Pediatric Nursing: cram pack

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

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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 9-month-old has episodes of severe crying with knees drawn up, and passes a stool that looks like red-currant jelly. What is the likely cause?

  1. ACoeliac disease
  2. BConstipation
  3. CIntussusception
  4. DPyloric stenosis
2.Pediatric nursingHard

A 4-year-old says it is wrong to hit his sister "because then I get a time-out". Which level of Kohlberg's moral development does this reflect?

  1. APostconventional level
  2. BConventional level
  3. CFormal operational level
  4. DPreconventional level
3.Pediatric & critical-care dosingMedium
250 units250 mLregular insulin? mL/h98 kg0.05 units/kg/h

Practice exercise (made-up values, not clinical guidance). An infusion contains 250 units of regular insulin in 250 mL. The order is 0.05 units/kg/h for a patient who weighs 98 kg. Find the pump rate R in mL/h. Round to one decimal place.

250 units/250 mL0.05 units/kg/h98 kg
R = mL/h
4.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine? mL/h97 kg12.5 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 500 mg in 250 mL. The order is 12.5 mcg/kg/min for a patient who weighs 97 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

500 mg/250 mL12.5 mcg/kg/min97 kg
R = mL/h
5.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftsoup180 mLtea240 mLIV infusion125 mL/h × 12 hIV antibiotic1 × 50 mLurine375 mLurine150 mLwound drain50 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

soup: 180 mLtea: 240 mLIV infusion: 125 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
6.IV fluids & fluid balanceHard
1000 mL300 mL infused50 mL/h12:30t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 50 mL/h. At 12:30, 300 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL300 mL infused50 mL/h
t = h

3Solutions

1.Pediatric nursing

Answer: C · Intussusception

Why this is the answer

Intussusception causes intermittent colicky pain, vomiting, a sausage-shaped mass and stools with blood and mucus. It is an emergency.

Answer

C · Intussusception
2.Pediatric nursing

Answer: D · Preconventional level

Why this is the answer

At the preconventional level, typical of young children, right and wrong are judged by punishment and reward. Formal operational is one of Piaget's cognitive stages, not a Kohlberg level.

Answer

D · Preconventional level
3.Pediatric & critical-care dosing

Answer: R = 4.9 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

0.05·98 = 4.9 units/h

Concentration

250/250 = 1 units/mL

Pump rate

R = 4.9/1 = 4.9 mL/h

Answer

R = 4.9 mL/h
4.Pediatric & critical-care dosing

Answer: R = 36.4 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

500 mg = 500 000 mcg
500 000/250 = 2000 mcg/mL

Dose per minute and per hour

12.5·97 = 1213 mcg/min
1213·60 = 72750 mcg/h

Pump rate

R = 72750/2000 = 36.38 ≈ 36.4 mL/h

Answer

R = 36.4 mL/h
5.IV fluids & fluid balance

Answer: I = 1970 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 + 240 = 420 mL
IV infusion: 125·12 = 1500 mL
IV antibiotic: 1·50 = 50 mL
I = 1970 mL

Answer

I = 1970 mL
6.IV fluids & fluid balance

Answer: t = 14 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 − 300 = 700 mL

Time

t = 700/50 = 14 h

Answer

t = 14 h

That is about 14 h 00 min, so the bag runs out at about 02:30.

ExamProblems · examproblems.com/courses/pediatric-nursing