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 advice best prevents dog bites in young children?

  1. ATeach the child to stare into the dog's eyes to show who is in charge
  2. BChoose a small breed, as small dogs never bite
  3. CLet the child hug the dog while it eats so it gets used to children
  4. DNever leave a young child alone with a dog, even the family pet
2.Pediatric nursingHard

A 3-year-old says the IV pump "is angry" when it beeps. Which feature of thinking does this show?

  1. AObject permanence, typical of the sensorimotor stage
  2. BConservation, typical of concrete operations
  3. CAbstract reasoning, typical of formal operations
  4. DAnimism, typical of preoperational thinking
3.Pediatric & critical-care dosingMedium
20 000 units500 mLheparin? mL/h53 kg14 units/kg/h

Practice exercise (made-up values, not clinical guidance). A bag contains 20 000 units of heparin in 500 mL. The order is 14 units/kg/h for a patient who weighs 53 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

20 000 units/500 mL14 units/kg/h53 kg
R = mL/h
4.Pediatric & critical-care dosingHard
500 mg250 mLdobutamine26 mL/h84 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 500 mg in 250 mL runs at 26 mL/h. The patient weighs 84 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

500 mg/250 mL26 mL/h84 kg
D = mcg/kg/min
5.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftjelly100 mLjuice200 mLice chips200 mLIV infusion80 mL/h × 8 hIV antibiotic1 × 100 mLurine475 mLurine425 mLurine500 mLurine275 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.

jelly: 100 mLjuice: 200 mLice chips: 200 mLIV infusion: 80 mL/h × 8 hIV antibiotic: 1 × 100 mL
I = mL
6.IV fluids & fluid balanceHard
1000 mL→ 80 mL/hstart 08:00ttotal​ = ? h120 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 08:00 at 120 mL/h. After 3 hours the rate is changed to 80 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 mL120 mL/h · 3 h80 mL/h
t = h

3Solutions

1.Pediatric nursing

Answer: D · Never leave a young child alone with a dog, even the family pet

Why this is the answer

Most dog bites to young children are from familiar dogs, often to the face. Constant supervision, teaching children not to disturb dogs that are eating or sleeping and not to hug or stare at dogs reduces the risk.

Answer

D · Never leave a young child alone with a dog, even the family pet
2.Pediatric nursing

Answer: D · Animism, typical of preoperational thinking

Why this is the answer

Animism, giving lifelike qualities to objects, is a feature of Piaget's preoperational stage. Nurses can use it by explaining equipment in simple, friendly terms and letting the child touch it.

Answer

D · Animism, typical of preoperational thinking
3.Pediatric & critical-care dosing

Answer: R = 18.6 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

14·53 = 742 units/h

Concentration

20 000/500 = 40 units/mL

Pump rate

R = 742/40 = 18.55 ≈ 18.6 mL/h

Answer

R = 18.6 mL/h
4.Pediatric & critical-care dosing

Answer: D = 10.3 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

500 000/250 = 2000 mcg/mL

Micrograms per minute

26·2000 = 52000 mcg/h
52000/60 = 866.7 mcg/min

Per kilogram

D = 866.7/84 = 10.32 ≈ 10.3 mcg/kg/min

Answer

D = 10.3 mcg/kg/min
5.IV fluids & fluid balance

Answer: I = 1140 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
ice chips: 200/2 = 100 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 1·100 = 100 mL
I = 1140 mL

Answer

I = 1140 mL
6.IV fluids & fluid balance

Answer: t = 11 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

120·3 = 360 mL
1000 − 360 = 640 mL left

Second part

640/80 = 8 h

Total time

t = 3 + 8 = 11 h

Answer

t = 11 h

That is about 11 h 00 min, so the bag runs out at about 19:00.

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