Pediatric Nursing
Pediatric Nursing tests developmental assessment, age-specific normal values, weight-based dosing and the rapid deterioration pattern of children. The child is not a small adult: respiratory failure and dehydration dominate the clinical picture long before hypotension appears.
Age-specific baselines
Newborn respiratory rate is 30–60/min with heart rate 100–160/min; rates fall gradually through school age. Blood pressure cuffs must cover two-thirds of the upper arm, because an undersized cuff falsely elevates the reading. Children compensate for shock by increasing heart rate and peripheral resistance, so hypotension is a late and ominous sign.
Fluid and medication maths
Maintenance fluids follow the 4-2-1 rule: 4 mL/kg/h for the first 10 kg, 2 mL/kg/h for the next 10 kg, 1 mL/kg/h thereafter. Oral rehydration solution is preferred for mild to moderate dehydration, given in small frequent amounts while breastfeeding continues.
Worked example
A 26 kg child needs maintenance IV fluid. Reasoning: 4 × 10 = 40 mL/h, plus 2 × 10 = 20 mL/h, plus 1 × 6 = 6 mL/h, giving 66 mL/h. Always cross-check any calculated pediatric dose against the maximum adult dose before administration.
Traps that cost marks
- Using adult vital-sign ranges or an adult cuff size.
- Giving aspirin to a febrile child, risking Reye syndrome.
- Treating croup and epiglottitis identically: a barking cough suggests croup, while drooling and tripod positioning suggest epiglottitis and demand no throat examination.
- In tetralogy spells, the knee-chest position plus oxygen is the immediate action.