What is an example of a math problem involving a bolus for dehydrated ped pts

hiddencatRN, BSN, RN · Apr 10, 2012

I'm not sure I follow your question. Is this homework?

AMN74 · Apr 11, 2012

It's been more than 20 years since I've done peds but if it's over 20-30 minutes I wouldn't push it. In the old days we had syringe pumps for that when it was not enough to put in at least a 50 ml bag and hang on a pump.

KelRN215, BSN, RN · Apr 11, 2012

criteria: 20 m|/kg over 20-30 minutes for a dehydrated pt. is a bolus an ivp?

no. a bolus is a bolus, you don't push it, it's run on a pump. we almost always run boluses over an hour in pediatrics. 10-20 ml/kg is standard for a bolus in pediatrics. 40 ml/kg is the max at my institution.

J-Swish · Apr 11, 2012

Just want to know what kind of math question is shown in regards to a fluid bolus for a pt with severe dehydration. I'm just given that much info to know yet I have not seen an example of such a question. I'm also given that criteria as seen from above.

hiddencatRN, BSN, RN · Apr 11, 2012

Like, your patient is 15 kg and needs a 20ml/kg bolus, how much is the total bolus and what do you set the pump for to have it run in 20 minutes? Is that what you mean by an example?

J-Swish · Apr 11, 2012

That totally makes sense. In that case, the total bolus is 300 mL? And the pump should be set to: 300mL/.33 hr?

KelRN215, BSN, RN · Apr 11, 2012

That totally makes sense. In that case, the total bolus is 300 mL? And the pump should be set to: 300mL/.33 hr?

No. If a 15 kg child was to get a 20 mL/kg bolus, they would need to receive 300 mL of Normal Saline. To run 300 mL over 20 minute, you set the pump to run 900 mL/hr with a VTBI (volume to be infused) of 300. Pump rates are set as mL/hr. You were on the right track, but what they'd be looking for is mL/hr.

Syringe pumps will allow you to program volume/time (300 mL/20 min) but you couldn't run 300 mL on a syringe pump and in the end, it would still give you the rate of 900 mL/hr and you would need to know that that is correct.

Double-Helix, BSN, RN · Apr 11, 2012

In regard to fluid boluses in general, how fast you give the bolus depends on the clinical situation.

If you have a patient that is showing signs of shock- hypovolemic, septic, obstructive- then you're going to give fluid boluses as quickly as you can. Sometimes you are pushing the bolus with a syringe by using a stock cock- drawing it off the bag and pushing it into the patient. You can give 3-5 boluses of 20cc/kg in the treatment of shock.

The exception is cardiogenic shock, or any time you have a patient with impaired cardiac function. You need to be very careful giving a bolus with these patients because you could cause pulmonary congestion.

If you're giving a bolus for rehydration of mild to moderate dehydration, you can give the bolus more slowly, over half an hour or an hour.