CPedN(C) - Pediatric Nursing cheat sheet

Infant weight: expected gain ~20-30 g/day in the first 3-4 months; birth weight doubles by ~5 months and triples by ~12 months.

Length increases ~25 cm in year 1 (50% over birth length); head circumference grows ~12 cm in year 1, ~2 cm in year 2, then ~1 cm/year until age 5.

Primitive reflexes and their expected disappearance: Moro 3-4 months, palmar grasp 3-4 months, rooting/sucking 3-4 months, tonic neck 4-6 months, stepping 6-8 weeks.

Developmental milestones: social smile 6-8 weeks; sits unsupported 6-8 months; pincer grasp 9-10 months; walks alone 12-15 months; 2-word phrases 18-24 months; 50 words by 24 months.

Denver-style screening is surveillance, not diagnosis: an isolated delay warrants rescreening and referral, not an immediate label.

Immunization timing anchors: 2, 4, 6, 12-15, and 18 months; 4-6 years; 11-12 years (Tdap, HPV series, meningococcal); annual influenza from 6 months.

Growth chart interpretation: crossing two major percentile lines downward suggests failure to thrive and requires dietary and organic-cause evaluation.

Adolescent puberty (Tanner): girls breast budding ~8-13 years with menarche ~2-2.5 years later; boys testicular enlargement ~9-14 years as the first sign.

Family-centered care core elements: dignity and respect, information sharing, participation, and collaboration; the family is the constant, the care team is the variable.

Communication with children is developmental: use simple concrete words and play for toddlers/preschoolers; offer choices between two acceptable options for autonomy.

Use 'ask-tell-ask' and teach-back to confirm understanding; avoid yes/no questions when assessing concerns.

Interpreters are required when a family has limited English proficiency; family members (especially children) should not serve as medical interpreters.

Atraumatic care: minimize separation, promote a sense of control, prevent bodily injury and pain; parents should be offered the option to stay during procedures.

Anticipatory guidance is matched to the next developmental stage (e.g., childproofing before crawling, drowning prevention before walking).

Informed consent for a minor: parents/guardians consent; assent is sought from children developmentally able (typically school-age and older).

Cultural assessment should include health beliefs, decision-making roles, dietary practices, and language preference before teaching.

Normal pediatric vital sign ranges (awake): newborn HR 100-160, RR 30-60; infant HR 90-160, RR 30-53; toddler HR 80-140, RR 22-37; school-age HR 70-120, RR 18-25; adolescent HR 60-100, RR 12-20.

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

Weight is the most sensitive pediatric growth and fluid measure; weigh on the same scale at the same time and record in kilograms.

Pain scales by age: NIPS/FLACC for neonates and preverbal children; FACES or numeric scale for age 4-8 and older; self-report is preferred when able.

Head circumference is measured until age 2-3 years (or up to 36 months) and plotted on the growth chart with length and weight.

Pediatric GCS uses age-appropriate verbal and motor responses; use the pediatric-modified scale for children under 5 years.

Capillary refill, skin temperature, and mucous membranes are core perfusion and hydration indicators; central capillary refill is more reliable than peripheral in shock.

Normal pediatric urine output is 1-2 mL/kg/hour for infants and 0.5-1 mL/kg/hour for children; lower output suggests hypovolemia or renal impairment.

Weight-based dosing: verify ordered mg/kg against a calculated dose and a published pediatric reference before administration; the safe dose range must be confirmed.

Pediatric doses are limited by the maximum adult dose; do not exceed it when weight-based calculation yields a higher value.

Oral syringes (not teaspoons) are used for liquid doses; measure at eye level and use the marked device supplied with the product.

Intramuscular injection sites: vastus lateralis in infants and toddlers; deltoid in older children; ventrogluteal is acceptable in older children when landmarks are clear.

IV fluid maintenance uses the 4-2-1 rule (4 mL/kg/hr for the first 10 kg, 2 for the next 10, 1 for each kg thereafter); the Holliday-Segar daily method is 100/50/20 mL/kg/day.

Most pediatric medications are calculated per kilogram, so a decimal error is dangerous: leading zeros are used (0.5 mg, not .5 mg) and trailing zeros avoided (5 mg, not 5.0 mg).

Common high-alert pediatric drugs include insulin, opioids, heparin, and concentrated electrolytes; require independent double-check.

Therapeutic drug monitoring (e.g., aminoglycosides, vancomycin, phenytoin) requires peak/trough timing per protocol; draw levels at the specified interval.

Dehydration classification: mild <5% weight loss, moderate 5-10%, severe >10%; severe dehydration with shock requires isotonic IV bolus 20 mL/kg and reassessment.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy; treat with IVIG and aspirin to prevent coronary aneurysms.

Diabetic ketoacidosis in children: isotonic fluid resuscitation, insulin infusion only after fluids, and frequent monitoring for cerebral edema (headache, bradycardia, hypertension).

Nephrotic syndrome triad: proteinuria, hypoalbuminemia, and edema; monitor weight, urine protein, and infection risk (loss of immunoglobulins).

Sickle cell vaso-occlusive crisis: hydrate, give analgesia (opioids), oxygen for hypoxia, and monitor for acute chest syndrome (fever, chest pain, falling saturation).

Appendicitis: periumbilical pain migrating to the right lower quadrant, guarding, rebound tenderness; do not give enemas or apply heat before evaluation.

Cystic fibrosis care: airway clearance, pancreatic enzyme replacement with meals, fat-soluble vitamin supplementation, and monitoring for respiratory exacerbations.

Chronic illness transition planning begins in early adolescence and addresses self-management, medication independence, and transfer of care.

Pediatric airway differences: larger head, smaller and more anterior airway, larger tongue, narrowest point at the cricoid in young children; use uncuffed-tube sizing (age/4 + 4) as a starting guide.

Respiratory distress signs: nasal flaring, grunting, intercostal/suprasternal retractions, head bobbing, and tripod positioning; bradycardia with hypoxia is an ominous sign.

Asthma severity is assessed by ability to speak, work of breathing, and peak flow; give short-acting beta-agonist and oxygen, and consider systemic corticosteroids for exacerbations.

Croup (laryngotracheobronchitis) presents with a barking cough and inspiratory stridor; epiglottitis presents with drooling, tripod posture, and muffled voice-do not inspect the throat.

Oxygen saturation targets are generally 92-95% or higher; delivery devices range from nasal cannula to high-flow and nonrebreather based on FiO2 need.

Congenital heart disease: cyanotic lesions (tetralogy of Fallot, transposition, tricuspid atresia) versus acyanotic (VSD, ASD, PDA, coarctation).

Tet spell management: calm the child, knee-chest position, supplemental oxygen, and notify the provider; avoid vigorous crying and dehydration.

Heart failure in infants presents with feeding difficulty, poor weight gain, tachypnea, and diaphoresis with feeds; monitor intake, weight, and digoxin levels.

Exclusive breastfeeding is recommended for the first 6 months; iron-fortified cereal or iron-rich foods are introduced around 6 months, and whole cow's milk is avoided before 12 months.

Estimated daily fluid requirement: 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for each remaining kg (Holliday-Segar).

Normal serum potassium 3.5-5.0 mEq/L; hypokalemia causes weakness and arrhythmias, and potassium is never given IV push-always diluted and infused with a pump.

Normal serum sodium 135-145 mEq/L; rapid correction of hyponatremia risks cerebral edema and osmotic demyelination, so correction is gradual.

Hypocalcemia signs in children include tetany, carpopedal spasm, and seizures; check ionized calcium and give calcium slowly with cardiac monitoring.

Signs of dehydration: sunken fontanel, decreased skin turgor, dry mucous membranes, decreased urine output, and tachycardia; weight loss quantifies severity.

Oral rehydration solution is preferred for mild-moderate dehydration; avoid high-sugar drinks and continue breastfeeding during rehydration.

Failure to thrive evaluation: plot weight-for-length, assess intake and feeding skills, screen for organic causes (GI, cardiac, renal), and involve a dietitian.

Pediatric basic life support: start CPR with 30 compressions to 2 breaths for single rescuers (15:2 for two rescuers in infants/children); compression depth is at least one-third of chest diameter.

Infant compressions use two fingers or two-thumb encircling technique at the lower half of the sternum; rate is 100-120 per minute.

Choking: for an infant, use back blows and chest thrusts; for a child, use abdominal thrusts (Heimlich) if the child is conscious and unable to cough effectively.

Poisoning: contact poison control immediately; do not induce vomiting; activated charcoal is given only per poison control/provider direction and within the appropriate time window.

Burns: cool with running water for 20 minutes, remove clothing and jewelry, and cover with a clean dry dressing; avoid ice and topical home remedies.

Drowning prevention: constant adult supervision, four-sided pool fencing, and swim instruction; drowning is a leading cause of injury death in young children.

Car seat safety: rear-facing until at least age 2 or per seat limits; forward-facing with harness; booster seat until the seat belt fits properly.

Fever in an infant under 3 months is a medical emergency requiring prompt evaluation (sepsis workup) regardless of how well the infant appears.

Erikson stages: trust vs mistrust (infancy), autonomy vs shame (1-3 years), initiative vs guilt (3-6), industry vs inferiority (6-12), identity vs role confusion (adolescence).

Separation anxiety peaks around 8-18 months; hospitalization interventions include rooming-in, consistent caregivers, and familiar objects.

Adolescent depression screening uses validated tools (e.g., PHQ-A); warning signs include withdrawal, declining school performance, and changes in sleep/appetite.

Suicide risk assessment requires direct, nonjudgmental questioning; asking about suicide does not increase risk.

ADHD core features are inattention, hyperactivity, and impulsivity present before age 12 and across more than one setting.

Autism spectrum disorder: impaired social communication and restricted/repetitive behaviors; early intervention improves outcomes, and screening occurs at 18 and 24 months.

Eating disorders: anorexia nervosa has low BMI and body image distortion; bulimia has binge-purge cycles; medical stabilization precedes psychotherapy.

Post-traumatic stress in children may present as regression, sleep disturbance, and reenactment through play; provide safety and routine.

Ethical principles: autonomy (assent and adolescent consent), beneficence, nonmaleficence, justice, and veracity; apply them to pediatric decision-making.

Emancipated minors (married, military, or legally emancipated) may consent to their own care; mature minor laws vary by jurisdiction.

Mandatory reporting: suspected child abuse or neglect must be reported to the designated authority; the nurse does not need proof, only reasonable suspicion.

Scope of practice: delegation to unlicensed assistive personnel must follow state nurse practice acts and institutional policy; assessment and teaching remain with the RN.

Documentation must be objective, timely, and factual; record what was observed and done, not opinions or conclusions.

Incident reports document the event for quality improvement and are not placed in the patient record; they are not a substitute for charting the facts.

Patient safety goals emphasize correct patient identification, handoff communication (SBAR), medication safety, and infection prevention.

Advocacy includes recognizing and addressing implicit bias, ensuring informed consent, and protecting confidentiality under HIPAA with appropriate exceptions.