CCRN Pediatric key terms

A rapid three-part visual assessment-appearance, work of breathing, and circulation to the skin-used to decide within seconds whether a child needs immediate lifesaving intervention, before any equipment is applied.

A state in which cardiac output falls but blood pressure stays normal because the child raises heart rate and constricts peripheral vessels; subtle signs such as tachycardia, delayed capillary refill, and cool mottled extremities appear before hypotension.

A systolic blood pressure below 70 mmHg plus twice the child's age in years for ages 1 to 10. Hypotension is a late, ominous sign because children usually maintain pressure until decompensation.

The seconds required for color to return after blanching a fingertip or the sternum; normally under 2 seconds, and prolongation suggests poor peripheral perfusion from shock, cold stress, or vasoconstriction.

A heart rate under 60 beats per minute accompanied by poor perfusion in an infant or child, treated with chest compressions because pediatric cardiac output depends heavily on heart rate rather than stroke volume.

Increased work of breathing-retractions, nasal flaring, grunting, tachypnea, head bobbing-with gas exchange still preserved. It is a warning state that may progress to failure if the cause is not corrected.

Inadequate oxygenation or ventilation despite escalating support, marked by rising carbon dioxide, falling oxygen saturation, cyanosis, decreasing consciousness, or exhaustion after prolonged distress. It requires immediate assisted ventilation.

Weight-based maintenance fluid calculation providing 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each kilogram above 20, reflecting energy expenditure and insensible losses.

An isotonic crystalloid volume of 20 mL/kg given rapidly for suspected shock, with reassessment after each bolus; smaller volumes are used in cardiac or renal dysfunction to avoid fluid overload and pulmonary edema.

Blood glucose low enough to threaten brain injury-commonly below 40 mg/dL in newborns and below 45 to 50 mg/dL in children-treated promptly with dextrose because infants have limited glycogen stores and high glucose demand.

Continuous seizure activity, or repeated seizures without regaining consciousness, lasting 5 minutes or longer. It requires immediate benzodiazepine therapy plus airway and oxygenation support to prevent hypoxic brain injury.

Mean arterial pressure minus intracranial pressure. Therapy after brain injury targets both lowering intracranial pressure and maintaining adequate blood pressure so the brain remains perfused.

Use of an external ventricular drain or parenchymal probe to measure pressure inside the skull after severe brain injury, guiding treatment to prevent herniation and secondary ischemic injury.

A life-threatening complication of pediatric DKA signaled by headache, altered mental status, bradycardia, or hypertension. It is treated emergently with hypertonic saline or mannitol and slowed fluid administration.

Acute hypoxemic respiratory failure from non-cardiogenic lung injury, defined by severity of oxygenation impairment and chest imaging findings, usually managed with lung-protective ventilation and cautious fluid balance.

A bedside scoring tool combining vital signs and behavioral cues to detect clinical deterioration early and trigger escalation of care before an arrest or unplanned transfer occurs.

Life-threatening organ dysfunction caused by infection, with fever or hypothermia, tachycardia, poor perfusion, and altered mental status. Management includes prompt antibiotics, fluid resuscitation, and vasoactive infusions.

A circuit that oxygenates and pumps blood outside the body to support or replace heart and lung function in reversible failure that has not responded to conventional mechanical ventilation or vasoactive therapy.

An acute, fluctuating disturbance of attention and awareness occurring in critically ill children, frequently hypoactive and therefore missed, and associated with longer stays and worse functional outcomes.

An observational screening tool completed by bedside caregivers over a shift, scoring items such as eye contact, communication, and activity to detect delirium in infants and young children who cannot report symptoms.

New or worsening physical, cognitive, emotional, or social impairment that persists after critical illness in a child and also affects family functioning following discharge from the intensive care unit.

A partnership approach that treats the family as part of the care team, honoring parents' knowledge, presence at the bedside, cultural values, and preferences during rounds, assessments, and decision-making.

Permission obtained from a legally authorized person after explaining the procedure, its risks, benefits, and alternatives. For children this is ordinarily a parent or guardian, documented before the intervention.

The child's own agreement to treatment, sought in developmentally appropriate language once the child can understand what is proposed; it complements rather than replaces parental permission.

A person under 18 who is legally treated as an adult for consent purposes because of marriage, military service, or a court order, and may therefore consent independently to treatment.

The nurse's legal duty to report suspected child abuse or neglect to designated authorities, regardless of parental objection, institutional pressure, or the nurse's personal relationship with the family.

The experience of knowing the right action but being prevented from taking it by institutional, legal, or interpersonal constraints; it is common in pediatric intensive care and is linked to burnout and turnover.

A judgment that an intervention cannot achieve its intended physiologic benefit. Disputes are resolved through ethics consultation and a defined institutional process, not by unilateral withdrawal at the bedside.

The person legally authorized to make health care choices for a child who cannot, ordinarily a parent or guardian, expected to apply the child's best interests rather than the adult's own preferences.

Paired ethical duties to act for the patient's good and to avoid causing harm. They are weighed together when judging whether a painful, risky, or burdensome treatment offers enough likely benefit.

Removing therapies that no longer provide acceptable benefit, when consistent with the child's best interests and family agreement, while continuing comfort measures, symptom control, and family support.

An interdisciplinary approach begun at diagnosis of a serious illness that relieves symptoms and supports the child and family, delivered alongside curative treatment rather than only at end of life.

Irreversible cessation of all brain function established through rigorous neurologic examination and apnea testing, after which organ donation may be raised with the family in a sensitive, non-coercive manner.

Speaking up and acting to protect a pediatric patient's safety, rights, and access to care, including questioning orders, requesting clarification, and escalating concerns until they are addressed.

A defined escalation pathway a nurse follows when a safety concern is not resolved by the immediate care team, moving to the charge nurse, nursing supervisor, and physician leadership as needed.

A system of accountability in which honest errors and near misses are treated as learning opportunities while reckless behavior is not tolerated, encouraging staff to report safety events openly.

A collaborative conversation in which clinicians present options and evidence while the family's values, goals, and circumstances shape the chosen plan of care for the child.

The duty to protect a patient's health information, balanced for adolescents against state laws allowing minors to consent to sensitive services and against safety concerns that require limited disclosure.