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HLT-LPN37-04 · Lesson 11 · 22 clock hours · theory

Common Pediatric Conditions, Medications, and Nursing Care

Objective. Students describe pathophysiology, assessment findings, and LPN nursing interventions for high-priority pediatric conditions including respiratory illnesses (croup, asthma, bronchiolitis), gastrointestinal conditions (dehydration, pyloric stenosis), and communicable diseases, and accurately calculate weight-based pediatric medication doses.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Common Pediatric Conditions, Medications, and Nursing Care

Pediatric patients are not simply small adults. Their anatomy, physiology, and response to illness differ significantly from those of adults, and the LPN must recognize these differences to provide safe, effective care.

Respiratory Conditions

Croup (Laryngotracheobronchitis) most often affects children between 6 months and 3 years of age. It is usually caused by a viral infection (most commonly parainfluenza virus) that causes swelling of the larynx, trachea, and bronchi. The hallmark sign is a harsh, barking cough that sounds like a seal, accompanied by inspiratory stridor and hoarseness. Symptoms typically worsen at night. The LPN assists with positioning the child upright, providing humidified cool air or mist, keeping the child calm to reduce airway spasm, and monitoring for increasing respiratory distress. A child with severe stridor at rest, drooling, or cyanosis requires immediate escalation to the registered nurse or provider.

Asthma can occur at any pediatric age but is common in school-age children. It is a chronic inflammatory condition causing reversible airway obstruction, bronchospasm, and increased mucus production. Assessment findings include expiratory wheezing, prolonged expiratory phase, use of accessory muscles, nasal flaring, and decreased oxygen saturation. The LPN monitors respiratory status, positions the child in high Fowler's or tripod position, administers prescribed bronchodilators (such as albuterol), and tracks peak flow readings when ordered. Pulse oximetry is a key monitoring tool. Silent chest—absence of breath sounds in a previously wheezing child—is an emergency sign indicating severe obstruction.

Bronchiolitis is most common in infants under 12 months and is most frequently caused by respiratory syncytial virus (RSV). It causes inflammation and mucus plugging in the small airways (bronchioles). Signs include tachypnea, nasal flaring, intercostal retractions, fine crackles, and wheezing. Care is primarily supportive: maintain airway, provide supplemental oxygen as ordered, ensure adequate hydration, and use bulb suctioning or nasopharyngeal suction for nasal congestion. Contact precautions are used to limit RSV spread.

Gastrointestinal Conditions

Dehydration is one of the most common and potentially dangerous pediatric conditions. It results from fluid losses that exceed intake—frequently due to vomiting, diarrhea, or poor feeding. Assess hydration status using: mucous membrane moisture (dry in dehydration), skin turgor (tenting indicates significant loss), fontanel in infants (sunken fontanel is a sign of dehydration), urine output (decreased or dark, concentrated urine), and vital signs (tachycardia and hypotension indicate worsening). Classify dehydration as mild, moderate, or severe based on clinical findings. LPN interventions include accurate intake and output measurement, administration of oral rehydration solutions (ORS) or IV fluids as ordered, and monitoring weight. A sign of deterioration requiring immediate escalation includes absent urine output, altered mental status, or hemodynamic instability.

Pyloric Stenosis occurs in infants, typically between 2 and 8 weeks of age. Progressive hypertrophy of the pyloric muscle causes gastric outlet obstruction. The classic sign is projectile, non-bilious vomiting after feedings. The infant appears hungry after vomiting. An olive-shaped mass may be palpated in the right upper quadrant. The diagnostic clue is ultrasound confirmation of pyloric thickening. Surgical correction (pyloromyotomy) is the treatment. The LPN monitors fluid and electrolyte status, tracks vomiting frequency, and provides pre- and post-operative care as directed.

Communicable Diseases

Otitis Media (middle ear infection) is most common in children under 2 years. Bacterial or viral pathogens cause fluid accumulation behind the tympanic membrane. Signs include ear pain (tugging or pulling at the ear in infants), fever, irritability, and sometimes decreased hearing. The LPN assesses pain level, administers analgesics and antibiotics as ordered, and teaches families about completing the full antibiotic course.

Varicella (Chickenpox) is caused by varicella-zoster virus. It is highly contagious and presents with a characteristic pruritic rash that progresses from macules to papules to vesicles and crusts, in successive crops over several days. Airborne and contact precautions are required in healthcare settings. The LPN promotes comfort (cool compresses, antihistamines as ordered, trimmed fingernails to reduce scratching), monitors for complications such as secondary bacterial skin infection, and reinforces vaccination education.

Weight-Based Pediatric Medication Dosing

All pediatric doses are calculated on a per-kilogram basis. The LPN must:

1. Convert the child's weight from pounds to kilograms if needed (divide pounds by 2.2).

2. Calculate the ordered dose using dimensional analysis.

3. Verify the calculated dose against the safe dose range in a current drug reference.

4. Flag and do not administer any dose outside the safe range without provider clarification.

Dimensional analysis (factor-label method) keeps units visible throughout the calculation, reducing errors. Always label each unit. Double-check your arithmetic and ask a second nurse to verify high-risk medications.

LPN Scope of Practice and Safety

The LPN works under the supervision of a registered nurse or provider. Key safety responsibilities include: accurate weight-based calculations, monitoring for adverse medication effects, recognizing signs of deterioration, and communicating assessment changes promptly. Never administer a calculated dose outside the safe range. In pediatrics, small errors in dosing can have serious consequences due to the child's limited physiologic reserve. Always use appropriately sized equipment (blood pressure cuffs, oxygen masks), and involve caregivers in assessment and teaching.

Key terms10

StridorA high-pitched, harsh sound heard on inspiration caused by partial obstruction of the upper airway; a hallmark of croup.
BronchospasmSudden constriction of the muscles in the walls of the bronchioles, narrowing the airway; a key feature of asthma.
RetractionsInward pulling of the skin between or below the ribs during breathing, indicating increased work of breathing in a child.
Skin turgorThe skin's elasticity and ability to return to normal position after being pinched; poor turgor (tenting) suggests dehydration.
Pyloric stenosisHypertrophy of the pyloric muscle causing gastric outlet obstruction in young infants, characterized by projectile non-bilious vomiting.
Oral rehydration solution (ORS)A balanced electrolyte and glucose solution used to replace fluid and electrolyte losses in mild to moderate dehydration.
Dimensional analysisA calculation method that tracks measurement units through each step of a math problem to ensure the correct unit of the final answer.
Safe dose rangeThe minimum and maximum dose per kilogram of body weight considered both effective and safe for a specific drug in pediatric patients, as published in a current drug reference.
Varicella-zoster virusThe virus responsible for chickenpox (varicella) and, after reactivation in later life, shingles (herpes zoster).
Silent chestAbsence of breath sounds in an asthmatic child who was previously wheezing; indicates critical airway obstruction and requires immediate emergency response.

Worked examples4

1. A child weighs 44 pounds. Ibuprofen is ordered at 10 mg/kg/dose. The available suspension is 100 mg/5 mL. How many mL should the LPN administer per dose?
  1. Step 1 – Convert weight to kilograms: 44 lb ÷ 2.2 = 20 kg
  2. Step 2 – Calculate ordered dose in mg: 10 mg/kg × 20 kg = 200 mg
  3. Step 3 – Set up dimensional analysis to convert mg to mL: 200 mg × (5 mL / 100 mg) = 1000 mL·mg / 100 mg = 10 mL
  4. Step 4 – Verify against safe dose range: standard ibuprofen pediatric dosing is 5–10 mg/kg/dose. The calculated dose of 10 mg/kg falls within the safe range. Administer 10 mL.
Answer: 10 mL per dose; dose is within the safe range.
2. Amoxicillin is ordered at 40 mg/kg/day divided every 8 hours for a child weighing 33 pounds. The suspension available is 250 mg/5 mL. How many mL will the child receive per dose?
  1. Step 1 – Convert weight: 33 lb ÷ 2.2 = 15 kg
  2. Step 2 – Calculate total daily dose: 40 mg/kg/day × 15 kg = 600 mg/day
  3. Step 3 – Divide into doses: every 8 hours = 3 doses per day; 600 mg ÷ 3 = 200 mg per dose
  4. Step 4 – Convert to mL using dimensional analysis: 200 mg × (5 mL / 250 mg) = 1000 mL·mg / 250 mg = 4 mL per dose
  5. Step 5 – Verify safe range using drug reference; confirm calculated dose per kg per day is within the published range before administering.
Answer: 4 mL per dose every 8 hours; verify against current drug reference before administration.
3. A provider orders acetaminophen 15 mg/kg/dose for a child weighing 22 pounds. Available: acetaminophen 160 mg/5 mL. How many mL per dose? Is the dose within a typical safe range?
  1. Step 1 – Convert weight: 22 lb ÷ 2.2 = 10 kg
  2. Step 2 – Calculate dose: 15 mg/kg × 10 kg = 150 mg
  3. Step 3 – Convert to mL using dimensional analysis: 150 mg × (5 mL / 160 mg) = 750 mL·mg / 160 mg ≈ 4.7 mL
  4. Step 4 – Verify safe range: acetaminophen is typically dosed at 10–15 mg/kg/dose in pediatric patients. A dose of 15 mg/kg is at the upper end of the standard range. Consult your current drug reference and confirm with the supervising nurse or provider before administration.
Answer: Approximately 4.7 mL per dose; dose is at the upper limit of the typical range—verify with drug reference and supervising nurse.
4. A 2-year-old weighing 13 kg is ordered azithromycin 10 mg/kg on day 1. The oral suspension contains 200 mg/5 mL. What volume will you administer?
  1. Step 1 – Weight is already in kg: 13 kg
  2. Step 2 – Calculate dose: 10 mg/kg × 13 kg = 130 mg
  3. Step 3 – Dimensional analysis: 130 mg × (5 mL / 200 mg) = 650 mL·mg / 200 mg = 3.25 mL
  4. Step 4 – Verify against current drug reference for azithromycin pediatric dosing and confirm the dose is within the published safe range before administration.
Answer: 3.25 mL for day 1 dose; confirm safe range in current drug reference.

The math in this lesson2

Learners convert 44 lb to 20 kg, find a 200 mg ibuprofen dose at 10 mg/kg, and give 10 mL of 100 mg/5 mL.
7.RP.2N-Q.1
Brush up in the math halls at newSchoolWorks.com:
In class: Build a pediatric condition comparison chart for six conditions (croup, asthma, bronchiolitis, dehydration, otitis media, varicella), including: age group most affected, hallmark signs and symptoms, one diagnostic clue, two LPN nursing interventions, and one priority safety concern. · Complete six weight-based pediatric medication dosing problems (e.g., ibuprofen mg/kg, amoxicillin mg/kg/day divided doses) in dimensional analysis format, verify that each calculated dose falls within the safe dose range using a current drug reference, and flag any dose outside range. · Case study: a 2-year-old with moderate dehydration and frequent vomiting—students assess hydration status using clinical indicators (mucous membranes, skin turgor, fontanel, urine output, vital signs), prioritize two nursing interventions, and state one sign that would indicate deterioration requiring immediate escalation.
Materials: Pediatric nursing textbook, current drug handbook with pediatric dosing, dimensional analysis worksheets, calculator, safe dose range reference card, comparison chart template, case study packet, NCLEX-PN test plan (Pharmacological and Parenteral Therapies; Physiological Adaptation)
Check: Condition chart ≥ 78% accurate; all six medication calculations correct with dimensional analysis shown and safe-dose verification documented (any error requires remediation before clinical rotation); dehydration case study: correct assessment indicators identified and priority interventions appropriate.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Physiological Adaptation
1. A nurse is caring for a toddler with croup. Which assessment finding requires the most immediate escalation to the registered nurse?
Physiological Adaptation
2. A 6-month-old infant diagnosed with bronchiolitis is admitted to the unit. Which intervention is the LPN's priority?
Physiological Adaptation
3. An LPN is assessing a 9-month-old infant for dehydration. Which finding is most consistent with moderate dehydration?
Physiological Adaptation
4. A 2-year-old with moderate dehydration and frequent vomiting is receiving IV fluids. Which finding would indicate deterioration requiring immediate escalation?
Physiological Adaptation
5. A child with asthma who was wheezing suddenly has no audible breath sounds bilaterally. The nurse should recognize this as:
Pharmacological and Parenteral Therapies
6. An LPN calculates a weight-based dose of amoxicillin for a 5-year-old. After completing the calculation, the dose exceeds the maximum safe dose listed in the drug reference. What is the correct action?
Safety and Infection Control
7. Which isolation precaution is required for a hospitalized child with active varicella?
Pharmacological and Parenteral Therapies
8. A nurse is performing dimensional analysis to calculate a pediatric ibuprofen dose. The child weighs 55 pounds and the order reads 10 mg/kg/dose. The available suspension is 100 mg/5 mL. What volume should be administered?
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