Your FREE CPN Flashcards 2026 – 250+ Cards

CPN Flashcards

Normal heart rate — newborn (0–1 mo)

100–160 beats/min at rest (up to ~180 when crying); pediatric vital signs are age-specific and fall as the child grows.

Normal heart rate — infant (1–12 mo)

90–160 beats/min at rest.

Normal heart rate — toddler (1–3 yr)

80–130 beats/min.

Normal heart rate — preschooler (3–5 yr)

80–120 beats/min.

Normal heart rate — school-age (6–12 yr)

70–110 beats/min.

Normal heart rate — adolescent (13+ yr)

60–100 beats/min — approaching the adult range.

Normal respiratory rate — newborn/infant

Newborn 30–60/min; infant 30–53/min. Count for a full minute and watch the abdomen — infants are obligate abdominal (diaphragmatic) breathers.

Normal respiratory rate — toddler and preschooler

Toddler 22–37/min; preschooler 20–28/min.

Normal respiratory rate — school-age and adolescent

School-age 18–25/min; adolescent 12–20/min.

Normal systolic BP — quick estimate for ages 1–10

Minimum expected systolic BP ≈ 70 + (2 × age in years). Below that suggests hypotension; the 50th-percentile systolic ≈ 90 + (2 × age).

Why is hypotension a LATE sign of shock in children?

Children compensate with vigorous tachycardia and vasoconstriction; blood pressure is maintained until ~25% of blood volume is lost, so hypotension means decompensated shock — act on tachycardia, poor perfusion, and weak pulses first.

Earliest sign of respiratory distress in a child

Tachypnea (an increased respiratory rate) is the earliest and most sensitive sign; retractions, nasal flaring, and grunting follow.

Grunting in an infant — what does it signify?

End-expiratory grunting is the body's attempt to create its own PEEP and keep alveoli open. It signals significant respiratory distress and impending failure — a red-flag finding.

Pediatric Assessment Triangle (PAT) — three components

Appearance, Work of breathing, and Circulation to the skin. It is a rapid, hands-off, 'across-the-room' impression used to identify a sick child and set urgency before vital signs.

Anterior fontanelle — normal closure age

Closes by 12–18 months. A bulging fontanelle suggests increased intracranial pressure or meningitis; a sunken fontanelle suggests dehydration.

Posterior fontanelle — normal closure age

Closes by 2–3 months of age.

FLACC pain scale — what is it and who is it for?

An observational scale (Face, Legs, Activity, Cry, Consolability), each scored 0–2 for a 0–10 total. Used for nonverbal children and infants ~2 months to 7 years.

Wong-Baker FACES pain scale — who is it for?

A self-report scale of six faces from smiling (no hurt) to crying (worst hurt); used for children roughly 3 years and older who can point to how they feel.

FACES / numeric pain scale for older children

Children ~8 years and older can usually use the 0–10 numeric rating scale, like adults. Match the pain tool to the child's developmental level.

Capillary refill time — normal and significance

Normal is under 2 seconds. A refill longer than 2–3 seconds is an early sign of poor perfusion or dehydration in a child.

Signs of dehydration in a child

Decreased urine output (fewer wet diapers), no tears, dry mucous membranes, sunken eyes, sunken fontanelle (infant), poor skin turgor, tachycardia, and prolonged capillary refill. Weight loss is the best objective measure.

Most reliable indicator of a child's fluid status

Daily weight — a body-weight change is the most accurate measure of fluid gain or loss. Urine output (mL/kg/hr) is the next best bedside indicator.

Minimum acceptable urine output in a child

At least 1 mL/kg/hr in infants and young children (about 0.5–1 mL/kg/hr in older children/adolescents). Less suggests inadequate perfusion or hydration.

Glasgow Coma Scale — pediatric modification

The Pediatric GCS modifies the verbal and (for infants) motor responses for preverbal children. Total 3–15; a score of 8 or less indicates a need to protect the airway.

Sign of increased intracranial pressure in an INFANT

A bulging or tense fontanelle, widening sutures, increasing head circumference, a high-pitched cry, irritability, and poor feeding. Open sutures let infants tolerate rising pressure differently than older children.

Late signs of increased ICP in a child (Cushing's triad)

Hypertension with a widening pulse pressure, bradycardia, and irregular respirations — a late, ominous sign. Also: altered consciousness, abnormal posturing, and a fixed/dilated pupil.

Where do you assess skin turgor in an infant?

Over the abdomen or the inner thigh; tenting (slow recoil) indicates dehydration.

Normal weight gain in the first year

Birth weight doubles by ~6 months and triples by 12 months. Average newborn weight is ~3.4 kg.

Normal length/height growth in the first 2 years

Length increases ~50% by 1 year. By age 2, the child is about half their expected adult height.

Erikson — infant (birth–1 yr) stage

Trust vs. Mistrust — consistent, responsive caregiving (feeding, comfort) builds trust. The nurse promotes it by meeting needs promptly and encouraging consistent caregivers.

Erikson — toddler (1–3 yr) stage

Autonomy vs. Shame and Doubt — toddlers assert independence ('me do it,' toilet training). Offer simple choices and routines; expect negativism and ritualism.

Erikson — preschooler (3–6 yr) stage

Initiative vs. Guilt — preschoolers explore, imagine, and ask 'why.' Encourage play and curiosity; avoid shaming. Magical thinking is normal at this age.

Erikson — school-age (6–12 yr) stage

Industry vs. Inferiority — children master skills, schoolwork, and peer activities. Support accomplishment and competence.

Erikson — adolescent (12–18 yr) stage

Identity vs. Role Confusion — teens form a sense of self and value peer acceptance and privacy. Respect autonomy and confidentiality.

Piaget — sensorimotor stage (birth–2 yr)

The infant learns through senses and movement; the key milestone is object permanence (~8–9 months) — knowing an object exists when out of sight, which is why peek-a-boo delights them and separation anxiety emerges.

Piaget — preoperational stage (2–7 yr)

Magical thinking, egocentrism, and animism dominate; the child cannot yet reason logically. They may believe illness is punishment — reassure and use concrete, simple explanations.

Piaget — concrete operational stage (7–11 yr)

Logical thinking about concrete events; the child grasps conservation, cause-and-effect, and time. Use real objects and simple diagrams when teaching.

Piaget — formal operational stage (11+ yr)

Abstract and hypothetical reasoning develops; adolescents can think about consequences and the future. Teach as you would an adult, respecting their reasoning.

Gross motor milestone — when does an infant roll over?

Rolls front-to-back around 4 months and back-to-front around 5–6 months.

Gross motor milestone — when does an infant sit unsupported?

Sits without support around 6–8 months.

Gross motor milestone — when does an infant crawl and pull to stand?

Crawls and pulls to a stand around 9 months; cruises (walks holding furniture) around 10 months.

Gross motor milestone — when does a child walk independently?

Most children walk alone around 12 months (range 9–15 months). Walking by 18 months at the latest.

Fine motor milestone — pincer grasp

A neat pincer grasp (thumb-to-finger) develops around 9–10 months — important for self-feeding and a choking-hazard teaching point.

Language milestone — first words and vocabulary

Babbles at ~6 months, says first word ~12 months, has ~50 words and two-word phrases by 2 years; speech is ~75% intelligible by age 3.

Social smile — when does it appear?

A responsive social smile appears around 2 months of age — an early developmental marker.

When does stranger/separation anxiety peak?

Stranger anxiety begins ~6–8 months and separation anxiety peaks in toddlers (~10–18 months). Encourage rooming-in and consistent caregivers during hospitalization.

Hospitalized toddler — three phases of separation anxiety

Protest (crying, clinging), Despair (withdrawn, sad, hopeless), and Detachment/Denial (superficial adjustment). Despair and detachment can be mistaken for 'settling in.'

When can an infant start solid (complementary) foods?

Around 6 months, when the infant can sit with support and has good head control. Introduce single-ingredient foods one at a time, a few days apart, to identify allergies.

Foods to avoid in the first year

No honey (botulism risk) before 12 months, no cow's milk as a main drink before 12 months, and avoid choking hazards (whole grapes, nuts, hot dogs, popcorn, hard candy).

Safe-sleep guidance to prevent SIDS

Place the infant on their BACK to sleep, on a firm flat surface, alone, with no soft bedding, pillows, bumpers, or toys. Room-share without bed-sharing; avoid overheating and smoke exposure.

Car seat guidance — rear-facing

Use a rear-facing seat until the child reaches the seat's maximum height/weight limit — at least to age 2 and ideally longer. Rear-facing best protects the head, neck, and spine in a crash.

Car seat progression after rear-facing

Forward-facing with a 5-point harness next, then a belt-positioning booster until the seat belt fits properly (usually 4'9" and 8–12 years), then a lap-and-shoulder belt. Children under 13 ride in the back seat.

Leading cause of death in children over 1 year

Unintentional injury (accidents) — especially motor-vehicle crashes and drowning. Injury prevention/anticipatory guidance is a major Health Promotion focus.

Top injury-prevention focus by age — infant

Falls, suffocation/aspiration (small objects), and motor-vehicle safety. Never leave an infant unattended on a high surface; keep small objects out of reach.

Top injury-prevention focus by age — toddler

Drowning, poisoning, and falls — toddlers are mobile and curious. Secure water, lock up medications/cleaners, and use the Poison Control number (1-800-222-1222).

Drowning prevention guidance

Constant 'touch supervision' of young children near water, four-sided isolation pool fencing with self-latching gates, life jackets, and swim lessons. Drowning is silent and fast.

When is a toddler developmentally ready for toilet training?

Usually 18–24 months, when the child can walk, stay dry ~2 hours, pull pants up/down, follow simple instructions, and shows interest. Readiness — not a fixed age — guides training.

Recommended screen-time guidance (AAP)

Avoid screens (other than video-chat) under 18 months; limit to high-quality programming with a caregiver for ages 18–24 months; ~1 hour/day of high-quality media for ages 2–5.

Developmental surveillance vs. screening

Surveillance is the ongoing process of monitoring development at every visit; screening uses a validated tool (e.g., ASQ, M-CHAT for autism at 18 and 24 months) at recommended ages. Both catch delays early.

Recommended exclusive breastfeeding duration

Exclusive breastfeeding for about the first 6 months, continuing alongside complementary foods to 12 months and beyond as mutually desired.

Vitamin supplementation for breastfed infants

Exclusively/partially breastfed infants need 400 IU/day of vitamin D starting in the first days of life. Iron supplementation is started ~4 months in exclusively breastfed infants.

Vaccines given at birth

Hepatitis B (first dose). The newborn hepatitis B vaccine is given before hospital discharge.

Vaccines at the 2-month well visit

DTaP, IPV (polio), Hib, PCV (pneumococcal), RV (rotavirus, oral), and the second hepatitis B (per schedule). The first big round of primary-series vaccines.

When is MMR first given?

The first dose of MMR (measles, mumps, rubella) is given at 12–15 months — it is a live vaccine, so it waits until maternal antibodies wane. Second dose at 4–6 years.

When is varicella (chickenpox) vaccine given?

First dose at 12–15 months, second dose at 4–6 years — a live vaccine, like MMR.

Contraindications to live vaccines (MMR, varicella)

Severe immunosuppression, pregnancy, and a prior anaphylactic reaction to the vaccine. A mild illness or low-grade fever is NOT a contraindication.

When is the influenza vaccine recommended in children?

Annually for everyone 6 months and older. Children under 9 receiving flu vaccine for the first time need two doses 4 weeks apart.

When is HPV vaccine recommended?

Routinely at age 11–12 (can start at 9). Two doses if started before age 15; three doses if started at 15 or older.

Tdap booster timing in adolescence

A single Tdap booster at age 11–12, then Td or Tdap every 10 years thereafter.

Meningococcal vaccine schedule

MenACWY at 11–12 years with a booster at 16; MenB may be given to teens 16–18 based on shared decision-making.

Asthma — quick-relief vs. controller medications

Quick-relief (rescue) = short-acting beta-2 agonist (albuterol) for acute symptoms. Controller (long-term) = inhaled corticosteroid (the cornerstone), taken daily to prevent inflammation — not for an acute attack.

Why rinse the mouth after an inhaled corticosteroid?

To prevent oral thrush (candidiasis) and hoarseness. Using a spacer with a metered-dose inhaler also improves delivery and reduces deposition in the mouth.

Signs of impending respiratory failure in pediatric asthma

A 'silent chest' (no wheezing because air movement is too poor to make sound), worsening fatigue, decreasing level of consciousness, and rising CO₂ — ominous, not reassuring. Wheezing that stops can mean worsening, not improvement.

Bronchiolitis / RSV — most common cause and treatment

Respiratory syncytial virus (RSV) is the leading cause; it is most serious in infants under 2. Treatment is supportive — oxygen, suctioning, hydration, and monitoring. Antibiotics do not help a viral infection.

Croup — classic presentation and care

Viral laryngotracheobronchitis with a barky 'seal-like' cough, inspiratory stridor, and hoarseness, usually worse at night. Mild croup: cool mist/humidified air and calm the child; moderate-severe: corticosteroids (dexamethasone) and nebulized epinephrine.

Epiglottitis — the 4 D's and what NOT to do

Drooling, Dysphagia, Dysphonia, and Distress — a child who is tripoding, drooling, and toxic-appearing. It is an airway emergency: do NOT inspect the throat or place anything in the mouth; keep the child calm and prepare for emergent intubation. Hib vaccine made it rare.

Cystic fibrosis — key respiratory management

Chest physiotherapy and airway clearance, bronchodilators and dornase alfa, and aggressive treatment of pulmonary exacerbations. Thick secretions cause chronic infection — give CPT BEFORE meals to avoid vomiting, or well after.

Cystic fibrosis — nutrition and pancreatic enzymes

Give pancreatic enzyme replacement (PERT) with every meal and snack, a high-calorie/high-protein diet, and fat-soluble vitamins (A, D, E, K). CF impairs fat absorption, causing steatorrhea and poor growth.

Tonsillectomy — the priority postoperative concern

Hemorrhage. Watch for FREQUENT SWALLOWING, restlessness, and tachycardia — early signs of bleeding. Avoid red/brown fluids, coughing, straws, and throat clearing. Bleeding risk peaks at surgery and again 5–10 days later when scabs slough.

Position for an unconscious child after tonsillectomy

Side-lying or prone to facilitate drainage of secretions and blood and protect the airway.

Type 1 diabetes — three classic 'polys'

Polyuria (excessive urination, often new bedwetting), Polydipsia (excessive thirst), and Polyphagia (excessive hunger) with weight loss — the hallmark new-onset presentation in children.

Diabetic ketoacidosis (DKA) in a child — recognition

Hyperglycemia with ketosis and metabolic acidosis: fruity (acetone) breath, Kussmaul (deep, rapid) respirations, abdominal pain, dehydration, and altered consciousness. A medical emergency.

DKA treatment order in a child

Isotonic IV fluids FIRST to correct dehydration, then a regular insulin infusion, with careful potassium monitoring/replacement (insulin shifts K⁺ into cells). Lower glucose slowly to avoid cerebral edema, the most feared pediatric complication.

Hypoglycemia in a child — signs and treatment

Shakiness, sweating, pallor, irritability/confusion, tachycardia, and hunger. Treat a conscious child with 15 g fast-acting carbohydrate (e.g., 4 oz juice), recheck in 15 minutes; give glucagon if unresponsive or unable to swallow.

Anaphylaxis — first-line treatment

Intramuscular epinephrine into the lateral thigh (vastus lateralis) is the first and most important treatment — give it immediately. Then position, give oxygen, IV fluids, and adjuncts (antihistamines, steroids) and prepare for a possible second dose.

Febrile seizure — typical features and parent teaching

A generalized seizure with fever in a child 6 months–5 years, usually brief (<15 min) and benign. Protect the airway, keep the child safe (do not restrain or put anything in the mouth), and treat the fever. Most children do not develop epilepsy.

Bacterial meningitis — classic signs in a child

Fever, severe headache, nuchal rigidity (stiff neck), photophobia, altered consciousness, and a petechial/purpuric rash with meningococcus. Positive Kernig's and Brudzinski's signs. In infants, signs are subtle: poor feeding, irritability, bulging fontanelle.

Meningitis — key nursing priority

Institute droplet isolation immediately on suspicion (for bacterial/meningococcal), give antibiotics promptly after cultures, and monitor neuro status and for increased ICP. A quiet, low-stimulation environment reduces seizure risk.

Sickle cell — vaso-occlusive crisis management

Pain crisis from sickled cells occluding vessels. Priorities: Hydration (IV/oral fluids), Oxygenation, pain control (often opioids), and warmth. Avoid cold, dehydration, and hypoxia, which trigger sickling. (Think 'HOP' — hydration, oxygen, pain.)

Acute lymphoblastic leukemia (ALL) — common presentation

The most common childhood cancer; presents with fatigue/pallor (anemia), bruising/petechiae/bleeding (thrombocytopenia), and fever/infection (neutropenia), plus bone pain and lymphadenopathy from marrow infiltration.

Neutropenic precautions for a child on chemotherapy

Private room, strict hand hygiene, no fresh flowers/plants, avoid raw fruits/vegetables and crowds, no live vaccines, and monitor for any fever. In neutropenia, fever is an emergency — there may be few other signs of infection.

Wilms tumor (nephroblastoma) — critical nursing rule

Do NOT palpate the abdomen — palpation can rupture the encapsulated tumor and spread cancer cells. Post a sign at the bedside. It presents as a firm, nontender abdominal mass, usually in toddlers.

Intussusception — classic sign

Telescoping of the bowel causing colicky pain with drawing up of the legs and 'currant jelly' (blood and mucus) stools, often with a sausage-shaped mass. An air or contrast enema can be both diagnostic and therapeutic.

Pyloric stenosis — classic sign

Projectile, nonbilious vomiting in a hungry infant (~3–6 weeks), with an olive-shaped mass in the right upper quadrant and visible peristaltic waves. Causes hypochloremic, hypokalemic metabolic alkalosis from vomiting.

Tetralogy of Fallot — 'tet spell' management

A hypercyanotic spell: place the infant in the knee-chest position (older child squats) to increase systemic vascular resistance and improve pulmonary blood flow, give oxygen, and calm the child. The four defects: VSD, overriding aorta, pulmonary stenosis, RV hypertrophy.

Coarctation of the aorta — classic finding

Higher blood pressure and bounding pulses in the upper extremities (arms) with lower BP and weak/absent femoral (lower) pulses. Suspect it when arm-leg BP differs markedly.

Kawasaki disease — diagnostic features and key complication

Fever ≥5 days plus conjunctivitis, rash, cervical lymphadenopathy, mucosal changes (strawberry tongue, cracked lips), and extremity changes (red, swollen, peeling). The feared complication is coronary artery aneurysm; treat with IVIG and aspirin.

Gastroenteritis / acute diarrhea — first-line treatment

Oral rehydration solution (ORS) is first-line for mild-to-moderate dehydration; resume a normal age-appropriate diet early. Avoid sugary drinks and the old 'BRAT' diet as the sole plan. Use IV fluids for severe dehydration or persistent vomiting.

Acute glomerulonephritis (post-streptococcal) — presentation

Follows a strep infection by 1–2 weeks: tea/cola-colored (hematuria) urine, periorbital edema, hypertension, and decreased urine output. Monitor BP, fluid balance, and daily weight.

Nephrotic syndrome — classic features

Massive proteinuria, hypoalbuminemia, generalized edema (often periorbital and dependent), and hyperlipidemia. Managed with corticosteroids; monitor weight, edema, and for infection.

Pediatric medication dosing — the foundational principle

Pediatric doses are weight-based (mg/kg), calculated on an accurate, current weight in kilograms. Always verify the dose is within the safe range and does not exceed the maximum adult dose.

Safe-dose calculation — how to check an order

Multiply the recommended mg/kg/dose (or /day) by the child's weight in kg to get the safe range, then compare it to the ordered dose. If the order falls outside the range, hold it and clarify — this prevents a 10-fold error.

Acetaminophen dosing and toxicity antidote

10–15 mg/kg/dose every 4–6 hours, not exceeding the daily maximum. Overdose causes hepatotoxicity; the antidote is N-acetylcysteine (NAC).

Ibuprofen — pediatric use limit

10 mg/kg/dose every 6–8 hours for children 6 months and older. Avoid in dehydration or renal impairment; not for infants under 6 months.

Why are children more vulnerable to medication errors and toxicity?

Immature organ function (hepatic/renal), a higher body-water percentage, and a smaller margin between therapeutic and toxic doses. Tiny calculation errors have large effects, so double-check high-alert drugs.

Two patient identifiers in pediatrics

Use two identifiers (name and date of birth) by checking the ID band and confirming with the caregiver — never rely on a child's stated name or a parent's verbal report alone.

Maintenance fluid calculation — the 4-2-1 rule

Hourly maintenance fluids: 4 mL/kg for the first 10 kg, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each kg above 20. Example: a 25-kg child = 40 + 20 + 5 = 65 mL/hr.

Atraumatic care — definition

Care that minimizes or eliminates the physical and psychological distress of healthcare for children and families — preventing/minimizing separation, promoting a sense of control, and minimizing pain (e.g., topical anesthetic before IV, clustering painful procedures).

Family-centered care — two core concepts

Enabling (creating opportunities for families to use their abilities) and empowering (families keeping control and a sense of competence). Care is a partnership that respects family strengths, choices, and culture.

Why involve the family in a hospitalized child's care?

The family is the constant in the child's life. Rooming-in, parental presence during procedures, and shared decision-making reduce the child's fear and separation anxiety and improve outcomes and satisfaction.

Preparing a TODDLER for a procedure

Prepare just before the procedure (limited time concept), keep explanations very brief and concrete, allow comfort objects, expect resistance, and let the parent stay. Toddlers fear separation most.

Preparing a PRESCHOOLER for a procedure

Use simple, concrete words and avoid frightening/literal terms ('dye,' 'cut,' 'put you to sleep'); allow medical play and choices; reassure that the procedure is not a punishment (magical thinking). Prepare 1–3 days ahead.

Preparing a SCHOOL-AGE child for a procedure

Give clear, factual explanations with simple diagrams or models, prepare days in advance, allow questions, and offer choices to give a sense of control. They fear loss of control and bodily harm.

Preparing an ADOLESCENT for a procedure

Provide detailed information, respect privacy and body image, include them in decisions, and allow time alone with the provider. They fear loss of independence, altered appearance, and being different from peers.

Therapeutic play vs. play in the pediatric setting

Therapeutic play uses dolls, puppets, and medical equipment to help a child express feelings and understand/cope with procedures. Play is essential — it is the 'work' of childhood and a key assessment and coping tool.

How does a preschooler typically view illness and hospitalization?

As a punishment for misbehavior (magical thinking) and with fear of bodily mutilation. Reassure the child that they did nothing wrong and use non-threatening explanations.

Age-appropriate communication — infants

Use a soft, soothing voice and gentle touch; keep the caregiver in view; perform exams toe-to-head, saving distressing parts (ears, mouth) for last.

Best assessment order for a young child

Do the least-invasive, least-distressing parts first (observation, heart and lung auscultation while calm) and save the most distressing (ears, throat) for last. Quiet observation before touching yields the most information.

Tanner stages — what do they describe?

Sexual Maturity Rating (Tanner stages 1–5) describes the progression of secondary sex characteristics in puberty — used to assess developmentally appropriate progression in adolescents.

Confidentiality with adolescents — general rule

Provide time alone with the adolescent and assure confidentiality for sensitive topics, but explain its limits — you must break it for safety concerns such as suicidal/homicidal ideation or abuse. State law governs minors' consent for certain services.

Mandatory reporting — when must a pediatric nurse report?

Nurses are mandated reporters who must report reasonable suspicion of child abuse or neglect to child-protective authorities — suspicion is enough; proof is not required, and reporting in good faith is legally protected.

Signs that should raise suspicion of child abuse

Injuries inconsistent with the history or the child's developmental stage, patterned/multiple injuries in various healing stages, delayed care, and a history that changes. Also: fearful or withdrawn behavior. Document objectively.

Informed consent for a minor — who provides it?

Generally a parent or legal guardian gives informed consent for a minor; the child gives developmentally appropriate ASSENT. Exceptions: emancipated minors and 'mature minor' consent for specific services (varies by state law).

Assent vs. consent in pediatrics

Consent is the legal permission given by the parent/guardian. Assent is the child's affirmative agreement to participate, sought from school-age children and adolescents — respecting their developing autonomy even when they cannot legally consent.

Using an interpreter for a family with limited English

Use a trained, qualified medical interpreter (in person or via phone/video) — not a family member, and especially not a child. This ensures accurate, confidential, legally valid communication and consent.

The 'rights' of medication administration

Right patient, drug, dose, route, time — plus right documentation, reason, response, and to refuse. In pediatrics, the weight-based dose check is built into the 'right dose.'

Delegation to unlicensed assistive personnel (UAP)

Delegate only stable, predictable tasks within the UAP's scope (e.g., vital signs on a stable child, hygiene). The nurse cannot delegate assessment, teaching, evaluation, or judgment, and remains accountable.

Evidence-based practice (EBP) — what is it?

Integrating the best current research evidence with clinical expertise and the patient's/family's values and preferences to guide care decisions — the basis for updating unit practices and protocols.

Quality improvement (QI) vs. research

QI applies data-driven methods (e.g., PDSA cycles) to improve a local process or outcome (like reducing CLABSI). Research aims to generate new generalizable knowledge and requires IRB oversight and consent.

The nurse's role as a child/family advocate

Advocacy means acting on the child's and family's behalf — ensuring their voice is heard, questioning unsafe orders, protecting rights, facilitating access to resources, and supporting informed decisions, even amid disagreement.

SBAR — what is it used for?

Situation, Background, Assessment, Recommendation — a structured handoff/communication tool that standardizes nurse-to-provider and shift report, reducing errors during transitions of care.

Pediatric early warning systems (PEWS)

A scoring tool tracking behavior, cardiovascular, and respiratory status to detect early clinical deterioration in a hospitalized child and prompt timely escalation before an arrest.

First action when a child shows signs of deterioration

Perform a rapid assessment (airway, breathing, circulation, disability), call for help/activate the rapid-response or PEWS pathway, and stay with the child. Early recognition and escalation prevent cardiopulmonary arrest.

Most pediatric cardiac arrests — underlying cause

Respiratory in origin (hypoxia), unlike adults (usually cardiac). This is why airway and breathing are the priority and why early recognition of respiratory distress is lifesaving in children.

Pediatric pain — a common misconception to avoid

Infants and children DO feel pain and may under-report or be unable to verbalize it. Assess pain regularly with an age-appropriate tool, believe the child, and treat pain proactively — undertreatment is a documented problem.

Nonpharmacologic pain management in children

Distraction, guided imagery, swaddling/positioning, nonnutritive sucking and sucrose for infants, comfort holds, music, and parental presence — used alongside (not instead of) appropriate analgesia.

Eczema (atopic dermatitis) — key management

Keep skin hydrated: lukewarm baths, fragrance-free moisturizers applied immediately after bathing ('soak and seal'), topical corticosteroids for flares, identify/avoid triggers, and keep nails short to reduce scratching and infection.

Hirschsprung disease — classic newborn sign

Failure to pass meconium within 48 hours, abdominal distension, and bilious vomiting. Aganglionic bowel cannot propel stool. Watch for enterocolitis (the dangerous complication: fever, explosive diarrhea, distension).

Gastroesophageal reflux (GER) in infants — conservative care

Small frequent feeds, thickened feeds if advised, frequent burping, and keeping the infant upright after feeds. Most physiologic reflux resolves by ~12 months; GERD (with poor growth or complications) needs evaluation.

Bronchopulmonary dysplasia / chronic lung disease of prematurity

Chronic lung injury in former premature infants on prolonged oxygen/ventilation. Care focuses on oxygenation, growth/nutrition (high calorie needs), preventing respiratory infection (RSV prophylaxis), and developmental follow-up.

Down syndrome — common associated findings to monitor

Congenital heart defects (especially AV canal), hypotonia, feeding difficulty, hypothyroidism, atlantoaxial instability, hearing/vision issues, and developmental delay. Provide family support and early-intervention referral.

Cerebral palsy — nursing focus

A nonprogressive motor disorder from early brain injury. Focus on mobility/positioning, nutrition and safe swallowing (aspiration risk), managing spasticity and contractures, communication, and maximizing function with the interdisciplinary team.

Autism spectrum disorder — care adaptations

Maintain routines, reduce sensory overload, use clear concrete communication and visual supports, allow extra time and transitions warnings, and involve caregivers who know the child's cues. M-CHAT screening occurs at 18 and 24 months.

Lead poisoning — screening and effects

Screen high-risk children at 12 and 24 months. Lead causes neurodevelopmental harm (cognitive/behavioral problems) and anemia. Reduce exposure (old paint, dust); chelation therapy for high levels.

Iron-deficiency anemia in toddlers — common cause and teaching

Often from excessive cow's milk intake (limit to ~16–24 oz/day) crowding out iron-rich foods. Give iron with vitamin C (juice) to enhance absorption, between meals; expect dark stools; keep iron locked away (overdose is toxic).

Administering oral medication to a young child — safe technique

Use an oral syringe for accuracy, aim toward the side/back of the cheek, give slowly to prevent aspiration, do not mix medication into a full bottle/essential food, and never call medicine 'candy.'

IM injection site for infants

The vastus lateralis (anterolateral thigh) is the preferred IM site for infants and young children — it is large and away from major nerves/vessels. The deltoid is used in older children/adolescents.

Apparent life-threatening event / BRUE — nursing role

A Brief Resolved Unexplained Event in an infant; provide reassurance, thorough assessment to rule out serious causes, education, and (when indicated) CPR teaching for caregivers and follow-up.

Failure to thrive — nursing assessment focus

Plot growth on standardized charts over time (weight, length, head circumference), assess feeding/intake, caregiver-child interaction, and psychosocial factors. Look for organic and non-organic causes; involve the team.

Growth chart percentiles — what's concerning?

A single point matters less than the TREND. Crossing two major percentile lines (up or down), a flattening curve, or being below the 5th/above the 95th warrants evaluation. Plot weight-for-length/BMI for proportionality.

Dehydration severity — mild, moderate, severe (by weight loss)

Mild ≈ 3–5% body-weight loss, moderate ≈ 6–9%, severe ≈ 10% or more. Severe dehydration (lethargy, very prolonged cap refill, weak pulses, hypotension) needs immediate IV resuscitation.

IV fluid bolus for pediatric shock/dehydration

An isotonic crystalloid bolus (normal saline or lactated Ringer's) of 20 mL/kg given rapidly, reassessing perfusion after each bolus and repeating as needed.

Bacterial vs. viral fever workup in a young infant

Fever (≥100.4°F / 38°C) in an infant under ~2–3 months is treated urgently — a full sepsis workup is often done because young infants can have serious bacterial infection with few localizing signs.

Cleft lip/palate — feeding priority

Feeding and preventing aspiration are priorities: use specialized cleft nipples/bottles, hold upright, burp frequently, and support bonding. Post-op cleft-lip repair: protect the suture line (no objects in mouth, elbow restraints, avoid crusts).

Developmental dysplasia of the hip — newborn signs

Ortolani and Barlow maneuvers (clunk on abduction/adduction), asymmetric thigh/gluteal folds, and limited hip abduction. Treated early with a Pavlik harness to keep hips flexed and abducted.

Scoliosis screening in adolescents

Use the Adams forward-bend test, observing for rib hump and shoulder/hip asymmetry; a scoliometer confirms the curve. Screening occurs in early adolescence during the growth spurt.

Bryant's / skin traction — nursing care

Maintain proper alignment and counter-traction, keep weights hanging freely off the floor, perform frequent neurovascular checks (the 6 P's), and provide skin/pin care to prevent breakdown and infection.

Cast care teaching for a child

Elevate the limb, apply ice early, do frequent neurovascular checks (color, warmth, movement, sensation, capillary refill, pulses), keep the cast dry, never put objects inside it, and report increasing pain, numbness, or foul odor.

Burns in children — fluid resuscitation principle

Children have a higher body-surface-to-mass ratio, so they lose fluid and heat fast and need careful weight-based fluid resuscitation. Use the modified rule of nines/Lund-Browder for pediatric body proportions (larger head).

Poisoning — immediate steps

Call Poison Control (1-800-222-1222), assess airway/breathing/circulation, identify the substance and amount/time, and follow their guidance. Do NOT routinely induce vomiting; ipecac is no longer recommended.

Acetaminophen poisoning — what to monitor

Liver function (the toxic effect is hepatotoxicity). Give N-acetylcysteine (NAC) per the Rumack-Matthew nomogram based on the timed acetaminophen level.

Status epilepticus — emergency management

A seizure lasting >5 minutes or recurring without recovery. Protect the airway, give oxygen, position safely, and administer a benzodiazepine (lorazepam/midazolam/diazepam) as the first-line drug. Do not restrain or force anything into the mouth.

Spina bifida (myelomeningocele) — pre-op nursing care

Protect the exposed sac: position prone, cover with sterile moist (saline) dressing, prevent infection and trauma, monitor for latex allergy (high risk), and assess neuro/motor function below the lesion.

Hydrocephalus / VP shunt — signs of malfunction or infection

Increased ICP signs: bulging fontanelle and increasing head circumference (infant), headache, vomiting, irritability, altered consciousness, and 'sunsetting' eyes. Fever suggests shunt infection — report promptly.

Hemophilia — bleeding episode management

Replace the deficient clotting factor, apply the RICE measures (Rest, Ice, Compression, Elevation) for bleeds, and avoid IM injections, aspirin/NSAIDs, and contact sports. Watch for hemarthrosis (joint bleeds).

Immune thrombocytopenic purpura (ITP) — care

Low platelets cause petechiae, bruising, and bleeding. Implement bleeding precautions (soft toothbrush, no contact sports/IM injections), monitor platelet counts, and watch for signs of intracranial bleeding.

Respiratory distress vs. respiratory failure

Distress = increased work of breathing with compensation (tachypnea, retractions, flaring). Failure = the body can no longer compensate (bradypnea, decreased effort, altered consciousness, cyanosis, rising CO₂) — an emergency requiring support.

Oxygen delivery in young children — comfort tips

Use the least invasive effective method, involve the caregiver, allow a position of comfort, and use distraction. A frightened, crying child increases oxygen demand — keeping the child calm IS treatment.

Newborn screening — what does it detect?

A heel-stick blood test (24–48 hr of age) screening for metabolic, genetic, and endocrine disorders (e.g., PKU, congenital hypothyroidism, sickle cell, CF) plus hearing and critical congenital heart disease (pulse oximetry).

Phenylketonuria (PKU) — dietary management

A low-phenylalanine diet for life: avoid high-protein foods and aspartame; use special formula. Untreated PKU causes intellectual disability — early diagnosis via newborn screening prevents it.

Congenital hypothyroidism — why early treatment matters

Thyroid hormone is essential for brain growth; untreated congenital hypothyroidism causes irreversible intellectual disability. Newborn screening enables early levothyroxine therapy to ensure normal development.

Otitis media — risk factors and prevention teaching

Common in young children due to short, horizontal eustachian tubes. Reduce risk by avoiding bottle-propping/feeding while supine, eliminating smoke exposure, breastfeeding, and keeping vaccines (PCV) current.

Strabismus — why early treatment matters

Misaligned eyes can cause amblyopia ('lazy eye') and permanent vision loss if not corrected during the critical period of visual development. Treatment includes patching, corrective lenses, or surgery.

Adolescent risk-screening — the HEEADSSS assessment

Home, Education/employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety — a psychosocial interview framework for adolescents, conducted confidentially.

Pertussis (whooping cough) — recognition and infection control

Paroxysmal coughing with an inspiratory 'whoop' and post-tussive vomiting; most dangerous in young infants (apnea). Use droplet precautions, give macrolide antibiotics, and protect infants via maternal Tdap and cocooning.

Measles — recognition and isolation

High fever, the 'three C's' (cough, coryza, conjunctivitis), Koplik spots, and a descending maculopapular rash. Highly contagious — use airborne precautions. Prevented by MMR vaccine.

Varicella (chickenpox) — isolation and contagious period

Use airborne and contact precautions. The child is contagious from ~1–2 days before the rash until all lesions have crusted over. Avoid aspirin (Reye syndrome risk).

Reye syndrome — key association

Acute encephalopathy and liver dysfunction linked to aspirin use during a viral illness (flu, varicella). Never give aspirin to children for fever/viral illness — use acetaminophen or ibuprofen instead.

Fifth disease (erythema infectiosum)

Parvovirus B19 causing a 'slapped-cheek' facial rash followed by a lacy body rash. Usually mild; the child is most contagious BEFORE the rash, so isolation after the rash appears is not needed for healthy children.

Hand-foot-and-mouth disease

Coxsackievirus causing fever and painful vesicles on the hands, feet, and in the mouth. Supportive care; ensure hydration (mouth sores hurt). Highly contagious via contact — emphasize hand hygiene.

Roseola (exanthem subitum) — classic pattern

High fever for 3–4 days that abruptly resolves, FOLLOWED by a pink maculopapular rash. The rash appears as the fever breaks; risk of febrile seizure during the fever phase.

Standard precautions — when to use

With ALL patients regardless of diagnosis: hand hygiene and using PPE when contact with blood/body fluids is anticipated. The foundation of infection prevention.

Hand hygiene — the single most important infection-control measure

Wash hands or use alcohol-based hand rub before and after every patient contact. Soap and water are required for visibly soiled hands and for spore-forming organisms like C. difficile.

RSV / bronchiolitis — infection control

Contact precautions (and droplet) — RSV spreads via respiratory secretions and contaminated surfaces. Cohort patients, emphasize hand hygiene, and protect high-risk infants.

Failure to pass urine / oliguria in a child — concern

Decreased urine output signals dehydration, poor perfusion, or renal impairment. Reassess hydration, perfusion, and intake/output, and escalate — it is an early warning of deterioration.

Nasogastric tube placement verification in children

Check pH of aspirate (gastric is acidic) and measured length, and confirm with X-ray when required by policy — auscultation of an air bolus alone is not a reliable method.

Pediatric obesity — screening and counseling

Calculate and plot BMI percentile annually; obesity is BMI ≥95th percentile for age/sex. Counsel on '5-2-1-0' (5 fruits/veggies, <2 hr screen, 1 hr activity, 0 sugary drinks) and family-based lifestyle change.

Anticipatory guidance — what is it?

Proactive, age-specific teaching to parents about what to expect next in the child's development, nutrition, safety, and behavior — a core Health Promotion activity at well-child visits.

Well-child visit schedule (first 2 years)

Visits at birth, 3–5 days, then 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months, then annually. Each combines growth/development surveillance, immunizations, screening, and anticipatory guidance.

Temper tantrums — anticipatory guidance for toddlers

Tantrums are a normal expression of frustration and the drive for autonomy. Advise parents to stay calm, ensure safety, ignore attention-seeking tantrums, avoid giving in, and offer limited choices to reduce power struggles.

Sun safety teaching for children

Keep infants under 6 months out of direct sun; for older children use shade, protective clothing, hats, and broad-spectrum SPF 30+ sunscreen reapplied every 2 hours. Sunburns in childhood raise lifetime skin-cancer risk.

Dental health teaching

Wipe gums in infancy; brush with a smear (under 3) or pea-size (3–6) of fluoride toothpaste twice daily; first dental visit by age 1; avoid bottle in bed (early-childhood caries / 'bottle mouth').

Adolescent leading cause of death and screening implication

Unintentional injury (especially motor vehicle), then suicide and homicide. Screen for risky behaviors, depression/suicide, substance use, and seat-belt/helmet use confidentially (HEEADSSS).

Type 1 diabetes — sick-day rules teaching

Continue insulin even when not eating, check blood glucose and ketones more often, maintain hydration, and have a plan for when to call the provider. Illness raises glucose and DKA risk — never stop insulin.

Insulin types — onset peak duration (rapid vs. long-acting)

Rapid-acting (lispro/aspart): onset ~15 min, peak ~1 hr — given with meals. Long-acting (glargine/detemir): peakless basal coverage ~24 hr. Match administration timing to onset/peak to prevent hypoglycemia.

Nephrotic syndrome — daily nursing monitoring

Daily weight, abdominal girth, strict intake/output, edema assessment, urine protein dipstick, and infection surveillance (these children are immunosuppressed by steroids and protein loss).

Sickle cell — preventive care/teaching

Daily penicillin prophylaxis in young children, keep vaccines current (including pneumococcal/meningococcal), maintain hydration, avoid extreme cold/heat and high altitude, and seek care for fever or pain crisis.

Acute otitis media — pain and antibiotic teaching

Give analgesia for pain; many cases are observed without immediate antibiotics ('watchful waiting'). If antibiotics (amoxicillin first-line) are prescribed, complete the full course. Recurrent infections may need ENT referral.

Urinary tract infection in young children — presentation

Often nonspecific: fever without a source, irritability, poor feeding, vomiting, or foul-smelling urine in infants; dysuria/frequency in older children. Obtain a clean catch or catheter specimen before antibiotics.

Constipation/encopresis in children — first-line management

Disimpaction if needed, then maintenance with osmotic laxatives (e.g., polyethylene glycol), increased fiber and fluids, scheduled toilet sitting, and behavioral support. Address fear of painful stooling.

Appendicitis in a child — classic presentation and warning

Periumbilical pain migrating to the right lower quadrant (McBurney's point), anorexia, nausea, low-grade fever, and rebound tenderness. SUDDEN relief of pain may signal perforation — an emergency, not improvement.

Pediatric postoperative care priorities

Airway and respiratory status, pain control with age-appropriate assessment, hydration/IO, monitoring the surgical site, early activity as allowed, and atraumatic, developmentally appropriate care with the family present.

Why are infants prone to hypothermia?

A large body-surface-to-mass ratio, thin skin, and limited subcutaneous fat. Keep newborns/infants warm (skin-to-skin, radiant warmer, hat); cold stress increases oxygen and glucose demand.

Neonatal jaundice — physiologic vs. pathologic timing

Physiologic jaundice appears AFTER 24 hours and peaks ~3–5 days. Jaundice within the first 24 hours of life is PATHOLOGIC and needs urgent evaluation. Treat significant hyperbilirubinemia with phototherapy.

Phototherapy nursing care

Maximize skin exposure, protect the eyes with shields, monitor temperature and hydration (increased insensible losses), reposition frequently, and monitor bilirubin levels. Expect loose green stools.

Bronchiolitis — when to suspect deterioration

Worsening retractions, apnea (especially in young/premature infants), poor feeding/dehydration, persistent hypoxia, and lethargy. Apnea can be the first sign in young infants — admit and monitor.

Asthma action plan — green/yellow/red zones

Green = doing well (controller as scheduled); Yellow = caution/symptoms (add rescue, follow plan); Red = medical alert (rescue + seek emergency care). Teach families to recognize and act on each zone.

Peak expiratory flow monitoring in asthma

Tracks airflow at home; a personal best is established, then readings are compared (green ≥80%, yellow 50–79%, red <50%). A falling peak flow can precede symptoms and guide the action plan.

Pediatric dosing of epinephrine auto-injector

0.15 mg for children ~15–30 kg and 0.3 mg for ≥30 kg, injected into the lateral thigh. Teach families to use it at the first sign of anaphylaxis and to call emergency services and seek care afterward.

How to weigh a child for accurate dosing

Weigh in kilograms on a calibrated scale, ideally without heavy clothing/diaper, at admission and routinely. Do not use a stated or estimated weight for medication calculation when an accurate weight is obtainable.

Therapeutic communication with children — general principles

Get on the child's eye level, use simple honest language, be truthful about whether something will hurt, give choices when possible, allow the child to handle equipment, and include the caregiver.

Restraints in pediatrics — guiding principle

Use the least restrictive method for the shortest time, only when necessary for safety, with an order and frequent monitoring. Prefer therapeutic holding, distraction, and parental presence over physical restraint.

Comfort positioning vs. restraint for procedures

Comfort/therapeutic holding (e.g., upright on a parent's lap, a 'hug hold') keeps a child secure and calm and is preferred to supine restraint — it reduces fear and improves cooperation (atraumatic care).

Discharge teaching — the teach-back method

Ask the caregiver to explain or demonstrate the instructions in their own words to confirm understanding, rather than asking 'do you understand?' This verifies learning and is a facilitation-of-learning best practice.

End-of-life / palliative care for a child

Focus on comfort, symptom management, honest developmentally appropriate communication, family support, honoring wishes and culture, and involving palliative care/child life early — care of the family is care of the child.

A child's concept of death by age

Preschoolers see death as temporary/reversible (magical thinking); school-age children understand it is permanent and may personify it; adolescents understand it abstractly and universally. Tailor communication accordingly.

Immunization documentation and consent

Provide the Vaccine Information Statement (VIS), obtain consent, document lot number, site, route, date, and the VIS edition date. Report adverse events to VAERS.

Cultural humility in pediatric care

Recognize and respect a family's beliefs, practices, and language; ask rather than assume; incorporate acceptable cultural practices; and use trained interpreters. Avoid imposing personal values.

When to hold a vaccine vs. proceed

Proceed with mild illness, low-grade fever, or current antibiotics. Defer for moderate-to-severe acute illness; permanently avoid only with a true contraindication (e.g., anaphylaxis to a component, severe immunosuppression for live vaccines).

Apgar score — what and when

Assessed at 1 and 5 minutes after birth: Appearance, Pulse, Grimace, Activity, Respiration, each 0–2 (total 0–10). 7–10 reassuring; <7 needs intervention/reassessment. It guides resuscitation needs, not long-term outcome.

Why count a young child's respirations before disturbing them?

Crying and agitation falsely raise the rate. Count respirations (and ideally heart rate) while the child is quiet/asleep, observing the abdomen in infants, for an accurate baseline.

Bronchodilator before or after chest physiotherapy in CF?

Bronchodilators and mucolytics (e.g., dornase alfa) are given BEFORE airway clearance/CPT to open airways and loosen secretions, making clearance more effective.

Pediatric burn — escharotomy concern

Circumferential burns can cause a tourniquet effect, compromising circulation (extremity) or breathing (chest). Monitor neurovascular status and respiratory effort; an escharotomy may be needed to relieve pressure.

Signs of opioid over-sedation in a child

Decreasing respiratory rate, increasing sedation (hard to arouse), and falling oxygen saturation. Monitor closely, stop/reduce the opioid, stimulate, support breathing, and have naloxone available.

Sucrose and nonnutritive sucking for infant pain

Oral sucrose with a pacifier (nonnutritive sucking) is an evidence-based analgesic for minor painful procedures (heel stick, immunizations) in infants up to ~6–12 months — an atraumatic-care measure.

Pediatric pain reassessment after an intervention

Reassess pain after the expected onset of the intervention (e.g., ~30–60 min for oral analgesia, ~15 min for IV) using the same age-appropriate scale, and document the response.

Recognizing sepsis in a child

Fever or hypothermia, tachycardia and tachypnea, altered mental status, poor perfusion (prolonged cap refill, mottling), and decreased urine output. Begin the sepsis bundle: cultures, broad-spectrum antibiotics, and fluid boluses quickly.

Difference: stridor vs. wheezing

Stridor is a harsh sound usually on INSPIRATION from upper-airway obstruction (croup, epiglottitis, foreign body). Wheezing is usually on EXPIRATION from lower-airway narrowing (asthma, bronchiolitis).

Foreign-body aspiration — presentation and high-risk age

Sudden coughing, choking, stridor or wheezing, and respiratory distress, most common in toddlers (curious, incomplete dentition). Prevent by keeping small objects and choking-hazard foods away; teach back blows/chest thrusts for infants.

Lumbar puncture in a child — positioning and post-care

Position curled on the side (or sitting) to widen the intervertebral spaces; hold the child securely (therapeutic hold). Afterward, monitor the site, encourage fluids, and watch for headache or leakage.

Blood transfusion in a child — safety priorities

Verify the order and patient with two nurses, use the correct filter/tubing, stay with the child for the first 15 minutes, monitor vital signs, and stop immediately for any reaction (fever, chills, rash, dyspnea, hypotension).

Pediatric chest tube — nursing care

Keep the drainage system below chest level, ensure tubing is patent and connections secure, monitor for tidaling/bubbling per system type, assess respiratory status, and keep an occlusive dressing and clamp at the bedside.

Tracheostomy care in a child — emergency readiness

Keep a same-size and a smaller spare tube, obturator, suction, and a manual resuscitation bag at the bedside at all times. Suction only as needed, maintain humidification, and never leave the child unattended without supplies.

Difference between croup and epiglottitis — key distinction

Croup: gradual, viral, barky cough, child can usually lie down, lower-grade illness. Epiglottitis: rapid, toxic, drooling, no cough, tripod position, high fever — a true airway emergency. Do not examine the epiglottitis throat.

Why is the head proportionally larger in young children — clinical relevance

A larger head and weaker neck muscles raise head-injury risk and affect positioning and the modified rule of nines for burns. It also makes neutral-airway positioning (slight sniffing, shoulder roll) important in infants.

Therapeutic relationship with the family of a chronically ill child

Build trust through consistency, honesty, active listening, and partnership; recognize caregiver expertise about their child; support coping and respite; and connect them with resources and peer/community support.

Documentation standard in pediatric nursing

Record objective, accurate, timely findings (weights in kg, vital signs, intake/output, pain scores, interventions, and responses). Good documentation supports continuity, safety, legal protection, and quality improvement.

Recognizing the deteriorating neonate/infant — subtle signs

Poor feeding, lethargy or irritability, temperature instability, color changes (pallor, mottling, cyanosis), apnea, and grunting. Young infants show illness through nonspecific behavior — take feeding and activity changes seriously.

Diabetes insipidus vs. SIADH in children

DI: too little ADH → large volumes of dilute urine, dehydration, high serum sodium. SIADH: too much ADH → water retention, low urine output, dilutional hyponatremia. Monitor sodium, I/O, and neuro status.

Precocious puberty — definition and concern

Secondary sexual characteristics before age 8 in girls or 9 in boys. Concerns include accelerated bone age with reduced adult height and psychosocial impact; refer for endocrine evaluation.

Growth hormone deficiency — nursing teaching

Treated with daily subcutaneous growth hormone injections, usually at bedtime to mimic natural secretion. Teach injection technique and site rotation, monitor growth velocity, and provide psychosocial support about stature.

Failure to gain developmental milestones — nursing action

Document the specific delays, perform/refer for validated developmental screening, and refer to early-intervention services. Early identification and referral improve outcomes — do not adopt a 'wait and see' approach for clear delays.

Adolescent eating disorder — assessment red flags

Significant weight change, distorted body image, restrictive/binge-purge behaviors, amenorrhea, electrolyte abnormalities, and bradycardia/orthostasis. Monitor for refeeding syndrome when nutrition is restored; involve a multidisciplinary team.

Adolescent depression/suicide screening — nursing duty

Screen routinely and confidentially; if suicidal ideation is disclosed, ensure immediate safety, do NOT keep it confidential, stay with the child, and arrange urgent mental-health evaluation. Ask directly — it does not increase risk.

Vaccine hesitancy — the nurse's approach

Listen respectfully, address concerns with accurate evidence-based information, use presumptive language, share the strong safety record, and build trust without coercion. Document the discussion and any refusal.

Pediatric CPR — compression depth and rate

Compress at 100–120/min, about one-third the depth of the chest (~1.5 in / 4 cm in infants, ~2 in / 5 cm in children). Compression-to-ventilation 30:2 (single rescuer) or 15:2 (two rescuers, infant/child).

Choking infant vs. child — relief maneuvers

Conscious choking infant: 5 back blows then 5 chest thrusts (no abdominal thrusts). Child (≥1 yr): abdominal thrusts (Heimlich). If unresponsive: begin CPR and check the mouth before ventilations.

Maintaining the child's sense of control during hospitalization

Offer realistic choices (which arm, flavor, order of tasks), keep routines, allow personal items, and involve the child in self-care. A sense of control reduces stress and improves cooperation across all ages.

Sibling and family support during a child's hospitalization

Acknowledge siblings' needs, encourage age-appropriate involvement and visiting, keep them informed, and connect the family with social work, child life, and support services — care extends to the whole family unit.

Recognizing increased work of breathing — specific signs

Nasal flaring, grunting, retractions (subcostal, intercostal, suprasternal), head bobbing (infants), tripod positioning, and tachypnea. The more signs present, the greater the distress — act early.

Routine vital-sign frequency in a stable hospitalized child

Typically every 4 hours when stable, more often if acutely ill, post-op, on continuous monitoring, or after a medication change. Always trend values against the child's age-appropriate norms and baseline.

Daily weights — when and how in pediatrics

Weigh at the same time daily, on the same scale, with similar clothing — usually before breakfast. Essential for dosing accuracy and for tracking fluid status in cardiac, renal, and critically ill children.

Pediatric pain in nonverbal/cognitively impaired children

Use a validated observational/behavioral tool (e.g., FLACC or r-FLACC, or an individualized baseline) and the caregiver's knowledge of the child's pain cues. Behavioral changes may be the only sign of pain.

Recognizing and responding to a vaccine adverse reaction

Observe for ~15 minutes after administration for anaphylaxis. Manage minor reactions (soreness, low fever) with comfort measures and acetaminophen, and report serious adverse events to VAERS.

Asthma trigger education

Identify and reduce triggers: tobacco smoke, allergens (dust mites, pets, pollen, mold), cold air, exercise, and respiratory infections. Trigger control plus controller medication reduces exacerbations.

Pediatric oxygen saturation target

Generally maintain SpO₂ ≥ 92–94% in most acutely ill children (individualized for chronic lung or cardiac disease). Persistent hypoxia despite oxygen signals worsening — escalate care.

Recognizing dehydration vs. fluid overload by weight

A weight LOSS suggests fluid deficit (dehydration); a weight GAIN with edema suggests fluid overload (renal, cardiac, or over-resuscitation). Trend the daily weight to guide fluid management.

First-line treatment for mild-moderate dehydration

Oral rehydration therapy with an ORS given in small frequent amounts; it is as effective as IV fluids for mild-moderate cases and is less invasive (atraumatic care).

Pediatric hypertension screening

Measure BP routinely starting at age 3 (and earlier if risk factors), using a correctly sized cuff, and interpret against age-, sex-, and height-based percentiles — not adult values.

Correct BP cuff size for a child

The bladder width should be ~40% of the arm circumference and cover ~80–100% of the arm length. A too-small cuff falsely raises and a too-large cuff falsely lowers the reading.

Pediatric medication — high-alert drugs needing independent double-check

Insulin, opioids, anticoagulants (heparin), chemotherapy, and concentrated electrolytes (e.g., potassium). Two nurses independently verify the drug, dose, and pump settings before administration.

When a medication order seems wrong — nurse's duty

Hold the medication and clarify with the prescriber before giving it. The nurse is accountable and must not administer an order believed to be unsafe — patient safety overrides hierarchy.

Reporting a near-miss or medication error

Report it promptly through the incident/occurrence system in a non-punitive, just-culture environment; assess and monitor the child; and use the data for quality improvement to prevent recurrence.

Child life specialist — role on the team

Provides developmentally appropriate preparation, therapeutic play, distraction, and emotional support to help children and families cope with hospitalization and procedures — a key partner in atraumatic care.

Recognizing nonaccidental trauma patterns

Suspicious patterns: posterior rib fractures, spiral fractures in non-ambulatory infants, immersion/patterned burns, retinal hemorrhages (abusive head trauma), and multiple bruises in unusual or protected areas. Report suspicion.

Promoting bonding and development in a hospitalized infant

Encourage parental holding/skin-to-skin and caregiving, maintain consistency, provide developmentally appropriate stimulation and rest, and minimize separation — hospitalization should not interrupt attachment.

Health-promotion screening across childhood — what to remember

Vision and hearing (newborn and periodically), lead (12 and 24 months), anemia, autism (18 and 24 months), dyslipidemia (once 9–11, again 17–21), depression (adolescents annually), and BMI/blood pressure as scheduled.