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

A 13-year-old has a concussion during a football match. What is the correct advice?

  1. AReturn to the match as soon as the headache improves
  2. BNo sport that day; return step by step once symptoms have gone
  3. CContinue training as usual unless there was a loss of consciousness
  4. 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?

  1. AAn extensively hydrolysed formula
  2. BA lactose-free cow's milk formula
  3. CA rice milk drink fortified with calcium
  4. DA goat's milk formula
3.Pediatric & critical-care dosingMedium
25 000 units250 mLheparin? mL/h107 kg12 units/kg/h

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
500 mg250 mLdobutamine? mL/h58 kg10 mcg/kg/min

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
IntakeOutput12-hour shiftwater240 mLmilk200 mLice chips100 mLIV infusion50 mL/h × 12 hIV antibiotic2 × 100 mLurine450 mLurine150 mLwound drain80 mLvomit250 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. 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
1000 mL100 mL infused120 mL/h17:00t = ? h

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.

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