In the print window, choose “Save as PDF” to keep a copy on your device.
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
Why should a child with rubella avoid contact with pregnant women?
AThe child may catch a pregnancy-related infection
BRubella in early pregnancy can cause serious birth defects
CRubella causes pregnant women to go into labour early
DPregnant women always develop severe pneumonia if they catch rubella
2.Pediatric nursingHard
The nurse has taught a parent about treating head lice. Which statement shows a need for further teaching?
A"Lice can spread when children's heads touch."
B"I'll use a fine-toothed comb on wet hair to find lice."
C"After one treatment, I won't need to check her hair again."
D"I'll check everyone else in the family for lice as well."
3.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 20 000 units of heparin in 500 mL. The order is 20 units/kg/h for a patient who weighs 100 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
20 000 units/500 mL20 units/kg/h100 kg
R = mL/h
4.Pediatric & critical-care dosingHard
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 67 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
800 mg/500 mL10 mcg/kg/min67 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. Count ice chips as half their volume.
milk: 200 mLtea: 200 mLice chips: 100 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 1 × 50 mL
I = mL
6.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 125 mL/h. At 12:30, 150 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
500 mL150 mL infused125 mL/h
t = h
3Solutions
1.Pediatric nursing
Answer: B · Rubella in early pregnancy can cause serious birth defects
Why this is the answer
Congenital rubella syndrome can cause deafness, eye defects such as cataracts, heart defects and developmental problems, especially when infection occurs early in pregnancy. MMR vaccination protects against this.
Answer
B · Rubella in early pregnancy can cause serious birth defects
2.Pediatric nursing
Answer: C · "After one treatment, I won't need to check her hair again."
Why this is the answer
Many treatments do not kill all eggs, so a second application or repeated wet combing over about two weeks is usually needed, with checks afterwards. Checking family members and wet combing are correct.
Answer
C · "After one treatment, I won't need to check her hair again."
3.Pediatric & critical-care dosing
Answer: R = 50 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
20·100 = 2 000 units/h
Concentration
20 000/500 = 40 units/mL
Pump rate
R = 2000/40 = 50 mL/h
Answer
R = 50 mL/h
4.Pediatric & critical-care dosing
Answer: R = 25.1 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
10·67 = 670 mcg/min
670·60 = 40200 mcg/h
Pump rate
R = 40200/1600 = 25.13 ≈ 25.1 mL/h
Answer
R = 25.1 mL/h
5.IV fluids & fluid balance
Answer: I = 1100 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: 200 + 200 = 400 mL
ice chips: 100/2 = 50 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 1·50 = 50 mL
I = 1100 mL
Answer
I = 1100 mL
6.IV fluids & fluid balance
Answer: t = 2.8 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
500 − 150 = 350 mL
Time
t = 350/125 = 2.8 h
Answer
t = 2.8 h
That is about 2 h 48 min, so the bag runs out at about 15:18.