Pediatric Oral Liquid Medications – Dosage Calculation (Nursing)

00:01 So we’re talking about pediatric oral liquid medications.

00:06 This is something that you’ll commonly give on a pediatric unit.

00:09 So remember, 250 milligrams, what does that represent? Right, the dosage of BugAway that is in 5 milliliters.

00:21 Now, 5 milliliters is what tells us that it’s something that’s liquid.

00:25 So, pediatric oral liquid medications are usually provided a safe range.

00:29 The order will tell us what’s a safe range of medication the child can receive in a 24-hour period based on their weight.

00:37 That’s why we’re talking about weight-based dosage calculation.

00:41 Okay, so for example, you saw in this label usual dose children, 20-40 mg/kg/day.

00:49 So, that’s going to give us the range.

00:51 When we know the child’s weight, we know that a safe range for this patient, this child is 20-40 mg/kg/day.

01:00 We’re going to give it to them in divided doses.

01:02 So, let’s keep breaking that down.

01:05 Okay, the label states 20-40 mg/kg/day in divided doses every 8 hours.

01:15 How we figure the safe and therapeutic range? We’re going to use an example of a 10-kilogram child.

01:21 You’re welcome.

01:23 Yeah, we started with a 10-kilogram child because it’s going to be a lot easier for you to see the math and to check yourself for correctness and then we’ll give you other examples to practice that are a little trickier.

01:34 But let’s start with something that’s very clear in the beginning.

01:38 So, the child weighs 10 kilograms.

01:41 I know that the low is the minimum dose there is 20 mg/kg/day.

01:47 So 10 times 20 equals 200.

01:51 When we say a range, the lowest number is the minimum dose that a child needs for it to be therapeutic or get the effect that we want.

02:00 40 is the maximum dose that we would give that patient.

02:06 So, 10 times 20 equals 200. That’s the lowest therapeutic dose.

02:12 Now, the range is 20-40.

02:14 So, we will multiply 10, the child’s weight, times 40 to get the maximum dose which is 400 milligrams.

02:22 Now, keep in mind this range is per day.

02:27 It’s the number of milligrams times the child’s weight in kilograms total that they can have in a day. That is really, really important.

02:38 This would be a horrible matter if you gave this dose to the patient every time.

02:44 Then you would give this child three times the safest level.

02:49 So, you want to make sure that you’re very clear.

02:53 It says divided doses.

02:55 That means you’re going to take the range and divide it into three doses because you’re giving it every eight hours.

03:01 So, now we’ve learned how to figure a safe and therapeutic range for a 10-kg child.

03:08 It’s going to range from 200 milligrams to 400 milligrams.

03:12 We took the range of 20-40 mg/kg/day.

03:17 Multiply that by 10 to come up with 200 and 40 to come up with 400 milligrams.

03:23 200 is the lowest therapeutic dose that will do anything for the child.

03:28 400 is the top, the maximum dose that we would give that child.

03:32 So that’s what our safe range is, 200-400 milligrams a day.

03:38 Now, remember we talked about divided doses in every 8 hours.

03:43 We know the safe range is 200-400 milligrams a day.

03:47 Well, there’s 24 hours in a day.

03:50 If this says to give us divided doses every 8 hours, we know we’re going to give three doses in a 24-hour period because if you divide 24 by every 8 hours like the order says, then you’re going to have 1 dose every 8 hours.

04:07 So, the order reads to give 125 milligrams every 8 hours.

04:14 Now, our job is to determine is this within the safe and therapeutic range.

04:18 Well, remember what the safe and therapeutic range is, right? It’s 200-400 milligrams a day.

04:25 Well, 125 milligrams times 3 doses equals 375 milligrams in a 24-hour period because we’re giving those 3 doses.

04:37 Let’s check this and see does it land right in between the safe range.

04:43 Is 375 in between 200 and 400? Well, of course it is.

04:49 So, that means that this order is safe because 375 is the total that that child will receive in 24 hours and that lets us know that this is safe.

05:01 Now, let’s look at another thing.

05:03 What if the order read, "Give 200 milligrams every 8 hours." Is this safe? So, I want you to think that you’re a nurse on a pediatric unit.

05:13 You have this child. You’re caring for them.

05:15 They weighed 10 kilograms.

05:17 This order read that you should give 200 milligrams every 8 hours.

05:22 Well, your job as a nurse is to go get that medication to look at the label.

05:26 Like we did, we walked through these previous steps.

05:28 Look what the safe range is and figure it out.

05:31 So we do that.

05:32 We figure out the safe range for a child is 200-400 milligrams a day because this child weighs 10 kilograms.

05:39 Now, you compare what we figured out as a safe and therapeutic range to the physician’s order.

05:45 So, 200 milligrams times 3 doses because we know we’re giving it every 8 hours equals 600 milligrams in one day.

05:52 Whoa! Wait a minute.

05:54 Compare that to the safe and therapeutic range.

05:58 Is 600 in the safe and therapeutic range of 200-400? No, it’s not.

06:04 So, this highlights what our responsibility is.

06:07 Now, usually in the hospital, there are several people involved in medication orders.

06:12 The physician makes the order.

06:13 The pharmacy fills it. They review it.

06:15 The nurses are the ones who actually administer the medication.

06:19 All of us are equally responsible for safe medication administration.

06:25 Usually, this type of thing would be caught in pharmacy.

06:28 But if it isn’t, it’s your job to make sure that you don’t give a medication that is unsafe to your patient.

06:35 So, if this happened to you and you experienced this, and you saw this order, what you would do is stop, not give the medication to the child and contact the healthcare provider to get a new order in a safe and therapeutic range.

06:48 Safety really is our responsibility. It’s everyone's responsibility.

06:56 But as nurses, we are the last people to actually give that medication to the patient.

07:01 So, we have a very heavy responsibility to protect our patients.

07:05 When a medication is ordered in divided doses, again, make sure the total daily dose is within the stated safe and therapeutic range that you see on the label.

07:17 And when it’s a divided dose, make sure that you’re giving that in three separate doses like in that previous example and not giving the total daily dose at each one of those three administrations.

07:30 Let’s look at another label.

07:32 Now, hopefully this one doesn’t look as overwhelming to you because you’ve already walked through one.

07:37 Again, the pharmaceutical company is Lawes.

07:40 Man, I wish I have that kind of money.

07:43 The name of the drug is CoughNot because if I was naming a drug that stopped coughing, that’s what I would call it. It’s an oral suspension.

07:52 So, we know that it’s going to be liquid.

07:54 Again, it says 250 milligrams.

07:56 That’s the dosage of the drug, CoughNot, in 5 milliliters.

08:01 Milliliters is a liquid measurement.

08:04 So, I know that we’ve got 250 milligrams in 5 milliliters or liquid measurement.

08:11 Now, we know to go over to the next side of the label.

08:13 Sometimes when you look at the label, this is kind of phew.

08:16 It’s kind of turned sideways.

08:17 But we have to straight it up for you so it’s easier to read.

08:21 But the usual dose for children for CoughNot is 50 mg/kg/day in equally divided doses at 6-hour intervals.

08:33 Okay, this one’s a little different than the example we just did.

08:36 So for CoughNot, children 50 mg/kg a day.

08:42 I want them in equally divided doses at 6-hour intervals.

08:47 All right, so let’s go into some calculating.

08:49 This is what we’re going to answer and I want you to try to do this on your own.

08:54 Then I’ll come back and walk you through the answers.

08:57 So, 250 milligrams of CoughNot, P.O., (that means by mouth), orally, q.6 hours.

09:04 So, I want you to think, I want you to calculate what is the average children’s dosage for a 20-kilogram child for one day.

09:13 How many doses will be given in one day? The order reads 250 milligrams CoughNot, P.O., q.6 hours.

09:22 Is this safe and does the healthcare provider need to be consulted? Okay, so pause the video and see if you can work through those four questions.

09:33 Then we’ll come back and walk through them together.

09:41 Let’s start with the first one.

09:44 What is the average children’s dosage for a 20-kilogram child for one day? Well, when we read the label, you can see we’ve got it highlighted there.

09:53 It says 50 mg/kg is the usual dose.

09:57 So 20, which is the child’s weight times 50 because we know it’s 50 mg/kg equals 1000 milligrams a day.

10:08 Well, how many doses will be given one day? Well, remember what the label said.

10:13 It said divided doses every six hours.

10:17 It’s 24 hours in a day.

10:18 So, if we give a divided dose every 6 hours, we’ll be giving four doses in 24 hours because 24 divided by 6 equals 4.

10:28 Now, the order reads 250 milligrams of CoughNot, P.O. (that means by mouth), q.6 hours. Is this safe? Well, we need to figure out the range, right? 4 doses at 250 milligrams because we already figured we’re going to give 4 doses, 250 milligrams.

10:49 That will equal 1000 milligrams in 24 hours.

10:53 Yeah, that is within the safe range.

10:57 So, does the healthcare provider need to be consulted? No, because the dosage is within the safe range.