Nursing Care of Children
What this domain tests
Nursing Care of Children tests growth and development, family-centered care, pediatric assessment, dehydration, respiratory distress, and weight-based medication safety. Pediatric items often hinge on recognizing normal versus abnormal findings for the child's age.
Core rules
- Use weight in kilograms for all pediatric doses and fluid calculations; 1 kg = 2.2 lb.
- Dehydration signs: sunken fontanel, decreased wet diapers, dry mucous membranes, lethargy, capillary refill over 2 seconds; urine output below 1 mL/kg/hr is concerning.
- Respiratory distress in children: nasal flaring, grunting, retractions, head bobbing; sit the child upright and avoid forcing oral intake.
- Development: head control by about 4 months, sitting unsupported by 6-8 months, pincer grasp by 9-12 months, walking by 12-15 months.
- Family-centered care: parents are partners; prepare the child with developmentally appropriate language and allow comfort items.
Worked example
An 8-month-old with vomiting and diarrhea has a sunken fontanel, dry mucous membranes, and only two wet diapers in 24 hours. Weight is 8 kg. What is the priority? Restore circulation and hydration; assess perfusion and prepare for oral rehydration or IV fluids per order. Reasoning: the infant has moderate dehydration; urgent action is fluid replacement, not dietary teaching.
Traps
- Using adult vital-sign ranges or adult doses.
- Missing subtle dehydration in infants because the child is not crying with tears.
- Forcing oral fluids in a child with respiratory distress because of aspiration risk.
- Describing normal development as delayed, such as expecting a 6-month-old to walk.