CPNP-AC cheat sheet

The Pediatric Assessment Triangle (appearance, work of breathing, circulation to skin) is completed in 30-60 seconds from the doorway, before hands-on contact, and determines the urgency of the next step.

Primary survey sequence is ABCDE (airway, breathing, circulation, disability, exposure); the focused secondary survey and history are obtained only after immediate threats are addressed.

Hypotension thresholds: systolic < 70 mmHg for infants 1-12 months, < 70 + (2 x age in years) for children 1-10 years, and < 90 mmHg for children 10 years and older.

Holliday-Segar daily maintenance: 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, 20 mL/kg for each kg thereafter; the 4-2-1 rule gives the equivalent hourly rate.

Tachycardia is an early compensatory sign of decreased cardiac output; hypotension is a late, pre-arrest finding because children maintain pressure through vasoconstriction.

Capillary refill longer than 2 seconds, mottling, and urine output below 1 mL/kg/hr are perfusion markers used alongside mental status and lactate to identify shock.

Pediatric Glasgow Coma Scale: eye 4, verbal 5, motor 6, total 3-15; modified verbal scoring is used for preverbal or intubated children.

Cushing triad (hypertension with widened pulse pressure, bradycardia, irregular respirations) is a late sign of elevated intracranial pressure and warrants immediate intervention.

Cardiac arrest epinephrine: 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO, maximum 1 mg per dose, repeated every 3-5 minutes.

Defibrillation energy for ventricular fibrillation or pulseless ventricular tachycardia: 2 J/kg for the first shock, 4 J/kg for the second, then at least 4 J/kg without exceeding 10 J/kg or the adult dose.

Isotonic crystalloid bolus is 20 mL/kg over 5-20 minutes with reassessment after each bolus; fluid-refractory septic shock may require 40-60 mL/kg in the first hour.

Vasoactive selection in pediatric septic shock: epinephrine 0.05-0.3 mcg/kg/min for cold shock with delayed refill and high vascular resistance; norepinephrine 0.05-0.3 mcg/kg/min for warm shock with vasodilation.

Diabetic ketoacidosis: isotonic fluid 10-20 mL/kg over 1 hour, then regular insulin 0.05-0.1 units/kg/hr; add dextrose when glucose reaches 250-300 mg/dL and continue insulin until ketoacidosis resolves; treat suspected cerebral edema with 3% saline 5-10 mL/kg or mannitol 0.5-1 g/kg.

Status asthmaticus: continuous albuterol up to 0.5 mg/kg/hr (maximum 20 mg/hr), ipratropium bromide, systemic corticosteroid within the first hour, and magnesium sulfate 25-50 mg/kg IV (maximum 2 g) over 15-30 minutes.

Pediatric acute respiratory distress syndrome ventilation targets: tidal volume 6-8 mL/kg predicted body weight, plateau pressure below 30 cmH2O, titrated PEEP, and tolerance of permissive hypercapnia.

Severe traumatic brain injury: head midline and elevated 30 degrees, avoidance of hypoxia and hypotension (systolic pressure at or above the age-specific 5th percentile), and PaCO2 maintained near 35-40 mmHg except during acute herniation.

Family-centered care rests on four core concepts: dignity and respect, information sharing, participation in care, and collaboration in policy and decision-making.

FLACC (Face, Legs, Activity, Cry, Consolability) scores 0-10 and is validated for behavioral pain assessment in children aged 2 months to 7 years.

Wong-Baker FACES is a self-report scale validated for children 3 years and older; numeric rating scales are appropriate for children 8 years and older.

The Neonatal Infant Pain Scale scores six indicators from 0-7 and is used for preterm and term neonates who cannot self-report.

Annual influenza vaccination is recommended for all children 6 months and older; children 6 months through 8 years receiving vaccine for the first time need two doses at least four weeks apart.

Children under 7-8 years typically interpret illness and hospitalization concretely, so procedural preparation must match cognitive stage, use literal language, and offer limited, real choices.

Caregiver teach-back (restating discharge instructions in their own words) identifies comprehension gaps before discharge and reduces avoidable return visits.

Atraumatic care minimizes separation from caregivers, limits invasive and painful procedures, and restores child control through positioning, comfort measures, and caregiver presence.

PDSA (Plan-Do-Study-Act) tests a small change, analyzes the result, and then adopts, adapts, or abandons it within a measurable improvement aim.

Root cause analysis is retrospective and event-focused after a sentinel event; failure mode and effects analysis is prospective and process-focused before harm occurs.

The Institute of Medicine six aims for improvement are safe, effective, patient-centered, timely, efficient, and equitable care.

The APRN Consensus Model defines four roles (certified nurse practitioner, clinical nurse specialist, certified nurse-midwife, registered nurse anesthetist) across six population foci, aligning licensure, accreditation, certification, and education.

Scope of practice is set by each state's nurse practice act and board of nursing rules (full, reduced, or restricted practice); national certification alone does not confer practice authority.

Never events (for example wrong-site surgery or a retained foreign body) are reportable serious safety events and are generally designated non-reimbursable hospital-acquired conditions.

Suspected child abuse, neglect, or exploitation triggers a legal mandatory report to designated authorities; the report is made in good faith and does not require the clinician to confirm the suspicion.

Pediatric assent is sought from children around 7 years and older as a developmental agreement; parental or guardian permission remains the legal authorization for care.