Pediatric Nursing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Pediatric nursing

Method

  1. Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
  2. Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
  3. Match the action to the development stage and involve the family.
  4. Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.

Pediatric & critical-care dosing

Daily dose
mg/day = mg/kg/day × weight (kg)
Doses per day
number = 24 h / dosing interval (h)
Pounds to kilograms
kg = lb / 2.2
Infusion concentration
units/mL = units in bag / bag volume
Pump rate
mL/h = dose per hour / concentration
Titrated drip
mL/h = mcg/kg/min × kg × 60 / (mcg/mL)
Dose from pump rate
mcg/kg/min = mL/h × (mcg/mL) / (60 × kg)
Units
1 mg = 1000 mcg

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

2Practice problems

1.Pediatric nursingMedium

A topical anaesthetic cream (lidocaine–prilocaine) is planned before a cannula insertion. What is important?

  1. AApply it just seconds before the needle
  2. BApply it to broken skin for faster effect
  3. CRub it firmly into the skin and wipe it off after about 1 minute, without a dressing
  4. DApply it well in advance, usually about 60 minutes, under an occlusive dressing
2.Pediatric nursingHard

A 3-year-old says the IV pump "is angry" when it beeps. Which feature of thinking does this show?

  1. AAnimism, typical of preoperational thinking
  2. BConservation, typical of concrete operations
  3. CAbstract reasoning, typical of formal operations
  4. DObject permanence, typical of the sensorimotor stage
3.Pediatric & critical-care dosingMedium
25 000 units500 mLheparin? mL/h85 kg16 units/kg/h

Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 500 mL. The order is 16 units/kg/h for a patient who weighs 85 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

25 000 units/500 mL16 units/kg/h85 kg
R = mL/h
4.Pediatric & critical-care dosingHard
800 mg500 mLdopamine? mL/h54 kg10 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 800 mg in 500 mL. The order is 10 mcg/kg/min for a patient who weighs 54 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

800 mg/500 mL10 mcg/kg/min54 kg
R = mL/h
5.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftsoup180 mLwater120 mLIV infusion60 mL/h × 8 hIV antibiotic1 × 100 mLurine250 mLurine475 mLurine375 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

soup: 180 mLwater: 120 mLIV infusion: 60 mL/h × 8 hIV antibiotic: 1 × 100 mL
I = mL
6.IV fluids & fluid balanceHard
500 mL100 mL infused75 mL/h21:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 75 mL/h. At 21:00, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL100 mL infused75 mL/h
t = h

3Solutions

1.Pediatric nursing

Answer: D · Apply it well in advance, usually about 60 minutes, under an occlusive dressing

Why this is the answer

Topical anaesthetic creams need time to reach full effect, usually around an hour, under an occlusive dressing. Plan ahead so the child benefits.

Answer

D · Apply it well in advance, usually about 60 minutes, under an occlusive dressing
2.Pediatric nursing

Answer: A · Animism, typical of preoperational thinking

Why this is the answer

Animism, giving lifelike qualities to objects, is a feature of Piaget's preoperational stage. Nurses can use it by explaining equipment in simple, friendly terms and letting the child touch it.

Answer

A · Animism, typical of preoperational thinking
3.Pediatric & critical-care dosing

Answer: R = 27.2 mL/h

Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Units per hour

16·85 = 1 360 units/h

Concentration

25 000/500 = 50 units/mL

Pump rate

R = 1360/50 = 27.2 mL/h

Answer

R = 27.2 mL/h
4.Pediatric & critical-care dosing

Answer: R = 20.3 mL/h

Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Concentration

800 mg = 800 000 mcg
800 000/500 = 1600 mcg/mL

Dose per minute and per hour

10·54 = 540 mcg/min
540·60 = 32400 mcg/h

Pump rate

R = 32400/1600 = 20.25 ≈ 20.3 mL/h

Answer

R = 20.3 mL/h
5.IV fluids & fluid balance

Answer: I = 880 mL

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Add the intake

oral: 180 + 120 = 300 mL
IV infusion: 60·8 = 480 mL
IV antibiotic: 1·100 = 100 mL
I = 880 mL

Answer

I = 880 mL
6.IV fluids & fluid balance

Answer: t = 5.3 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Volume left

500 − 100 = 400 mL

Time

t = 400/75 = 5.333 ≈ 5.3 h

Answer

t = 5.3 h

That is about 5 h 20 min, so the bag runs out at about 02:20.

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