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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
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?
ACoeliac disease
BConstipation
CIntussusception
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?
APostconventional level
BConventional level
CFormal operational level
DPreconventional level
3.Pediatric & critical-care dosingMedium
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
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
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
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.