Pediatric Medication Administration & Dosage Calculations — Safe Practices and NCLEX Math Review | Chapter 38: Saunders NCLEX-PN Review

Chapter 38 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri is a comprehensive guide to safe pediatric medication administration and dosage calculations. This chapter blends pharmacological precision with child-centered care, ensuring nurses are equipped to deliver medications accurately while providing comfort and safety for young patients.

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Oral Medication Administration

Administering oral medications to children requires age-appropriate tools such as oral syringes or medicine spoons to ensure accurate dosing. Always position the child upright to prevent aspiration and use techniques like taste masking (mixing with small amounts of food) when necessary. For suspensions, shake well, measure precisely, and administer promptly.

Tablet and Capsule Management

Crushing tablets is only safe when medication labeling permits. When necessary, mix crushed tablets with small amounts of soft food, ensuring the child consumes the entire dose. For capsule medications, verify if opening is safe per drug guidelines.

Parenteral Medication Administration

Subcutaneous and intramuscular (IM) injections require careful site selection based on age. The vastus lateralis is preferred for infants, while the deltoid and ventrogluteal sites may be used in older children. Use the correct needle gauge and length, adhere to volume limits, and ensure developmental comfort measures such as distraction or therapeutic play.

Intravenous (IV) Administration

IV medications in pediatrics demand precise dilution, accurate pump programming, and controlled infusion rates. Use burettes or microdrip sets for small-volume medications, follow flush protocols, and monitor the IV site for signs of infiltration or phlebitis. Intermittent infusions require careful piggyback setup and verification of compatibility.

Dosage Calculations

• Weight-based dosing: mg/kg/day or mg/kg/dose; divide daily doses appropriately.
• Conversions: Pounds to kilograms — divide by 2.2; kilograms to pounds — multiply by 2.2.
• Safe dose range checks: Compare calculated dose with recommended range before administration.

Body Surface Area (BSA) Calculations

Some medications require dosing based on BSA, calculated using a nomogram. For pediatric adjustments from adult doses, apply the formula: (Child’s BSA / 1.73 m²) × adult dose. Always verify with a second nurse when calculating high-risk medications.

Developmental Comfort Strategies

Comfort measures are essential for reducing anxiety and promoting cooperation. Techniques include allowing parent presence, using pacifiers for infants, providing toys or music for distraction, and explaining procedures in age-appropriate language.

Safety and Documentation

Always use two patient identifiers, verify allergies, follow the “rights” of medication administration, and document dose, route, time, and patient response. For NCLEX, remember to assess before and after medication administration, especially for drugs affecting vital signs or consciousness.

NCLEX Math Practice

This chapter provides example calculation problems for weight-based and BSA dosing, reinforcing accuracy and test readiness. Practice consistently to build speed and confidence in performing these essential calculations.

Conclusion

Safe pediatric medication administration requires mastery of dosage calculations, an understanding of developmental needs, and adherence to strict safety protocols. By combining mathematical accuracy with compassionate care, nurses can ensure optimal outcomes for pediatric patients and excel on the NCLEX-PN.

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