CCRN-K Pediatric cheat sheet

Pediatric assessment sequence: airway, breathing, circulation, disability (AVPU/GCS), exposure - hypotension is a late sign; use compensated shock indicators (tachycardia, delayed capillary refill >2 s, narrow pulse pressure, cool extremities).

Weight-based dosing uses kg; verify with a second nurse for high-alert drugs (insulin, opioids, heparin, chemotherapy, concentrated electrolytes). Maintenance fluids by Holliday-Segar: 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg above 20.

Pediatric vital sign thresholds vary by age: infants normally have respiratory rates 30-60/min and heart rates 100-160/min; adolescent resting HR 60-100/min. Tachypnea is the earliest and most sensitive sign of pediatric respiratory distress.

Respiratory distress vs failure: distress = tachypnea, retractions, nasal flaring, grunting with preserved mental status; failure = bradypnea, apnea, cyanosis, altered consciousness, silent chest - requires bag-mask ventilation.

Early warning scores (PEWS) trigger escalation when any single parameter scores 3 or total ≥4; document and activate rapid response rather than reassessing alone.

Dehydration classification: mild <5% weight loss, moderate 5-10%, severe >10% with lethargy, sunken eyes, prolonged cap refill; oral rehydration preferred in mild-moderate; isotonic crystalloid 20 mL/kg bolus for shock.

Sepsis bundle: obtain cultures before antibiotics, administer broad-spectrum antibiotics within 60 minutes of recognition, and give 10-20 mL/kg isotonic fluid boluses reassessing for hepatomegaly, rales, and worsening work of breathing.

Pain assessment by age: FLACC (2 months-7 years), Wong-Baker FACES (≥3 years), numeric 0-10 (≥8 years); reassess within 30-60 minutes after IV analgesic and 60 minutes after oral.

Informed consent requires the person legally authorized (parent/guardian for minors) to receive information on risks, benefits, alternatives, and to consent voluntarily; the nurse witnesses and clarifies but does not obtain consent for the provider.

Emancipated and mature minor rules vary by state; a minor parent, married minor, or minor in the military may consent to their own care - verify state statute rather than assuming parental consent is required.

Mandated reporting: nurses must report suspected child abuse or neglect to child protective services; reporting is not optional and does not require proof, only reasonable suspicion.

Confidentiality exceptions: suspected abuse, suicidal or homicidal ideation, reportable communicable diseases, and court orders; HIPAA permits disclosure of the minimum necessary information.

Ethical principles in pediatric care: beneficence, nonmaleficence, autonomy (assent by the child when developmentally able, typically ≥7 years), justice, and veracity; surrogate decision-making applies the best-interest standard.

Assent vs consent: assent is the child's affirmative agreement consistent with developmental capacity; dissent should be honored when the intervention can be deferred without harm.

Futile or non-beneficial treatment disputes are managed through ethics consultation and institutional policy; the nurse advocates for the child's expressed values and documents discussions.

Family-centered care principles: information sharing, respect and dignity, participation, and collaboration; parents are care team members, not visitors, and should be present during resuscitation when supported by a designated facilitator.

Teach-back is the validated method to confirm understanding: the learner restates the information in their own words; document the teach-back result, not just that teaching occurred.

Health literacy screening uses a single-item tool ("How confident are you filling out medical forms?") and universal precautions approach; written materials at or below a 5th-6th grade reading level.

Developmental teaching targets: preschool (concrete, short, play-based), school-age (simple cause-effect, procedural preparation), adolescent (privacy, peer influence, self-management).

Asthma action plan education includes green/yellow/red zones, inhaler with spacer technique, and when to call 911; spacer use improves lung deposition versus inhaler alone.

Discharge readiness requires the caregiver to demonstrate medication administration, recognize warning signs, and state the follow-up plan; provide written instructions and a 24-hour contact number.

Advocacy actions: request interpreter services for limited-English-proficiency families (do not use the child as interpreter), ensure culturally congruent care, and escalate unsafe orders through the chain of command.

Transition to adult care begins in early adolescence with increasing self-management; teach the youth to know their diagnosis, medications, and insurance by age 14-16.

Immunization education addresses vaccine schedule, expected side effects (fever, fussiness, local reaction), and VAERS reporting; respect parental concerns while correcting misinformation with evidence.

PDSA (Plan-Do-Study-Act) cycles are the core rapid-improvement method; small tests of change are scaled after demonstrated improvement rather than implementing institution-wide first.

Quality measures in pediatrics include CAHPS child surveys, pediatric readmission rates, CLABSI and CAUTI standardized infection ratios, and hospital-acquired pressure injury rates.

Root cause analysis (RCA) is retrospective and applied to sentinel events; failure mode and effects analysis (FMEA) is prospective and prioritizes risks by severity × occurrence × detection.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (discipline); it supports voluntary error reporting without punitive response to system failures.

Medication safety practices: independent double-check for high-alert drugs, weight in kilograms only, standardized concentrations, smart pump drug libraries, and barcode medication administration.

National Patient Safety Goals relevant to pediatrics include patient identification with two identifiers, hand-off communication using SBAR, and safe use of alarms with individualized limits.

Staffing and workload are linked to outcomes; nurse-sensitive indicators include falls with injury, pressure injuries, and central line infections - report through the quality dashboard.

Accreditation and regulatory standards (Joint Commission, state licensing) require documented competency validation, ongoing education, and performance improvement plans with measurable outcomes.