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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 statement reflects current guidance about introducing allergenic foods, such as egg and peanut, to infants?
AThey can be introduced from around 6 months as part of solids, and delaying them does not prevent allergy
BThey should be avoided until at least 3 years of age, because early contact is what causes most food allergies
CThey should only be given after a skin prick test in every infant
DThey should be given from 6 weeks, mixed into the baby's milk
2.Pediatric nursingHard
The nurse has taught the parents of a child with epilepsy. Which statement shows a need for further teaching?
A"When the jerking stops, I'll turn him onto his side."
B"I'll time the seizure and give the rescue medicine if it lasts too long."
C"I'll put a spoon in his mouth so he doesn't bite or swallow his tongue."
D"I'll move hard objects away and put something soft under his head."
3.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). An infusion contains 100 units of regular insulin in 250 mL. The order is 0.05 units/kg/h for a patient who weighs 82 kg. Find the pump rate R in mL/h. Round to one decimal place.
100 units/250 mL0.05 units/kg/h82 kg
R = mL/h
4.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 800 mg in 500 mL. The order is 6 mcg/kg/min for a patient who weighs 81 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
800 mg/500 mL6 mcg/kg/min81 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 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 12:30 at 80 mL/h. After 3 hours the rate is changed to 75 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL80 mL/h · 3 h75 mL/h
t = h
3Solutions
1.Pediatric nursing
Answer: A · They can be introduced from around 6 months as part of solids, and delaying them does not prevent allergy
Why this is the answer
Delaying common allergens does not prevent allergy, and early introduction may reduce the risk of peanut allergy. Peanut is given as smooth butter or powder, never whole nuts; infants with severe eczema or known food allergy may need specialist advice first.
Answer
A · They can be introduced from around 6 months as part of solids, and delaying them does not prevent allergy
2.Pediatric nursing
Answer: C · "I'll put a spoon in his mouth so he doesn't bite or swallow his tongue."
Why this is the answer
Putting objects in the mouth can break teeth, injure the mouth or block the airway; the tongue cannot be swallowed. Timing the seizure, protecting from injury and placing the child on the side afterwards are correct.
Answer
C · "I'll put a spoon in his mouth so he doesn't bite or swallow his tongue."
3.Pediatric & critical-care dosing
Answer: R = 10.3 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
0.05·82 = 4.1 units/h
Concentration
100/250 = 0.4 units/mL
Pump rate
R = 4.1/0.4 = 10.25 ≈ 10.3 mL/h
Answer
R = 10.3 mL/h
4.Pediatric & critical-care dosing
Answer: R = 18.2 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
800 mg = 800 000 mcg
800 000/500 = 1600 mcg/mL
Dose per minute and per hour
6·81 = 486 mcg/min
486·60 = 29160 mcg/h
Pump rate
R = 29160/1600 = 18.23 ≈ 18.2 mL/h
Answer
R = 18.2 mL/h
5.IV fluids & fluid balance
Answer: B = 540 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.
Total intake
oral: 200 + 200 + 240 = 640 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 2·50 = 100 mL
total intake = 1740 mL
Total output
150 + 400 + 400 + 150 + 100 = 1200 mL
Balance
B = 1740 − 1200 = 540 mL
Answer
B = 540 mL
Positive: more fluid went in than came out.
6.IV fluids & fluid balance
Answer: t = 6.5 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.
First part
80·3 = 240 mL
500 − 240 = 260 mL left
Second part
260/75 = 3.467 h
Total time
t = 3 + 3.467 = 6.467 ≈ 6.5 h
Answer
t = 6.5 h
That is about 6 h 28 min, so the bag runs out at about 18:58.