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1Formulas and methods
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
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
Which activity best supports a 9-year-old during a long hospital stay?
AStaying in bed with no visitors to rest
BSchoolwork and contact with classmates, plus games or hobbies
CWatching television alone for most of the day
DPlaying with baby toys in the toddler playroom with younger children
2.Pediatric nursingHard
Which finding in a 3-month-old with bronchiolitis requires immediate follow-up?
AFeeding slightly less than usual but still with wet nappies
BA runny nose and mild cough
CPauses in breathing (apnoea) and an oxygen saturation of 88%
DWheeze heard on auscultation
3.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 80 units/kg for a patient who weighs 106 kg. The vial contains 1 000 units/mL. What volume V do you draw up? Round to one decimal place.
80 units/kg106 kg1 000 units/mL
V = mL
4.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A patient who weighs 65 kg has an order for norepinephrine at 10 mcg/min. The bag contains 8 mg in 250 mL. Find the pump rate R in mL/h. Round to one decimal place.
8 mg/250 mL10 mcg/min65 kg
R = mL/h
5.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The patient weighs 73 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 120 mL/h. At 13:30, 550 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL550 mL infused120 mL/h
t = h
3Solutions
1.Pediatric nursing
Answer: B · Schoolwork and contact with classmates, plus games or hobbies
Why this is the answer
School-age children need to feel competent and connected. Hospital school, contact with friends and age-appropriate games, crafts and collections support Erikson's task of industry and reduce feelings of isolation.
Answer
B · Schoolwork and contact with classmates, plus games or hobbies
2.Pediatric nursing
Answer: C · Pauses in breathing (apnoea) and an oxygen saturation of 88%
Why this is the answer
Apnoea and low oxygen saturation are signs of severe bronchiolitis and need urgent assessment and support. The other findings are typical of mild bronchiolitis.
Answer
C · Pauses in breathing (apnoea) and an oxygen saturation of 88%
3.Pediatric & critical-care dosing
Answer: V = 8.5 mL
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 needed
80·106 = 8 480 units
Volume
V = 8480/1000 = 8.48 ≈ 8.5 mL
Answer
V = 8.5 mL
4.Pediatric & critical-care dosing
Answer: R = 18.8 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
8 000/250 = 32 mcg/mL
Dose per hour
The order is per minute for the whole patient, so the weight is not needed.
10·60 = 600 mcg/h
Pump rate
R = 600/32 = 18.75 ≈ 18.8 mL/h
Answer
R = 18.8 mL/h
5.IV fluids & fluid balance
Answer: U = 2.18 mL/kg/h
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.
Total urine
400 + 500 + 150 + 225 = 1275 mL
Per kilogram per hour
U = 1275/(73·8) = 2.183 ≈ 2.18 mL/kg/h
Answer
U = 2.18 mL/kg/h
6.IV fluids & fluid balance
Answer: t = 3.8 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
1000 − 550 = 450 mL
Time
t = 450/120 = 3.75 ≈ 3.8 h
Answer
t = 3.8 h
That is about 3 h 45 min, so the bag runs out at about 17:15.