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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 13-year-old has a concussion during a football match. What is the correct advice?
AReturn to the match as soon as the headache improves
BNo sport that day; return step by step once symptoms have gone
CContinue training as usual unless there was a loss of consciousness
DAvoid all mental and physical activity, including school, for at least 2 months
2.Pediatric nursingHard
A formula-fed infant is diagnosed with cow's milk protein allergy. Which formula is usually advised?
AAn extensively hydrolysed formula
BA lactose-free cow's milk formula
CA rice milk drink fortified with calcium
DA goat's milk formula
3.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 250 mL. The order is 12 units/kg/h for a patient who weighs 107 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
25 000 units/250 mL12 units/kg/h107 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 10 mcg/kg/min for a patient who weighs 58 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
500 mg/250 mL10 mcg/kg/min58 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.
water: 240 mLmilk: 200 mLice chips: 100 mLIV infusion: 50 mL/h × 12 hIV antibiotic: 2 × 100 mL
I = mL
6.IV fluids & fluid balanceHard
Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 120 mL/h. At 17:00, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.
1000 mL100 mL infused120 mL/h
t = h
3Solutions
1.Pediatric nursing
Answer: B · No sport that day; return step by step once symptoms have gone
Why this is the answer
A child with suspected concussion should never return to play the same day. After a short period of relative rest, a stepwise return to school and then sport is followed, progressing only while symptom-free, with medical review for red flags.
Answer
B · No sport that day; return step by step once symptoms have gone
2.Pediatric nursing
Answer: A · An extensively hydrolysed formula
Why this is the answer
Extensively hydrolysed formulas contain milk proteins broken into small pieces that rarely trigger allergy; amino acid formulas are used for severe cases. Lactose-free formula still contains cow's milk protein, goat's milk proteins cross-react, and rice milk is unsuitable for infants.
Answer
A · An extensively hydrolysed formula
3.Pediatric & critical-care dosing
Answer: R = 12.8 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
12·107 = 1 284 units/h
Concentration
25 000/250 = 100 units/mL
Pump rate
R = 1284/100 = 12.84 ≈ 12.8 mL/h
Answer
R = 12.8 mL/h
4.Pediatric & critical-care dosing
Answer: R = 17.4 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
10·58 = 580 mcg/min
580·60 = 34800 mcg/h
Pump rate
R = 34800/2000 = 17.4 mL/h
Answer
R = 17.4 mL/h
5.IV fluids & fluid balance
Answer: I = 1290 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: 240 + 200 = 440 mL
ice chips: 100/2 = 50 mL
IV infusion: 50·12 = 600 mL
IV antibiotic: 2·100 = 200 mL
I = 1290 mL
Answer
I = 1290 mL
6.IV fluids & fluid balance
Answer: t = 7.5 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
1000 − 100 = 900 mL
Time
t = 900/120 = 7.5 h
Answer
t = 7.5 h
That is about 7 h 30 min, so the bag runs out at about 00:30.