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

Which instruction about using an adrenaline (epinephrine) auto-injector is correct?

  1. AInject it into the buttock muscle and then let the child walk it off at home
  2. BInject into the outer thigh, through clothing if needed, and call emergency services
  3. CUse it only after an antihistamine has failed to work
  4. DInject into the upper arm muscle, but only after removing all the clothing first
2.Pediatric nursingHard

A family insists on staying with their child during a painful procedure. What is the most appropriate response in family-centred care?

  1. AAllow them to stay only if they stand in a corner and do not touch, hold or speak to the child
  2. BSupport their presence, prepare them for what they will see and give them a comforting role
  3. CTell them that their presence makes the child behave worse
  4. DInsist that they wait outside in every case
3.Pediatric & critical-care dosingMedium
250 units250 mLregular insulin? mL/h1 units/h

Practice exercise (made-up values, not clinical guidance). An infusion contains 250 units of regular insulin in 250 mL. The order is 1 unit/h. Find the pump rate R in mL/h. Round to one decimal place.

250 units/250 mL1 units/h
R = mL/h
4.Pediatric & critical-care dosingHard
800 mg500 mLdopamine14 mL/h80 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dopamine infusion of 800 mg in 500 mL runs at 14 mL/h. The patient weighs 80 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

800 mg/500 mL14 mL/h80 kg
D = mcg/kg/min
5.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftsoup200 mLjelly100 mLtea200 mLice chips240 mLIV infusion80 mL/h × 8 hIV antibiotic1 × 100 mLurine450 mLurine400 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-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.

soup: 200 mLjelly: 100 mLtea: 200 mLice chips: 240 mLIV infusion: 80 mL/h × 8 hIV antibiotic: 1 × 100 mL
I = mL
6.IV fluids & fluid balanceHard
500 mL200 mL infused60 mL/h18:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 60 mL/h. At 18:00, 200 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL200 mL infused60 mL/h
t = h

3Solutions

1.Pediatric nursing

Answer: B · Inject into the outer thigh, through clothing if needed, and call emergency services

Why this is the answer

Auto-injectors are given into the outer mid-thigh and can go through clothing. Emergency services are called after every use, as symptoms can recur, and a second dose may be needed.

Answer

B · Inject into the outer thigh, through clothing if needed, and call emergency services
2.Pediatric nursing

Answer: B · Support their presence, prepare them for what they will see and give them a comforting role

Why this is the answer

Family presence during procedures is supported in family-centred care. Prepare parents, give them a role such as holding or distracting the child, and let them choose whether to stay.

Answer

B · Support their presence, prepare them for what they will see and give them a comforting role
3.Pediatric & critical-care dosing

Answer: R = 1 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.

Concentration

250/250 = 1 units/mL

Pump rate

R = 1/1 = 1 mL/h

Answer

R = 1 mL/h
4.Pediatric & critical-care dosing

Answer: D = 4.7 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

800 000/500 = 1600 mcg/mL

Micrograms per minute

14·1600 = 22400 mcg/h
22400/60 = 373.3 mcg/min

Per kilogram

D = 373.3/80 = 4.667 ≈ 4.7 mcg/kg/min

Answer

D = 4.7 mcg/kg/min
5.IV fluids & fluid balance

Answer: I = 1360 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 + 100 + 200 = 500 mL
ice chips: 240/2 = 120 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 1·100 = 100 mL
I = 1360 mL

Answer

I = 1360 mL
6.IV fluids & fluid balance

Answer: t = 5 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 − 200 = 300 mL

Time

t = 300/60 = 5 h

Answer

t = 5 h

That is about 5 h 00 min, so the bag runs out at about 23:00.

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