Introduction to Pediatric Nursing Floor Layout and Safety

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Introduction to Pediatric Nursing
General Information
LAYOUT OF THE TECK ACUTE CARE CENTER (TACC)

Each floor has a specific associated colour meant for wayfinding purposes. When you exit the elevator
(or on the stairwell landing) note the colour for each floor.
Ground floor (navy blue) – the lobby, Medical Imaging and Emergency Department (ED). ED
can only be accessed by key card from the lobby, families must access via the exterior entrance
Second floor (purple) – Neonatal Intensive Care Unit (NICU)
Third floor (magenta) – NICU and General Procedures (aka Anesthetic Care Unit [ACU])
Fourth floor (orange) – Pediatric Intensive Care Unit (PICU) and Specialty Procedures (ACU)
Fifth floor (yellow) – Medical Reprocessing – no patient care areas on this floor
Sixth floor (green) – Neurosciences, Cardiology and Surgery
Seventh floor (teal) – General and Specialty Medicine
Eighth floor (royal blue) – Oncology and Hematology
LAYOUT OF THE INPATIENT UNITS

The inpatient floors have “front of house” and “back of house” areas.
Front of house areas are for patients and families, these areas include: playrooms, kitchens, family
spaces & meeting rooms, schoolroom, physiotherapy room.
Back of house is for staff only and requires key card access, these areas include: staff locker room, staff
lounge, some offices, staff and materials elevators. Patients and families are never to be in the back of
house, even for transport. The patient transfer elevators are located in the front of house, and patients
must be transported through the front of house halls even if it’s the “long way around”.
For T6 & T7 the inpatient areas are sectioned into “pods,” each with 12 rooms. Each pod is laid out /
organized similarly between T6 & T7. Each pod has a minimum of 3 RNs on shift, one being a “team
lead” that is responsible for organizing breaks, communicating with the charge nurse or helping to
support other staff.
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General Information Cont…

SAFETY – PATIENT, FAMILY & STAFF
It is everyone’s responsibility to ensure the safety of the patients, families and your colleagues. If you see a situation
where safety is at risk or a safety mishap has occurred, please initiate the appropriate action immediately and report it your
preceptor, Charge Nurse or CNC.
 All children and youth must wear a correct ID bracelet. It is your responsibility to check for this at the beginning
of each shift and whenever taking over the care of the child. You will need this for safe medication
administration.
 Know the patients for whom you are responsible. Delegate responsibility for your patients to another staff
member before you leave the ward for breaks or to transport a patient
 Please ask the parent or family to inform you if they are leaving the room so you can create a plan for the day
together.
 Encourage the family to care for their child as if they were at home according to their comfort level. Explain that
the health care team is in partnership with the family and will work with them in hospital. The parents know their
child best.
 Discuss the monitors and equipment and stress that the family and visitors do not touch them and if they beep the
call the nurse.
 Remind the family that the crib sides bedrails must be completely up at all times when not attending the child, use
appropriate padding and ensure the IV lines, tubing are positioned and secured to avoid entanglement.
 Children in high-chairs are to wear restraints. Do not leave the child unattended. When placing a child in a car
seat or bouncy chair, make sure he is not too big for it. Ensure that the car seat or bouncy chair is stabilized in the
crib. Do not leave equipment in the crib when not in use as the child may become tangled in it.
 Supervise all children during their bath.
 Talk to the family about not leaving any items that may be a choking hazard in the crib. Ensure you remove any
small pieces of equipment used for patient care from bed (caps and packages).
 Hold babies during feeds unless condition of patient contraindicates it and never prop babies and/or bottles.
 Avoid transporting child in arms. Use cribs, beds, buggies, stretchers or wheelchairs. Parent may wish to carry
child if the child reacts too negatively to the above modes of transportation. If so, the parent may ride in the
wheelchair, carrying the child.
 For safety, encourage families to keep room uncluttered and organized so care can be provided efficiently and in
case of an emergency situation. Keep fire exits free of obstruction. Keep hallways as clear as possible by ensuring
that articles are only on one side of the hallway.
 Ensure that there are no sharps, chemicals or small objects left in the rooms. Immediately wipe up any spills on
the floor.
 Always ensure that the call bell is within easy reach or access to caregivers in the patient’s room and teach them
how to use it.
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FAMILY-CENTERED CARE IS...
 Recognizing that the family is the constant in a child's life, while the service systems and personnel within those
systems fluctuate.
 Facilitating child/family/professional collaboration at all levels of service.
 Sharing with the family, on a continuing basis and in a supportive manner, the best information regarding their
child's health care.
 Understanding and incorporating the developmental needs of infants, children, adolescents, and their families in
health care delivery.
 Recognizing family strengths and individuality and respecting different methods of coping.
 Recognizing and honouring diversity, strengths and individuality within and across all families, including racial,
spiritual, social, economic, educational and geographical diversity.
 Encouraging and facilitating family-to-family support and networking.
 Implementing comprehensive policies and programs that provide support to meet the diverse health care needs of
families.
 Designing accessible service systems that are flexible, sensitive, and responsive to family-identified health care
needs.
Reference: Johnson, B.H., Seale Jeppson, E. & Redburn, L. (1992). Caring for children and families: Guidelines for hospitals ( 1st ed.).
Association for the Care of Children's Health, Bethesda, MD.
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INFECTION CONTROL
The following are some tips for caring for a child in isolation. Please refer to the infection control policies on line for
more details.
 Isolation in the hospital is the best way to keep viruses and bacteria contained. It means that the patients need to
stay in their room, and the others who enter the room must take precautions.
 Always remember to wash your hands with antibacterial soap before entering the room and leaving the room, if
you see another staff or visitor not following protocols gently remind them.
 There are ante-rooms that can be set for positive or negative pressure.
 Each patient's room must have the correct isolation sign posted on the door. Refer to the infection control policies
and Dr’s orders. It is your responsibility to ensure that all visitors including family members visiting your patient
adhere to isolation precautions.
 When patients are transported off the unit, ensure that isolation precautions are maintained and isolation
requirements are communicated to the receiving department.
 Isolation gowns, masks and gloves are stored outside of each room.
 Patient’s charts and other non-washable items must not go into the rooms. All nurses notes including flow sheets,
care plans, and other relevant clinical sheets are posted on clipboards hanging on the outside of each room.
 Items, such as examination equipment, that have been taken into the room must be cleaned off with
alcohol/germicidal detergent before bringing them out of the room. In cases where strict isolation Level II
precautions are indicated, cavi-wipes must be used to clean equipment coming out of room. Ear speculum and
paper measuring tapes are disposable.
 Each room is to have an isolation linen hamper in the pass-through which holds the plastic linen bags.
 All specimens from isolation must be bagged in biohazard clear plastic bags before sending to the lab. Label
containers prior to bagging and place completed requisitions in outside pocket of the bag.
 Sharps are to be disposed of in appropriate sharps containers in each room. Make sure the container is out of reach
of the children. When disposing of containers, ensure they are closed properly. They are to be double bagged in
clear plastic bags and put in designated area in soiled utility room.
 Do not take excess supplies into rooms unless you are certain it is needed because these excess items will be
disposed of when the patient is discharged. Note: an over-stocked room costs the unit money.
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STARTING YOUR SHIFT

Storing your belongings: Have your preceptor show you the locker room and the staff lounge in the
back of house area. There are some lockers available for students, you need to supply your own lock.
There is a refrigerator in the staff lounge to store your food.
Patient Assignments: are written on the eWhiteboard at the East Communication (Comm) Centre
(purple side) or on T8 on the main nursing station. Buddies are also posted here.
MARs and Kardexes can be picked up from the slots at the front desk on the specific pod you are
assigned to. A dedicated binder is available for you to house your patient’s MAR. We have special
white tape and a special marker that you can use to write your name on the binder. On day shift, please
return your patients’ kardex to the unit clerk / kardex binder (except for T8) following report. On night
shift, you can keep the kardex with the binder.
HANDOVER/COMMUNICATION
Nursing Report starts shortly after 0700 and 1900 at the team care station in the specific unit your
patients are in. The team lead will read the report out loud or each RN will take turns reading out loud
about their patients; this is a good opportunity to listen about your buddy’s patients too. NOTE: We do
not routinely do 1:1 handover report unless the patient is 1:1, or has complex lines/care needs.
Integrated Inpatient Careplans (Kardex): Only use a pen to update the kardexs, and yellow highlighters
are used for discontinued orders. After report on day shift, please give these to the unit clerk filing in
Careplan binders as this is where they are stored throughout the shift. Kardexes are kept with your MARs
during the day. On night shift the inpatient careplan is kept in your MAR binder for the duration of your
shift. It is the bedside nurse’s responsibility to update the info on the inpatient careplan every shift and as
needed.
MARS/MEDICATIONS
All medication and infusion orders are listed on the patient’s MAR that is electronically generated by
pharmacy. All medications administered must be signed off on the MAR
ALL new orders are to be scanned to Pharmacy promptly.
MEDS – meds may be stored in bins (IV meds), cassettes, Omnicell, fridge (2 fridges; one locked and one
unlocked). Most scheduled medications are already reconstituted
High Risk Infusions (eg. morphine, heparin) are documented on the MAR and nursing flowsheet
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SAFETY CHECK
All your patient rooms must be checked at the start of your shift for emergency equipment. Each room
should have:
 Sealed emergency equipment bag
 Wall suction connected to an appropriately size yanker (check suction is functioning)
 Wall oxygen (15L flowmeter) connected to an appropriately sized mask (check O2 working)
 Check Philips monitor settings/parameters match patient’s age range & information
 Check that the patient is wearing (ideally, but may also have nearby) an ID band
 Site to source IV check – including Alaris pump settings, IV fluid & rate
PEDIATRIC EARLY WARNING SIGNS (PEWS) AND SITUATIONAL AWARENESS FACTORS

(SAFS)
PEWS are a tool designed to help us identify any early changes in patient status. Our nursing
flowsheets are designed to help us calculate PEWS. Please ensure you have your preceptor review to
how score, total and escalated care as needed. Along with PEWS, are SAFs that are additional, non-
vital sign related potential signs that your patient could deteriorate, or needs additional support from the
interdisciplinary team. Patients who have one or more identified SAFs are identified on the
eWhiteboard. Most likely you will hear these patient’s being referred to a PAIR’d (old terminology).
On the eWhiteboard, a PAIR’d patient’s room number will be highlighted RED. Nurses need to touch
base with the team lead or charge nurse prior to 1100 & 1500 or 2300 & 0300 to discuss the patient’s
status. Please advise whether you’re concerned about the patient or need additional support to care for
the patient.
For more information please see Child Health BC’s webpage
https://www.childhealthbc.ca/initiatives/pediatric-early-warning-system-pews
BREAKS
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CHARTING/FLOWSHEET
Routines:
Vital signs q4h (unless ordered differently). VS include BP, Apex HR, Resp Rate (count), SpO2
(change probe site q4hrs), Temperature (temporal), pain (via appropriate scale)
PEWS score done Q4H and with patient changes
Intake & Output is calculated at 1600/0400, and/or more frequently as ordered
Neurovitals are done qshift at a minimum, and/or more frequently as ordered and including pupil
checks
Hourly patient checks include:
Visualizing patient and touch, look and compare (TLC) for Vascular access lines, and other lines or
tubing (site to source, infiltration/phlebitis score)
Document hourly vital signs off monitor on flow sheet
Document as necessary on flowsheets/nurses notes
Also helps to check in about any needs or questions from the patient or family
Weights: On babies these are done on night shift, generally between 0400- 0600hrs. Renal patients are
usually weighed at 0800 and 2000, after morning void but before breakfast. Please document a daily
weight on the new flowsheet and indicate which scale you are using. Keep the scale that is used
consistent.
Check charts for orders throughout the day and sign off by 1500 and ensure charts are thoroughly checked
on night shift prior to 0400 (MARS change at 0400).
PATIENT FLOW
Admissions – If you get a discharge, chances are … you will likely get an admission. It is important to connect with
the team lead or charge nurse once the discharged patient has left the unit. Make sure you have your RN familiarize
you with the SHARED Transfer of Care Policy for all admissions.
Discharges – We aim to get our patients out by 1100 to accommodate admissions. Please connect with the CRN or
discharge planning nurse for help with discharge teaching and instructions. Let the team lead and CNC know
discharge statuses. Connect with your RN about what to do after a patient is discharged.
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LEADERSHIP & SUPPORT

What are all these acronyms!?
CNC is the Clinical Nurse Coordinator, the units charge nurse responsible for managing patient flow on the unit,
attends rounds with the physician team, staff scheduling, and performance management, to name a few.
CRN is the Clinical Resource Nurse, responsible for supporting clinical learning on the floor, helping with complex
or deteriorating patients, new skills, finding resources and information.
CNE is the Clinical Nurse Educator, responsible for all things learning: career pathways, learning needs/goals,
workshops, education days.
INTERDISCIPLINARY TEAMS
We work closely with the physicians, physiotherapists, occupational therapists, dieticians, child life and much more.
Connect with your preceptor regarding who you contact for various questions and patient needs.
Nursing Unit Clerks (NUCs) rove around the various sections/pods to process orders then flag the chart for the
nurses to check. NUCs can process admission paperwork, complete requisitions for blood and other specimens and
notifies lab for blood draws. NUCs also update MARs and Kardexs, however both must also be checked by an RN to
ensure accuracy.
If there is not an NUC available to come to the Team Care Station, an RN may be required to process orders that are
time sensitive.
UNIT TOUR
Locate the following on a pod:
 Fire alarms and disaster information
 Patient and family elevators, staff elevators, patient transfer elevators
 Crash cart
 ABC boxes
 Medication rooms
 Storage rooms
 Clean Supply rooms
 Clean Prep rooms
 Linen cart
 Blanket warmer
 Macerator
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Our day on T7 will look something like this:
Time Day Shift Routine
0630 -0730 Meet at Yellow Nursing Station (Bear)
Receive Patient Assignment
Gather information
Introduce self to the Day R.N.
Report plan to Mary- Prioritize
Nursing report starts by 710 (approx.)**you must be present
***please note there are times when student assignments have to be switched
at the last minute.
0730-0830 Morning routine
Patient check **Hourly
Site to Source **Hourly
Safety Check
Weight /VS
Morning Meds ****only with Educator or R.N.
Documentation ****must be checked
0830-0930 Family Centred Care Rounds
1000 Coffee Breaks take your break – report off to me and your nurse ****Take
your Coffee earlier if needed
You get a ½ hour coffee
1000-1100 Check charts for new orders
1200-1300 VS
This is a good time to re-evaluate your care and make modifications to your
plan
1300-1400 Lunch break-45 mins
1600 -1700 Intake and Output// documentation / computer report/
1700-1730 Dinner/break
1730-1830 Post Conference
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Pediatric Nursing
PEDIATRIC ASSESSMENT TRIANGLE
One tool you can use to organize your initial, across the room, pediatric assessment is the pediatric assessment triangle.
The three main components of this assessment are:
 Appearance: tone, intractability, consolability, look or gaze, speech or cry
 Work of Breathing: nasal flaring, retractions, abnormal airway sounds, position of comfort, altered respiration rate
 Circulation to the skin: pallor, mottling, cyanosis
PEDIATRIC ASSESSMENT: DIFFERENCES

To reduce the anxiety of caring for children, it is important to understand the differences between adults and children.
First and foremost, children are NOT just small adults.
Differences include size, thought processes, physical and emotional maturity, social development and anatomic and
physiological differences. Some of the key differences as they relate to your basic pediatric assessment are presented
below.
Differences: Airway  autonomic nervous system not fully developed in

 smaller upper and lower airways infants
 large tongues in proportion to mouth  infant posture is primarily one of flexion
 soft larynx cartilage  cranial structures not fused until 16-18 months
 tracheal diameter is the size of little finger
 are obligate nose breathers for the first several Differences: Exposure
months
 higher body surface area to weight ratios
 larger and heavier heads
Differences: Breathing  immature immune systems (until 2-3 months of
 less compensatory reserve than adults age)
 cartilaginous sternum and ribs; the chest wall is  metabolize drugs at different rates
softer and more compliant  limited glycogen stores
 high metabolic rate (2x the adults’)  bones are still growing
 thin chest walls
Differences: Circulation
 less circulating blood volume
 capable of maintaining adequate cardiac output for
long periods
 greater % of total body weight as water
 decreased ability to concentrate urine (in the first
few months of life)
Differences: Neurological
 primary structures are present at birth. Additional
growth occurs over the first few years
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PEDIATRIC ASSESSMENT: ABCDE

One way to organize your assessment is to follow the ABCDE approach. In this acronym, the letters stand for:
A = airway
B = breathing
C = circulation
D = disability
E = exposure
Your key assessment points include:

Airway Assessment Breathing Assessment
 Vocalization  LOC
 Tongue obstruction  Respirations: spontaneous, rate, depth
 Foreign objects, loose teeth  Chest symmetry
 Vomit, bleeding, secretions in mouth  Quality of breath sounds
 Edema of lips, mouth tissue  Work of breathing indicators
 Preferred posture  Chest wall integrity
 Drooling
 Dysphagia
 Stridor, snoring, gurgling
Circulation Assessment Disability/Neurological Assessment

 Central and peripheral pulses  LOC:
 Skin colour  A = awake and alert
 Cap refill  V = only responsive to verbal stimuli
 Bleeding  P = only responsive to painful stimuli
 U = completely unresponsive
Expose Assessment
After ABCD:
 do a full head to toe
 do a full set of vital signs
 undress the child to examine and identify any
underlying injuries or signs of illness
PEDIATRIC ASSESSMENT: HEAD TO TOE

Head to Toe Special Needs
 general physical appearance Any condition with the potential to interfere
 nutritional status with normal growth and development
 appropriate clothing  physical
 reaction to caregiver  developmental
 body position & alignment  learning
 muscle tone  technological dependencies
 unusual odors  chronic illness
 head, face, neck: lacerations, deformity, symmetry, edema Special Needs Assessment
 fontanel: flat, depressed, full bulging  listen to caregiver
 chest: work of breathing, breath sounds  use developmental NOT age
 abdomen: injury, distension, tubes, scars, bowel sounds, palpate specific approaches
 extremities: bruising, swelling, discoloration, pain  emphasize ability not disability
 skin: rashes, bruising
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PEDIATRIC DEVELOPMENT
In addition to the physical components of your assessment, you will also need to consider the developmental needs of
your patients. Using the case studies below, identify how you would approach your assessment and the specific ways you
will alter your approach to account for their unique developmental needs.
Infants (One Month to One Year of Age)

Psychosocial Development
 Infancy is a period of rapid physical and psychosocial growth and development. Infants are dependent on caregiver to
meet their needs.
 Infants understand and experience the world through their bodies. Being held, cuddled, rocked, or comforted with
familiar touch and smells soothes infants.
 Common fears, especially for older infants, include separation and stranger anxiety. The infant’s relationship with the
primary caregiver is crucial to promote a sense of wellbeing.
 Infants explore objects by sucking, chewing, and biting. The more mobile, older infant has an increased risk for
injury by poisoning, foreign-body aspiration, falls, and drowning.
Approach to Assessment
Joshua is a one-week-old infant brought in to the hospital by his single mother. He had a septic workup in emergency and
is now being admitted to the floor for IV antibiotics. You are asked to admit him to the unit and to prepare the family for
the start of the IV (the IV nurse will be here in 20 minutes to start the IV).
 Please describe your approach to assessment of this newborn
 Describe how you will prepare the family for the IV insertion.
 Describe how you would assess Joshua for pain, and the pain assessment tool that would be appropriate.
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Toddlers (One to Two Years of Age)
 Toddlers are in a stage of rapid physical and psychosocial growth and development. By about 18 months of age, the
toddler is able to run, grasp, and manipulate objects, feed himself or herself, play with toys, and communicate with
others.
 Toddlers may have erratic eating patterns compared to infants and older children.
 Toddlers are curious and have improved mobility but have no sense of danger.
 Cognitively, toddlers’ thinking is concrete. They have increased ability to solve problems by trial and error.
 Toddlers are able to communicate verbally. Their negativism and insistence express an increasing need for autonomy,
or doing things for themselves.
 Common fears include separation from the caregiver and loss of control. They delight in the ability to control
themselves and others. The toddler tends to cling to a caregiver when apprehensive.
 Toddlers’ experiences are still strongly sensory-based: seeing is believing.
Jennifer is a two-year-old toddler who presents with difficulty breathing and wheezing. Her mother reports on
previous wheezing episode about six months previously. Jennifer is alert and interactive. She is tachypneic, with
laboured respirations, nasal flaring, and subcostal and intercostal retractions. You prepare to assess Jennifer.
 Please describe your approach to your nursing assessment of this toddler.
 What strategies may assist in gaining the child’s cooperation for administration of oxygen or inhaled
medications?
 How would you assess for pain in Jennifer?
 What pain assessment tool would you use?
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Preschoolers (Three to Five Years of Age)
 Preschoolers are magical and illogical thinkers. They often confuse coincidence with causation, have difficulty
distinguishing fantasy from reality, and have many misconceptions about illness, injury, and body functions (e.g., if
they have a cut, their “insides” will leak out).
 Preschoolers do not have a well-developed concept of time.
 Preschoolers often have an imaginary playmate.
 Preschoolers often take words and phrases literally
 Common fears include body mutilation, especially of genitalia, loss of control, death, darkness, and being left alone.
Daniel is a five-year-old child who presents to the emergency by family car after falling off his bicycle onto driveway.
His father thinks he fell onto his head and stated he did not respond for several minutes. He has vomited 10 times but
is alert and has a large hematoma on his occiput. He has been admitted to the unit for observation overnight and will
go for a CT scan of his head in one hour.
 Please describe your approach to assessment of this preschooler.
 How will you prepare him for the CAT SCAN of his head.
 How would you assess Daniel for pain?
 What pain assessment tool would be appropriate?
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School-aged Children (Six to 10 Years of Age)
 School-aged children are developing a sense of accomplishment and master of new skills. Successes contribute to
positive self-esteem and a sense of control
 Although the ability for logical thought processes is beginning, misinterpretation of words and phrases is common.
 Their concept of time is improved; awareness of possible long-term consequences of illness is present.
 By nine years of age, children can understand simple explanations about their anatomy and body functions.
 Older school-aged children tend to hide their thoughts and feelings.
 Common fears include separation from friends, loss of control, and physical disability. Risk-taking behaviour is
emerging.
 School-aged children develop a general knowledge of medical intervention, often based on media reports, television
shows, and nightmarish fantasies.
 They are more likely to want to be involved in their care.
Meredith is a seven-year-old girl in grade 2. She presented to the emergency room with a 10-hour history of RLQ pain, a
low-grade fever, and one episode of vomiting. Her WBC was found to be elevated when her blood work was drawn. Dr.
Blair is highly suspicious that she has appendicitis and has kept her NPO until the morning when has booked an OR time.
She has been admitted to the surgical unit overnight and you will be admitting her.
 Please describe your approach to assessment of this school-aged child
 How you might prepare her to go to the OR in the morning.
 How would you assess Meredith for pain?
 What pain assessment tool would you use?
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Early to Middle Adolescents (11 to 18 Years of Age)
 Adolescence is a period of experimentation and risk-taking activity.
 Adolescents are acutely aware of their body appearance. Anything that differentiates them from their peers is
perceived as major tragedy.
 Psychosomatic complaints are common.
 Adolescents’ quest for independence from their families often leads to family dissension.
 Peers are important for psychological support and social developments. Sexual interests are common.
 Adolescents may experience mood swings, depression, eating disorders, suicidal ideation, and violent behaviour. The
differential diagnosis of an emerging mental health disorder versus normal adolescent responses should be considered.
 Common fears include changes in appearance, dependency, and loss of control.
 Beliefs may be influenced by peer group, based on concerns with acceptance and rejection.
 Adolescents may regress to earlier stages of development for comfort.
 Adolescents move from concrete to formal operational cognitive development. However, they still lack the
conceptual thinking skills of the adult. They need concrete explanations
Steven is a 14-year-old youth who is referred by his primary care provider for a headache, fever, vomiting, and
photophobia. He appears ill but is alert and oriented. A lumbar puncture is going to be performed. He is very anxious.
You are asked to go in and do a quick nursing assessment and prepare the youth for the procedure.
Please describe your approach to performing a nursing assessment of Steven and strategies you might use to
prepare him for this procedure.
How would you assess Steven for pain?
What pain assessment tool would you use?
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IMPORTANT COMPETENCIES IN PEDIATRICS
Vital signs
AGE TEMP- RR HR resting HR resting B/P
(awake) (asleep)
RATURE
NEWBORN 37.5 C 30-60 100-180 80-160 70/45  10
1-6 WEEKS 37.5 C 30-60 100-180 80-180 80/52  10
6 MONTHS 37.5 C 25-40 80-160 70-120 85/53  10
1 YEAR 37.7 C 20-30 80-150 70-120 90/55  10
3 YEARS 37.2 C 20-30 80-120 60-100 91/55  10
6 YEARS 36.9 C 18-25 70-110 60-100 96/57  10
10 YEARS 36.7 C 15-20 55-90 50-90 102/62 10
14 YEARS 36.6 C 15-20 55-90 50-90 112/65 10
Ins & Outs

AGE TOTAL WATER REQ. PER WATER REQ. PER kg PER URINE OUTPUT
24 HR (ml) 24 HR (ml) ml/24 HR
3 DAYS 250-300 80-100 50-300
10 DAYS 400-500 125-150 50-300
3 MONTHS 750-850 140-160 350-550
6 MONTHS 950-1100 130-155 350-550
9 MONTHS 1100-1250 125-145 350-550
1 YEAR 1150-1300 120-135 350-550
2 YEARS 1350-1500 115-125 480-960
4 YEARS 1600-1800 100-110 480-960
6 YEARS 1800-2000 90-100 480-960
10 YEARS 2000-2500 70-85 480-960
14 YEARS 2200-2700 50-60 480-1488
18 YEARS 2200-2700 40-50 480-1488
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Peripheral Intravenous catheters (PIVs)
IVs can be lost very quickly in children. Their veins are smaller and more fragile. Interstitial IVs can cause a lot of
damage to the surrounding skin and tissues, which is why it is important to check the sight hourly. You can teach parents
what to look for as well as teens. We use the acronym TLC to remember what to assess each hour:
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Medication Calculations
In pediatric practice medication dosages are calculated based on the child’s weight making the dosages much more
precise. It is important that the child’s most recent weight in kilograms is documented to ensure accurate drug dosages.
During the “right dose” check one must:
(a) Validating ordered dose to make sure it is within the therapeutic range:
The recommended dose of Ampicillin is 100-200mg/kg/day divided q6h, and the nurse must ensure that the dose prescribed
is within therapeutic range by calculating the minimum and maximum dosages.
Minimum Dose Maximum Dose
100mg x 20kg = 2000mg/kg/day divided q6h 200mg x 20kg = 4000mg/kg/day divided q6h
500mg per dose 1000mg per dose
The child would receive 20kg x 100 mg/kg/day = 2000 mg/day divided into four doses (24 hours divided by 6 hours) or 500
mg/dose. Therefore, the prescribed dose is within the therapeutic range.
(b) Correct medication reconstitution:
(Prescribed dose/ mg available) x mL diluted in = Volume of medication to be administered
Calculation Example 1
Example of Medication Label: Physician Order: Give 500 mg of Ampicillin IV q6h

AMPICILLIN SODIUM 500mg The instructions on a 500mg vial of Ampicillin indicate to
For IM use: Add 1.8mL Sterile reconstitute with 1.8ml of sterile water to provide 250mg of
Water for Injection to yield Ampicillin per 1 ml.
approximately 2mL (250mg/mL).
For IV use: Further dilute to 10mL To administer the desired dose of 500 mg will require to
(50mg/mL). Shake Well. Use within
1 hour of reconstitution. draw 2 ml of already reconstituted Ampicillin (500mg /
250mg) x 1ml = 2ml
Calculation Example 2
Example of Medication Label: This child now has a temperature of 39.0C, and the
physician has ordered Ibuprofen as an
Ibuprofen 100mg/5mL suspension antipyretic. Physician Order: Give 200mg (10mg/kg) of
for oral use: Ibuprofen PO Q6h prn for fever
The instructions on the bottle of Ibuprofen indicate that
there is 100 mg of Ibuprofen in 5 ml of liquid, or as you can
calculate 20mg per 1 ml.
To administer 200 mg, you will need to draw 10mL of
20 |
Ibuprofen (200 mg x 1ml) / 20 mg = 10 ml
Medication Practice Questions

1. The physician orders 25 mg of Diphenhydramine (Benadryl) for Jasmin. An ampoule of Diphenhydramine contains 50
mg in a quantity of 1 ml. What dosage should the nurse administer?
a. 0.5 ml
b. 2 ml
c. 0.4 ml
d. 1.5 ml
2. Faruk weighs 14 kg and is dehydrated. The Physician orders an intravenous bolus of normal saline 20 mL/kg over 60
minutes.
A) What is the volume of fluids delivered by the end of the bolus? 280 ml
B) What will the flow rate be? 280 ml/hr; 4.7ml/min
3. A patient is to receive 1 unit of PRBCs over 4 hours. The label on the bag states: 300 ml. What will the flow rate be?
a. 60 ml/hr
b. 75 ml/hr
c. 100 ml/hr
d. 300 ml/hr
4. Simon is ordered Ibuprofen 450 mg q 6 hrs. Available: 300 mg tablets. How many tablets should the nurse administer?
a. 2 tablets
b. 1.5 tablets
c. 1 tablet
d. 0.5 tablet
5. Metronidazole 0.5 g PO is prescribed TID. It is available in 250 mg tablets. How many tablets will you administer with
each dose? 2
6. Asha is ordered Acetaminophen for fever. The prescribed dose is 60 mg PO q4h. She weighs 7 kg.
a. How much will she receive in one day? 240mg
b. If the safe range for Acetaminophen is 10 -15 mg/kg/dose PO q4h – q6h, is this patient receiving an appropriate
dose? No because it is under
c. The medication comes in a liquid form of 80 mg per 1ml and your order is based on 10mg/kg/dose. How many
ml do you need to administer. 0.875ml for a 70mg dose
21 |
7. Jennifer is ordered IV Cefazolin. She weighs 10 kg. The safe dose of Cefazolin is 50-100 mg/kg/day IV in equal doses
q 8 hrs.
a. What is the lowest daily amount she can safely receive? 500 mg
b. What is the highest daily amount she can safely receive? 1000 mg
c. If a safe dosage of Cefazolin is 75 mg/kg/day in equal doses q8h, how many mg does the patient require for
each dose? 250mg each dose x 3
d. The instructions on the vial tell you to mix the 500 mg vial with 2 ml sterile water to obtain concentration of
225 mg/ml. How many millilitres you need to draw from the vial to administer the dose ordered in question c)?
1.1ml
e. You need to administer the Cefazolin as an IV additive and the recommendation is to dilute it in normal saline
to 5-20 mg/ml and run over 30 minutes. What is the minimum volume you can dilute it to? 50ml
f. What is the rate you need to set your pump if you want the medication and the 4 cc normal saline flush to be
infused over 30 minutes? 108ml/hr
8. The physician's order is as follows: Morphine Infusion 5 mg in 50 ml Normal Saline, to deliver 20 mcg/kg/hr, run
infusion at 6 ml/hr. The patient weigh is 30kg. You obtain Morphine 10 mg/ml injection ampoules from the narcotic
cupboard.
a. In your pediatric textbook the recommended dose for Morphine infusion is 0.01 – 0.04 mg/kg/hr. Is the dose
you are giving appropriate? Yes it is 0.02mg/kg/hr
b. What is the volume of Morphine you must draw up to make up the above infusion?
a. 2.5 ml
b. 0.5 ml
c. 2 ml
d. 0.2 ml
9. The physician orders to maintain urine output ≥ 1 cc/kg/hr. Javier weighs 20 kg and over the past 6 hours, his total
urine output was 100 ml. Did Javier maintain the required amount as per the physician’s order? No should be 180
10. The physician orders replacement fluid intravenously. What would 100% fluid maintenance be for Javier? He weighs
9 kg. 100ml/kg (to 150ml/kg if renal & cardiac function adequate)
22 |
11. The average dose range for Clindamycin is 20-30 mg/kg/day IV q 8 hrs. For a 45 kg child calculate:
a. The recommended lower daily dosage 900mg
b. The recommended upper daily dosage 1350mg
c. If the order is to give 220 mg q 8 hr, is this within the recommended dosage range? No its below 300ml
d. If the order is to give 400 mg q 8 hr, is this within the safe dosage range? Show your calculations. Yes. it is
below the max. 30x45=1350  1350/3 = 450ml
e. If the order is for 550 mg q 8 hr, is this safe to administer? Show your calculations No. it is above the max.
30x45=1350  1350/3 = 450ml
12. For a child weighing 37 kg, calculate his or her:

a. 100% fluid maintenance: 1500 + 340 or 425 ml
b. 80% fluid maintenance: 1427 ~ 1540ml
c. Provide the formula you used for calculating 100% maintenance fluids. 1500ml for 1st 20kg + 20-25ml/kg for
each kg over 20kg
Pain
We assess pain q4h at minimum, ideally with vital signs, or more often if needed. We have a few difference tools in the
attempt to be objective and consistent in the pain rating and management. Some options are:
FLACC
FLACC relies on behavioural indicators to assess pain. This tool is particularly helpful to assess children unable to
communicate. To use the scale, observe the awake child for 1-5 minutes, or the asleep child for 5 minutes, score the child
in each of the 5 categories.
Face
0 - No particular expression 1 - Occasional grimace or frown, 2 - Frequent to constant frown,

or smile withdrawn, disinterested clenched jaw, quivering chin
Legs
0 - Normal position or 1 - Uneasy, restless, tense 2 - Kicking or legs drawn up

relaxed
Activity
23 |
0 - Lying quietly, normal 1 - Squirming, shifting back/forth, tense 2 - Arched, rigid, or jerking
position, moves easily
Cry
0 - No cry, awake or asleep 1 - Moans or whimpers, occasional 2 - Crying steadily, screams or

complaint sobs, frequent complaints
Consolability
0 - Content, relaxed 1 - Reassured by occasional touching, 2 - Difficult to console or comfort

hugging, or "talking to," distractible
Interpreting FLACC score
0= Relaxed and comfortable
1–3 = Mild discomfort
4–6 = Moderate pain
7–10 = Severe pain or discomfort or both
Numeric Scale (ages 3+)
Children are asked to indicate their pain intensity by putting a mark on the scale that corresponds to their pain intensity (or
how much they hurt). There are several variations you may see used during a pain assessment. For example, some scales a
re vertical and represent the concept of a pain thermometer. Other scales use colour increasing in intensity and have a slid
er for the child to move along the colour line. Visual analogue scales are designed to assess the intensity of pain only. Onc
e the scale is explained to the child, they are asked to point to the place on the line that best represents how
much pain they are feeling.
Faces Scale (ages 3+)
This type of scale shows five or six simple cartoon faces beginning with an emotionally neutral expression on the left,
progressing to a very distressed and grimacing face on the right. As with visual analogue scales, the child is asked which
24 |
face best represents how much pain they feel or, if used as a measure of fear and anxiety, which face that best represents
how their pain feels.
25 |

Introduction to Pediatric Nursing Floor Layout and Safety

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Introduction to Pediatric Nursing Floor Layout and Safety

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Welcome to

Student Group Information Package

LAYOUT OF THE TECK ACUTE CARE CENTER (TACC)

LAYOUT OF THE INPATIENT UNITS

General Information Cont…

 Supervise all children during their bath.

General Information Cont…

General Information Cont…

STARTING YOUR SHIFT

General Information Cont…

PEDIATRIC EARLY WARNING SIGNS (PEWS) AND SITUATIONAL AWARENESS FACTORS

General Information Cont…

General Information Cont…

LEADERSHIP & SUPPORT

General Information Cont…

0630 -0730 Meet at Yellow Nursing Station (Bear)

Receive Patient Assignment

Introduce self to the Day R.N.

Report plan to Mary- Prioritize

Nursing report starts by 710 (approx.)**you must be present

0730-0830 Morning routine

Patient check **Hourly

Site to Source **Hourly

Morning Meds ****only with Educator or R.N.

Documentation ****must be checked

0830-0930 Family Centred Care Rounds

You get a ½ hour coffee

1000-1100 Check charts for new orders

1300-1400 Lunch break-45 mins

1600 -1700 Intake and Output// documentation / computer report/

1730-1830 Post Conference

PEDIATRIC ASSESSMENT: DIFFERENCES

Differences: Airway  autonomic nervous system not fully developed in

PEDIATRIC ASSESSMENT: ABCDE

Your key assessment points include:

Circulation Assessment Disability/Neurological Assessment

PEDIATRIC ASSESSMENT: HEAD TO TOE

Infants (One Month to One Year of Age)

 Please describe your approach to assessment of this newborn

 Please describe your approach to your nursing assessment of this toddler.

 How would you assess for pain in Jennifer?

 What pain assessment tool would you use?

 Please describe your approach to assessment of this preschooler.

 How would you assess Daniel for pain?

 What pain assessment tool would be appropriate?

 Please describe your approach to assessment of this school-aged child

 How you might prepare her to go to the OR in the morning.

 How would you assess Meredith for pain?

 What pain assessment tool would you use?

How would you assess Steven for pain?

What pain assessment tool would you use?

NEWBORN 37.5 C 30-60 100-180 80-160 70/45  10

1-6 WEEKS 37.5 C 30-60 100-180 80-180 80/52  10

6 MONTHS 37.5 C 25-40 80-160 70-120 85/53  10

1 YEAR 37.7 C 20-30 80-150 70-120 90/55  10

3 YEARS 37.2 C 20-30 80-120 60-100 91/55  10

6 YEARS 36.9 C 18-25 70-110 60-100 96/57  10

10 YEARS 36.7 C 15-20 55-90 50-90 102/62 10

14 YEARS 36.6 C 15-20 55-90 50-90 112/65 10

Ins & Outs

3 DAYS 250-300 80-100 50-300

10 DAYS 400-500 125-150 50-300