CPN CPE III cheat sheet

Weight: doubles by 4–5 months, triples by 12 months, quadruples by 24 months.

Length increases ~50% by 12 months (birth length ~50 cm → ~75 cm).

Head circumference grows ~2 cm/month in first 3 months, ~1 cm/month from 4–6 months, ~0.5 cm/month 6–12 months.

Anterior fontanel closes 9–18 months; posterior fontanel closes by 6–8 weeks.

Primitive reflexes: Moro and rooting disappear by 3–4 months; palmar grasp by 4–6 months; tonic neck by 4 months.

Developmental milestones: sits unsupported 6–8 months, walks alone 12–15 months, 2-word phrases 18–24 months.

Growth chart interpretation: crossing ≥2 major percentile lines downward warrants evaluation.

Mid-parental height: boys (father + mother + 13 cm)/2; girls (father + mother − 13 cm)/2, ±8.5 cm.

BMI percentile ≥95th = obesity; 85th–94th = overweight; <5th = underweight for age ≥2 years.

Family-centered care core concepts: dignity and respect, information sharing, participation, collaboration.

Teach-back confirms comprehension: patient restates instructions in own words; a correct restatement confirms understanding.

Interpreters: use trained medical interpreters, not family members, for consent and critical discussions.

Confidentiality in adolescence: many states allow confidential care for STI, contraception, and mental health; verify state law.

Assent: children ≥7 years generally provide developmental assent; parents/guardians provide legal consent.

SPIKES framework for bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/summary.

Challenging conversations: avoid medical jargon, use open-ended questions, allow silence, and confirm understanding.

Family presence during resuscitation is supported by evidence when a facilitator is assigned to the family.

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

Hepatitis B: birth dose within 24 hours, then 1–2 months and 6–18 months.

HPV vaccine: 2 doses if started before 15th birthday, 3 doses if started at ≥15 years.

Car seat: rear-facing until age 2 or maximum seat weight; booster until seat belt fits (typically 4'9", 8–12 years).

Safe sleep: supine, firm surface, no soft objects, room-sharing without bed-sharing for first 6–12 months.

Lead screening: universal at 12 and 24 months in high-risk areas; otherwise risk-based questionnaire.

Newborn screening: hearing screen before discharge; bloodspot at 24–48 hours after birth.

Vision screening: red reflex at birth and each well visit; visual acuity at 3–5 years.

Dental: first dental visit by first tooth or first birthday; fluoride varnish from eruption.

Pediatric dehydration: mild <5% weight loss, moderate 5–10%, severe >10%; use ORS 50 mL/kg mild, 100 mL/kg moderate over 3–4 hours.

Bronchiolitis: supportive care; no routine albuterol, steroids, or antibiotics; oxygen for SpO2 <90%.

Asthma exacerbation: albuterol with ipratropium for severe; systemic steroids; magnesium sulfate for refractory cases.

Kawasaki disease: IVIG 2 g/kg + high-dose aspirin; risk of coronary artery aneurysm; echocardiogram at diagnosis and 2 weeks.

Type 1 diabetes: DKA criteria pH <7.30, bicarbonate <15, ketonemia; treat with isotonic fluid and insulin infusion after potassium assessment.

Nephrotic syndrome: edema, proteinuria >3+ or >40 mg/m²/hr, hypoalbuminemia <2.5 g/dL; first-line prednisone.

Croup: dexamethasone 0.15–0.6 mg/kg; nebulized epinephrine for stridor at rest.

Sickle cell vaso-occlusive crisis: hydration, analgesia (opioids), oxygen if hypoxic; do not withhold opioids for fear of addiction.

Weight-based dosing: verify mg/kg and maximum adult dose; never exceed adult maximum.

BSA formula: BSA (m²) = √(height cm × weight kg / 3600).

Pediatric dose calculation: mg dose = ordered mg/kg × weight kg; volume = dose ÷ concentration.

High-alert drugs in pediatrics: insulin, opioids, heparin, chemotherapy, concentrated electrolytes; independent double-check required.

Neonatal PK: reduced hepatic enzymes and GFR; half-life prolonged; dose intervals lengthened.

Acetaminophen max: 75 mg/kg/day or 4 g/day, whichever lower; 15 mg/kg/dose q4–6h.

Ibuprofen: 10 mg/kg/dose q6–8h; avoid <6 months and in dehydration due to renal risk.

Five rights plus: right patient, drug, dose, route, time, documentation, reason, and response.

Safe dosing: use leading zeros (0.5 not .5); trailing zeros prohibited (5 not 5.0).

APGAR: Appearance, Pulse, Grimace, Activity, Respiration; scored at 1 and 5 minutes; ≥7 normal.

Newborn weight loss up to 10% in first week is normal; regain birth weight by 10–14 days.

Physiologic jaundice appears after 24 hours; pathologic jaundice <24 hours requires evaluation.

Hyperbilirubinemia treatment thresholds: phototherapy based on hour-specific nomogram (Bhutani); exchange transfusion for severe.

Sepsis risk: GBS prophylaxis for maternal colonization, prior GBS infant, or unknown status with risk factors.

Kangaroo care: skin-to-skin reduces mortality, hypothermia, and infection in preterm infants.

Neonatal resuscitation: 21% O2 for term, 21–30% for preterm <35 weeks; positive pressure ventilation at 40–60 breaths/min.

Breastfeeding: colostrum first 2–3 days; 8–12 feeds/24h; adequate output 6 wet diapers/day after day 5.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin.

Hypotension in children is a late sign; use age-based thresholds: 1–12 months <70 mmHg, 1–10 years <70 + (2 × age), >10 years <90 mmHg.

PALS compression: ventilation ratio 30:2 single rescuer, 15:2 two rescuers; rate 100–120/min; depth 1/3 AP diameter.

Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO q3–5 min for cardiac arrest.

Anaphylaxis: IM epinephrine 0.01 mg/kg (max 0.5 mg) of 1 mg/mL into lateral thigh; repeat q5–15 min.

Fluid resuscitation: 20 mL/kg isotonic crystalloid bolus; reassess after each bolus.

Perioperative: NPO 2h clear liquids, 4h breast milk, 6h formula/solids; preop anxiety management with child life.

Postop pain: multimodal analgesia; avoid codeine in children <12 years and post-tonsillectomy due to CYP2D6 variability.

Autism screening: M-CHAT-R at 18 and 24 months; refer for diagnostic evaluation if positive.

ADHD criteria: symptoms ≥6 months, present before age 12, in ≥2 settings, causing impairment.

ADHD first-line: behavioral therapy for preschool; stimulants (methylphenidate, amphetamines) for school-age.

Depression screening: PHQ-9 or PHQ-A annually from age 12; Columbia Suicide Severity Rating Scale for risk.

Adolescent suicide: ask directly about suicidal ideation; asking does not increase risk.

Anxiety: CBT first-line; SSRIs (sertraline, fluoxetine) with monitoring for activation.

Eating disorders: medical instability indicators include bradycardia, orthostatic hypotension, hypothermia, electrolyte abnormalities.

Developmental delay: refer to Early Intervention (<3 years) or school-based services (≥3 years).

Informed consent elements: capacity, disclosure, comprehension, voluntariness, and authorization.

Emancipated minors: married, military, financially independent, or legally emancipated; can consent to own care.

Mandatory reporting: reasonable suspicion of abuse or neglect must be reported; do not investigate before reporting.

Nursing scope: state Nurse Practice Act defines scope; delegation must match assistive personnel competency.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, fidelity, veracity.

Advance directives and DNR: pediatric DNR requires parental consent and physician order; ethics committee for conflict.

Confidentiality: HIPAA permits disclosure for treatment, payment, operations; minimum necessary standard applies.

Documentation: objective, timely, factual; late entries labeled as such.

PDSA cycle: Plan, Do, Study, Act for iterative improvement.

Evidence hierarchy: systematic reviews/meta-analyses > RCTs > cohort > case-control > expert opinion.

PICO: Population, Intervention, Comparison, Outcome for clinical questions.

Root cause analysis: systems-focused, non-punitive; identifies contributing factors after a sentinel event.

Failure mode and effects analysis: prospective risk assessment of a process.

Handoff: use SBAR (Situation, Background, Assessment, Recommendation) for structured communication.

Medication reconciliation at admission, transfer, and discharge reduces adverse drug events.

Safety bundles: central line bundle (hand hygiene, maximal barrier, chlorhexidine, optimal site, daily review).

Benchmarking: NDNQI and pediatric quality measures track nursing-sensitive indicators.