Paediatric Nursing
What this domain tests
Growth and development, neonatal assessment, immunisation, nutrition, common childhood illnesses, fluid balance and weight-based drug calculations.
Core rules
- APGAR at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; each 0–2. It guides resuscitation, not long-term prognosis.
- Newborn: initial weight loss up to 10% in the first week; physiologic jaundice appears after 24 hours; jaundice within 24 hours is pathological.
- Milestones: social smile 6 weeks; head control 3 months; sits with support 6 months; stands with support 9 months; walks 12–15 months.
- Diarrhoea: ORS and zinc; continue feeding; assess dehydration with sunken eyes, skin pinch and lethargy.
- Maintenance fluid: Holliday–Segar 100 mL/kg/day for the first 10 kg, 50 for the next 10 kg, 20 for each kg thereafter; hourly 4-2-1 rule.
- Croup: barking cough, stridor, dexamethasone. Epiglottitis: drooling, tripod position; do not examine the throat.
Worked example
Child weighs 14 kg. Hourly fluid = (10 × 4) + (4 × 2) = 40 + 8 = 48 mL/hour. Daily = (10 × 100) + (4 × 50) = 1,000 + 200 = 1,200 mL/day. Check clinical status; boluses are separate and are usually isotonic crystalloid.
Traps
Using adult fluid rates; forgetting that 4-2-1 is hourly maintenance; calling jaundice at 12 hours physiological; missing zinc in diarrhoea; and examining the throat in suspected epiglottitis.