Pediatric Nursing: cram pack

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

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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

In a large ventricular septal defect, in which direction does blood mainly flow through the defect?

  1. AFrom the aorta into the pulmonary veins
  2. BThere is no flow at all, because the pressures in both ventricles are always equal
  3. CFrom left to right, increasing blood flow to the lungs
  4. DFrom right to left, causing cyanosis from birth
2.Pediatric nursingHard

The nurse has taught a parent about treating head lice. Which statement shows a need for further teaching?

  1. A"Lice can spread when children's heads touch."
  2. B"After one treatment, I won't need to check her hair again."
  3. C"I'll check everyone else in the family for lice as well."
  4. D"I'll use a fine-toothed comb on wet hair to find lice."
3.Pediatric & critical-care dosingMedium
heparin 5 000 units/mL80 units/kg · 56 kg → V = ? mL

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 56 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to two decimal places.

80 units/kg56 kg5 000 units/mL
V = mL
4.Pediatric & critical-care dosingHard
400 mg250 mLdopamine? mL/h99 kg2 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 2 mcg/kg/min for a patient who weighs 99 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

400 mg/250 mL2 mcg/kg/min99 kg
R = mL/h
5.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjuice100 mLwater200 mLIV infusion50 mL/h × 12 hIV antibiotic2 × 50 mLurine325 mLurine500 mLurine425 mLwound drain110 mLvomit150 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.

juice: 100 mLwater: 200 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
6.IV fluids & fluid balanceHard
1000 mL→ 60 mL/hstart 13:30ttotal​ = ? h100 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 13:30 at 100 mL/h. After 3 hours the rate is changed to 60 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

1000 mL100 mL/h · 3 h60 mL/h
t = h

3Solutions

1.Pediatric nursing

Answer: C · From left to right, increasing blood flow to the lungs

Why this is the answer

Left ventricular pressure is higher, so blood flows from left to right, overloading the lungs and right heart. This causes increased pulmonary blood flow and can lead to heart failure in infancy.

Answer

C · From left to right, increasing blood flow to the lungs
2.Pediatric nursing

Answer: B · "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

B · "After one treatment, I won't need to check her hair again."
3.Pediatric & critical-care dosing

Answer: V = 0.9 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

80·56 = 4 480 units

Volume

V = 4480/5000 = 0.896 ≈ 0.9 mL

Answer

V = 0.9 mL
4.Pediatric & critical-care dosing

Answer: R = 7.4 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

400 mg = 400 000 mcg
400 000/250 = 1600 mcg/mL

Dose per minute and per hour

2·99 = 198 mcg/min
198·60 = 11880 mcg/h

Pump rate

R = 11880/1600 = 7.425 ≈ 7.4 mL/h

Answer

R = 7.4 mL/h
5.IV fluids & fluid balance

Answer: I = 1000 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: 100 + 200 = 300 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·50 = 100 mL
I = 1000 mL

Answer

I = 1000 mL
6.IV fluids & fluid balance

Answer: t = 14.7 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.

First part

100·3 = 300 mL
1000 − 300 = 700 mL left

Second part

700/60 = 11.67 h

Total time

t = 3 + 11.67 = 14.67 ≈ 14.7 h

Answer

t = 14.7 h

That is about 14 h 40 min, so the bag runs out at about 04:10.

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