ACCNS-P flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Pediatric hypotension

A late sign of shock in children; decompensation presents first with tachycardia, poor perfusion, and altered mental status before blood pressure falls.

4-2-1 maintenance fluid rule

Hourly maintenance fluid equals 4 mL/kg for the first 10 kg, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each kilogram above 20.

PEWS trend

The Pediatric Early Warning Score is most predictive when tracked over time; a rising trend across serial vital signs signals clinical deterioration.

Weight-based dose verification

Doses are calculated from a verified weight in kilograms; converting pounds to kilograms incorrectly produces a 2.2-fold dosing error.

Infant increased ICP signs

Bulging fontanel, sunset eyes, irritability, and vomiting suggest increased intracranial pressure; bradycardia with hypertension indicates a late stage.

Dehydration severity

Weight loss below 5 percent is mild, 5 to 10 percent is moderate, and above 10 percent is severe; capillary refill and mucous membranes support classification.

Pediatric respiratory rate norms

Expected rates decline with age: newborn 30 to 60, infant 30 to 53, toddler 22 to 37, preschool 20 to 28, school-age 18 to 25 breaths per minute.

Capillary refill

A refill longer than 2 seconds indicates poor peripheral perfusion and is an early sign of pediatric shock, assessed before blood pressure changes.

Assent versus consent

Assent is the minor's developmentally appropriate agreement to participate; consent is the legal authorization given by a parent or guardian.

Mandated reporting threshold

Suspicion of child abuse or neglect requires reporting to child protective services; proof of abuse is not required to make the report.

Best interest standard

Used for children who were never competent, decisions weigh benefits and burdens according to what serves the child's overall welfare.

Substituted judgment standard

Applied to patients previously competent, decisions reflect what the patient would have chosen based on known values and prior statements.

Confidentiality exceptions

Confidentiality may be breached when there is imminent danger to self or others, a reportable communicable disease, or a valid court order.

Family-centered care

Care delivery that treats the family as the constant in a child's life and collaborates with family goals, culture, and preferences in planning.

Advocacy escalation

When a safety concern is unresolved, the nurse uses the chain of command, then ethics consultation or institutional review to protect the patient.

Emancipated minor

A minor granted adult legal status through marriage, military service, or court order; may consent independently to treatment under state law.

PDSA cycle

Plan-Do-Study-Act tests a small change, studies the result, and refines before spreading the improvement to a larger scale.

Donabedian framework

Quality is evaluated through structure (resources and staffing), process (care delivered), and outcome (results achieved) as linked categories.

Root cause analysis

A retrospective structured review after a sentinel event that identifies contributing system failures and designs prevention strategies.

Failure mode effects analysis

A prospective team method that maps a new process, ranks failure modes by severity and likelihood, and builds controls before launch.

Just culture

A response framework that consoles human error, coaches at-risk behavior, and sanctions reckless behavior to sustain safety reporting.

Benchmarking

Comparing unit performance metrics such as infection or readmission rates against internal historical data and external peer norms.

Skill mix evaluation

The CNS matches staff competency and licensure to patient acuity, ensuring the staffing plan meets pediatric care complexity needs.

Change management coalition

Building a guiding group of stakeholders, communicating rationale, piloting change, and sustaining it through audits and feedback.

Levels of evidence

Systematic reviews and meta-analyses of randomized trials rank highest; single case reports and expert opinion rank lowest in the hierarchy.

PICO question

A structured clinical question format specifying Population, Intervention, Comparison, and Outcome to guide a literature search.

Internal validity

The degree to which a study design supports causal conclusions by controlling bias and confounding in the study sample.

External validity

The degree to which study findings generalize to other populations, settings, and conditions beyond the study sample.

Sensitivity and specificity

Sensitivity is the proportion of true positives a test detects; specificity is the proportion of true negatives it correctly identifies.

Number needed to treat

The number of patients who must receive an intervention for one additional patient to benefit; equals 1 divided by absolute risk reduction.

Randomization purpose

Random assignment to groups reduces selection bias and balances known and unknown confounders between intervention and comparison groups.

Teach-back method

The learner explains or demonstrates the skill in their own words, confirming understanding and correcting gaps before discharge.