NURSES ROLE IN DRUG ADMINISTRATION TO CHILDREN

INTRODUCTION The administration of medication is often a chief responsibility of the nurse. The practice of administering medication involves providing the patient with a substance prescribed and intended for the diagnosis, treatment, or prevention of a medical illness or condition. Medications now come in multiple forms for administration via multiple routes. The prescribed route will depend on availability, cost, speed and mode of action, the condition being treated and the childs ability/tolerance of the chosen route. The age of a patient has a significant impact on the nurse-patient relationship. Children and the elderly require different treatment options and approaches to the relationship than middle-aged adults. Other family members are routinely involved to varying degrees, and heavily influence the nurse-patient relationship, depending on the age of the patient. For example, the relationship between a nurse and a pediatric patient will greatly rely on the relationship between nurse and parent, as well as parent and child. Likewise, the relationship with an elderly patient will involve influences from other contributing family members. Not only will the care of a patient vary with their age, but so does their ability to communicate and participate in decision-making, which also affects the nurse-patient relationship. Children are not simply little adults. Their anatomy, physiology and compensatory mechanisms are quite different, and they change as the child grows. Pediatric nurses must be experts in growth and development and communication, as well as skilled practitioners in gaining cooperation of many stakeholders, especially toddlers. For nurses to practice competently, they must ensure that they possess the knowledge, skills and abilities required for lawful, safe and effective practice. They must acknowledge their professional competence and only undertake practice and accept responsibilities for those activities in which they are competent. Medication management is clearly a complex role including:

administering medication safely and efficiently assessing and monitoring the effects of medication interdisciplinary collaboration evaluating desired and undesired effects of medication

NURSES ROLE IN DRUG ADMINISTRATION

The physical, metabolic and physiological state of infants and children is constantly changing. This has an impact on the pharmacokinetics of any medicines administered, further complicating the administration of medication to children (Kanneh, 2002).

TEN (10) GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY 1. Administer the right drug. 2. Administer the right drug to the right patient 3. Administer the right dose 4. Administer the right drug by the right route. 5. Administer the right drug at the right time. 6. Document each drug you administer. 7. Teach patient about the drugs he is receiving. 8. Take a complete patient drug history. 9. Find out if the patient has any drug allergies. 10. Be aware of potential drug-drug or drug-food interactions. CONCEPT OF HEALTH AND ILLNESS ACCORDING TO THE CHILDS PSYCHOSOCIAL AND DEVELOPMENTAL LEVELS 1. Infant: Has no concept of illness. Distressed by separation from parent. 2. Toddler and preschooler: Blames other people, events, or themselves for an illness. Distressed by parental separation and fear of body mutilation and change. 3. Schoolage child: Understands basic reason for illness. Also understands body parts and functions. Fear their body will not return to normal after an illness. 4. Adolescent: Understands cause of illness. Concerned with the effect of illness on body image. Concerned about modesty and privacy. BASIC PRINCIPLES IN ADMINISTERING MEDICATIONS Child development considerations are important in the administration of medicines. Some basic principles include:

Be confident

NURSES ROLE IN DRUG ADMINISTRATION

Approach the child/family with a positive attitude Be honest and understanding Allow the child to have control where appropriate Use appropriate language that the child understands Discuss with the child what they might taste/smell/see/hear/feel Listen to all involved Explain the benefits of compliance with the medicine taking CONSIDERATIONS FOR ADMINISTERING

CHILD DEVELOPMENT MEDICATIONS

There are some basic principles which will facilitate ease of administration: Infant (1-12 months) At this stage of development, the infant is usually developing basic trust and a need to have their parents or carer near. Ensure the childs gag reflex is present Use sensory measures, i.e. touching of skin, talking softly Provide comfort, i.e. a cuddle before, during and after administering the medication If the infant has a familiar/favourite blanket or toy etc, have it nearby for comfort Encourage parental involvement Toddler (1-3 years) At this stage of development, the toddler is developing their use of language slowly and remains very clearly attached to their parents/carer. Use a calm and confident approach and encourage the child to express their feelings Use basic language that they will understand to explain what is going to happen, using toys/dolls etc and encourage them to role-play with their own toys Give one direction at a time i.e. sit down Prepare the child shortly or immediately before the administration Pre-school (3-5 years) By this stage, the child has usually further developed the ability to communicate. Give simple explanations so the child understands what is going to happen and does not perceive it to be a punishment Use a positive approach and statements/reinforcements e.g. that they are good at taking the medicine not that they are good for taking the medicine

NURSES ROLE IN DRUG ADMINISTRATION

Allow the child some control by asking them to choose which vessel they want to use or where and how they would like to position themselves

School-age (6-12 years) The child at this stage of development is self-aware and has an awareness of the environment etc around them. They have an understanding of illnesses and treatments. Give an explanation of what is going on using teaching dolls, models, diagrams, drawings etc Involve the child in decision-making and allow time to answer questions Prepare in advance of administration and suggest ways of maintaining control, i.e. counting

Adolescent Adolescents usually value their independence but at the same time like to know someone is there to depend on. Always involve them in discussions if appropriate about what is going to happen MEDICATION ADMINISTRATION An Important Nursing Responsibility in Pediatric Patient Giving Oral Medications Infant (1 to 12 months) Do not attempt to administer oral medicine while the infant/child is asleep/crying Give with elevated support to head / shoulders. Plastic syringes are good to give accurate amount Depress chin with the thumb Ensure the medication is given slowly and use a medicine spoon to retrieve any medicine that has been spilt or spat out. Stroke a babys cheek or under the chin Oral syringe can be inserted into the side of the mouth between the cheek and the gum or can be placed on the tip of the tongue. Allow time for swallowing Do not force the vessel/medicine into the mouth Toddler (1 to 3 years) Usually helps to have a parent or someone else available Letting child handle the equipment helps reduce some fear
NURSES ROLE IN DRUG ADMINISTRATION

Explain why the medication will help Let child hold the medicine cup if he can cooperate Unless contraindicated, offer the child a flavored drink/ice cube between and after medicines Dont rush the child.

Pre-school (3 to 5 years) May use chewable as well as suspensions or elixir Loose teeth may pose a problem Often can cooperate better with parents. Letting parents give the medication is acceptable, although nurse is still responsible to prepare the drug and assist parent in giving it. Provide positive reinforcement as appropriate during and after the procedure. School age (6 to 12 years) Usually can take pills and capsules Need to be encouraged to swallow water immediately Ability to cooperate may vary and is often unpredictablebe prepared to allow more time in giving medications to your pediatric patients Adolescent Should be prepared to give explanations to adolescents specific to level of understanding. Teach therapeutic effects as well as side effects to report Stay with the patient until medications are consumed Expect that there may be mood swings Consider such adolescent issues as drug addictions or use of contraceptives which may cause drug interactions. Other routes of administration Eye drops or ointment Eye drop - Instill in lower conjunctival sac Ointment - from inner to outer canthus Nose drops With head tilted upward Maintain position for 1 minute Ear drops Warm first Pull pinna down and back < 3 years Massage area in front of ear

NURSES ROLE IN DRUG ADMINISTRATION

Maintain position with affect ear up 5 minutes

Rectal medications Use side lying position Insert lubricated suppository up to first knuckle Hold buttocks together1-2 minutes Intramuscular Medications Fewer medications are given by this route due to potential for pain. Medications typically given IM o NewbornVitamin K o Immunizations o At times antibiotics Vastus Lateralis muscle for newborns, infants and young children

Intravenous Medications Benefits: Quick response and effectiveness Less traumatic than IM Concerns: Extra caution to watch for irritation to small veins Extra caution to check for SDR with direct IV route NURSES RELATIONSHIP WITH THE PARENTS Provide a Calming Influence While most nurses are expected to have a soothing bedside manner, perhaps this is even more important for pediatric nurses. Children who are at the hospital or doctor's office are often scared. Doctors expect nurses to help calm down the patient and assist in alleviating fears before the doctor begins his check-up. Communicate with Parents A pediatric nurse must communicate clearly with parents as well as with children. Understanding that parents are likely very sensitive to the health of their children, she must speak with sensitivity while also being very clear about any health risks their child might be facing. Provide Health Teaching the name and purpose of the medication how much, how often, and for how long the medicine should be taken

NURSES ROLE IN DRUG ADMINISTRATION

how the medicine should be administered (whether it should be taken by mouth; breathed into the lungs; inserted into the ears, eyes, or rectum; or applied to the skin) any special instructions, like whether the medicine should be taken with or without food how the medicine should be stored how long the medicine can safely be stored before it needs to be discarded (asthma inhalers, for example) common side effects or reactions interactions with other medications your child may be taking what happens if your child misses a dose

NURSES ROLE IN DRUG ADMINISTRATION