The nurse has been assigned to the pediatric floor. Which nursing interventions indicate this nurse understands pharmacokinetic variables in children?

Question

1. Monitoring diagnostic lab work for therapeutic levels of phenobarbital in a premature infant
2. Monitoring blood sugars for hyperglycemia in an infant with eczema requiring frequent applications of topical corticosteroid cream
3. Monitoring a 5-month-old infant taking propranolol (Inderal) for a heart defect for symptoms of toxicity
4. Monitoring a 6-year-old taking salicylates for pain for hepatic toxicity
5. Monitoring a 2-week-old infant taking gentamicin for severe infection for decreased blood urea nitrogen (BUN)

Answer 1

Correct Answer: 1,2,3
Rationale 1: Low gastric acid production may slow the absorption of weak acids such as phenobarbital.
Rationale 2: The skin of infants is thin and very permeable, allowing topical drugs to be absorbed at a rapid rate. Frequent applications of topical corticosteroid cream can cause a systemic effect of hyperglycemia.
Rationale 3: Prior to 6 months, the child's liver function is immature and produces very small amounts of plasma proteins. This could lead to toxicity with drugs requiring high levels of protein binding such as propranolol (Inderal).
Rationale 4: Metabolic rate reaches adult levels by 5 years of age. Hepatic toxicity from salicylates would be unusual.
Rationale 5: Gentamicin is potentially nephrotoxic. This child has immature kidney function, which may result in an accumulation of the drug and an increased, not decreased, BUN.
Global Rationale: Low gastric acid production may slow the absorption of weak acids such as phenobarbital. The skin of infants is thin and very permeable, allowing topical drugs to be absorbed at a rapid rate. Frequent applications of topical corticosteroid cream can cause a systemic effect of hyperglycemia. Prior to 6 months, the child's liver function is immature and produces very small amounts of plasma proteins. This could lead to toxicity with drugs requiring high levels of protein binding such as propranolol (Inderal). Metabolic rate reaches adult levels by 5 years of age. Hepatic toxicity from salicylates would be unusual. Gentamicin is potentially nephrotoxic. This child has immature kidney function, which may result in an accumulation of the drug and an increased, not decreased, BUN.