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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
Which instruction about using an adrenaline (epinephrine) auto-injector is correct?
AInject it into the buttock muscle and then let the child walk it off at home
BInject into the outer thigh, through clothing if needed, and call emergency services
CUse it only after an antihistamine has failed to work
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?
AAllow them to stay only if they stand in a corner and do not touch, hold or speak to the child
BSupport their presence, prepare them for what they will see and give them a comforting role
CTell them that their presence makes the child behave worse
DInsist that they wait outside in every case
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 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
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
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.
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.