Pediatric Nursing
Domain 4 tests integrated management of the sick child, growth and development, immunisation, weight-based dosing and family-centred care. Kenya uses the IMCI approach, so classification and treatment plans appear repeatedly.
Dehydration classification and plans
- Plan A (no dehydration): extra fluids, continue feeding, zinc, teach danger signs.
- Plan B (some dehydration - two or more of sunken eyes, slow skin pinch, restlessness/irritability): oral rehydration solution 75 mL/kg over 4 hours, then reassess.
- Plan C (severe dehydration - two or more of lethargy/unconsciousness, sunken eyes, very slow skin pinch, inability to drink): IV Ringer's lactate 100 mL/kg - infants 30 mL/kg in 1 hour then 70 mL/kg over 5 hours; children 30 mL/kg in 30 minutes then 70 mL/kg over 2.5 hours.
- Zinc: 20 mg daily for 10–14 days (10 mg if under 6 months).
Immunisation backbone (Kenya EPI)
Birth: BCG and OPV0. At 6, 10 and 14 weeks: pentavalent, OPV, PCV and rotavirus. At 9 months: measles–rubella; a second MR dose follows later. Freeze-sensitive vaccines (pentavalent, PCV, hepatitis B, tetanus) must never be frozen.
Development
Social smile around 6 weeks, head control by 3 months, sitting unsupported 6–8 months, independent walking 12–15 months.
Worked example
A 14-month-old weighing 10 kg has diarrhoea, sunken eyes, a skin pinch under 2 seconds and drinks eagerly. Reasoning: two signs place the child in "some dehydration", so Plan B applies: 75 × 10 = 750 mL of ORS over 4 hours by cup and spoon, plus zinc for 14 days, continued breastfeeding, and reassessment. No IV bolus and no antibiotic for simple acute diarrhoea.
Traps
Classifying "some dehydration" as severe and bolusing fluid; giving ORS by bottle with a fast-flow teat; forgetting that a child's maintenance fluids must account for weight, not adult volumes.