Editing Pediatric Nursing – RN Flashcards (section)

== Medications and calculations ==

;Outline the safe-dose verification process and the RN's action if the order is out of range.
:Convert weight to kilograms (pounds divided by 2.2), multiply by the reference range while noting whether it is per dose or per day in divided doses, compare with the order, and confirm the dose does not exceed the usual adult dose. If the order is outside the safe range, hold the medication and contact the prescriber. Never adjust a dose independently.

;State the Holliday-Segar maintenance fluid formula.
:100 mL/kg/day for the first 10 kg, plus 50 mL/kg/day for the second 10 kg, plus 20 mL/kg/day for each kilogram above 20. Divide the daily total by 24 for the hourly rate.

;What is the standard pediatric fluid resuscitation bolus?
:20 mL/kg of isotonic crystalloid (0.9 percent sodium chloride or lactated Ringer's) given rapidly, with reassessment of perfusion after each bolus to decide whether to repeat.

;When is digoxin held in a child, and what is the earliest sign of toxicity?
:Take the apical pulse for one full minute and hold, then notify the provider, if the rate is below roughly 90 to 110 in an infant, 70 in a child, or 60 in an adolescent. Bradycardia with vomiting and anorexia is the typical early toxicity picture. Do not repeat a vomited dose.

;Which medication-safety practices are specific to pediatrics?
:Weigh and document in kilograms only; use oral syringes in milliliters, never household spoons; use a leading zero and never a trailing zero; two-nurse independent double check for high-alert drugs including insulin, opioids, heparin, and chemotherapy; volume-control sets or syringe pumps to prevent fluid overload; vastus lateralis for infant intramuscular injections; never mix medication into a full bottle of formula or call it candy.