Calculate a bolus rate (mL/kg/hour) to be given to a severely dehydrated child with diarrhea weighing 23 kg over 60 minutes. The pulse will be checked after the bolus.

Calculation Steps

Step 1: Determine the child’s weight in kg.

• Weight = 23 kg

Step 2: Determine the time period in hours.

• Time = 60 minutes = 1 hour

Step 3: Calculate the bolus rate in mL/kg/hour.

• Bolus rate (mL/kg/hour) = Total volume (mL) ÷ (Weight × Time)

Step 4: Assume a standard bolus volume for severe dehydration, which is typically 20 mL/kg.

• Total volume = 20 mL/kg × 23 kg = 460 mL

Step 5: Calculate the bolus rate.

• Bolus rate (mL/kg/hour) = 460 mL ÷ (23 kg × 1 hour) = 20 mL/kg/hour

Result

The bolus rate to be given to the severely dehydrated child is 20 mL/kg/hour.

Choice A reason:

Keeping the affected extremity below the level of the heart is not recommended in the management of hemarthrosis in a child with hemophilia A. Elevating the affected limb can help reduce swelling and pain by promoting venous return and decreasing pressure in the joint.

Choice B Reason:

The use of topical analgesic cream on the painful area is not a primary treatment for hemarthrosis in hemophilia A. While it may provide some temporary relief, it does not address the underlying issue of bleeding within the joint. The primary treatment involves replacing the missing clotting factor.

Choice C Reason:

Instructing the parent to call their health care provider to obtain a plan of care is important, but it is not the immediate management step for hemarthrosis. Prompt treatment with clotting factor replacement is crucial to stop the bleeding and prevent joint damage.

Choice D Reason:

Prompt infusion of Factor VIII is the primary treatment for hemarthrosis in a child with hemophilia A. This treatment helps to replace the missing clotting factor, stop the bleeding, and prevent further joint damage. Early intervention is essential to minimize complications and promote healing.