Chapter 13

Chapter 13

Chapter 18 Pediatric and Adult Dosages Based on Body Weight 2013 Delmar Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dosages 1.

2. 3. 4. 5. 6. 7. 8. Converting the weight of a child from pounds to kilograms

Converting the neonate and infant weight from grams to kilograms Performing pediatric dosage calculations Calculating the single or individual dose of medications Determining whether the prescribed dose is safe and therapeutic Calculating a safe and therapeutic 24-hour dosage range Calculating the single-dose range from a 24-hour dosage range Determining whether the actual dosage (in milligrams per kilograms per 24 hours) is safe to administer

2 Introduction Six rights of drug administration: Right patient Right medication Right route Right time

Right dose Right documentation 3 Kilogram Conversions (1 of 2) Converting pounds to kilograms: 2.2 lb = 1 kg

For example: Infant weighs 24 lb. Convert the infants weight to kilograms. 4 Kilogram Conversions (2 of 2) Converting grams to kilograms: 1,000 g = 1 kg

For example: Neonate weighs 2,300 g. Convert to kilograms. 5 Calculating the Single or Individual Dose (Milligrams/Dose) Some medications administered as a single dose: Acetaminophen

Ibuprofen Usually these are medications for relief of pain or other symptoms. Dose is based on childs weight. Systematic approach to determining single dose: Change the childs weight to kilograms. Find the recommended dosage in a reliable source. Multiply kilogram weight by recommended dose. The answer is the single dose.

6 Mathematically Prove Whether the Prescribed Dose Is Safe and Therapeutic (Milligrams/Kilogram/Dose) Systematic approach: Change the childs weight to kilograms. Find the recommended dosage in a reliable

source. Multiply kilogram weight by recommended dose. The answer is milligrams per kilogram per dose. 7 Calculate the 24-Hour Dosage (Ranges)

Most drugsespecially antibioticsare calculated based on 24-hour dose. The physician determines the dosage. Work the examples in the text. 8 Calculate the Individual Dose or Single Dose (Milligrams/Kilogram/24 Hours Divided)

Divide the 24-hour dosage into single doses given throughout the day. Follow formula for determining mg/kg/24 h. Then divide 24 hours by hours per single dose. 9 Determine the Actual Milligrams/Kilogram/24 Hours or Dose/Kilogram/24 Hours

Divide the total milligrams received per 24 hours by the patients weight in kilograms. Compare the ordered dosage with the recommended dosage. 10 Caution Those who administer drugs to patients are legally

responsible for recognizing incorrect and unsafe dosages Administering Medications to Children Children aged birth to one year have a high percentage of body water Children aged 1 to 12 years metabolize drugs more

readily than adults Administering Medications to Children (Continued) Immature physiological processes related to absorption, distribution, metabolism and excretion Place children at risk for overdose, toxic reactions, and death

Remember 1 kg = 2.2 lbs 1 lb to 16 oz When converting pound to kilograms Round kilogram weight to one decimal place (tenths) Pounds to Kilograms

Convert 45 lb to kg Think of 45 = approximately 23 45 lb = 45 lb 2.2 lb/kg = 20.5 kg Conversions Convert 10 lbs 12 oz to kg Then Verifying Safe Dosages

Order: morphine sulfate 1.8 mg IM stat The child weighs 79 lbs Is the dose safe? Verifying Safe Dosages (Continued) Convert 79 lb to kg 79 lbs = 79 lb 2.2 lb/kg = 35.9 kg Verifying Safe Dosages (Continued)

Calculate mg/kg as recommended by a drug resource Resource indicates the usual IM/subcut dosage may be initiated at 0.05 mg/kg/dose The dose is safe and matches the order Body Weight To verify safe pediatric dosage Convert childs weight from pounds to kilograms

(rounded to tenth) Calculate safe weight in mg/kg or mcg/kg Compare ordered dosage to recommended dosage and decide if dosage is safe Body Weight (Continued) To verify safe pediatric dosage If safe, calculate the amount to give and administer the dose

If dosage seems unsafe, contact ordering practitioner Verifying Safe Pediatric Dosages: Body Weight Method Convert childs weight from pounds to kilograms (rounded to tenths)

Verifying Safe Pediatric Dosages: Body Weight Method (Continued) Calculate safe dosage in mg per kg or mcg per kg (rounded to tenths) for a child of this weight As recommended by a reputable drug reference Multiply mg per kg by childs weight in kg Verifying Safe Pediatric

Dosages: Body Weight Method (Continued) Compare ordered dose to recommended dose Decide if dosage is safe Verifying Safe Pediatric Dosages: Body Weight Method (Continued) If safe:

Calculate amount to administer dose If dosage seems unsafe, consult with ordering practitioner NOTE: Dosage per kg may be mg per kg, mcg per kg, g per kg, mEq per kg, units per kg, milliunits per kg, etc. Calculation of Safe Dosage

Order: amoxicillin 200 mg p.o. q.8h for a child who weighs 22 lbs Is this dosage safe? Calculation of Safe Dosage (Continued)

Convert lb to kg Approximate equivalent: 1 kg = 2.2 lbs Think: of 22 = 11 22 lbs = 22 lb 2.2 lb/kg = 10 kg Calculation of Safe Dosage (Continued) Calculate recommended dosage Amoxil (amoxicillin) label describes recommended

dosage as 20 to 40 mg per kg per day in divided doses every 8 hours Label recommends that total daily dosage be divided and administered every 8 hours, resulting in 3 doses in 24 hours Calculation of Safe Dosage (Continued) Calculate minimum and maximum dosage for each single dose

Minimum total daily dosage 20 mg/kg/day 10 kg = 200 mg per day Minimum dosage for each single dose 200 mg 3 doses = 66.7 mg per dose Calculation of Safe Dosage (Continued) Maximum total daily dosage 40 mg/kg/day 10 kg = 400 mg/day

Maximum total daily dosage 400 mg 3 doses = 133.3 mg/dose Single dosage is 66.7 to 133.3 mg per dose Calculation of Safe Dosage (Continued) Decide if ordered dosage is safe 200 mg Allowable, safe dosage is 66.7 to 133.3 mg per dose

Dosage is considered too high and not safe Contact physician to discuss order Caution Once an adolescent attains a weight of 50 kg (110 lbs) or greater, the standard adult dosage is frequently prescribed Verify that the order for a childs dosage does not exceed the maximum

Quick Review To use the body weight method to verify the safety of pediatric and adult dosages - Convert body weight from pounds and ounces to kilograms: 1 kg = 2.2 lbs; 1 lb = 16 oz - Calculate the recommended safe dosage in mg/ kg - Compare the ordered dosage with the

recommended dosage to decide if it is safe Quick Review (Continued) - If the dosage is safe, calculate the amount to give for 1 dose; if not safe, notify the prescriber - Combination drugs are ordered by dose volume; check a reputable drug reference to be sure the dose ordered contains the

recommended safe amount

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