ACCNS-P cheat sheet

Pediatric assessment sequence: observe first (respiratory effort, color, interaction), then auscultate and palpate; crying alters heart and respiratory rates.

Pediatric Early Warning Score (PEWS): rising score across repeated vital-sign sets signals deterioration; a single abnormal value is less predictive than trend.

Weight-based dosing: verify mg/kg against a verified weight in kilograms; doses calculated from pounds are a common 2.2-fold error.

Hypotension is a late sign in children; decompensation appears first as tachycardia, then weak pulses, delayed capillary refill >2 seconds, and altered mental status.

Maintenance fluid (4-2-1 rule): 4 mL/kg/hr for first 10 kg, 2 mL/kg/hr for next 10 kg, 1 mL/kg/hr for each kg above 20.

Normal pediatric respiratory rates fall with age: newborn 30-60, infant 30-53, toddler 22-37, preschool 20-28, school-age 18-25, adolescent 12-20 breaths/min.

Signs of increased intracranial pressure in infants include bulging fontanel, sunset eyes, and irritability; bradycardia with hypertension indicates a late herniation pattern.

Dehydration classification: <5% body weight loss mild, 5-10% moderate, >10% severe; capillary refill and mucous membranes are more reliable than thirst alone.

Assent is required from minors developmentally able to understand; consent from a parent or legal guardian remains the legal authorization.

Emancipated and mature minors may consent independently for defined services under state law; scope varies by jurisdiction.

Mandated reporting: suspicion of abuse or neglect requires reporting to child protective services; the reporter does not need proof.

Surrogate decision-making standard is best interest for never-competent children, substituted judgment for previously competent patients.

Confidentiality exceptions: imminent danger to self or others, reportable communicable disease, and court order.

Family-centered care treats the family as the constant and the care team as temporary; care plans incorporate family goals and cultural preferences.

Ethical principles in pediatrics: beneficence, nonmaleficence, autonomy (through assent), justice, and fidelity; conflicts are resolved by identifying which principles collide.

Nurse as patient advocate: escalate concerns through chain of command and, if unresolved, use ethics consultation or institutional review.

Quality improvement model: Plan-Do-Study-Act cycles test small changes before spread; measure with a balanced set of process and outcome indicators.

Structure-process-outcome (Donabedian) framework links staffing and policy (structure) to care delivery (process) to results (outcome).

Root cause analysis is retrospective and used after a sentinel event; failure mode and effects analysis is prospective and used before a process launch.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (sanction).

Staffing ratios and skill mix are linked to pediatric outcomes; CNS role includes evaluating acuity and matching competency to patient need.

Change management: identify stakeholders, build a guiding coalition, communicate the why, pilot, then sustain with audits and feedback.

Benchmarking compares unit metrics such as catheter-associated infection rates and readmission rates against internal and external norms.

CNS systems role includes policy development, evidence-based protocol adoption, and translating regulatory standards into unit practice.

Levels of evidence hierarchy: systematic reviews and meta-analyses of randomized trials at the top; expert opinion and case reports at the bottom.

PICO framework structures clinical questions: Population, Intervention, Comparison, Outcome.

Internal validity concerns whether the study design supports causal inference; external validity concerns generalizability to other populations.

Sensitivity is the proportion of true positives detected; specificity is the proportion of true negatives detected.

Number needed to treat equals 1 divided by the absolute risk reduction.

Randomized controlled trials reduce selection bias through randomization and reduce detection bias through blinding.

Qualitative methods (interviews, focus groups) generate meaning and experience data; quantitative methods test hypotheses with numerical measurement.

Teaching a pediatric patient or family: assess readiness and health literacy, use teach-back, and confirm return demonstration for psychomotor skills.