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Pediatric Nursing Exam - Key Topics to Keep in Mind 🍼

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1. Growth & Development Milestones (VERY commonly tested)

• Erikson's stages: Infant = Trust vs Mistrust; Toddler = Autonomy vs Shame; Preschooler = Initiative vs Guilt; School age = Industry vs Inferiority
• Piaget: Sensorimotor (0-2 yrs), Pre-operational (2-7 yrs), Concrete operational (7-12 yrs)

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2. Vital Signs - Normal Ranges by Age (frequently tested)

• Hypotension in a child is a LATE sign of shock - always treat early tachycardia seriously
• Normal urine output: 1.5-2 mL/kg/hr in infants/young children; 1 mL/kg/hr in older children

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3. Pediatric CPR (Harriet Lane Handbook)

• Start CPR if pulse <60 bpm WITH poor perfusion, or pulseless
• Compression rate: 100-120/min
• Depth: at least 1/2 the AP diameter of the chest
• Ratio: 30:2 (single rescuer or adolescent); 15:2 (infant/child with 2 rescuers)
• If advanced airway placed: 1 breath every 2-3 seconds (20-30/min) with continuous compressions
• Pulse check site: Brachial in infants; Carotid or femoral in children
• Shockable rhythms: VF and pulseless VT

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4. Immunization Schedule (India - very common in nursing exams)

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5. Common Pediatric Conditions - Key Points

Respiratory

• Croup (Laryngotracheobronchitis): Seal bark cough, stridor, "steeple sign" on X-ray; give nebulized epinephrine, dexamethasone, cool mist
• Bronchiolitis (RSV): Wheezing in infant <2 years; mainly supportive; no antibiotics
• Epiglottitis: Tripod position, drooling, "thumbprint sign"; do NOT examine throat; airway emergency
• Asthma: Expiratory wheeze; use salbutamol (albuterol) first, then steroids

GI

• Intussusception: Colicky pain, "currant jelly" stool, sausage-shaped mass; treat with air enema
• Pyloric stenosis: Projectile non-bilious vomiting at 2-8 weeks; olive-shaped mass; "caterpillar" peristalsis; treat surgically (pyloromyotomy)
• Hirschsprung disease: Failure to pass meconium in 48 hrs; absent ganglion cells; explosive stool on rectal exam

Dehydration (high-yield)

• ORS: 75 mEq/L sodium (WHO low-osmolarity); give 75 mL/kg over 4 hours for moderate dehydration

Hematology

• Iron deficiency anemia: Most common pediatric anemia; microcytic hypochromic; treat with 3-6 mg/kg/day elemental iron
• Sickle cell crisis: Vaso-occlusive; precipitated by cold, infection, dehydration; give fluids, oxygen, analgesics
• ITP: Petechiae/purpura after viral illness; platelet <20,000; usually self-limiting

Infections

• Measles: Koplik spots (pathognomonic), rash starts face → trunk; Vitamin A supplementation
• Dengue: Hemorrhagic fever; tourniquet test positive; watch for warning signs (abdominal pain, bleeding, rapid breathing)
• Meningitis: Neck stiffness, Kernig sign, Brudzinski sign, bulging fontanelle in infants

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6. Neonatal Conditions

• APGAR score: Assessed at 1 and 5 minutes - Appearance, Pulse, Grimace, Activity, Respiration (0-2 each, max 10)
  • 7-10 = Normal; 4-6 = Moderate depression; 0-3 = Severe
• Neonatal jaundice: Physiological after 24 hrs; pathological if within 24 hrs; treat with phototherapy
• NEC (Necrotizing Enterocolitis): Premature infants; bloody stool, abdominal distension; "pneumatosis intestinalis" on X-ray
• RDS: Premature; grunting, nasal flaring, subcostal retractions; surfactant deficiency; give surfactant therapy
• Neonatal sepsis: Temperature instability, poor feeding, jitteriness; early (<72 hrs) vs late onset

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7. Pain Assessment in Children

• FLACC scale (Infants/non-verbal): Face, Legs, Activity, Cry, Consolability (0-10)
• Wong-Baker FACES scale: 3-7 years (visual faces from happy to crying)
• Numeric scale (0-10): Children 8 years and older
• Nonpharmacologic: Distraction, positioning, sucrose in neonates

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8. Therapeutic Communication with Children

• Infants: Calm voice, involve parents, non-nutritive sucking
• Toddlers: Short simple sentences, allow choices, rooming-in
• Preschoolers: Explain using play/dolls, avoid "won't hurt" promises
• School age: Explain procedures, allow questions
• Adolescents: Ensure privacy, involve in decisions

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9. Key Nursing Formulas

• Pediatric drug dose (Clark's rule): Child dose = (Weight in kg / 70) x Adult dose
• Maintenance fluids (Holliday-Segar):
  • First 10 kg: 100 mL/kg/day
  • Next 10 kg (10-20 kg): 50 mL/kg/day

  • 20 kg: 20 mL/kg/day

• ETT size: (Age/4) + 4 (uncuffed); reduce by 0.5 for cuffed
• Normal blood glucose: 70-100 mg/dL (neonatal: 40-60 mg/dL)

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10. Quick Mnemonics

• APGAR: Appearance, Pulse, Grimace, Activity, Respiration
• FACES of meningitis: Fever, Altered consciousness, Convulsions, Eye changes (photophobia), Stiff neck
• "Pyloric at 2-8 weeks, Intussusception at 3 months-6 years"
• For CPR compression: "Push Hard, Push Fast, Allow Recoil, Minimize Interruptions"

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Last-Night Tips

1. Sleep at least 6 hours - fatigue kills recall more than one extra hour of studying
2. Review vitals normal ranges and developmental milestones one more time in the morning
3. For clinical questions - always ask: Is the airway safe? Is the child in shock?
4. Nursing process order in answers: Assessment → Diagnosis → Planning → Implementation → Evaluation
5. When in doubt about priority - airway always comes first