Pediatric Nursing
What this domain tests
Pediatric Nursing tests growth and development, family-centered care, recognition of pediatric deterioration, and weight-based treatment.
Core rules
- Use pediatric norms: respiratory rates fall and blood pressure rises with age. Infants normally breathe 30-60 times per minute; adolescents approach adult values.
- Respiratory distress is graded by work of breathing: nasal flaring, grunting, retractions, and head bobbing are late and ominous. A silent chest is an emergency.
- Maintenance fluids use the 4-2-1 rule: 4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the next 10 kg, 1 mL/kg/hr thereafter.
- Dehydration: assess mental status, mucous membranes, tears, fontanel, capillary refill, and urine output. Weight loss is the most objective measure.
- Give medications by weight and verify the safe dose range; most pediatric arrests are respiratory in origin.
Worked example
A 14 kg child needs maintenance IV fluid. Calculate the hourly rate. Reasoning: first 10 kg x 4 = 40 mL/hr; remaining 4 kg x 2 = 8 mL/hr; total 48 mL/hr. Check that the ordered rate matches and that the child is not in shock, because resuscitation boluses are separate from maintenance.
Traps
- Applying adult vital sign ranges to infants and calling tachypnea normal.
- Confusing a febrile seizure with epilepsy; most are self-limiting and do not need long-term anticonvulsants.
- Using adult doses or half the adult dose instead of weight-based calculation.
- Reassuring yourself with a normal oxygen saturation while the child grunts or retracts.