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Poly-pharmacy in paediatrics - Coggle Diagram

- - - - Other medications included 1gram paracetamol four times daily. Due to possible impaired kidney function due to sepsis, the patient was not able to have ibuprofen.
        
        Paracetamol
        Paracetamol is a para-aminophenol derivative that exhibits analgesic and antipyretic activity. Its mechanism of action is believed to include inhibition of prostaglandin synthesis, primarily within the central nervous system. It is given by orally, rectally (suppositories) or intravenously for mild to moderate pain and fever. Paracetamol is distributed into most body tissues. Binding to the plasma proteins is minimal at therapeutic concentrations but increases with increasing doses. Paracetamol is metabolised in the liver and excreted in the urine mainly as glucuronide and sulphate
        conjugates.
        
        Indications
        For fast effective temporary relief of pain and discomfort associated with headache, muscular aches, period pain, arthritis/osteoarthritis, toothache, migraine, cold & flu symptoms, tension headache, sinus pain/headache and backache. Reduces fever.
        
        Normal dosages
        Adults: 500mg to 1g every four to six hours as required. Maximum daily dose: 4000 mg.
        Children: 15 mg/kg per dose (maximum 1 g) every four hours; maximum 75 mg/kg per day (without exceeding 4 g) for 48 hours, maximum of 60 mg/kg per day (without exceeding 4 g) thereafter
        
        Contraindications
        Paracetamol should be used with caution in patients with:
        • Impaired liver function: Underlying liver disease increases the risk of paracetamol-related liver damage
        • Impaired kidney function: Administration of paracetamol to patients with moderate to severe renal impairment may result in accumulation of paracetamol conjugates.
        
        Interactions
        • The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular daily use of paracetamol with increased risk of bleeding; occasional doses have no significant effect. Anticoagulant dosage may require reduction if paracetamol medication is prolonged.
        • Paracetamol absorption is increased by substances that increase gastric emptying, eg metoclopramide.
        
        Side effects
        Side effects from paracetamol are rare but include:
        -allergic reaction, including a rash or swelling
        -rash
        -blood disorders
        -liver and kidney damage (when taken at higher than recommended doses).
      - Flucloxacillin
        Flucloxacillin is indicated for the treatment of infections due to Gram-positive organisms, including
        infections caused by β-lactamase producing staphylococci. Flucloxacillin should not be taken if allergic to penicillins, cephalosporin antibiotics, and beta-lactam antibiotics.
        
        Side effects
        Flucloxacillin Can cause liver damage- signalled by yellowing of the whites of the eyes
        Other side effects include vomiting or stomach upset, diarrhoea, and oral or vaginal thrush.
        
        Very rare side effects
        very rare cases of
        blood and fluid abnormality (high anion gap metabolic acidosis) which occurs when there is an increase in plasma acidity when flucloxacillin is used concomitantly with paracetamol, generally in the presence of risk factors
        
        After co-administration of flucloxacillin and paracetamol, a close monitoring is recommended in order to detect the appearance of acid-base disorders, namely HAGMA, including the search of urinary 5-oxoproline
        
        Normal dosage ranges
        Osteomyelitis, endocarditis: up to 8 g daily, in divided doses six to eight hourly.
        Flucloxacillin capsules come in two strengths:
        250 mg: each capsule contains 250 mg of flucloxacillin as the
        sodium salt.
        500 mg: each capsule contains 500 mg of flucloxacillin as the
        sodium salt.
        
        Flucloxacillin can be given intravenously, orally, intramuscular, or nebulised
        
        Typical indications include:
        • Skin and soft tissue infections: boils, abscesses, carbuncles, furunculosis, cellulitis, infected wounds,
        infected burns, protection of skin grafts, and impetigo.
        • Infected skin conditions: ulcer, eczema and acne.
        • Respiratory tract infections: Pneumonia, lung abscess, empyema, sinusitis, pharyngitis, tonsillitis,
        quinsy, otitis media and externa.
        • • Other infections caused by flucloxacillin-sensitive organisms such as osteomyelitis, enteritis,
        endocarditis, urinary tract infection, meningitis, septicaemia.
        
        Interactions
        flucloxacillin should be taken with caution in those taking oral contraceptives as this may effect the reliability. Flucloxacillin may increase warfarin requirement to maintain therapeutic international normalised ratio (INR).
      - Potassium chloride
        The potassium ion (K+) is the principal intracellular cation of most body tissues. Potassium ions participate in a number of essential physiological processes including the maintenance of intracellular tonicity; the transmission of nerve impulses; the contraction of cardiac, skeletal, and smooth muscle; and the maintenance of normal renal function.
        Potassium Chloride and Sodium Chloride infusion solutions are indicated as a source of water and to restore electrolyte balance as required by the patient’s clinical condition, such as hypokalaemia.
        
        Dosage
        The choice of the specific Potassium Chloride and Sodium Chloride infusion solutions formulation, dosage, volume, rate and duration of administration is dependent upon the age, weight, clinical and biological (acid‐base balance) condition of the patient, concomitant therapy and laboratory determinations
        
        Contraindications
        The Potassium Chloride and Sodium Chloride infusion solutions are contraindicated in patients with:
        -Known hypersensitivity to the product.
        -Documented hyperkalaemia, hyperchloraemia or hypernatraemia.
        -Potassium retention.
        -Congestive heart failure.
        -Severe impairment of renal function.
        -Acidosis
        -Haemolysis
        -Addison’s disease.
        
        Interactions
        Caution is advised in patients treated with lithium. Renal sodium and lithium clearance may be increased during administration of Potassium Chloride and Sodium Chloride infusion solutions and this can result in decreased lithium levels.
        
        Side effects
        Adverse reactions to potassium containing solutions include hyperkalaemia, paraesthesia of the extremities, flaccid paralysis, mental confusion, hypotension, cardiac arrhythmias, heart block, ECG abnormalities and cardiac arrest.
      - Glucose and Sodium Chloride
        Glucose is readily metabolised into carbon dioxide and water, with a release of energy. As such, an administration of a glucose solution either by oral or parenteral route provides water for body hydration as well as energy In addition, it may
        reduce catabolic loss of nitrogen from the body and aid in prevention of depletion of liver glycogen. That is, in the absence of glucose, amino acids undergo deamination followed by oxidation in order to release energy.
        Sodium is the major cation of extracellular fluid and functions principally in the control of water distribution, fluid and electrolyte balance and osmotic pressure of body fluids. Chloride, the major extracellular anion, closely follows the physiological disposition of the sodium cation in maintenance of acid‐base balance, isotonicity and electrodynamic characteristic of the cells.
        
        Dosage
        The dosage, volume, rate and duration of administration of Glucose and Sodium Chloride infusion solution are dependent upon the age, weight, clinical condition of the patient, laboratory determinations and concomitant therapy. For patients with electrolyte and glucose abnormalities and for paediatric patients, consult a physician experienced in intravenous fluid therapy. Electrolyte supplementation may be indicated according to the clinical needs of the patient.
        
        Contraindications
        Glucose and Sodium Chloride infusion solutions are contraindicated in patients with the following medical conditions:
        -know hypersensitivity to the product or active substances
        -known allergy to corn or corn products, because cornstarch is used as raw material for glucose production
        -cardiac failure including congestive heart failure
        -lactacidosis
        -uncontrolled diabetes
        -clinically significant hyperglycaemia
        -hyperkalaemia
        -severe impairment of renal function
        -bloating‐ascitic syndrome in cirrhosis
        -acute ischaemic stroke
        -patients who have had a head trauma within 24 hours
        - patients presenting with a clinical state in which there exists oedema with sodium retention, or with renal, hepatic or cardiac impairment with oedema, hypervolaemia, hypernatraemia.
        
        Indication
        Glucose and Sodium Chloride infusion solution is indicated for replenishing fluid losses, as an energy source and for restoration or maintenance of sodium and chloride ion concentrations. It may be used as a vehicle of medication delivery where intravenous delivery is appropriate and the medicine is compatible with this solution
        
        Side effects
        -fever
        -blood clot or inflammation surrounding the site of injection
        -leakage of fluid into the surrounding tissues (extravasation)
        -hypovolemia
- - - - Documentation
        All medicines administration must be documented in the medicines record or chart. Such documentation should occur simultaneously with administration and be legible, accurate and meet legislative and organisational requirements, as well as any specific policy requirements of the facility. The medicines chart should contain, at a minimum, the complete name and date of birth of the person. People with similar or the same names must have alerts written on their charts. Use of the NHI is also recommended.
        
        Paediatrics
        Due to the nature of the clinical environment, it was essential to consider medication management in children
        -children and infants should only be weighed in kilograms (kg) and kilograms should be the standard weight on prescriptions, medical records and staff communications;
        -use oral syringes to administer oral medicines; and
        -avoid storing adult and paediatric concentrations in the same automated dispensing machine cabinet drawer or other storage facility.
        
        Errors
        If an error is made in the administration of a medicine, the RN must take every action to prevent any potential harm to the client, and report the error as soon as possible to the prescribing health professional, the line manager or employer (according to local workplace policy). The RN must document the incident and the action taken. A reportable event form must be completed. If an EN, HCA or student nurse makes an error, this must be reported to the supervising RN as soon as possible so the above actions can be taken.
        
        Medication rights
        1) Right patient: Two identifiers, ask patient and check ID band
        2) Right medication: Check for allergies, check name, strength, and form of physical medication against prescribed chart.
        3) Right dose: Check prescription, check NZF, calculate dose
        4) Check the prescription and appropriateness, confirm patient can take it via prescribed route, check if medication can be given via that route
        5) Right time: Check the frequency, does administration fit within timeframe, timing of last dose
        
        1) Right to refuse
        2) Right reason
        3) Right documentation
        
        These medication rights were implemented before and after every medication given in practice to ensure safe practice with the scope that acts in the best interest of the patient