Chapter 13: Key Pediatric Nursing Interventions

Safe medication practice requires strict adherence to the Rights of Pediatric Medication Administration while recognizing that a child’s physiological immaturity affects drug response due to differences in pharmacodynamics (cellular behavior) and pharmacokinetics (absorption, distribution, metabolism, excretion). Accurate dosing is critical, calculated primarily by body weight (mg/kg/day) or Body Surface Area (BSA) using a nomogram. Administration techniques must be adapted for the child’s developmental stage, such as preferring liquids for children under age 5-6, ensuring the head is elevated during oral administration, adjusting the pinna (down and back under age 3; up and back for older children) during otic administration, and choosing appropriate sites like the vastus lateralis for infrequent intramuscular (IM) injections. IV therapy requires meticulous care due to the high risk of fluid volume overload and site complications, utilizing sites from peripheral veins (including scalp veins in infants) to large central veins (using devices like PICC lines or implanted ports). Maintenance fluids are calculated strictly based on the child’s weight in kilograms, requiring constant monitoring for issues like infiltration and maintaining patency. Nutritional support encompasses enteral nutrition (tube feedings like gavage feedings via nasogastric/orogastric tubes or long-term gastrostomy/jejunostomy tubes) and Total Parenteral Nutrition (TPN) administered via central venous access for maximal caloric support. Tube placement must be confirmed before every feeding, initially via radiography (the gold standard) or, at the bedside, by checking external tube length, monitoring aspirate appearance, and measuring pH levels (gastric secretions usually pH < 5). Nurses must continuously work to prevent medication and infusion errors by double-checking calculations, confirming patient identity using two identifiers, and promoting family education to enhance safety and compliance, especially for home care.