PRACTICAL 10 ADMINISTRATION

OF MEDICATION
AND DRUG
SUPPLEMENT
Structure

10.0 Objectives
10.1 Introduction
10.2 Safety Measures in the Administration of Drugs
10.3 Possible Errors in Drug Administration
10.4 Routes for Administration of Drugs
1004.1 Oral Route
1004.2 Injection Route
1004.3 Rectal Route
100404 Inhalation Route
10.4.5 Topical Route

10.5 Calculation for Administration of Medication

10.6 Let Us Sum Up

10.0 OBJECTIVES
After completing this practical, you should be able to:

• administer drugs through various methods to the paediatric patients;

• calculate and administer accurate dose as required;

• become familiar with the actions of the more commonly used groups of
drugs;

• recognize the fact that narrow margins exist between therapeutic level and
toxic level in some drugs;

• practice the safety principles so that drug error is avoided; and

• identify importance of drug interaction.

10.1 INTRODUCTION
In Practical 9 you have learnt about how to perform therapeutic procedures.
Now as you know all the therapeutic and diagnostic conditions require
administration of medication. You are already swift in performing this activity.
But to administer drugs to paediatric patients is a more specialized skill. Although
the physician prescribes medications, and gives a written order to prevent
misunderstanding, you as a nurse has the responsibility for administering most
drugs. The need for accuracy in preparing and giving drugs to children is even
greater than with adult patients. Since the paediatric dose is often relatively small
in comparison with the adult dose, a slight increase in the amount of a drug
62
administered represents a greater proportional error, as there exist a narrow Administration of Medication
and Drug Supplement
margin between therapeutic level and toxic level in some drugs.

Your responsibility is especially grave, because a child is often unable to

communicate verbally any signs of distress that indicate over dosage, side effect
or allergic reaction. It is essehtial for you to remember that parents/guardians of
patients depend on your ability to identify any undesirable effects and report
them to the physician. Hence it is very essential that you are well-informed about
the dose, route of administration, duration of action, side effects, allergic reaction
and possible interaction with-other medication and with diet. This practical will
help you to administer medication accurately and effectively. The main focus will
be on various routes of drug administration and we will also review the
techniques in calculation and administration of paediatric doses.

,
10.2 SAFETY MEASURES IN THE
ADMINISTRATION OF DRUGS
It is essential to revise the five "Rights" before administration of medication to
the paediatric group. These as you know are:

i) The right patient

ii) The right drug

iii) The right dose

iv) The right route

v) The right time

The sixth right added recently is "the right of the parents and child to know" the
drug they are receiving, its action and side effect, thus reducing the chances of
misuse as they would be likely to use it unsafely if they were not given the
information.

For example, if the child was receiving Tablet Eptoin for convulsion and the
mother had not noticed the convulsion which her child was having as they were
of mild nature. She may find that after this particular medication the baby sleeps.
And, hence, may administer it when the baby is irritable or crying to make the
child sleep, thinking the baby will have peaceful sleep and this ifself can be
harmful.

10.3 POSSIBLE ERRORS IN DRUG

ADMINISTRATION
There can be various reasons for error in administering drugs:

i) P60r communication of intention by the prescriber ..

ii) Failure to keep an established routine when administering therapy.

iii) Lack of understanding of the objectives of therapy.

iv) ~.:ilure of the nurse to recognize that the medical officers and pharmacy
departments may make errors.

v) Poor concentration or constant interruption.

63
!
Nursing Techniques in vi) Ignoring the need for an experienced person to double check the drug, the
Paediatric Care-Il dose, identification of the patient and any previously administered
preparation.

vii) Failure to calculate to one's own satisfaction.

viii) Failure to learn appropriate paediatric doses of commonly used medications.

ix) Lack of knowledge regarding drug interaction and side effects.

x) Inadequate security of drug storage.

xi) Failure to record administered doses.

If you are in doubt, do not give the medication, however no medication should be
omitted without the medical officers order.

If an error is made, a medical officer must be informed and action prescribed to

be carried out. An incident form should be completed. It is necessary to report
this incident to your sister incharge/senior nursing staff/doctor.

10.5 ROUTES FOR ADMINISTRATION OF DRUGS

There are various routes by which we can administer drugs, and you are already
highly skilled in administering drugs by various routes.

Oral

Rectal

Injection Intradermal

Hypodermic (subcutaneous)

Intramuscular

Intravenous

Intrathecal

Inhalation

Topical Inoculation

Eye

Nose

Ear

Now we shall revise the procedure for each one of above mentioned routes of
drug administration.

10.4.1 Oral Route

Paediatric Medications are prepared as Tablets (which can be crushed),
powders, granules, mixtures, emulsions, elixirs and syrup~

It is easier to persuade older children to swallow capsules. At the same time it is

essential to remember that children can be easily persuaded to have bitter
medication if they are assured of a reward in the form of a chocolate or sweets
if permitted.
They can be made acceptable if given along with fruit flavoured syrups. But do Administration of Medication
and Drug Supplement
not mix the medication with food as the child may develop aversion to particular
food if mixed with the medicine. Capsules should not be opened and administered
as the powder is unpalatable. If child cannot swallow; open the capsule and mix
powder with the honey/sugar or other sweetened syrups.

Equipment

• Prescription sheet

• Oral medication e.g. tablets, syrup, etc.

• Medicine measures

• Millilitre measures

• 1 ml syringe

• 5 ml spoon, Plastic droper (preferable caliberated)

• Medicine tray with medication card

• Glass of fruit juice or sweets

• Glass of water.

• Toy appropriate to the age.

Procedure

• Read the child's prescription sheet carefully.

• Confirm that medicine contained in the bottle is prescribed for the child.
For example, if liquid, shake the bottle first to mix the content.

• Hold the measure at eye level and keep a finger at the appropriate
graduation and pour the medication.

• While pouring ensure the bottle label is upper most.

• Replace the stopper and place the measure containing medicine on a small
tray and take to the child's bedside with the medicine card.

• If the quantity of medicine is small then tip it in to a sp?on.

• Rinse the measuring glass to wash off the residue. e.g. if elixir of digoxin is
to be measured the best is to use 1 ml syringe for accurate dose.

• After administering, record it in the medication chart as administered and

also in the nurse's notes.

Now we shall see how to dispense tablets:

• Tip the tablet from the container into a spoon after checking to see if it is
the prescribed drug. Then crush it between two spoons or in a crusher or it
can be dissolved in a tea spoon of water, and administered. It can be mixed
with jam or fruit juice or sugar or honey.

As a nurse you must remember:

• Talk to the child before administering the medicine. Seat the child in your lap
to achieve better control, the child can be restrained in a sheet or sit with his
right arm tucked under your (nurse's) left arm. Then you can control his left
arm as you administer the medicine as shown in Fig. 10.1, 10.2 and 10.3.
65
Nursing Techniques in
Paediatric Care-Il

Fig. 10.1: Administering oral drugs Fig. 10.2: Administering oral drugs
(with cup/spoon) with dropper)

Fig. 10.3: Administering oral drugs (with syringe)

You should take care that the child does not inhale the medicine when he is
struggling.

• Provide something pleasant after the medicine is administered.

• After medicine is administered orally, wipe bottles and close container and
replace in the cupboard. The used measure glass, spoon, droppers are
thoroughly washed, rinsed and dried before replacing in the cupboard.

Activity 1
Administer in your paediatric ward following oral medication using different
measuring. methods:

• 1/4 teaspoon syrup of diazepam.

• 3 drops of vitamin C

• Tablets gardenal 0.5 mg.

10.4.2 Injection Route

An injection is an unpleasant experience for a person at any age and is

particularly traumatic to the small child who often lives in fear to the next
"needle prick". It is essential that those children who are older should be told the
truth at all times or their trust in human nature is lost. The child must be told the
injection hurts but the pain will soon be over and that the "prick" is to help him
to get better soon.
66
To allay fear and anxiety, the drug should be prepared away from the bed side Administration of Medication
so that the procedure is over before the child is fully aware of the situation. It is and Drug Supplement
essential that you have another nurse to help restrain the patient while you
administer the drug. The most commonly used syringe in paediatric unit is of 2
ml. It is graduated in 0.1 ml (1110 ml) division, so that drug dosage requiring
multiples of 0.1 ml can be accurately administered.

For administration of a drug in less than 0.1 ml. 1 ml Mantoux syringe bearing
0.01 ml (11100 ml) graduation is essential. Special syringes for administration of
insulin are graduated in 20 units/m).

Needles used should be preferably disposable, sharp and straight needle for each
injection.

It is essential to remember the colour code used by each manufacture for their
own brand of needle according to the diameter of the needle lumen and length.
Injections, can be administered intramuscular, subscutaneous, intra-venous,
hypodermic intrathecal depending on the type of drug to be administered.

Equipment
Tray containing:

• Sterile equipment: syringe, needle, spirit swab or medicated swab

Tray containing other articles:

• Medication card

• Drug Vial

• Sterile distilled water ampoule

• File
• Kidney tray

Procedure
This method requires strict aseptic method. As the protective skin is punctured
and micro-organisms can easily gain entry.

Hence, ensure that the articles are sterile and hands thoroughly washed and
dried before you handle the syringe.

Remember

• Do not touch the sterile needle.

• Read the patients prescription sheet carefully.

• Take out the appropriate drugs and once again check with patients papers/
injection card.

• The needle is attached to the syringe and the needle is left sheathed untill
required.

Now we shall see how to use multi dose and single dose vials.

Using a Multidose Vial

• Dilute the drug according to the manufacture's recommended quantity of
diluent.
67
Nursing Techniques in • The quantity of diluent added is of considerable importance particularly as
Paediatric Care-II
single dose container intended for one dose for an adult may well be used
for fractional doses for children. For example, Ampicillin 250 mg is diluted
with 2 ml of water for injection to give a resulting strength of 125 mg in
1ml.

• Insert the needle through the rubber diaphragm at right angle and inject air.

• Apply negative pressure by withdrawing the piston to the appropriate level.

• Read the syringe at eye level and adjust with the point of the needle still in
the bottle.

• Do not eject excess drug into the air.

• Reinsert the needle into the sheath until ready for use.

Using a Single Dose Ampoule

• Collect the drug into the body of the ampoule.

• With a file snap off the neck.

• Draw the medication in required amount in the syringe and eject the excess
back into the ampoule.

• Reinsert the needle into its sheath until ready for use.

• Place the syringe in the injection tray.

• Take a swab of spirit and the tray and go to patient's bed side. Check once
again if its the right patient, drug, dose and time.

• Appropriate site is selected and after immobilizing the child, inject the drug.
The right technique should be used when administering the drug.

• Withdraw the needle and firmly massage the site. With a swab to enhance
circulation and quick absorption of the drug; discard the swab in a Kidney
tray or dustbin.

• Record in nurses notes and chart in order book or TPR chart, if required.

• Wash the syringe, if disposable then dispose the needle separately in a sharp
instrument bin and the syringe separately in another bin.

Now we shall focus on various routes of giving injections.

Routes of Injection
i) Hypodermic-Subcutaneous Injection
• By this route the drug is mainly absorbed into the blood stream by way of
the lymphatic drainage.

• Absorption is slower by this route. Hence those drugs which are gradually
absorbed are to be given.

• Commonly chosen site is usually outer aspect of the upper arm and the
anterior or lateral aspects of the thigh.

• Pinch the skin between the thumb and first or second finger of the left hand
and the needle is inserted at an angle of 45 to within 2 mm.
0

• With the left hand support the needle on the syringe and with the right hand
inject the fluid smoothly, and slowly into the subcutaneous tissue.
68
• When the contents of the syringe is ejected w.i~hdraw the needle and hold Administration of Medication
and Drug Supplement
the swab over the site.

• Massage in an upward direction to help disperse the fluid.

• It the patient gets the drug through this route often, rotate the site. If the
drug is insulin, insert the needle at 90° to reduce formation of fibrous tissue.

ii) Intra-Muscular Route of Injection

Purpose
• When rapid action is required.

• When drug would prove irritating to the subcutaneous tissue.

• Site selected must be where there is a reasonable amount of muscle with no
underlying nerves or blood vessels that can be damaged.

The site selected for children are:

• Ventrogluteal area.
• Vastus lateralis (infant and young child).

• Rectus femoris (alternate site) for infant and young child.

• Gluteal region (Children who have been walking for 1 year at least).

• Deltoid (any age), needle guage usually used is 25-22 guage. 1Yzinch needle
for gluteus maximus .
. Ventrogluteal: The site is easily located in a triangle formed by placing index
finger on the arterior superior spine and middle finger on the iliac crest. The
needle is held perpendicular to skin. (Fig. lOA)

.:~'~l
(, \ / ')\ Iliac crest

(
(/et!
/frl~,
J
'.: "~'~
.r ~
lV

~r;\
.

;1.
.'
Superior anterior
Iliac tubercle

v:: .
- /; /'

,:--.'
t
.-\
'V
\

, "
~ ~.l)

\(1
Injection site for the ventral gluteal muscle,

Fig. 10.4: Ventrogluteal site

The injection can be given directly below the iliac crest in line with the lateral
thigh.
Infant can be held in cradle position with arms and legs secured by mother or
assistant.

Vastus lateralis and Rectus Femoris: For vastus lateralis locate greater
trochanter of femur and knee then divide this area into three and give the
if'.~~..:~ion
in the middle third, while injecting compress the muscle slightly.
(Fig. 10.5)

The needle should be injected in lateral thigh anterior to femur and needle
perpendicular to thigh or slightly angled towards anterior thigh. 69
Nursing Techniques in To inject the rectus femoris muscle, angle the needle on a straight front to back
Paediatric Care-Il
course in the midanterior portion of the thigh.

Greater --t--f--;.
trochanter

Injection
site

Lateral
condyle------+-

Fig. 10.5: Injection site for the vastus lateralis muscle

Dorsogluteal/Posteriolateral Gluteal Site is the most commonly used site in infant

not well developed. This muscle develops as the child walk for at least a year
and hence, can be close to the sciatic nerve.

The site is above a line connecting the posterior superior iliac spine and the
greater tronchanter of the femur.

Fig. 10.6: Posteriolateral gluteal site marking

• Position child in prone position.

• The site is above a line connecting the posterior superior iliac spine and
greater trochanter of the femur.

• Inject the needle direct at a 90° angle.

• Since this muscle develops with it is used only after the child is walking for
at atleast one or more years.

• If the needle is inserted inferiorly or medially it can result in sciatic nerve

damage.

Detoid Site: The muscle is small in children and infants. Hence, can
accommodate small amount of medication. The site is located between the
acromion and the arm pit olecranon process. Measure 2 finger breadth below the
acromian process. Grasp muscle at injection site and compress between thumb
70 and finger.
 Administration of Medication
and Drug Supplement

Fig. 10.7: Deltoid site

• If injections are to be administered frequently, a definite rotation of site is

essential to ensure maximum absorption and minimum fibrosis.

• It is best to-avoid deltoid muscle in childhood and even more in infancy as it

is poorly developed. It provides the smallest margin of safety.

• Ensure that the muscle is stretched or pinched between the thumb and
forefinger of the left hand to prevent drug exuding back on withdrawal of
the needle.

• Do not insert full length of the needle, as it can be difficult to withdraw and
may break off at the hilt as it is the weak points. Secondly, if the muscle is
not well developed it can easily hit the bone.

• Create "I ight negative pressure after injecting the needle by withdrawing the
piston as it help to reveal if blood vessel is damaged and the needle must be
immediately withdrawn if blood is seen and reinserted in another site.

• When giving iron injection use "Z" technique so that staining and leakage of
the drug is prevented.

• If the child is prescribed more than one drug to be given through intra-
muscular route at the same time; it is considered less traumatic to give all
the drugs through one needle provided it is not contraindicated to mix
different drugs. Certain drugs are essential to be given by separate needles
e.g. barbiturates, cortisone acetate, digoxin, chloramphenicol, tetracyclines,
erythromycin, procaine, penicillin, phenytoin, etc.

• Maximum volume to be administered in a single site is 1 ml for older infants

and small children. Avoid exceeding 2 cc at one injection site for older
children

• Firmly but gently restrain the limb when needle is inserted.

• Allow the antiseptic to dry before penetrating the skin.

• The needle should be inserted swiftly and withdrawn but the drug should be
injected slowly to avoid painful distension of the tissue.

• The manufacture's recommended concentration should not be exceeded as

too great a concentration of solution can cause painful irritation of tissue,
leading to aseptic necrosis.

• Apply firm pressure at injection site, massage site to hasten absorption

unless contraindicated (DPT, DT vaccine) .
71
Nursing Techniques in • An older child should be thanked for the cooperation, but younger child
Paediatric Care-If should be shown love and comfort.

• Record the drug, dose and time given in the nurse's note/order book/injection
sheet.

Exercise

Administer Inj. Gentamycin IM to child and write down the steps you followed.

iii) Intravenous Route

This route of administering drugs is becoming more popular in the paediatric

practice.

Purpose of this Route

• When rapid action is required.

• High serum concentration required of the drug.

• Children who cannot absorb drugs from gastro-intestinal route because of

continuing diarrhoea, dehydration or other problems.

Equipment

Tourniquet, scalpvein or venflow, spirit swab, adhesive

Procedure

• Select the vein. A vein in the antecubital fossa i.e. the cephalic or median
basilic is usually selected and the elbow extended.
• Make the vein prominent by constriction above the site with the hand of the
assisting nurse or a rubber tourniquet can be used. If the vein on the dorsum
of the hand is selected and digital constriction is applied around the wrist
precaution should be taken not to occlude the radial pulse.

• Once the vein is prominent clean the area with spirit and let it dry.

• Children are often unpredictable and cannot be expected to cooperate totally

when receiving an injection. It is advisable to have someone available to help
hold the child if needed. Distract child with conversation or toy.

• Gently enter the vein. Once blood is seen in the scalp vein tubing release the
pressure.

• Secure the scalp vein with adhesive.

• Inject the drug kept ready and close the scalp vein opening, two way set can
also be connected and kept.

• When intravenous drugs are discontinued, the needle should be withdrawn

and firm pressure applied over the site and the limb may be elevated for one
minute.

Key Points to Remember in this Method of Administration

• It is essential not only that the correct drug and volume of drug dosage be
used but also that the desired concentration of the drug reach the site where
it can be most effective.

• If the infusion of fluid is slow, then the drug actually reaching the child is
delayed and hence there can be mistiming of peak level in the blood.
72
• Do not change the set immediately after injecting the drug as there can be Administration of Medication
and Drug Supplement
some loss of drug with the discarded set.

• Multiple drugs can be administered sequentially.

• It is essential to remember the rate of infusion of a drug influence the effect

of a drug on the child.

• Faster the rate of infusion, greater would be the peak concentration of a

drug in the vascular system.

• If the rate of infusion is almost the same as the rate of clearance, the drug
serum level may be close to non-existent. Hence, those drugs with high rate
of clearance should not be administered by this method.

• When administering drug by this route, it is essential to remember the

expected action of the drug, untoward reaction, side-effects and their
antidotes.

• Check and cross check the amount of drug prescribed.

• Check the solution in which it is to be diluted compatibility of the drug and

intravenous solution.

• The precise dilution of the drug for effectiveness.

,
, 1

• The length of time needed to infuse the drugs e.g. drugsIike calcium
gluconate, soda bicarb are to be given slowly.

• The compatibility of the intravenous drugs given.

• Drugs designed for intravenous administration should only be given.

• Some drugs given intravenously are very toxic or irritating to body tissues
outside the intravascular system. Hence, it is important to check the site of
infusion for proper placement and signs of infiltrations.

• Do not administer intravenous drugs with blood or blood products like

lipids etc.

• Administer the drug within the stability time period when mixed.

• Do not mix antibiotic with each other or with vitamins and any other
supplements as they may inactivate them.

• As there is no control over a drug administered intravenously, therefore,

continuous monitoring is essential for drug reaction.

• Ensure that the arm is well immobilized strapping to the arm board.

Exercise
i) Select a child receiving IV drugs. Calculate and administer the drugs.

10.4.3 Rectal Route

A drug may be administered by rectal route in the form of suppository or enema
for either systemic or local effect.

Suppositories
Its a cone-shaped gelatinized preparation sometimes containing medicine.

Purpose of Giving Suppositories

• To evacuate the bowel. 73

Nursing Techniques in • To administer a drug which is unpleasant to take orally (aminophylline).
Paediatric Care-Il
• In the relief of rectal or anal discomfort (Anusol).

Equipment

Tray containing:

• Prescribed suppositories and medicine card

• A bowl of warm water

• Gloves
• Kidney tray to receive used gloves

Procedure

• Provide privacy

• Gain co-operation and relax the child

• Place the child in left lateral position with flexed lower limb, draw the
buttocks to the edge of the bed, place a mackintosh under the buttocks, child
is well draped leaving the buttocks exposed.

• Place infant in supine position, with a pillow under his head and back and
diaper under buttocks. Gentle restraint may be needed.

• Lubricate the suppository.

• Separate the buttocks and visualise the anus.

• With the gloved hand insert the lubricated suppository through the anal
sphincter to the length of index finger. The anal area is cleansed and the
glove and gauze piece is discarded. If there is tendency for the suppository
to be expelled, the buttock may be held together for few minutes.

• The child is made comfortable and kept with the mother.

Special Points to Remember

• Glycerine suppositories should be lubricated by dipping the tip in warm water

and bowel action may be expected in 20 to 3D minutes later.

• Dulcolax suppositories should be lubricated with KY jelly or vaseline. Bowel

action can be expected in 5 to 10 minutes.

• Suppositories containing drugs like aspirin preparation in case of pyrexia

should not by rejected. These should be inserted deep in the anus. The
mother and child should be ensured that a bowel action is not necessary.

Enema

Enema may be given for the purpose of cleansing, for therapeutic purpose; to
relieve intra-cranial pressure, abdominal distension, intusssception and for
diagnostic purpose.

The procedure has to be done in the same way as for an adult patient. But its
essential to remember that small tubing will be required and more precaution to
be taken and the amount of fluid required is less. The tube should be inserted 2
to 4 inches only. Hang solution reservoir not higher than 30-45 cm above the
infant's hips.

The equipment used should be thoroughly washed, dried and replaced.

74
Exercise Administration of Medication
and Drug Supplement
Insert suppository in a two year old baby. Write down the problems faced by you
during the procedure.

10.4.4 Inhalation Route

Therapies that can be administered by inhalation are oxygen, humidification-cool
mist and steam, administering local medication. The commonly used administered
medication through-inhalation is by using Nelson's inhaler.

Purpose

To relieve nasal congestion and sinusitis

Equipment

Nelson's Inhaler, cover, Gauze measure, flat bowl or tray, prescribed drug like
tincture of bezoin 5 ml or menthol crystals, paper napkin/tissue/handkerchief/
sputum mug.

Procedure

Measure and fill 300 ml of boiled water in Nelson's inhaler.

• Add to it 5 ml of tincture benzoin.

• Do not pour water above level of air inlet.

• Cover the mouth piece with gauze and position it opposite to the air inlet.

• Cover the inhaler with linen and place on a flat bottomed bowl or tray.

• Support the child.

• Instruct the child to take deep breath through mouth and breath out through
the nose; give for 7-10 minutes.

• Encourage to cough out secretions.

Precaution
• Ensure child is well positioned.

• Ensure that the fluid is not filled above the air inlet.

• Protect the child well to avoid burning.

• Do not over boil as child can get steam burn.

10.4.5 Topical Route

The medication in topical route is administered through .ear, nose and eye.

Drops are instilled into the nose, ear and' eyes of the child in much the same way
as they are in the adult with the following exceptions.
• The dose of medication may be smaller than the amount the adult receives.

• The use of a medicine dropper that has a smooth tip to prevent injury.

• Medication warmed to room or body temperature before administration.

• Child's co-operation must be obtained, if child is young then he must be

adequately restrained.
75
Nursing Techniques in • The young child's head must be immobilized to prevent any accidents.
Paediatric Care-If
Nasal Drops (Fig.lO.8)

Fig. 10.8: Instillation of nasal drops

Purpose

• To relieve nasal obstruction.

• To shrink the mucous membrane.

• To relieve the stuffed feeling.

• To reduce excessive nasal discharge.

Procedure

• Hold the infant in cradle position when administering nasal drops.

• Tilt his head back and stabilize it in the crook of your arm by pressing it
between your arm and body.

• Squeeze drops into each nostril as prescribed.

• Ask him to sniff after you instill the drops.

• Ensure that he does not sneeze; as the medication will be sprayed out.

• If child is older, place in supine in a bed with a pillow under his shoulders to
'hyperextend his head over the pillows. After instilling keep the head below
the level of the shoulder for 3 to 5 minutes.

Equipment

Nasal Drops, Dropper, Medication Card

Points to Remember
Ensure the drops come in contact with the surface of the posterior portions
of the nose.

If nose is filled with secretions, suction with a soft rubber bulb nasal syringe.

Keep drops and dropper separate for individual child or at least use separate
droppers for several children.

Rotate the head when drops are instilled in the right nostril to right side
similarly when drops are instilled in left, rotate head to left side.

Activity 2
Select a child receiving nasal decongestion drops and administer the same.
76
Eye Drops Administration of Medication
and Drug Supplement
Medication is instilled in the form of drops or ointment. (See Fig. 10.9)

Purpose

• To dilate pupil e.g. Atropine 1 per cent, drosyn 5 per cent or 10 per cent

• To constrict the pupil e.g. Pilocarpine 0.5 per cent.

• To prevent or control infection e.g. antibiotic chloromyetcine ointment.

• To lubricate eye ball e.g. caster oil or paraffin.

• Prior to examination of the cornea e.g. flouresicin 2 per cent.

• To induce local anaesthesia prior to removal of foreign body e.g. cocaine

hydrochloride.

• To reduce inflammatory response e.g. Sofracord Hydrocortisone eye

ointment.

Equipment
Eye drops, pipette/tube with ointment, sterile cotton swabs, medication card,
Kidney tray.

Procedure
• Clean the eye using sterile distilled water or boiled cooled water.

• Position the child in supine position if young child preferable mumify the
child with blanket or baby sheet.

• Check the prescription.

• Wash and dry your hands.

• Fill the pipette or dropper with the required medication.

• Rest your right hand on the forehead of the child, and with the index finger
and thumb using mild traction to hold both lids apart.

• The dropper is held a few millimeters over the lower-fornix and while the
child looks upward, the medication is expressed within the conjuntival sac.

An alternative to instill drops is when the child looks downwards. The solution is
expressed into the upper-fornix.

• Mop the excess medication from the cheek of the child.

Fig. 10.9: Instillation of eye drops 77

Nursing Techniques in • Apply slight pressure over lacrimal sac to prolong the presence of the drug
Paediatric Care-II in the conjunctival sac or position the face of the child upwards for 2-3
minutes to discourage the drainage into lacrimal passage and also to prevent
dilution of the drug with the tears. In case of ointment wipe the nozzle with
a cotton swab.

• Apply a thin strip of ointment to the exposed lower-fornix of the conjunctiva.

Precaution

• Do not touch the tip of dropper or nozzle to the conjunctiva of the eye.
• Do not put solution/drops directly into the cornea.
Activity
Select two children receiving eye drops and eye ointment and practice
administering the same.

Ear Drops
Now we shall discuss the procedure of instilling ear drops. (Fig 10.10)

Purpose
• To soften wax (4 per cent sodium bicarbonate, olive oil, wax solvent etc.)
• To relieve the pain due to otitis media (phenol drops etc.)
• To treat infection of the external auditory meatus (e.g. chloramphenicol or
neomycin ear drops etc.)
• To float out small insect (e.g. olive oil).

Equipment
Ear drops, pipette/dropper, medication card.

Procedure

• Examine the ear to e' sure it is clean.

• Exclude ear perforation.
• Position the child in supine position and restrain.
• Place the child laterally on his unaffected side or in a sitting position with his
head tilted toward the unaffected side.
• If child is under 3 years, hold pinna of ear down and back wards if child is
above 3 years then hold the pinna up and backwards.

78 Fig. 10.10:Instillationof ear drops

 Instill the warm ear drops holding the dropper to the edge of the meatus. Administration of Medication
and Drug Supplement
Maintain the position of the child for 5 to 10 minutes to ensure that the
medication remains in contact with the ear drum for few minutes.

Place a small well loosened cotton swab in the outer meatus to absorb the
excess solution.

Points to Remember
• Do not insert the dropper into the ear canal or hold it too far from the ear.

• Do not instill cold drops as it comes in contact with the tympanic membrane
the child can experience pain or severe vertigo.

• Do not tightly plug the ear as it can block the free flow of discharge from
the ear canal.

Activity 3
Practice administering eye drops to childreri of various age groups and write
down the steps used.

10.5 CALCULATION OF DOSAGE FOR

ADMINISTRATION OF MEDICATION
Many formulae are used to determine the dose of a drug to be given to a child.
Some of the formulae rely on weight of the child, others on age of the child and
more recently surface area of the child has been considered the best guide for
paediatric drug dose. ~

On admission, the child can be weighed as required during his stay in hospital. It
is also essential to remember while using age of the child, that children of the
same age group vary considerably in size. So age alone prove a poor guide to
those calculation specially where the child is very sick.

The three formulae that can be used are given below:

i) Young's Rule
.Calculating the dose of a drug according to age.

x Adults dose
_A-=g_e_o_f_C_h_il_d = Child's dose
Age + 12

e.g. A child aged 8 years, suffering from tuberculosis requires to be given Inj.
Streptomycin Intramuscularly. Calculate the dose.

8
= X 1000 mg (lgm) = Child's dose
8 + 12

8
= -xlOOOmg
20

800mg
=
2

= 400 mg 79
Nursing Techniques in ii) Clark's Rule
Paediatric Care-II
Calculating the child's dosage of a drug according to body weight.

~ x 1000 mg = Child's dose

150

e.g. A child weighing 20 Ibs requires IM streptomycin.

Adult dose = 1 gm

12
- x 1000 mg = Child's dose
150

2
= -xl000mg
15

= 133 mg
ill) Percentage method of estimating paediatric drug dosage
As a child has a relatively greater surface area than an adult and requires
relatively larger dose of a drug than his weight alone would suggest.

Using surface area, a child's dose may be estimated by the following formulae.

Surface area of child .

Child's dose = x Adult dose
Surface area of adult
Example 1
A seven year old child of normal height and weight has a surface area of
0.85 sq. mts.

0.85 1
= -- =- or 50 per cent of the adult dose
170 2

For the infant under one year of age, the drug dose is usually calculated on
weight basis, the dose/kg body weight being estimated from the required dose for
a 1 year old child i.e. 25 per CCl1t of the adult dose. Since the child of one year
weighs about 10 kg.

e.g. If the adult dose of a drug is 60 mg. the dose for a child of 1 year = 15 mg
for an infant weighing (i.e. 25 per cent of adult dose)

6
= -x15mg
10

3
= -x15mg
5
= 9mg
Formula: for administration of the drugs

D
-xQ=A
H

Desired Strength
80 ------ = Fractional amount of stock solution required
Strength in hand
 e.g. Stock bottle of streptomycin for intramuscular use, contains 1 gm. or Administration of Medication
1000 mg/4 ml. and Drug Supplement

The child is prescribed a dose of 100 mg

Strength required
Strength available

100
1000 in 4 ml

= =~ of4 ml =_4_ = 0.4 ml

10 10 ml

Example 2
Stock bottle of Elixir and Digoxin is prepared as 0.05 mg or 50
microgrammes in 1 ml.

Raju is prescribed 0.125 mg or 125 mcg of Digoxin.

Strength required
Strength available

0.125.
=--Ill
1 m1 Of-Ill
125. 1 ml
0.05 50
:.1250f1ml
50
25 5 1
=- of 1\ml - of 1 ml. 2.5 Of 2- ml
10 ' 2 2

Example 3
Calcium gluconate is prepared as 10 per cent solution.
FOf Sita the prescribed dose is 100 mg (0.1 gm).

A 10 per cent solution contains 10 gm in 100 ml.

100 ml contains 10 g

.. 10 ml contains 1 gm

1 ml contains 0.1 g

1 ml of 10 per cent solution would contain 100 mg of calcium gluconate.

Exercise
.~. i) Intramuscular cloxacillin stock vial contain 250 mg in 2 ml. Ravi is
prescribed a dose of 62.5 mg. Work out the calculation in order to determine
the amount of medication to be injected.

ii) Calculate the following drugs tobe given IV, Inj. Ampicillin 100 mg, Inj.
Gentamycin 5 mg and Calcium Gluconate 10% -1 mg. 81
Nursing Techniques in Guideline-Administration of Medication
Paediatric Care-II
Name

Age

Bed No.

MRD No.

Date of admission
Drug Sheet/Medication Sheet

Medication Action Side-effects Nurses Responsibility Observation and

Route/Freq./Dose Recording
-
..
,~-~
~"';
",,"'''''
- .'
C

.~

#'

10.6 LET US SUM UP

In this practical you have seen the various methods of administering medications
namely, oral, rectal, injection, inhalation and local application to eye, ear and nose.
It is essential to remember the following points whenever administering
medication through which ever route i.e. the right patient, the right drug, the
right time and the right route. Always record the drugs administered to avoid
repetition or readministration.

It is essential to be aware of side effect and complication and the antidote that
can be given for side effect and reaction.

If the precaution are followed and drugs administered with skill and right
technique, they can be made less painful for the young patients.

82