CPN CPE CIS cheat sheet

Weight in kilograms is the dosing anchor: 1 kg = 2.2 lb; estimate 1-10 years as (age in years + 4) x 2 kg only when no scale is available.

Infant weight doubles by 4-6 months, triples by 12 months, and quadruples by 24 months; birth weight is regained by 10-14 days.

Length increases about 25 cm in year 1 (50 to 75 cm), 12 cm in year 2, then 5-7 cm/year until puberty.

Head circumference grows ~2 cm/month in the first 3 months, 1 cm/month from 4-6 months, and 0.5 cm/month in the second half of year 1.

Anterior fontanel closes at 9-18 months; posterior fontanel closes by 2-3 months; sunken = dehydration, bulging = increased ICP.

Developmental milestones: head control 3-4 months, sits unsupported 6-8 months, walks 12-15 months, two-word phrases 18-24 months.

APGAR is scored at 1 and 5 minutes on Appearance, Pulse, Grimace, Activity, Respiration (0-2 each); it never guides resuscitation.

Pediatric vital sign trend: heart rate falls and blood pressure rises with age; a normal adult HR in a child signals distress.

Pain tools by age: NIPS/N-PASS for neonates, FLACC (2 months-7 years), Wong-Baker FACES (3+ years), numeric scale (8+ years).

Exclusive breastfeeding is recommended for about 6 months; iron-fortified cereal or pureed meat is introduced around 6 months with continued breast milk to 12 months.

Whole cow milk is avoided before 12 months (low iron, high protein/minerals); whole milk, not reduced-fat, is used from 12 to 24 months.

Honey is contraindicated under 12 months due to infant botulism risk; no choking-risk foods (whole grapes, nuts, popcorn) under 4 years.

Back to sleep, firm flat surface, no loose bedding or soft objects in the crib, and room-sharing without bed-sharing reduce SIDS risk.

Immunization schedule: hepatitis B at birth; DTaP, IPV, Hib, PCV, and rotavirus at 2, 4, and 6 months; MMR and varicella at 12-15 months.

Lead screening is targeted at 12 and 24 months for at-risk children; universal newborn hearing screening occurs before discharge.

Vision and anemia screening: red reflex at every well visit, visual acuity around 3-5 years, hemoglobin at approximately 12 months.

Dental: first dental visit by first tooth or first birthday; fluoride varnish from tooth eruption; no bottle at bedtime.

Injury prevention by stage: car seat rear-facing to age 2 or seat limit, water heater below 49 C (120 F), poison control 1-800-222-1222.

Family-centered care core concepts: dignity and respect, information sharing, participation, and collaboration; the family is the constant, the system is not.

Atraumatic care principles: minimize separation, minimize physical and emotional harm, promote a sense of control.

Use developmentally matched preparation: sensory/tour before 2 years, concrete short explanations at 3-6 years, and procedural detail with coping plans at 7+ years.

Speak to the child at eye level and at their developmental, not chronological, age; offer real choices only when both options are acceptable.

Teach-back confirms comprehension: ask the caregiver to explain the plan in their own words rather than asking 'do you understand?'

Use qualified medical interpreters, not siblings or children; document interpreter use and language preference.

Grief and loss: siblings and parents need honest, concrete language ('died'), not euphemisms; avoid implying illness is punishment.

Ethical decision-making in pediatrics uses best-interest standard plus assent from the child and consent from the parent or guardian.

Pediatric dehydration: 5% weight loss = mild, 10% = moderate, 15% = severe; first-line is oral rehydration solution 50 mL/kg over 4 hours for mild-moderate.

Isotonic maintenance fluid (0.9% NaCl with dextrose) is preferred in children; hypotonic fluids risk hospital-acquired hyponatremia.

Asthma: short-acting beta-2 agonist is rescue, inhaled corticosteroid is controller; a rescue inhaler used more than twice weekly signals poor control.

Croup: barking cough and inspiratory stridor treated with dexamethasone; nebulized epinephrine for moderate-severe stridor.

Bronchiolitis: supportive care (oxygen, hydration, suctioning); no routine bronchodilators, corticosteroids, or antibiotics.

Kawasaki disease: fever 5+ days plus conjunctivitis, rash, mucositis, extremity changes, cervical lymphadenopathy; treat with IVIG plus aspirin to prevent coronary aneurysm.

Diabetic ketoacidosis: never give bolus insulin to a child; rehydrate first, then continuous insulin, and monitor for cerebral edema.

Nephrotic syndrome: heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia; first-line is oral corticosteroid.

Sickle cell vaso-occlusive crisis: aggressive hydration, analgesia (opioids are appropriate), oxygenation, and prompt fever workup for infection.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin; it is completed before touching the child.

Compression rate 100-120/min, depth one-third of chest AP diameter, ratio 30:2 single rescuer and 15:2 for two rescuers with an infant or child.

Pulse check in an unresponsive infant/child: feel the brachial (infant) or carotid/femoral (child) for no more than 10 seconds.

Weight-based resuscitation: epinephrine 0.01 mg/kg IV/IO of 0.1 mg/mL (0.1 mL/kg); defibrillation 2 J/kg, then 4 J/kg, then 4 J/kg or more.

Bradycardia with poor perfusion is treated with oxygen and CPR, then epinephrine; do not delay compressions for a monitor.

Fluid bolus in shock is 20 mL/kg isotonic crystalloid, reassessing after each bolus; use 10 mL/kg in neonates, cardiac, or DKA patients.

Signs of shock in children: tachycardia, delayed capillary refill over 2 seconds, mottling, narrowed pulse pressure, then hypotension as a late sign.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg (max 0.5 mg) of 1 mg/mL into the anterolateral thigh, repeated every 5-15 minutes.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg), then a second dose, then a longer-acting antiepileptic.

Verify the safe dose range against weight in kilograms for every pediatric order; a single decimal error can be a tenfold overdose.

Most pediatric doses are capped at an adult maximum; compute mg/kg and compare with the maximum before administering.

Use the 'rule of six' only for continuous infusions: mg of drug in 100 mL = (dose in mcg/kg/min x weight in kg x 6) / rate in mL/h.

High-alert medications include insulin, heparin, opioids, and concentrated electrolytes; require independent double-check.

Oral liquids are measured in an oral syringe in milliliters; household teaspoons vary and are not acceptable for dosing.

Avoid aspirin in children with viral illness (Reye syndrome); avoid tetracyclines under 8 years and codeine in children under 12.

Therapeutic drug monitoring: vancomycin trough before the fourth dose; aminoglycoside peak and trough per protocol.

Report adverse drug events through the institution's event system; the goal is system improvement, not individual blame.

Vein selection in infants: scalp, hand, antecubital, and saphenous veins; avoid the antecubital fossa in a crawling infant when possible.

Use the smallest catheter that meets therapy needs; in neonates, a 24-gauge or smaller peripheral catheter is typical.

Verify tip location before use: peripheral short catheters are not for vesicants or central-only solutions.

PICC tip should sit in the lower third of the superior vena cava or cavoatrial junction; confirm with imaging before infusing.

Blood administration: 10-15 mL/kg over 3-4 hours; use a 170-260 micron filter and 0.9% NaCl only in the same line.

Two-person verification of blood products includes patient identifiers, unit number, blood type, and expiration.

Extravasation: stop the infusion, do not remove the catheter immediately, aspirate, and follow the antidote protocol for the drug.

Calculate drip rate: mL/h = (gtt/min x 60) / drop factor; use a pump for all pediatric maintenance fluids.

Two patient identifiers are required before any medication, blood product, or procedure; use name plus date of birth or medical record number.

Handoff communication uses SBAR: situation, background, assessment, recommendation.

The Joint Commission National Patient Safety Goals include identifying patients correctly, improving staff communication, and using medicines safely.

Root cause analysis follows a sentinel event; failure mode and effects analysis is proactive before a process change.

Nurse staffing and skill mix, not just numbers, affect pediatric outcomes; report unsafe assignments through the chain of command.

Mandatory reporting includes suspected child abuse or neglect, and it is based on reasonable suspicion, not proof.

Scope of practice is defined by state nurse practice act plus institutional policy; delegation to unlicensed assistive personnel requires supervision and evaluation.

Quality indicators in pediatrics include central line-associated bloodstream infection rates, unplanned extubation, and medication error rates.