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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