Pediatric and Adolescent Nursing
This domain tests assessment and management of infants, children and adolescents, with emphasis on dehydration, pneumonia, immunization and weight-based safety. In Mongolia, winter air pollution sharply increases childhood respiratory admissions, so pneumonia and asthma questions are frequent.
Core rules
- Every paediatric dose is weight-based; calculate mg/kg, then check the maximum adult dose, then check the volume drawn up.
- WHO dehydration plans: Plan A for no dehydration, extra fluids at home; Plan B for some dehydration, oral rehydration solution 75 mL/kg over four hours; Plan C for severe dehydration, Ringer's lactate 100 mL/kg IV - 30 mL/kg in the first hour then 70 mL/kg over five hours for infants under 12 months, or 30 mL in 30 minutes then 70 over 2.5 hours for older children.
- Zinc 20 mg daily (10 mg under six months) for 10-14 days in diarrhoea, with continued feeding.
- Fast breathing thresholds: 60 or more under 2 months, 50 or more at 2-12 months, 40 or more at 1-5 years. Give oxygen if SpO2 is below 90%.
- Immunization in Mongolia begins at birth with BCG and hepatitis B, continues with pentavalent in the first year, and includes a measles-containing vaccine in the second year - confirm the current national schedule before teaching it.
- Aspirin is contraindicated under 16 (Reye syndrome); codeine is contraindicated under 12.
Worked example
A 10 kg child with lethargy, sunken eyes and slow skin pinch has some dehydration. Reasoning: Plan B. Fluid needed = 75 mL/kg x 10 kg = 750 mL of oral rehydration solution over four hours, given by cup and spoon, with continued breastfeeding. Reassess at four hours: if hydrated, move to Plan A plus zinc; if worse, move to Plan C. Do not give a rapid IV bolus, because this child is not in shock.
Traps
Bolus fluids for dehydration without shock; forgetting the maximum dose ceiling; using adult tablets; stopping feeds during diarrhoea; assuming a quiet child is a well child.