CCRN Pediatric cheat sheet

Systolic hypotension in children is a late shock sign; a common bedside threshold is systolic BP <70 mmHg + (2 × age in years), and compensated shock shows tachycardia, delayed capillary refill, and narrow pulse pressure.

PALS cardiac arrest: IV/IO epinephrine 0.01 mg/kg of 1:10,000 every 3–5 minutes (max 1 mg); defibrillation 2 J/kg first, 4 J/kg second, then ≥4 J/kg up to 10 J/kg.

Maintenance fluids use the 4-2-1 rule: 4 mL/kg/hr for first 10 kg, 2 mL/kg/hr for next 10 kg, 1 mL/kg/hr above 20 kg; septic shock boluses are 20 mL/kg isotonic crystalloid with reassessment.

Impending pediatric respiratory failure: grunting, nasal flaring, retractions, head bobbing, silent chest, or exhaustion; croup has barking cough, epiglottitis has drooling and tripod positioning and the airway is not inspected.

Cushing triad-hypertension with widened pulse pressure, bradycardia, irregular respirations-signals increased ICP and herniation; pediatric GCS uses age-adjusted verbal and motor scores.

Ductal-dependent congenital heart lesions require prostaglandin E1 to maintain ductal patency; tet spells are treated with knee-chest position, oxygen, morphine, fluids, and phenylephrine.

Pediatric DKA cerebral edema presents with headache, altered mental status, bradycardia, hypertension, or falling oxygen saturation; treat with hypertonic saline or mannitol and avoid rapid fluid shifts.

Status epilepticus first-line is a benzodiazepine; acetaminophen toxicity is treated with N-acetylcysteine; burn resuscitation uses 4 mL/kg per %TBSA lactated Ringer over 24 hours, half in first 8 hours.

Use FLACC (0–10) for preverbal pain and Wong-Baker FACES for school-age children; neonatal hypoglycemia is commonly <40 mg/dL in the first 24 hours and is treated with feeding or IV dextrose.

Family-centered care treats the family as a constant; parents/guardians give informed consent, while children give developmentally appropriate assent and emancipated minors may consent under state law.

Suspected child abuse or neglect must be reported to child protective services in good faith; proof is not required, and failure to report can be legally actionable.

Delegation transfers task performance only; the RN retains accountability for assessment, teaching, evaluation, and verifying delegate competence.

Veracity is truth telling; fidelity is keeping commitments; advocacy is speaking up for the child's safety and rights, including escalating through the chain of command.

Just culture separates human error from at-risk behavior and reckless conduct; it promotes error reporting and system fixes while retaining individual accountability for unsafe choices.

Pediatric palliative care can begin at diagnosis and continue with curative treatment; organ donation is discussed separately by trained requesters and the procurement organization is notified when donation is possible.

Adolescent confidentiality protections vary by state; verify law and policy before disclosing health information to parents and encourage voluntary family involvement.

Moral distress occurs when a nurse knows the right action but is constrained by institutional or hierarchical barriers; ethics consultation and structured debriefing are appropriate resources.