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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
How should a parent respond to a 2-year-old's temper tantrum in a safe place?
AStay calm, keep the child safe and do not give in to the demand
BShout loudly at the child to make the tantrum stop sooner
CSmack the child to show that tantrums are not allowed
DGive the child the sweet he wants so the tantrum stops
2.Pediatric nursingHard
Which finding at a 6-month check most needs referral?
AThe baby is wary of a stranger
BThe baby does not turn towards sounds or voices
CThe baby puts every toy and object into the mouth
DThe baby is not crawling yet
3.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 70 units/kg for a patient who weighs 86 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to one decimal place.
70 units/kg86 kg5 000 units/mL
V = mL
4.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A dopamine infusion of 400 mg in 250 mL runs at 8 mL/h. The patient weighs 75 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
400 mg/250 mL8 mL/h75 kg
D = mcg/kg/min
5.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 56 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 was started at 11:15 and runs by pump at 80 mL/h. How many mL V are left in the bag at 19:15?
1000 mL80 mL/h11:15 → 19:15
V = mL
3Solutions
1.Pediatric nursing
Answer: A · Stay calm, keep the child safe and do not give in to the demand
Why this is the answer
Tantrums are normal as toddlers seek autonomy but cannot yet manage frustration. Staying calm, keeping the child safe, ignoring the outburst and giving attention for calm behaviour work best; giving in reinforces tantrums.
Answer
A · Stay calm, keep the child safe and do not give in to the demand
2.Pediatric nursing
Answer: B · The baby does not turn towards sounds or voices
Why this is the answer
Not responding to sounds at 6 months may signal hearing loss and needs referral. Crawling usually starts at about 8–10 months, and mouthing objects and wariness of strangers are normal at this age.
Answer
B · The baby does not turn towards sounds or voices
3.Pediatric & critical-care dosing
Answer: V = 1.2 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
70·86 = 6 020 units
Volume
V = 6020/5000 = 1.204 ≈ 1.2 mL
Answer
V = 1.2 mL
4.Pediatric & critical-care dosing
Answer: D = 2.8 mcg/kg/min
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
400 000/250 = 1600 mcg/mL
Micrograms per minute
8·1600 = 12800 mcg/h
12800/60 = 213.3 mcg/min
Per kilogram
D = 213.3/75 = 2.844 ≈ 2.8 mcg/kg/min
Answer
D = 2.8 mcg/kg/min
5.IV fluids & fluid balance
Answer: U = 1.45 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
250 + 325 + 400 = 975 mL
Per kilogram per hour
U = 975/(56·12) = 1.451 ≈ 1.45 mL/kg/h
Answer
U = 1.45 mL/kg/h
6.IV fluids & fluid balance
Answer: V = 360 mL
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.