John Idris Rees Nursing Implications: Anti-infectives

1. (2 points) How should the nurse identify a pediatric client prior to administering
medication?

The nurse should identify the patient using at least two unique identifiers one should be
the name and the other can be the patient's ID number or patients date of birth. The
joint commission requires only these identifiers to be used and they should be checked
against the patient's armband, medication administration record (MAR) or chart. After
these checks have been done the nurse should also ask the patient their name as a
third identifier (but this should only be used as an additional identifier). A room or room
number should never be used as an identifier.

2. (2 points) What other nursing assessment could have prevented this error? In
other words what should the nurse have checked (besides identifiers) before
giving the ampicillin?

The nurse should have firstly checked the patient's history for allergies to penicillin and
asked the mother if the child was allergic to penicillin, this would have indicated that this
wasn't the right patient for this drug.

It is also good practice to talk with the patient (and in the case of pediatric patients their
guardians) about what drugs you are administering and why. This would have given an
extra opportunity for the information of the patients name to have come out and their
allergy to penicillin and prevented this med error.

3. (2 points) Does the Davis Guide contain the same information on dosing
Tobramycin that is listed in the Critical Thinking Scenario?

The information in the critical thinking assignment is not the same as Davis. In Davis
they do not use a minimum and maximum dosage range instead they have different
dosing guidelines that are based on the age and weight range of the patient for example
a child who is 1000 g does not receive the same equivalent dosage as a child who
weighs 3000 g.
I think Davis calculates dosages this way because of the vast difference in size and
weight of neonates and as a result the dosages can be better suited to an individual
child.

4. (2 points) What problems might have occurred if the infant had received too
high a dose of Tobramycin?
Neonates have an increased risk of developing a neuromuscular blockade and so an
overdose would increase this risk. Also neonates have immature renal function so an
overdose could prove fatal. An overdose in Tobramycin could also cause congenital
deafness.