PNC(C) cheat sheet

Leading health indicators for children include infant mortality, low birth weight, immunizations, and injury prevention; screen at every well visit.

Bright Futures periodicity: newborn, 1 week, 1, 2, 4, 6, 9, 12, 15, 18, 24, 30 months, then annual from age 3 through adolescence.

Immunization schedule: HepB at birth; DTaP, IPV, Hib, PCV, and rotavirus at 2, 4, and 6 months; MMR and varicella at 12-15 months and 4-6 years; Tdap and HPV at 11-12 years.

Anticipatory guidance topics by age: safe sleep and car seat for infants, poison control and drowning prevention for toddlers, helmet and stranger safety for school age, substance use and driving for teens.

BMI percentile interpretation: underweight below 5th, healthy 5th to 84th, overweight 85th to 94th, obesity at or above 95th percentile.

Lead screening is indicated at 12 and 24 months for children at risk; blood lead level of 5 mcg/dL or higher requires case management.

Newborn screening bloodspot is collected 24 to 48 hours after birth and repeated at 1 to 2 weeks of age.

Birth weight doubles by 4 to 6 months, triples by 12 months; length increases about 50 percent by 12 months.

Infant weight gain averages 20 to 30 g per day in the first 3 months; growth charts are corrected for prematurity until 24 months.

Primitive reflexes: Moro and rooting disappear by 3 to 4 months; palmar grasp by 4 to 6 months; Babinski persists until 12 to 24 months.

Developmental milestones: social smile 2 months, head control 4 months, sits unsupported 6 to 8 months, walks 12 to 15 months, two-word phrases 18 to 24 months.

Erikson stages: trust versus mistrust infancy, autonomy versus shame toddler, initiative versus guilt preschool, industry versus inferiority school age, identity versus role confusion adolescence.

Piaget stages: sensorimotor birth to 2 years, preoperational 2 to 7 years, concrete operational 7 to 11 years, formal operational 11 years and older.

Separation anxiety peaks at 8 to 18 months; stranger anxiety peaks at 6 to 9 months; parallel play is typical for toddlers, cooperative play for preschool age.

Pediatric vital sign order: respiratory rate first in infants, then heart rate, blood pressure, temperature; all are age dependent.

Normal infant heart rate 100 to 160 beats per minute; toddler 90 to 150; school age 70 to 120; adolescent 60 to 100.

Normal respiratory rates: newborn 30 to 60, infant 30 to 53, toddler 22 to 37, preschool 20 to 28, school age 18 to 25, adolescent 12 to 20 breaths per minute.

Hypotension is a late sign of shock in children; use capillary refill over 2 seconds, mottling, and narrowed pulse pressure as early indicators.

Head circumference is measured until 36 months; it should equal chest circumference at about 1 year and be less than chest after age 2.

Pain scales by age: FLACC for infants and toddlers, Wong-Baker FACES for ages 3 and older, numeric scale for ages 8 and older.

Abdominal assessment sequence is inspection, auscultation, percussion, palpation; palpate the painful area last.

Pediatric weight-based dosing: verify dose in mg/kg and confirm the safe range against a reference before administration.

Safe dose check formula: ordered dose divided by weight equals mg/kg; compare with recommended minimum and maximum ranges.

Intravenous maintenance fluids use the Holliday-Segar method: 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, 20 mL/kg for each kg above 20.

Five rights include right patient, drug, dose, route, and time; pediatric additions are right weight and right documentation.

Oral medication tips: use an oral syringe into the cheek for infants, avoid mixing in essential formula, and never call medication candy.

Therapeutic drug monitoring: digoxin level 0.5 to 2 ng/mL; vancomycin trough 10 to 15 mcg/mL; gentamicin peak and trough per protocol.

Acetaminophen maximum is 75 mg/kg per day or 4 g per day for adolescents; ibuprofen is avoided under 6 months of age.

Asthma severity is classified by symptom frequency, night waking, and peak flow; rescue albuterol is given before inhaled corticosteroids.

Early signs of respiratory distress: tachypnea, nasal flaring, retractions, grunting, head bobbing; bradycardia and apnea signal impending failure.

Croup presents with a barking cough and inspiratory stridor; treat with dexamethasone and nebulized epinephrine for moderate to severe symptoms.

Epiglottitis causes drooling, tripod positioning, and muffled voice; never inspect the throat without airway readiness.

Cystic fibrosis care includes airway clearance, nebulized hypertonic saline, pancreatic enzymes with meals, and fat-soluble vitamin supplementation.

Congenital heart defects with decreased pulmonary blood flow cause cyanosis; those with increased flow cause heart failure and poor feeding.

Digoxin administration: count the apical pulse for one full minute and hold for heart rate below 90 in infants or below 70 in children.

Pediatric Glasgow Coma Scale scores eye, verbal, and motor responses; the lowest possible score is 3 and the highest is 15.

Signs of increased intracranial pressure in infants include bulging fontanel, sunset eyes, and irritability; in older children, headache and vomiting.

Seizure first aid: protect the head, turn to the side, do not restrain or place objects in the mouth, time the event, and call for help after 5 minutes.

Meningitis precautions: droplet isolation for 24 hours after antibiotics; nuchal rigidity, photophobia, and Kernig or Brudzinski signs support diagnosis.

Hip dysplasia screening uses Ortolani and Barlow maneuvers in newborns and asymmetric thigh folds or a positive Galeazzi sign later.

Scoliosis screening uses the Adams forward bend test; curves of 10 degrees or more on Cobb angle measurement warrant referral.

Visual screening: fix and follow by 3 months, cover-uncover test for strabismus, and acuity screening beginning at age 3 to 4 years.

Dehydration classification: mild under 5 percent weight loss, moderate 5 to 10 percent, severe over 10 percent with shock signs.

Oral rehydration solution is given 50 mL/kg over 4 hours for mild dehydration and 100 mL/kg over 4 hours for moderate, plus replacement losses.

Pyloric stenosis presents at 3 to 6 weeks with projectile nonbilious vomiting and a palpable olive; metabolic finding is hypochloremic hypokalemic metabolic alkalosis.

Intussusception causes colicky pain, currant jelly stools, and a sausage-shaped mass; air or contrast enema is diagnostic and therapeutic.

Type 1 diabetes presentation includes polyuria, polydipsia, weight loss, and possible diabetic ketoacidosis; initial management includes isotonic fluid and insulin infusion.

Diabetic ketoacidosis monitoring: hourly glucose, electrolytes, and neurologic checks; potassium is replaced once urine output is established.

Congenital hypothyroidism is detected on newborn screening; untreated disease causes intellectual disability, so treatment begins within 2 weeks.

Sickle cell vaso-occlusive crisis management: hydration, analgesia, oxygen if hypoxic, and prompt treatment of infection.

Acute chest syndrome findings include fever, chest pain, hypoxia, and new infiltrate; it is the leading cause of death in sickle cell disease.

Neutropenic precautions apply when absolute neutrophil count is below 500; include hand hygiene, no fresh flowers, and no sick visitors.

Signs of anaphylaxis: urticaria, angioedema, bronchospasm, and hypotension; give epinephrine intramuscularly into the outer thigh immediately.

Chemotherapy safety: use closed-system transfer devices, double gloves, and a spill kit; pregnant nurses should not handle hazardous drugs.

Iron deficiency anemia shows microcytic hypochromic indices and low ferritin; give iron with vitamin C and avoid coadministration with milk.

Hodgkin lymphoma presents with painless cervical lymphadenopathy, night sweats, and weight loss; Reed-Sternberg cells confirm diagnosis.

Autism spectrum warning signs: no babbling by 12 months, no pointing by 14 months, no two-word phrases by 24 months, and loss of skills at any age.

Attention deficit hyperactivity disorder requires symptoms before age 12, in two or more settings, causing impairment; first-line medication is a stimulant.

Depression screening in adolescents uses a validated tool such as the PHQ-9; ask directly about suicidal ideation and safety plan.

Eating disorder red flags: bradycardia, orthostatic hypotension, hypothermia, lanugo hair, and electrolyte abnormalities; refeeding syndrome risk with rapid nutrition.

Adverse childhood experiences increase risk for later mental health and chronic disease; trauma-informed care avoids re-traumatization.

Screen time guidance: no screen media before 18 months, 1 hour per day of high-quality content for ages 2 to 5 years, consistent limits thereafter.

Family-centered care includes the child in decisions appropriate to developmental level and supports sibling coping.

Pediatric early warning scores trigger escalation when respiratory rate, heart rate, blood pressure, or mental status deviate from age norms.

Medication error prevention includes independent double checks for high-alert drugs, weight in kilograms only, and barcode scanning at the bedside.

Informed consent for minors is given by a parent or legal guardian; emancipated minors and specific adolescent services may consent independently.

Mandatory reporting applies to suspected child abuse or neglect; the nurse reports to the designated agency and documents objectively.

Infection control: standard precautions for all patients; contact precautions for respiratory syncytial virus, varicella requires airborne plus contact.

Patient identification uses two identifiers, never the room number; verify allergies before every medication administration.

Quality improvement uses plan-do-study-act cycles and tracks outcome, process, and balancing measures.