a cold compress or wrapped ice cube on site about 1 minute before injection, or apply cold to contralateral site.
            • Have child hold a small adhesive bandage and place it on puncture site after IM injection is given.
          • Insert needle quickly using a dartlike motion at a 90-degree angle unless contraindicated.
          • Avoid tracking any medication through superficial tissues:
            • Replace needle after withdrawing medication.
            • Use the Z-track or air-bubble technique as indicated.
            • Avoid any depression of the plunger duringinsertion of the needle.
          • Remove needle quickly; hold gauze firmly against skin near needle when removing it to avoid pulling on tissue.
          • Apply firm pressure to site after injection; massage site to hasten absorption unless contraindicated, as with irritating drugs.
          • Place a small adhesive bandage on puncture site; with young children, decorate it by drawing a smiling face or other symbol of acceptance.
          • Hold and cuddle young child, and encourage parents to comfort child; praise older child.
          • Allow expression of feelings.
          • Discard syringe and uncapped, uncut needle in puncture-resistant container located near site of use.
          • Record time of injection, drug, dose, and injection site.

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