Preview of "Microsoft Word - N146APedsReaderFall13 (1) .Doc" PDF

NURSING 146A
PEDIATRIC CLINICAL
PRACTICUM
SEMESTER 3
ALL SECTIONS
Fall 2013
NURS 146A, Pediatric Nursing, Fall 2013 Page 1 of 74
TABLE OF CONTENTS
Nurs 146A
All Sections
Page
Number
Syllabus (Greensheet)-------------------------------------------------------------
The Professional Safe Practice Policy ------------------------------------------
ANA Professional Behavior Objectives-----------------------------------------
14
Tips for Success---------------------------------------------------------------------
15
Fluid Management and other measurements---------------------------------
18
Communicating in Spanish-------------------------------------------------------
23
Example of a Narrative Note-----------------------------------------------------
31
Developmental Stages: Infancy To Adolescence-----------------------------
33
Pediatric Assessment: Guidelines And Information-------------------------
43
Understanding Lab Values--------------------------------------------------------
48
Pediatric)Unit)Treasure)HuntGetting Acquainted-------------------------)
55
Practice)Calculation)Exam66666666666666666666666666666666666666666666666666666666)
59
Sample)Nursing)Care)Map/Plan6666666666666666666666666666666666666666666666666)
63
Immunization)Schedules))2011666666666666666666666666666666666666666666666666)
68
Nursing)146a)Clinical)Evaluation)ToolHow)you)will)be)evaluated.6666)
71
San Jos State University

School of Nursing
NURS 146A, Pediatric Nursing, 2 Units
Fall 2013
Instructor:
Office Location:
Telephone:
Email:
Office Hours:
Class Days/Time:
Classroom:
Prerequisites:
During Clinical days and by Appt.

Wednesdays from 0600 - 1600
Clinical Agency
NURS 23, NURS 24, NURS 33, NURS 34, NURS 43, NURS
44, NURS 53, NURS 54, NURS 128
Faculty(Web(Page(and(MYSJSU(Messaging((
Copies of the course materials such as the syllabus, major assignment handouts, etc. may be
found on my faculty web page accessible through the Quick Links>Faculty Web Page links
on the SJSU home page. You are responsible for regularly checking with the messaging
system through MySJSU.
Course(Description((
Focuses on providing family centered care to culturally diverse childrearing families and
children using concepts of systems theory in acute care, home, and community settings.
Course Goals and Student Learning Objectives
NOTE: PLO = Program Learning Outcome. Full text of these outcomes can be found on
the School of Nursing website and in the Student Handbook.
Incorporating the concepts of communication, critical thinking, and therapeutic nursing
interventions, upon completion of this course the student will:
SLO1. With moderate assistance, perform a complete and accurate biopsychosocial and
environmental assessment for childrearing clients and families using a systematic and
culturally appropriate approach. [PLO #1--assessment]
SLO2. Apply physiologic and pathophysiological theory to safely manage a clients care
with moderate assistance. [PLO #2 client centered care][SLO #2]
SLO3. Use the nursing process to develop a comprehensive evidence-based plan of care for
childrearing clients and families. [PLO #3 EBP][SLO #3]
SLO4. Identify appropriate community resources that address the health literacy needs of
clients and families. [PLO #4 health literacy]
SLO5. With assistance, initiate client advocacy interventions in the childrearing setting.
[PLO #5 advocacy]
SLO6. Under direct supervision, demonstrate accountability by safely administering and
evaluate pharmacologic and complementary modalities used in the pediatric and settings.
[PLO #6 medications/CAM]
SLO7. Use relevant healthcare technology to provide nursing care to clients in the
childrearing settings. [PLO #7 technology]
SLO8. Apply appropriate communication skills with clients/families and members of the
inter-professional healthcare team. [PLO #8 communication]
SLO9. Determine the appropriateness of delegating nursing activities in the childrearing
settings. [PLO #9 clinical judgment]
SLO10.
Consistently demonstrate safe nursing practice according to professional
nursing standards in the childrearing setting. [PLO #10 professional practice]
SLO11.
Implement safe nursing care; incorporating appropriate members of the interprofessional health care team. [PLO #11-- coordination of care]
SLO12.
Identify health care policies relevant to childrearing families. [PLO #12
health policy]
Required(Texts/Readings((
Textbook(
All resources used in Semester 3, and those previously required for Semester 1 and 2
courses.
Drug handbook for IV medications, etc.as per clinical faculty recommendation and/or
agency resources
Handbook of San Jose State University Nursing Students (Purchased in Semester 1)
Other(Readings(
Other readings as assigned.
Read Safe Clinical Practice in your School of Nursing Handbook for Nursing Students.
Please bring this with you to the first day of class.
Other(equipment(/(material(requirements((
Uniform per School of Nursing policy, stethoscope, watch with second hand, black pen,
black Sharpie marker, bandage scissors, pocket calculator.
Library(Liaison((
Our research librarian is Ms. Valeria Molteni, Health & Science Librarian Liaison to the
Department of Biological Sciences, Nutrition, Food Science, and Packaging, and the School
of Nursing. Her contact information is: Dr. Martin Luther King, Jr. Library, San Jose State
University, One Washington Square, San Jose, California 95128-0028. Her office phone
number is 408-808-2023 and her email address is: valeria.molteni@sjsu.edu
Classroom(Protocol(
Course Requirements and Protocols
1.
Demonstrate successful completion of all course objectives.
2.
The student is expected to be prompt, to be present, and to participate during

scheduled hours. If a student is to be absent from the practicum area, it is the
student's responsibility to notify the appropriate persons prior to the assigned time,
and such absence may result in an inability to meet course objectives (thus,
unsatisfactory progress in the course).
3.
Unexcused absence or tardiness limits full participation required to evaluate, thus

resulting in possible failure of the course.
4.
Complete oral, psychomotor and written activities on dates and times specified by
faculty using assigned format.
5.
Successful completion of Pediatric Clinical Calculation Exam with a 90% or greater.
6.
Assignments will not be accepted after the due date unless there are serious and
compelling reasons, and only if approved by the clinical faculty.
7.
Participation in Clinical Simulation Scenarios as scheduled
TEACHING/LEARNING STRATEGIES
Faculty will provide guidance, role modeling, and resources during clinical learning
experiences and individual clinical conferences. Students will be required to complete all
course requirements regarding simulation, readings and/or audiovisual program assignments
as determined by each clinical faculty.
EVALUATION AND GRADING
This is a Credit/No Credit course. Students and Faculty will complete a Clinical Practicum
Evaluation Form to document student progress and final completion of the course
objectives. See Student Handbook for explanation of Credit/No Credit policies in clinical
practica.
Professional behaviors are expected at all times. Additional expectations will be discussed
at the first class session. No personal use of cell phones, PDAs, or laptops in the clinical
setting.
The student is required to meet all course objectives satisfactorily and safely as specified on
this green sheet and the practicum evaluation tool in order to receive a grade of credit (CR).
The School of Nursing, for didactic and clinical course work, as a minimum score of 73%,
defines the grade of CR. Unsafe nursing behaviors, documented by the instructor, will be
sufficient cause for a grade of no credit (NC). Guidelines for safe student practice are
regulated by the Laws Relating to Nursing Education, Licensure-Practice, California State
Nurse Practice Act, agency policies and the current Handbook for Student Nurses. All
students are held accountable for safe practice and other policies described in the Student
Handbook. Failure of a practicum course halts progression until the course is successfully
repeated for credit.
Documentation of limitations or a health clearance, based on physical or mental health, will
be required by the instructor prior to continuance in the course. An alternate course of
action for absenteeism may be negotiated between the instructor and the student based upon
agency policies, safe practice, and the student's ability to meet the objectives. The purpose
is one of mutual decision making with the instructor having the final approval of any course
of action and progression in the course.
All clinical students must submit to the instructor copies of written documentation of
updated and accurate completion of the Health Statement & Clinical Documentation form
found on the School of Nursing Website: http://www.sjsu.edu/nursing/bs_forms.htm prior to
the first clinical experience every semester. Students will not be allowed in the clinical
setting without this documentation. Coverage must extend throughout the semester.
Dropping(and(Adding(
Students are responsible for understanding the policies and procedures about add/drops,
academic renewal, etc. Information on add/drops are available at http://info.sjsu.edu/webdbgen/narr/soc-fall/rec-298.html. Information about late drop is available at
http://www.sjsu.edu/sac/advising/latedrops/policy/ . Students should be aware of the current
deadlines and penalties for adding and dropping classes.
University(Policies(
Academic(integrity(
Students should know that the Universitys Academic Integrity Policy is available at
http://www.sa.sjsu.edu/download/judicial_affairs/Academic_Integrity_Policy_S07-2.pdf.
Your own commitment to learning, as evidenced by your enrollment at San Jose State
University and the Universitys integrity policy, require you to be honest in all your
academic course work. Faculty members are required to report all infractions to the office of
Student Conduct and Ethical Development. The website for Student Conduct and Ethical
Development is available at http://www.sa.sjsu.edu/judicial_affairs/index.html.
Instances of academic dishonesty will not be tolerated. Cheating on exams or plagiarism
(presenting the work of another as your own, or the use of another persons ideas without
giving proper credit) will result in a failing grade and sanctions by the University. For this
class, all assignments are to be completed by the individual student unless otherwise
specified. If you would like to include in your assignment any material you have submitted,
or plan to submit for another class, please note that SJSUs Academic Policy F06-1 requires
approval of instructors.
Campus(Policy(in(Compliance(with(the(American(Disabilities(Act(
If you need course adaptations or accommodations because of a disability, or if you need to
make special arrangements in case the building must be evacuated, please make an
appointment with me as soon as possible, or see me during office hours. Presidential
Directive 97-03 requires that students with disabilities requesting accommodations must
register with the DRC (Disability Resource Center) to establish a record of their disability.
SAN JOSE STATE UNIVERSITY

The Valley Foundation School of Nursing
The Professional Safe Practice Policy

The Professional Safe Practice Policy for SJSU Nursing Students
Providing safe nursing care for clients is an ethical and legal responsibility for professional nurses. In the The
Valley Foundation School of Nursing (SON), this includes both faculty and students. This policy covers
situations in all the clinical settings. Safe clinical practice is mandated by the California Board of Nursings
(BRN) Nurse Practice Act (http://www.rn.ca.gov/npa/npa.htm) and supported by the American Nurses
Association and other professional nursing organizations. Individuals who do not meet the stated professional
standards for ethical and legal conduct in a clinical setting are held accountable to the The Valley Foundation
School of Nursings policies/procedures. Procedures are identified within the The Valley Foundation School of
Nursing for sanctions. The Valley Foundation School of Nursing (SON) seeks consultation with the California
Board of Registered Nursing (BRN) on matters that affect nursing practice and those that challenge ethical
standards, criminal conduct, unsafe clinical practice, and/or potential legal standards of the profession.
Unprofessional conduct, in any clinical venue related to the The Valley Foundation School of Nursing is
grounds for disqualification from the nursing major.
If the student fails to maintain professional conduct, or if the student is considered unsafe by the faculty and/or
the agency in which the student is placed for clinical practice, that student is removed from the setting. If the
student is not able to complete the course objectives, this constitutes a NO CREDIT for the course. Dependent
on the specific circumstance, and if allowed, the clinical course may be repeated one time if a similar clinical
experience can be arranged with another agency, and a faculty member will assume the responsibility for the
student's learning experiences (Refer to the Schools current policy for grievance and disqualification). Unsafe
clinical practices of this nature are carefully managed at the administrative level so that the student is provided
with a maximum learning opportunity while the client (the recipient of care) is adequately protected. If, in the
opinion of a designated SON faculty committee/s (e.g. Curriculum Coordinating Committee, Semester
Curriculum Committees, Executive Committee, etc.) the student cannot provide safe care for clients or if the
student fails to follow ethical/legal guidelines of the profession, then disqualification from the major will be
recommended. When that occurs and if the student so desires, he/she must follow the Universitys policy and
procedures for grievances which are outlined in the University Catalog, and/or the Universitys catalog on the
website. Students will be oriented to these safe clinical practice policies during the first semester of enrollment
in the major, and both faculty and students will be responsible for reviewing the policy prior to beginning
clinical rotations. All beginning nursing students must purchase the Student Handbook; this document
delineates these policies.
Final Revised 5.12.13 RR
Drug testing and criminal background checks are required for all nursing students before beginning clinical
rotations.
A. POLICY:
(1) A student whose behavior or pattern of behavior is found to be unsafe may be terminated from a clinical
practicum for reasons of unsafe practices at any time during the semester and will receive a grade of "no credit"
for the clinical course.
(2) If a student fails to maintain professional conduct in clinical, the student may be disqualified from the
program, or other sanctions may be determined by appropriate parties.
B. DEFINITIONS:
The student will demonstrate professional behaviors which follow the legal and ethical codes of nursing;
promote the actual or potential well-being of clients, health care workers, and self in the biological,
psychological, sociological, and cultural realms; demonstrate accountability in preparation, documentation, and
continuity of care; and show respect for the human rights of individuals.
Indicators to be used as guidelines for evaluating safe practice and professional conduct include the following:
1. Regulatory: The student practices within the boundaries of the California State Nurse Practice Act, the
guidelines and objectives of the The Valley Foundation School of Nursing, and follows the rules and
regulations of each health care agency. Examples of unsafe practice include, but are not limited to, the
following:
a. failure to notify the agency and/or instructor of absence on a clinical day.
b. failure to adhere to the SON dress code.
c. presenting for clinical practicum under the influence of drugs and/or alcohol.
d. failure to make up missed clinical experiences, if required to do so.
e. habitual or unexplained tardiness to clinical agency.
f. excessive utilization of faculty time to ensure safe practice by one student to the detriment of other
students in the clinical rotation.
g. inadequate and/or poor preparation; and/or understanding of nursing care, patient's medications or
patient's nursing needs, etc.
2. Ethical: The student practices according to the American Nurses Associations (ANA) Code of Ethics,
Standards of Practice, and the California State Nurse Practice Act. Examples of unsafe practice or unethical
behaviors include, but are not limited to the following:
a. refuses assignment based on client's race, culture, or religious preference.
b. inappropriate nursing care in any assigned activity related to clinical practice.
c. ignoring unethical and/or illegal behavior(s) of other health care providers in the clinical setting(s)
which affects client welfare.
3. Biological, Psychological, Social, and Culture Realms: The student's clinical practice meets the total needs of
the human system from a biological, psychological, sociological, and cultural standpoint. Examples of unsafe
10
practice or violations of the safety policy include, but are not limited to the following:
a. failure to display stable mental, physical, or emotional behavior(s) which may affect others' well
being.
b. failure to follow through on suggested referrals or interventions to correct deficit areas which may
result in harm to others (deficit areas defined in (3a) above).
c. acts of omission or commission in the care of clients, such as, but not limited to: physical abuse;
placing in hazardous positions, conditions, or circumstances; mental or emotional abuse; and
medication errors.
d. unprofessional or inappropriate interpersonal relationships with agency staff, co-workers, peers, or
faculty resulting in miscommunications, and/or disruption of client care and/or unit functioning.
e. lack of physical and/or mental health necessary for carrying out comprehensive nursing care.
f. placing fellow clinical classmates, faculty, and/or staff at personal and/or professional risk.
4. Accountability: The student's clinical practice demonstrates safe practice in the responsible preparation,
documentation, and promotion of continuity in the care of clients. Examples of such unsafe practice include but
are not limited to the following:
a. failure to provide concise, inclusive, written and oral communication.
b. failure to accurately record comprehensive client behaviors.
c. failure to report questionable nursing practices.
d. attempting activities without adequate orientation or theoretical preparation or appropriate
assistance.
e. dishonesty.
f. lack of preparation by student to provide safe care for clients.
5. Human Rights: The student's conduct shows respect for the individual, client, health team member, faculty,
and self, including but not limited to the legal, ethical, and cultural realms. Examples of unsafe practice include
but are not limited to the following:
a. failure to maintain confidentiality of interactions.
b. failure to maintain confidentiality of records.
c. dishonesty in relationships and/or in actions.
d. utilization of stereotypical assessments which are detrimental to patient care.
e. failure to recognize and promote every patient's rights.
f. failure to report client abuse across the lifespan or abuse related to other professionals.
C. PROCEDURE:
A student whose behavior or patterns of behavior endangers the safety or threatens the integrity of a patient,
peer, staff member, clinical instructor, faculty member, or agency personnel will be given a verbal and written
warning by the primary clinical instructor, and/or by the The Valley Foundation School of Nursing Director.
Potential life-threatening episodes require immediate actions, and the procedure listed below may not be
realistic, as they relate to procedure items C-1-c through C-1-g (as listed below). Documented evidence from
11
the student, faculty, and/or staff will be considered in the decision of whether to terminate a student from a
clinical practicum and/or further action is needed to determine if disqualification from the nursing program is
warranted.
1. The primary instructor in a clinical course will:
a. provide instruction, guidance, and interpretation of objectives during the clinical experience.
b. suspend the student from the clinical practicum if the issue of safety is of significant magnitude
affecting one or more parameters of safe clinical practice and/or jeopardizes the well-being of patients,
staff, or peers until a decision has been obtained through the conflict resolution process.
c. document patterns of behavior related to attainment of clinical objectives. Documentation may
include direct observation by the clinical instructor as well as agency personnel and patient comments,
as appropriate. Written work will also be evaluated.
d. give a verbal and written warning for patterns of behavior that are not safe. To that end, the
instructor will:
(1) provide specific facts of problem areas or deficiencies in relation to course objectives,
evaluation tool(s), and performance.
(2) delineate corrective action and expected outcomes in writing with copies given to the
student and the clinical instructor. One copy will also be placed in the student's file in the The
Valley Foundation School of Nursing Office. The student and the clinical instructor must sign
the written warning. If the student does not sign, the clinical instructor will then document
that the student had the opportunity to sign the warning and refused to do so; pertinent
discussion at the time that the student read the written warning should also be documented.
Copies will be provided to the Semester Curriculum Chairs, Retention Coordinator,
Undergraduate Coordinator and The Valley Foundation School of Nursing Director.
(3) set a specific time for a change in the behavior to be accomplished
e. re-evaluate progress: If positive attainment of expected outcomes is achieved, then
the student will be allowed to continue with the clinical course. The written warning
may not be removed from students file.
f. provide the student an opportunity for input and/or data regarding the evaluation of
his/her clinical performance.
g. consult with the Semester Curriculum Chair and/or School Director as needed for
problem-solving and guidance.
Revised/adapted 12/9/95; Revised updated11/5/07

Copies: SJSU Nursing Faculty-Student Handbooks
Final approv_NOV5_2007_ Prof Safe Practice POLICY.
12
AMERICAN NURSES
ASSOCIATION
PROFESSIONAL BEHAVIOR
OBJECTIVES
13
PROFESSIONAL BEHAVIOR OBJECTIVES:

The following Professional Behavior Objectives have been derived from the American Nurses'
Association Code of Ethics and form the California Board of Registered Nursing regulation governing nursing
students and The Valley Foundation School of Nursing. In addition to other course objectives and requirements
specific to a given practicum course, students are expected to meet each professional behavior objective listed
below in order to pass a nursing practicum course. Failure to meet one or more of the objectives may constitute
grounds for failing.
1.
Demonstrates Internalization of Professional Behavior.

a.
b.
c.
d.
e.
f.
g.
h.
i.
2.
Provides Safe Care Based on Scientific Principles

a.
b.
c.
3.
Prepares a written nursing care plan prior to initiating nursing care.

Prepares for client care by acquiring theory and knowledge essential to specific nursing care
of assigned patients/clients medication dosages, specific treatment, procedures, etc.).
Implements safe care based on scientific principles, e.g., asepsis, protection from physical and
psychological injury, correct medicine and administration, developmentally sensitive care.
Demonstrates Ethical Behavior

a.
b.
4.
Appears for clinical assignment in appropriate dress consistent with agency dress code with
proper identification (name pin and SJSU badge).
Presents a professional appearance in regard to neatness and personal hygiene.
Arrives at the clinical setting on time and notifies staff or instructor when leaving or returning
to setting.
Notifies clinical agency and/or instructor in a timely manner when unable to report to the
clinical assignment.
Notifies instructor if there are any physical or psychological conditions that would limit the
ability to perform safe, effective nursing care.
Does not report for clinical under the influence of alcohol and/or mind altering drugs.
Does not discriminate against patients/clients on the basis of race, creed, national origin,
physical disability, sexual preference, or disease entity.
Is courteous to faculty, peers, staff and interdisciplinary team members.
Avoids the use of profane language with clients and staff.
Maintains confidentiality of all client, family, and agency information.

Informs instructor or staff of any unsafe practices observed in the clinical area.
Demonstrates Critical Thinking

a.
Prioritizes care problems and communicates interventions both in written and verbal form
14
TIPS FOR SUCCESS
15
NURSING STUDENTS TIPS FOR SUCCESS

Compliments of past Pediatric Clinical Students
WHAT TO BRING
You are expected to be in uniform with closed-toed shoes and name BADGE. Scrub pants and colored
tops or scrubs are acceptable in the pediatric area (check w/ agency). Well fitting T-shirts without ads,
political statements, or crude remarks are acceptable. NO JEANS -- School Identification is ESSENTIAL
Please, leave valuables at home. Coats, backpacks, etc. can be placed in the areas where your clinical
instructor designates. Remember you are sharing your space with the staff nurses and 9+ other students. Many
students wear fanny packs to carry belongings throughout the day.
Bring your own stethoscope, black pen(s), calculator, and something to write on.
These will MAKE YOUR LIFE EASIER!
BREAKS AND MEALTIME
You may have to two fifteen-minute breaks and 30 minutes for a meal ONLY when you have completed the
work and your patient(s) are taken care of.
You may leave for a break/meal IF your patient is NOT having a procedure and/or you are not infusing a
medication.
You may leave for a break/meal ONLY AFTER assisting a nurse when help is requested.
You must report to the RN that you are working with and your instructor, whenever you leave the unit for
any reason and, upon returning.
Please use the cafeteria for breaks and/or lunch. You are welcome in the nurses lounge when not busy
(check agency preferences). Remember we are temporary gracious guests
The food and beverages on the unit are for patient use ONLY. Do not eat or drink in patient care areas
(OSHA /JCAHO regulations). Food can be brought and stored in the small refrigerator in the nurses
lounge or area specifically designated for students.
OTHER HELPFUL HINTS
Take Pre-Rounding seriously. The more you prepare, the more you will get out of your clinical day.
Be on time!
Meet with your supervising RN assigned to your patient within the first hour of your shift to discuss the
plan of the rest of the day. Clarify who is doing what. Double check on currency of Med Orders! There
should be total clarity about who is responsible for what aspect of care.
Keep track of skills you would like to practice each clinical day. Your clinical instructor is your guide and
resource. You are ultimately responsible for what you get out of your clinical experience.
Baseline Patient Physical Assessments should be completed as early in your day as possible. Document,
Document, Document! Remember if it is not in the chartyou didnt do it!
All equipment in the room must be checked first thing in your day (e.g. IV fluid, rate, site, date tubing was
changed, O2 rate, NG suction setting, drainage, position of NG, status of all tubes and drains.)
All Medications (PO/IV/IM/SC) must be checked with a RN or clinical instructor BEFORE
administrationDo your 5 RIGHTS.
Be attentive and respectful to the culture on your assigned unit, but dont compromise standards of care. If
there is a question, contact your clinical instructor immediately.
Remember, according to Benner you are not yet a novice practitioner. If you dont know, ask. Providing
safe patient care is our NUMBER ONE PRIORITY!!
16
ADDITIONAL HELPFUL INFORMATION
Fluids and Electrolytes

How do children DIFFER from Adults in terms of their fluid and electrolytes?
Children have:
1.
GREATER % of total body weight that is water
2.
HIGHER basal metabolic rate
3.
HIGHER body surface ratio to weight ratio
4.
GREATER water turnover per kilogram of body weight
5.
SEVERE dehydration is a pediatric emergency
Fluid and electrolyte therapy for children may be understood in terms of 4 major components:
1.
Rapid volume expansion to treat shock and restore perfusion
2.
Continuation of Deficit replacement
3.
Provision of maintenance requirements
4.
Replacement of Ongoing Losses
17
FLUID MANAGEMENT
IN
PEDIATRICS
AND OTHER
PERTINENT MEASUREMENTS
18
FLUID MANAGEMENT
Fluid Requirements in Children--General Information
Calculating Fluids for Your PatientEXAMPLE
Intake Review last Dr. orders regarding fluids (for example: IV at 10cc/hr or TPN at 100cc/hr) and previous 24hour intake and output totals. This # is total cc/day (example: 1600cc/24 hrs)
Check most recent weight in Kg or grams (example: 35# = ~ 16 kg)
cc/kg/day = 1600 divided by 16 kg = 100cc/kg/day
cc/hr = 1600 divided by 24 hrs per day = ~ 67 cc/hr
Check with nurse about all oral intake fluid approximation. (example: How many cc in bedside cup, or
jello cup, or crushed ice???)
Document hourlyespecially if NPO.
Output Assume weighing diapers and all other output unless otherwise told.
Estimate in cc or gm emesis or other body fluid losses. Weigh for accuracy when possible.
Maintenance fluid is the amount of fluid the body needs to replace usual daily losses from the respiratory tract,
the skin, and the urinary and GI tracts.
A well child usually drinks more than maintenance requirements. If a child takes in significantly less than
maintenance requirements, he or she will gradually become dehydrated.
The requirement for maintenance fluids varies with the weight of the child (Table 4-1). Infants need more fluid
per kilogram of body weight than do older children. Various medical conditions will also affect these
requirements (Table 4-2).
Daily Maintenance Fluid Requirements (24-Hour Period)
Calculation
1. 100 mL/kg for the first 10 kg body weight
2. + 50 mL/kg for the next 10 kg body weight
3. + 20 mL for each kilogram of body weight over 20 kg
Examples
For 10-kg child: 10 kg 100 mL/kg = 1000 mL
For 15-kg child: (10 kg 100 mL/kg) + (5 kg 50 mL/kg) = 1250 mL
For 25-kg child: (10 kg 100 mL/kg) + (10 kg 50 mL/kg) + (5 kg 20 mL/kg) = 1600 mL
19
Conditions Modifying Daily Fluid Requirements

Requirement Increased
Fever,* sweating, vomiting or diarrhea
Diabetes
Burns
Requirement Decreased
Meningitis
Congestive heart failure
Renal failure
*Daily maintenance fluids should be increased by 12% for every degree Celsius body temperature above 37.5C
(rectal).
CLINICAL FEATURES OF DEHYDRATION
Feature
Heart rate
Systolic blood
pressure
Urine output
Mucous
membranes
Anterior
fontanel
Tears
Skin*
Skin perfusion
Mild Dehydration
(<5%)
Normal
Normal
Moderate Dehydration (5% to 10%)
Severe Dehydration
(>10%)
Rapid, weak
Hypotension
Decreased
Slightly increased
Normal to orthostatic, >10 mm Hg
change
Moderately decreased
Slightly dry
Very dry
Markedly decreased,
anuria
Parched
Normal
Normal to sunken
Sunken
Present
Normal turgor
Normal capillary
refill (<2 seconds)
Decreased, eyes sunken

Decreased turgor
Capillary refill slowed (2--4 seconds);
skin cool to touch
Absent, eyes sunken

Tenting
Capillary refill
markedly delayed (>4
seconds); skin cool,
mottled, gray
*Skin condition is less useful in diagnosis of dehydration in children >2 years of age.
URINARY OUTPUT IN CHILDREN
In pediatrics, urine output is defined according to the weight of the child. There are 2 major concepts.
NORMAL URINE OUTPUT AMOUNTS:
Infants and toddlers
=
2-3 ml/Kg/hour
Preschool & young school age
=
1-2 ml/Kg/hour
School age & adolescents
=
0.5-1 ml/Kg/hour
MINIMUM URINE OUTPUT:
The child with a health alteration may have less than normal urine output. Examples of conditions that may cause
decreased urine output:
Dehydration R/T vomiting, diarrhea, fever, or other losses of body fluids
Third spacing of fluid R/T surgery, mechanical ventilation, or disease process
Hypotension R/T decreased cardiac output or vasodilation
Decreased fluid intake R/T anorexia or fluid restrictions.
20
Minimum urine output is defined as the minimum amount of urine production needed to ensure adequate renal function to
clear the body of waste products. These amounts are as follows:
Infants and children weighing < 30 kg:
= 1 ml/Kg/hour
Older children and adolescents 30-60 kg = 0.5 ml/Kg/hour
Children weighing > 60 kg.
=30 ml per hour
Pediatric Clinical Practice Guidelines for Nurses in Primary Care (2001) ISBN: 0-662-30588 -4 Catalogue
Number: H35-4/11-2001E -- (2011)--http://www.hc-sc.gc.ca/fniahspnia/pubs/services/_nursinginfirm/2001_ped_guide/chap_04-eng.php
Normal Blood Pressures in Pediatric Populations
Systolic (mm Hg)

Diastolic (mm
Hg)
Nbn
76-87
68
1
105
68
3
106
68
6
111
70
Age in Years
9
12
115
121
74
77
15
127-129
79-82
18
127-136
80-84
Adapted from: Merenstein G. B., Kaplan D. W., & Rosenberg A. A. (1997) Handbook of Pediatrics
Eighteenth Edition. Connecticut: Appleton & Lange p27-33.
Age Specific Heart Rates (Beats/Min)

Age
2%
Mean
98%
< 1 day
93
123
154
1-2 days
91
123
159
3-6 days
91
129
166
1-3 wks
107
148
182
1-2 mo
121
149
179
3-5 mo
106
141
186
6-11 mo
109
134
169
1-2 yrs
89
119
151
3-4 yrs
73
108
137
5-7 yrs
65
100
133
8-11 yrs
62
91
130
12-15 yrs
60
85
119
Adapted from: Siberry, G. K. & Ianone, R. (2008). The Harriet Lane Handbook: A manual for
pediatric house officers 18th Edition, St. Louis: Mosby.
21
Mean Respiratory Rates 1 Standard Deviation

Age (yr)
Boys
Girls
Age (yr)
Boys
Girls
0-1
318
30 6
9-10
19 2
19 2
1-2
26 4
27 4
10-11
19 2
19 2
2-3
25 4
25 3
11-12
19 3
19 3
3-4
24 3
24 3
12-13
19 3
19 2
4-5
23 2
22 2
13-14
19 2
18 2
5-6
22 2
21 2
14-15
18 2
18 3
6-7
21 3
21 3
15-16
17 3
18 3
7-8
20 3
20 2
16-17
17 2
17 3
8-9
20 2
20 2
17-18
16 3
17 3
pediatric house officers St. Louis: Mosby, 18th edition
Temperature
Calculation: Conversions
Celsius to Fahrenheit
Fahrenheit to Celsius
([9/5] x temperature) + 32
(temperature 32) x (5/9)
Fever = > 38 in infants
Fever = > 39 in older children
Eighteenth Edition. Connecticut: Appleton & Lange p181.
Other Conversions
1 lb = 16 oz = 454 g; 1 kilogram = 2.2 lbs
Lbs to grams multiply by 454
Grams to lbs multiply by 2.2
Inches to centimeters multiply by 2.54
Lbs to kilograms divide by 2.2
(See weight conversion table on page 182)
Eighteenth Edition. Connecticut: Appleton & Lange p181-182
Average Weights for Age (kg)
Preterm
Newborn
Infant
1 yr
3yr
6yr
10 yr
Adolescent
Adult
1.5
3
5
10
15
20
30
50
70
pediatric house officers St. Louis: Mosby. 18th Edition (inside cover).
22
COMMUNICATING IN SPANISH
SOME POINTERS!!
23
Spanish Translation for English Terms Pertinent to Client Care

(Adopted by ANA Board of Directors March 27,1989)
Body Parts
El Cuerpo
anus
el ano
lips
los labios
areola
la areola
mouth
la boca
arm
el brazo
nails
las unas
bladder
la vejiga
nipple
el pezon
breast
el seno o pecho
penis
el pene
eyes
los ojos
skin
la piel
finger
el dedo
stomach el estomago
fontanel
la mollera
teeth
los dientes
hair (head)
el cabello
toe
el dedo
hair (body)
el pelo
umbilicus
el ombligo
hands
los manos
uterus
el utero
head
la cabeza
vagina
la vagina
hips
la cadera
leg
la pierna
incision
la incision
In the Hospital Room
En el Cuarto
bathroom
cuarto de bano
meal
la comida
bed
la cama
pillow
el almohada
blanket
la frazada
sheet
la sabana
call button
boton rojo de llamar
shower
la ducha
chair
la silla
soap
el jabon
curtain
la cortina
telephone
el telefono
injection la inyeccion
thermometer
el termometro
IV fluid
el suero
towel
la toalla
water
el agua
24
Important People
Personas Importantes
mother/father
madre/padre
patient
el or la paciente
sister/brother
hermana/o
nurse
la enfermera/o
daughter/son
hija/o
doctor
la doctora/
el doctor
aunt/uncle
tia/o
grandma/grandpa abuela/o
friend
amiga/o
you
usted
wife/husband
esposa/o
me
yo
her/him
ella/el
us
nosotros
Descriptions
Descripciones
good/bad
bueno/malo
quiet/noisy
callado/ruidoso
large/small
grande/chico
better/worse
mejor/peor
first/last
primero/ultimo
a lot/a few
mucho/poco
strong/weak
fuerte/debil
before/after
antes/despues
clean/dirty
limpio/sucio
fast/slow
rapido/lento
Feelings
Sentimientos
burning
quemadura
pain/ache
dolor
constipated
estrenida
scared
asustada
dizzy
mareada
strong
fuerte
hunger
hambre
weak
debil
nausea
nausea
worried
preocupada
How do you feel?
Como Siente Usted?
Are you hot/cold?
Tiene usted calor/frio?
Are you in pain? Where?
Tiene usted dolor? Donde?
Are you hungry/thirsty?
Tiene usted hambre? sed?
Are you happy/sad?
Esta usted contenta? triste?
Are you angry/confused?
Esta usted enojado?
confuso?
25
Do this, Please
Hagase Esto, Por Favor
Breathe deeply
Respira profundo
Lie down
Acuestese
Sit up
Levantese
Rest awhile
Descansa un rato
Swallow
Tragalo
Drink this
Bebelo
Try to relax
Tranquila; no mas
When?
Quando?
now
ahora
morning
la manana
today
hoy
afternoon
la tarde
tomorrow
manana
night
la noche
yesterday
ayer
2 hours ago
hace dos horas
next time
la proxima vez
in 2 hours
en dos horas
first time
la primera vez
in 6 weeks
en seis semanas
More Words
Mas Palabras
______________________
_______________________
______________________
_______________________
______________________
_______________________
______________________
_______________________
______________________
_______________________
______________________
_______________________
______________________
_______________________
______________________
_______________________
26
Some Common Terms Seen in the Hispanic/Latino Health System
Castigo de Dios: (Punishment from God). Imbalance between God and ones environment.
Curandero/a: (folk healer). One who heals through prayers, rituals, herbs, massage, and the laying on of
hands. They often live in the immediate village.
Empacho: Surfeit; a stomach disorder that some Latinas believe is caused by a large ball of undigested food
stuck in the stomach.
Espiritualista: (spiritualist). One who foresee the future in cards and premonitions and can interpret dreams.
Also uses treatment that is counter magic to witchcraft.
Mal aire: (bad air). Believed to enter vaginal cavity and cause illness to women who overexpose themselves to
air during such conditions as postpartum recovery period; may cause illness to men also.
Mal ojo: (evil eye). A voluntary or involuntary injury to a child by an individual who looks at and admires a
child without touching him.
Mal puesto/ Dano: Witchcraft or a bad deed; a magically caused disease or a spell cast on a victim.
Novena: Nine days of prayer for the deceased.
Partera: (midwife). One who delivers babies at home.
Remedios caseros: Home remedies.
Sobadores: (folk chiropractors). One who heals by massage and manipulation.
Susto: Fright; said to be caused by traumatic experience.
Yerbero: (herbalist). One who uses herbs as curative measures.
Even Though I Dont Speak English

(Accepted for publication by Critical Care NurseSeptember 2001)
Irene Gonzales PhD RN CNP
(The following is a letter from a friend who was a patient in a large metropolitan hospitaladmitted from the
Emergency Department and sent to the ICU for a week.)
To Those Caring For Me Today:

I am not my best when I come to you. I come to you weak and broken, with tubes coming out of every
orifice. I am overwhelmed with the machines and total environment around me. I am frightened, vulnerable,
and in desperate need of your help. My life is in your hands. Even though I cant speak or understand English
these are things I want you to know.
Who am I?
27
I am a proud vital precious human being. I share experiences, a language, and values within my own
culture that I am willing to share with you. Even though I may be a member of a specific cultural group
please dont assume we all are alike. I am a unique individual. I have intimate knowledge of my own goals,
my own preferences, my own important support systems, and clear functional needs for my independence.
Help me to share them with you. I have morals; traditions, & beliefs that may be different from yoursplease
know that they are not better or worse, wrong or rightthey are simply different. These aspects of my life are
as important to me as the struggling breaths I take.
I may have had some experiences in my past, about being thought of as different; so forgive
me if I sound overly sensitive or overly cautious. Not speaking or understanding English, simply means not
speaking or understanding that specific language. I can hear the gentleness of your voice, the smile on your
face, and the concern in your eyes. I can feel when you are in a hurry, if youre impatient, or not truly present.
I know when you are having a bad day. I can express my fears and concerns in many other ways, and I can
touch your heart and contribute to you.
I know when you are doing a good job with my care and when you enjoy being at work. I value my
health and that of my entire family. I may know a great deal about health and wellness. I can follow directions
and take on responsibility for my own recovery and improving health. I am very teachable
I live a life that I value when I am away from you. I functioned well in my life before I came here. I
didnt plan to be sick or injured, and the last place I wanted to be was in a hospital. I want to go home.
What do I need?
I have family members who I need and depend on during my illness and recovery. Please help them to
understand what is happening to me and how they can help. My family loves me, they know I cant get well
without them, and they need to know that they are valued and welcome here with me. My family may not know
your rules, so help them gently to understandnot just what they are, but why they are important. I need you to
be patient with me and my family if the things that are familiar in your world are foreign to ourswe are
willing to learn. We respect your profession, your knowledge, and your expertise. I wish to be respected as
well.
I need you to teach me how to get well. I need you to reach out of your comfort level and be willing to
help me without making assumptions and judgments. I need you to be willing to learn new things about me
28
things like what I think and what my preferences aremy family can definitely help you with this. I need you
to remain willing and open-minded to the possibility of change: in attitude, in increased knowledge, and in the
learning of new skills.
What I greatly appreciate.

Thank you for introducing yourself and anyone else when entering my roomthat makes me feel
respected and valued. Thank you for respecting my need and desire for privacy. Thank you for asking me if I
would prefer that certain procedures or treatments be performed by persons of the same gender. This may be
very important to me. My cooperation and compliance may depend on it. Thank you for telling me what you
are going to do before you do it. Thank you for being gentle and unhurried when you work with me.
Thank you for finding out about the language I speak and going out of your way to learn even a few
simple words to speak to me. Thank you for showing interest in me and in my family, before you engage in
your task or ask your questions. This demonstrates to me that you care about me as a whole person.
Thank you for getting someone specially trained to translate for me. Thank you for continuing to
speak directly to me when you engage me in conversation. Thank you for addressing me formally when you
speak in my languageThis is another sign of respect and value. Thank you for writing instructions in my
language and drawing pictures of the new and complicated things you are teaching me.
Thank you for not making assumptionsI appreciate it when you ask me, or my family about my
preferences. Thank you for asking me what I need, instead of assuming that you know the best for me. Thank
you for not assuming that I understand what you have said to meyou may need to repeat the information
again. I may be nodding my head out of respect for your role not out of understanding. Ask me to summarize
my understanding to be sure.
Other things that you do naturally may mean different things to me and to my family. Please dont be
concerned if I dont look you in the eye when you speak to me; in my culture it may be a sign of disrespect. I
may have difficulty asking questions because, in my culture, asking too many questions may indicate disrespect
for you as an authority figure. If a decision is to be made, I may not be able to make it myself. I may need my
familys input before I can answer. When telling me about my medicines, I may not understand what a
teaspoon is because we do not use different size spoons at our house. It may not make sense to take my
29
medicines three time a day with my meals if, at my house, we only eat twice in a day. When you say that you
are going to take my temperature, I may not understand that you are checking for possible infectionI may
be concerned that you wish to remove a part of me that is not yours to take. In my culture, a gentle touching of
a small childs head, to show affection, or an offer to take a picture may actually mean a stealing of ones
soul. On the other hand, a gentle touch to my hand, arm, or shoulder may be better than any sedative or
analgesic you could give me to calm and relieve my stress. I need you to know when being too close is not
acceptable, and when being too far implies a lack of concern and caring.
Thank you for treating me, and my family, as a unique and vital part of the health care team. Thank
you for not judging me even though I may appear different on the outsideI am still very much the same on the
inside. Thank you for supporting my family while I am here. That is just another way you can show that you
care.
Yes, even though I cant speak or understand English I can definitely tell you how very grateful I am
with every fiber of my beingthat you have given a piece of your life to me. Maybe someday you will need
my help and I can be there for you. Stop and Listen carefully What you hear is our hearts and spirits
connecting forever.
Respectfully and gratefully, Your Patient For Today
30
DEVELOPMENTAL
STAGES:
INFANCY TO
ADOLESCENCE
31
DEVELOPMENTAL STAGES: INFANT TO ADOLESCENCE

INFANT0 TO 2 MONTHS
1. PHYSICAL DEVELOPMENT
2. PSYCHOSOCIAL/COGNITIVE
Hands held in fisted position
Needs constant adult supervision
Lifts head 45 degrees in prone position
Regards face
Rolls part way to side from supine
Visually follows moving person
Tonic neck reflex dominant in supine position
Visually fixes on object
Head lag in pulling to sit
Tracts object
Step reflex
Responds to auditory stimuli
Head droops in the prone position

Roots to (turns) to nipple
Suckling reflex
Good swallowing pattern-suck, swallow, breathe
Lip closure present
Will bring hand to mouth
3 MONTHS
Hands held in open position
Maintain grasp
Tracts 180 degrees
Bilateral reaching
Attempts to locate sound source
Midline play
Good suck and swallow coordination
Lifts head to 90 degrees in prone position
Regards own hands
Props on elbows
Cuddles and conforms when held
Slight head lag when pulled to sitting
Recognizes mother/father
Curve in sitting, head bobs
Responds to verbal stimulation

Smile response to smile
Vocalizes to social stimulation
Some consonant sounds
4 MONTHS
Ulnar palmar grasp
Pivot prone position
Reaches for familiar adult
Symmetrical position in supine
Laughs out loud
Sits 30 seconds with support at low back
Looks at pettet
Light weight bearing in supported standing
Attempts to locate sound source for a variety
32
Plays with own hands
Turns eyes
Brings object to mouth
Turns head
Anticipates being picked up

5 MONTHS
Radial palmar grasp
Remembering object in visual field
Wrist rotation
Initiates noise production
Volitional reach and grasp
Smiles at mirror image
Purposeful repetition of activity
Expressive babbling
Retains one cube

Props on extended elbow
Rolls from prone to supine
Assists in pull to sitting
Head control in supported sitting
Takes pureed food from spoon
6 MONTHS
Raking grasps
Plays by banging
Transfers objects hand to hand
Attention detail of objects
Lifts head in supine
Imitates speech sounds
Rolls to prone from supine
Stranger anxiety
Sits 30 seconds with arm support

Eye-hand coordination in reaching
Picks up and retains 2 cubes
Pats and attempts to hold bottle
Gumming action on solid food
7 TO 8 MONTHS
Uses thumb in opposition on cube
Unilateral reaching
Uncovers toys
Inferior pincer picks up pellet
Differentiates exploration of objects
Begins pulling apart activities
Stranger anxiety
Moves from prone to sitting
Touches and pats mirror image
Belly crawls
Chews crackers/semi-solid food
Assumes creeping position in prone
Drinks from cup when it is held for them
Sits alone readily
Finger feeding
33
Takes full weight in supported standing
Holds own bottle

9 TO 10 MONTHS
Reaches with forearm in mid-position
Begins isolated finger movements
Says first words
Puts cube in cup
Uses expressive jargon
Looks at pictures in a book
Responds to verbal requests and gestures
Creeps reciprocally
Imitative play
Goes from creeping position to sitting

Pulls to standing
Lowers self from furniture to floor
Holds spoon
Uses upper lip to remove food from spoon
11 TO 12 MONTHS
Adaptive grasp of crayon
Imitates scribbling
Extends to show without release
Voluntary release
Plays pat-a-cake
Neat pincer
Says mama or dad a specifically
Bangs 2 cubes together
Social games
Puts 2-3 cubes in cup
Separation anxiety
Pokes at holes in pegboard

Creeps
Cruises
Walks with one hand held
Turns pages in book
13 TO 15 MONTHS
Points with index finger
Spontaneous scribbling
Carries or hugs doll
Build tower of 2 blocks
Vocabulary of 1-3 words
Walks, alone 2-3 steps
Uses 1 word sentences
Falls by sitting
Identifies common objects

Uses exclamatory expressions
Gives toy on request
Solitary play
34
Separation anxiety
16 TO 18 MONTHS
Uses both hands at midline
Puts cover over box
Uses gestures
Seldom falls
Vocabulary of 6-7 words
Walks backward and sideways with pull toy
Selects 2-3 common
Turns pages 2-3 at a time
Points to body parts named
Uses stick to obtain objects outside of reach
Follows simple instructions
Builds tower of 3 blocks
Solitary play
Feeds self with spoon, spills
Separation anxiety
Drinks from cup unassisted

Tales off shoes
19 TO 21 MONTHS
Circular scribbling
Builds tower of 5-6 cubes
2 word sentences
Runs stiffly
Begins to indicate need for toilet/change
Squats to play
Solitary play
Walks up stairs holding rail
Takes pants off
Unwraps candy
Takes socks and shoes off
Finds 2 hidden objects
Separation anxiety
22 TO 24 MONTHS
Holds crayon with thumb and finger
Lacks impulse control and needs constant adult
supervision
Imitates vertical crayon strokes
Parallel play
Walks with heel toe progression
Names object in picture 3 out of 6
Runs well, avoids obstacles
Names body parts
Seats self easily
Turns pages one at a time
Picks up object from floor without falling
Undresses completely
Kicks stationary ball
Separation anxiety
25 TO 30 MONTHS
Snips with scissors
supervision
35
Copies circular design
Names 5 pictures
Copies cross
Understands on, under, big
Walks backward 10 feet
Understands concept of one
Stands on either foot momentarily
Understands simple pronouns
Jumps off floor with both feet
Selects picture from memory
Throws ball overhand
Pretends to engage in familiar activities
Builds tower of 8 blocks
Doesnt share well yet

Wants own way
Separation anxiety
31 TO 36 MONTHS
Cuts well with scissors
supervision
Holds pencil with adult-like grasp
Spontaneous greeting
Walks tip toe for 10 feet
Says first and last name
Ascends stairs alternating feet
Holds fingers up to show age
Attempts to brush teeth
Identifies 2-3 pictures and action of pictures
Rides tricycle
Plays guessing games

Repeats 3 digits
Remembers 3 objects
Spontaneous play
Group play
Sharing
Imaginary playmates
Separation anxiety
Greatest fear is separation from parents and harm to
body including fears of castration after age 3 and
punishment for wrongdoing
PRESCHOOL (4 TO 5 YEARS OF AGE)
Pulse, respiratory rates and blood pressure decrease
At age 4 is very independent and aggressive
Height and weight remain constant
Show off and tattles on others
First permanent teeth erupt
Can be selfish and impatient
Right and left handedness firmly established

Walks down stairs with alternating feet
Greatest fear is separation from parents and harm to

body
Imaginary play very important (may have imaginary
36
playmate)
Throws and catches a ball well
Ties shoelace in bow by age 5
At age 5 is less rebellious

Ready to accomplish tasks and wants to do things
right
Hops on one foot
Has fewer fears
Uses scissors, pencil and simple tools well
Says first and last name
Slight farsightedness and refined hand-eye

coordination (not ready for small print)
Imaginary playmates
Relies on adult authority to control world
Cares for self, dressing, brushing teeth, etc.
Play is more cooperative with other children
Development of conscience
May view forbidden activities and wishes as
punishable by physical mutilation, body damage, and
castration
More independent with strangers, less anxiety with
strangers
At age 4 identifies strongly with parent of opposite
sex
At age 5 tends to seek out parent of same sex
Improving impulse control but still needs constant
adult supervision
3. COGNITIVE
Views world in terms of self and literal concrete terms
Starts to understand rules and conformity
4. EFFECTS OF HOSPITALIZATION
Feels loss of control over usual routines when
hospitalized
Difficult to differentiate between reality and fantasy
because of magical thinking and fear of mutilation
May notice prejudices
May think he/she caused the illness/injury
Still somewhat egocentric but, developing more social
May regress in behavior or become withdrawn, angry,
awareness
aggressive, noncompliant, clingy, or have tantrums.
Understands time in association with daily events

By age 5 can follow three commands given in a row
Has a vocabulary of 2,100 words, counts, and
identifies coins
Uses 6-8 word sentences, describing drawings in
detail
37
PRESCHOOL (4 TO 5 YEARS OF AGE)

Lacks good impulse control until around age 7 years
By age 6, height and weight gain slowly
(needs constant adult supervision until age 7 and then

can be less supervised for short periods only)
Dexterity increases
Greatest fear is body injury, disability, loss of control,

loss of status
Very active
Separation anxiety decreases
Use hand as tool, draws, prints, colors well
Developing sense of industry and independence
By age 7, grows at least 2 inches per year
Eager to learn, school activities important
Posture becomes more tense and stiff
More emphasis on emotional and intellectual growth
More graceful
Greater capacity to express emotion
Repeats activities to become proficient
Can assume independent chores
Loose teeth and ugly duckling stage
Peer group important
By age 8, fine motor control is well developed,

movements smoother
Playmates often same sex
Good hand-eye coordination
By age 12, more self-critical
Can completely dress self
Develops interest in opposite sex
By age 12, pubescent changes begin
Family relationships important, but may test limits
Remainder of teeth erupt

Posture more adult-like
Enjoys hobbies, physical activities, sports
3. COGNITIVE
Developing concept of time and time intervals
Loss of control, autonomy, and competence
Has 2, 250 to 2,600 word vocabulary
May interpret medical procedures as punishment
Develops complex sentence structure
Loss of contact with peer group may be difficult
Uses words to express ideas, feelings
School routines interrupted
Views world as something to experience or

manipulate
Combines own with others viewpoints
Can relate to past, present, and future
May still think concretely about some things (gray
areas are difficult for the child to grasp)
By age 12, can separate cause and intent from
outcome
By age 12, understands body and body function s
38
After age 9, understands that illness has multiple

causes
ADOLESCENTS (12 TO 18 YEARS OF AGE)
Adult stature by 18 years (female) and 20 years (male)
Greater self-direction and competence
Puberty changes in female (see Tanner stages)

Breast development
Axillary and pubic hair
Labia matures
Increasing confidence and self-esteem
Vaginal discharge
Menstruation
Puberty changes in male (see Tanner stages)
Penile and testes enlargement
Deepening of voice
Gynecomastia
Family group involvement
Axillary, public, facial, and body hair coarsens

Nocturnal emission
Acne
Orthodontia
Increasing ability to be responsible for own actions

and make independent decisions
Ability to accept others in a diverse society
Less impulsive behavior
Ability to delay gratification
Ability to give and accept affections
Increasing leadership abilities
Eriksons self-identity vs. role confusion
3. COGNITIVE
Problem solving abilities
Piaget-concrete thinking to formal operations (the
ability to conceptualized and hypothesize)
May struggle with dependence on parents and need for
independence
Regressive behavior
School progress
5. ANTICIPATORY GUIDANCE
Accident prevention (drivers ed, swimming lessons
sports)
Infectious disease (mononucleosis, URI, herpes,
condyloma, hepatitis, gonorrhea, HIV/AIDS, HPV)
39
Sexual activity (knowledge, birth control, safe sex)

Nutrition
Females (menstruation)
Males (nocturnal emission)
Substance abuse (changes in behavior, grades family
withdrawal)
Abusive relationships
Suicidal ideations
40
PEDIATRIC ASSESSMENT:
GUIDELINES AND INFORMATION
41
PEDIATRIC ASSESSMENT GUIDE

A. Physical Assessment Measurements:
a.
Temperature (record type)
b.
Pulse
c.
Respiratory
d.
Blood Pressure
e.
Height or length
f.
Weight
g.
Head Circumference
Value & % for
age & gender
B. General Appearance
a.
Describe childs activity and alertness
b.
Does child appear well nourished?
c.
Describe quality of voice or cry
d.
Is there anything about childs appearance that is particularly striking?
C. Skin:
a.
Color and temperature
b.
Turgor (skin has resiliency and returns to a normal position after pinching)
c.
Lesions, bruises, abrasions, rashes
d.
Birthmarks
e.
Hair (color, texture, sheen, distribution)
f.
Nails
D. Head:
a.
Symmetry
b.
Are sutures or ridges felt? (ridges may be felt up to 6 months)
c.
Are fontanels open or closed? (Posterior closes by 2 months, anterior by 18 months)
d.
Is head clear of lesions and scaling?
E. Eyes:
a.
Pupils
i. Are they equal and round in shape?
ii. Do they constrict and dilate in response to light?
b.
Does child follow objects side-to-side, up and down, obliquely? (by 4 months can follow 180
degrees side-to-side)
c.
Do eyes converge when an object is brought close to the nose?
d.
Is there a muscle imbalance? (Strabismus may be normal for 6 months)
e.
Are eyes sunken?
f.
Are sclerae and conjunctiva clear?
42
F.
Ears:
a.
Ears symmetrically placed and well shaped?
b.
Hearing appears normal to whispered voice?
c.
Canal patent; non obstructed; no pre or post-auricular tags/pits
G. Nose:
a.
Nares patent; intact septum
b.
Nasal drainage or crusting?
c.
Pain or tenderness when pressure applied over sinuses?
H. Mouth:
a.
Mucous membranes
b.
Tongue (symmetry)
c.
Conditions of gums
d.
Palate
e.
Number of teeth (Estimate of average number of teeth is obtained by subtracting 6 from age
in months up to 20 primary teeth)
f.
I.
J.
Are cavities apparent
Neck:
a.
Mobility and symmetry? Masses?
b.
Lymph node enlargement?
c.
Pain evident when neck is flexed chin to chest?
Chest:
a.
Symmetrical?
b.
Lungs: respiratory rate and regularity; Breath sounds
c.
Heart: rate and quality; murmurs?
K. Abdomen
a.
Symmentrical, protruding. (Childrens abdomen normal round protrude until puberty)
b.
Does umbilicus protrude?
c.
Bowel sounds in 4 quadrants
d.
Can femoral pulses be felt equally and bilaterally?
L. Genitalia and Anus:

a.
Male genitalia:
i. Meatus at tip of penis?
ii. Meatus clear of any inflammation?
iii. Foreskin loose? (if circumcised)
iv. Foreskin constricting (if not circumcised)
v. Both testicles palpable in scrotal sac?
b.
Female genitalia:
43
i. Meatus and vaginal opening visible?

ii. Discharge from vagina?
iii. Clitoris small?
iv. Labia symmetrical, not enlarged or adherent?
c.
Anus:
i. Anal sphincter appear well constricted?
ii. Fissures present?
iii. + anal wink
M. Extremities:
a.
Mobile with full range of joint movement
b.
Of equal length, strength, mobility, and temperature
c.
Legs straight. (bowing of legs normal up to 2 yrs; knock kneed from 2 to 3 yrs)
d.
Walks easily with good balance. (broad-based gait normally to 3 years)
e.
Hands are symmetrical with no simian crease
f.
Digits of hand are in proportion and not clubbed
N. Back:
a.
Back is symmetrical
b.
Spine straight and mobile
c.
No indentations or tufts of hair noted on spine
d.
Scapula are at an equal level when standing or when child bends over to touch toes
e.
Iliac crests of equal level.
O. Neurological:
a.
Infants:
i. Babinski reflex positive
ii. Hand grasp equal
iii. Tonic neck reflex noted. (lasts up to 5 months)
iv. Moro reflex noted. (last up to 5 months)
b.
Older child:
i. Fine and gross motor coordination appears normal for age
ii. Senses of touch, taste, smell are intact
iii. Demonstrates age-appropriate language skills
iv. Demonstrates appropriate long and short-term memory for age
v. Demonstrates ability to do abstract thinking
NEUROLOGICAL RECORD
44
General Comments: A coma score needs to be documented once a shift on every neuro/rehab patient. When
neuro checks are ordered by a PMP or done on a nursing judgment, the entire record should be completed as
often as ordered. On a seizure flow sheet, seizure activity columns are to be left blank if there is not observed
seizure activity. In infants or toddlers w/ open fontanels, an assessment of the fontanel should be done every
shift, using all descriptors that apply.
Example: Fontanel
0800pulsatile, soft, flat

1600pulsatile, soft, bulging
2300non-pulsatile, tense, bulging
Extra-Ocular Movements (EOM):

Document all letters that apply: Example F, T, C indicates normal eye movements
(F) Focus: appears to focus and fix on object or light
(T) Track: Follows objects in all four fields
(C) Conjugate: Eyes move together in following objects
(D) Disconjugate: Eyes do not move together and gaze is abnormal
(N) Nystagmus: Involuntary, cyclical movement of eyeball noticed in any field when testing gaze.
Limb Movements (spontaneous or on command; not reflex)
(F) Full spontaneous movement
(L) Limited movement; IV board or cast limiting movement
(N) No movement
(FI) Limb is flaccid as in a hemiparesis or hemiplegia
(P) Posturing, either decorticate or decerebrate
The type of posturing is noted in the BM column of the coma score
Seizure Activity
Type is designated as either C for convulsive seizure with any motor component or N for a non-convulsive
or absence seizures with staring or unusual behaviors.
Newborn Reflexes
Root3-4 mo
Suck10-12 mo
Palmar Grasp3-4 mo
Plantar Grasp8-10 mo
Tonic Neck (Fencing)4-6 mo
Moro (startle)3-4 mo
Babinskiwithin 2 years
Stepping2-3 mo
45
HELPING HINTS ON
UNDERSTANDING
LAB VALUES
46
UNDERSTANDING LAB VALUES
EVALUATE THE WHITE BLOOD CELL COUNT W/ DIFFERENTIAL
Total White Blood Cell Count: = leukocytosis; = leucopenia
Hemoglobin: anemia; polycythemia (may lead to hyperviscosity syndrome)
Hematocrit: anemia (3X hemoglobin)
Red Blood Cell Count: Age dependent
Structural Variations: Anisocytosis = marked variation in size; Poikilocytosis = abnormal shape

(thalassemia, sickle cell, liver disease); Basophilic stripping = lead poisoning
RBC INDICES:
MCH (mean corpuscular Hg = color of an average RBc

o
Normal color = normochromic
Too much color = hyperchromic
Too little color = hypochromic
MCV (mean corpuscular volume = size of an average RBC)

o
Normal size = normocytic
Too large = macrocytic
Too small = microcytic
MCHC (mean corpuscular Hg content= average amount of Hg on a RBC)
PLATELETS DIFFERENTIAL:
Thrombocytes
Increased in acute infection, iron deficiency anemia
Neutrophils = phagocytosis: Segs (mature), Bands (immature), Mylocytes (more immature,

Metamylocytes (most mature)
Lymphocytes
Basophiles (inc. in leukemia, irradiation, splenectomy)
Eosinophils (inc. w/ allergies, parasites)
Monocytes (inc. w/ TB, Rocky Mountain Spotted Fever, bacterial endocarditis, monocytic
leukemia
47
LEFT SHIFT: increased neutrophils (Segs, Bands = Bacterial)

RIGHT SHIFT: increased lymphocytes = viral
Lab Value
Common association with each Lab Value
Crit.
Crit.
(labs are not absolute; they
Value
Value
are ranges)
(low)
(high)
ALBUMIN
dehydration, exercise
INFANT: (4.4-5.4 g/dl)
liver disease, severe malnutrition, diarrhea, burns,
CHILD: (4.0-5.8 g/dl)
starvation
ADULT: (6-8 g/dl)

AMYLASE
inflammation of pancreas/salivary glands, acute
38-108 IU/L @ 37 C
pancreatitis, peptic ulcer

chronic pancreatitis, liver necrosis, burns
BICARBONATE (serum)
akalosis
Arterial 21-28 mmol/L
acidosis (bicarbonate ion concentration is regulated by
Venous 22-29 mmol/L
the kidneys)
BILIRUBIN
erythroblastosis fetalis, sickle cell, hepatitis
Child: direct 0.2-0.4 mg/dl;
iron deficiency anemia, drug influencesASA, PCN
indirect 0.4-0.8 mg/dl

BUN
dehydration, impaired renal function, GI bleed, shock
Infant: 4-16 mg/dl
starvation, severe liver damage, poor absorption
Child/Adult: 5-20 mg/dl
Celiacs, low protein diet, overload of fluids, infancy
CALCIUM (total serum)
too much dietary intake, hyperparathyroidism,
3.0
17
Newborn: 6-10 mg/dl
myeloma, metastatic carcinoma, thiazide therapy
mg/dl
mg/dl
Child: 2.0-2.6 mg/dl
diarrhea, extensive chronic infection, burns,
Adult: 2.1-2.6 mg/dl
hypoparathyroidism, (chronic renal failure pancreatitis)
CARBON DIOXIDE
decreased alveolar ventilation (acidosis)
(partial pressure-arterial)
increase alveolar ventilation
Child: 32-48 mmHg

CHLORIDE
diarrhea, hypernatremia, renal disease, dehydration,
Infant: 97-110 mg/dl
hyperventilation
Child/Adult: 98-106 mg/dl
prolonged vomiting, burns, ulcerative colitis,

gastroenteritis, diabetes mellitus
CHOLESTEROL
atherosclerosis, nephrosis, pancreatic disease,
Adult range: 100-200 mg/dl
increased dietary intake
Child/: 5-100 mg/dl
poor nutritional intake
48
CLOTTING TIME
time whole bid 1-8 min (glass tubes) 5.15 min (room
(Whole bid)
temp)
CREATININE
renal failure, shock, urinary tract obstruction, lupus,
< 6 yrs: 0.5-0.8 mg/dl
acromegaly
> 6 yrs: 0.8-1.3 mg/dl
muscular dystrophy, pregnancy, eclampsia, severe liver

disease
ESR
collagen disease, infections, cell destruction
Child: 3-13 mm/hr
polycythemia, sickle cell, rheumatic fever
Adult range: 0-10 mm/hr

GLUCOSE (serum)
diabetes mellitus, pancreatitis, Cushings, Increased
40
~300
FASTING
epinephrine intake
mg/dl
mg/dl
Newborn: (50-100 mg/dl)
adrenocortical insufficiency hepatic necrosis
Child: (60-100 mg/dl)

Adult: (70-110 mg/dl)
HEMATOCRIT
dehydration, polycythemia, stress, burns
Newborn: 42-50%
iron deficiency anemia, cirrhosis of liver, hemorrhage
Child 6-12: 30-35%

Adult: 37-49%
HEMOGLOBIN
dehydration, hypovolemia, diarrhea, stress, burns
1/3 of Hematocrit
acute blood loss, anemias, malnutrition, leukemia
IRON
hematochromatosis, excessive iron intake, liver
300
Infant: 40-100 mcg/dl
necrosis
mcg/dl
Child: 50-120 mcg/dl
anemia, hereditary immunodeficiency, leukemia,

lymphoma, nephritic syndrome
PCO2
acute respiratory acidosis, hypoventilation
20
75
Child and adult (34-45)
acute respiratory alkalosis, hypoxia, hyperventilation,
mmHg
mmHg
7.0
7.6
anxiety
PH ARTERIAL
metabolic alkalosis, GI loss-vomiting
Newborn: 7.11-7.36
metabolic acidosis, renal tubular acidosis, hypoxia,
Child & Adult: 7.3-7.45
diarrhea
PO2
breathing oxygenated enriched air
Child & Adult: 75-100 torr
carbon dioxide exposure, anemia, pulmonary disorders
POTASSIUM
oliguria, anuria, renal failure, acidosis, massive tissue
3.0
7.0
Infant: 0.1-5.3 mg mg/L
damage (burns)
mmol/L
mmol/L
Child & Adult: 3.4-4.7
vomiting diarrhea, malnutrition, stress, injury, diuretics
mmol/L
49
MAGNESIUM
severe dehydration, renal failure, leukemia
Infant: 1.4-2.9 meq/l
malnutrition, cirrhosis of the liver, chronic diarrhea
Child: 1.5-2.5 meq/l

PLATELET
polycythemia
Newborn, Infant & Child:
leukemias, aplastic anemias
150-400 thousand mm3 (ul)

Adult: 280-400 thousand
mm3 (ul)
PT/PTT
SLE deep thrombocytopenia, salicylates, steroids,
PT: 11-15 seconds
trauma
PTT 60-85 seconds
immune thrombocytopenia, anemias, pneumonia,

allergies
RETIC. COUNT
hemolysis, hemolytic anemia, hemorrhage
Child: 0.5-2%
red cell aplasia, renal disease, drug ingestion
Adult : 0.5-1.5%
SODIUM
dehydration, low total body sodium from excessive
120
165
Child: 138-145 mmol/l
sweating, glycosuria, mannitol use, coma, Cushings, DI
mmol/L
mmol/L
Adult range: 136-146
burns, diarrhea, vomiting, severe nephritis, CHF,
mmol/l
SIADH
TOTAL PROTEIN
dehydration, chronic inflammation
Child: 6.2-8.0 gm/dl
over hydration, hepatic insufficiency, malnutrition
Adult range: 6-8 gm/dl

TRIGLYCERIDES
familial hypertriglyceridemia, nephritic syndrome
Child: 5-40 mg/dl
malnutrition
Adult range: 10-190 mg/dl

WBC
UTI, bacterial infections, toxic states, tissue damage
Child: (6000-17,000) 1wk-
infectious typhoid fever, systemic lupus, drug reactions
4yrs
Older Child: (5000-15,000)
5-15 yrs
BLOOD PRODUCTS
Blood Products are colloid products containing proteins and therefore requiring rigorous matching.
PRBCs
Blood packed at a HCT of >50%. A T&C required. (For infants and children,
10-20 ml/kg over 3-4 hr)
Platelets
A cross match is unnecessary. Negative should receive negative. Platelets can

be given push or drip. The dose id 0.2 units/kg to a maximum of 10 units
50
WBCs
A cross match is needed because of the red cells in the product
The blood bank should be notified the day prior to administration
In the room have: Tylenol, A narcotic analgesic, SoluCortef, Decadron,

Benedryl, Epinephrine, Oxygen, and the Crash care close
FFP
ALBUMIN
Pre-wet filter and hang for 20-60 minutes; observe carefully
ABO group necessary but cross-matching is not
If given for clotting factorsto by used within 4 hr
If given for volume expanderused within 24 hr
Comes in 5% (preferable for children) and 25% from pharmacy
If undiluted use within 4 hr
Administer slowly and observe for shock
RBC
MCH
MCV
NORMAL URINE
Newborn: 5.1
Newborn: 36
Newborn: 103
pH Newborn
Infant:
Infant:
Infant:
7.0
4.7-5.1
Child: >2 yrs: 4.6-4.8
30
Child: >2 yrs: 25
90
Child: >2 yrs: 80
Child -
5.04.8-
7.8
Specific Gravity: 1.0011.030
Sugar, Protein, Cells =
None
NORMAL ARTERIAL BLOOD GAS

NEWBORN
CHILD
pH
7.32-7.2
7.35-7.45
pCO2
30-40 mmHg
35-45 mmHg
HCO2
20-26 mEq/L
22-28 mEq/L
pO2
60-80 mmHg
80-100 mmHg
CEREBROSPINAL FLUID (CSF)

Pressure: 40-200 mmH2O
Protein: >6mo: <40
Appearance: Clear
Chloride: 110-128
WBC: Newborn 8-9; >6mo - 0
Sodium: 138-150
Glucose: >6 mo 0.4 or ~ 1/3 of blood glucose
SG: 1.007-1.009
Hazinski, M.F. (1992) Nursing Care of the Critically Ill Child, Mosby
51
52
PEDIATRIC UNIT TREASURE HUNT

NURSING 146A
PEDIATRIC UNIT TREASURE HUNT Adapt to various agencies as indicated.
(Please locate the following areas and termscheck them off as you find them)
Check
Item
Check
Item
Kitchen (Nourishment)
Exam/Treatment Room
Baby Food
IV Arm boards
Utensils
IV tray
Ice Machine
Scale (for weighing diapers)
Juice/Snacks
Therapy/Gym (PT)
Microwave
Staff Lounge
Linen Closets
Microwave
Staff restrooms
Refrigerator
Dirty Utility Room
Crash Carts
Bed scales (Different types)
Small Conference Room
Commodes
Patient Worksheets
Paper Bags for Discharge
Flow sheet binders
Clean Holding (Supply Room)
Reference Books/Texts/Binders
Infant and Child feeding tubes
Patient Education Resources
Small tubs for bathing
Tub Room
Gloves (sterile and unsterile)
Infant Seats
B/P cuffs (different sizes)
Wheel chairs
Incontinent Pads
High Chairs
Tape (different type)
Playroom
Infant formulas, glucose water, sterile
Medication Rooms
water, pedialyte, special formulas

Calibrated Infant feeders
Med Refrigerator
Nipples (distinguish types)
Syringe and Needles (needleless adapters;

connecting tubing
Suction Catheters
Syringe Pump
Urine Collection bags, single specimen and
Glucometer
24 hour
Sterile specimen cups
Videotapes/CDs/DVDs for Pts
Soft restraints
Narcotics
Kerlix, gauze roll
Breast Milk Refrigerator
53
IV solutions
Desk area
IV filters
Extra Chart Forms
Blood Tubing
Patient Charts
IV volutrol (buretrol/burrette) and tubing
Kardexes
Blood drawing supplies
Order Rack
IV starting supplies
Pediatric Crash Cart
In Patient Rooms:
1.
Take a Polaroid for Safety -- Check for equipment, suction, O2, side rails, arm bands on patient,
emergency med sheet @ foot of bed, any inappropriate items in bed w/ patient; is suction, O2 working; is it
accurate; is IV pump working, right solution, tubing, rate; chk IV site. Emergency call button; Who else is
in room w/ patient.
2.
Find closest gram scale for diaper weights and practice weighing a dry diaper
3.
Practice working w/ bed, crib, isolate: put side-rails up and down; change position of head, foot;
close/open isolette doors.
4.
Notice Monitor; what parameters recording; alarms; check B/P cuff attachment; O2 sat probe; play w/
everything.
Fixing, Mixing, and Dispensing Medications

1.
How each patients meds stored?
2.
Lock and Unlock Cartor practice access entry and lock out
3.
Play w/ med/patient scanner if used
4.
Medication Record: check how drugs are charted; find the page for scheduled and the page for PRN meds;
where else do you chart PRN meds; IM site codes; other codes; signatures.
5.
Find Binder at desk and review Kardex for several patientsalways yield to other healthcare providers.
Get a patients chart and review its contents. Notice the location of the history, progress notes, lab results,
social services notes, nutrition, consults, specialty service consults, x-ray results, specialty exam results,
problem list, previous admissions, growth charts, immunizations, admission and discharge notes, and previous
admissions.
Find Policy, Procedure, and Protocols for your unit.
Find Cafeteria, the Gift Shop, the Hospital Library, the Xerox machine
Find Radiology Dept., Emergency Department, PICU, NICU, OR, Waiting rooms
Others that your clinical instructor wishes to add for your location
54
PRACTICE CALCULATION EXAM
55
San Jose State University

N146A Practice Calculations
Name:
1.
Score:
Order: Keflex 250 mg po QID for a child weighing 50lbs; You have Keflex 250 mg capsules;
Recommended daily range po dosage for a child is 25 to 50 mg/kg/day in divided doses q6h.
a.
b.
c.
d.
Childs wt in KG?____ __________________________+______

Safe range for this child?_______________ mg/day_________
Is Order safe?_____ ________________
If yes, how many capsules will you administer?__________________
2.
Order: Lanoxin 12.5 mg po daily for an infant weighing 6lbs 8 oz.; You have Lanoxin 0.05 mg/ml.;
The recommended daily dosage for infant is 0.035 to 0.06 mg/kg/day in divided doses two times per
day.
a. Childs wt in KG?__ ____________
b. Safe range for this child?___ _________
c. Is Order safe?______ _______________
d. If yes, how many ml. will you administer?_____________
3.
Order: Benadryl 25 mg IV q6h for a child weighing 50lbs. You have available Benadryl 12.5 mg/ml.
The recommended daily dosage for a child weighing more than 12 kg is 5mg/kg/24hr in four divided
doses.
a. Childs wt in KG?_________ _____
b. Safe range for this child?________________________________
c. Is Order safe?____ _________________
d. If yes, how many ml. will you administer?_____ ________________
4.
The primary care provider (PCP) prescribes furosemide (Lasix) 2 mg/kg/day PO to be given in 2 equal
doses. The client weighs 6 lb. 4 oz. Available is furosemide 40 mg/5ml. How many ml will the
health care professional administer per dose?
5.
On hand you have Ampicillin 125 mg/5ml. You have been asked to give 75mg po. How many ml will
you give?_____________________
6.
Your nurse practitioner orders Cefotaxime 400mg IV q6h. You have Cefotaxime 200 mg/5ml. How
many mls will you draw up in the syringe?_____ ________
7.
The PCP prescribes acetaminophen (Tylenol), 10 mg/kg/day PO to be given in 4 equal doses. The
client weighs 7lb, 8oz. Available is acetaminophen 80 mg/ml. How many ml will the health care
provider administer per dose?
56
8.
The PCP prescribes erythromycin 5 mg/kg PO Q6hr. The childs weight is 8kg. The safe dosage
range is 5 to 10 mg/kg Q6hr. Is the prescribed dose safe?You are caring for an infant whose birth
weight was 8#3oz. She is 5 days old and weighs 6#12 oz. Weight loss is____________%.
9.
Order reads: Phenobarbitol 48 mg IV times one NOW as loading dose. You have Phenobarbitol 60
mg/ml IV: How many ml would you give?______________ ______
10. In question # 10. You change your route to PO. You have Phenobarbitol 32 mg tablets: How many
tablets would you give?______
11. Using the dose in question #10; You now have Phenobarbitol elixir 20mg/5ml. How many ml do you
give?_________
12. 0.5 g = __________mg
13. 30kg= _______ gm
14. 0.001 Gm= _______mg

17.
15.
2500Gm=_______ kg
85 mcg =______________mg
16. 350 mg=________ mcg

20. 12.5 kg = ____________ mg____
18. 1.4 liters = __________ ml
19.
275 mg = ______gms
23.
21. 0.004 mg = _______ mcg
15ml= ______________gms
22. 843 ml = _______ liters
57
Case study: A 10-year-old boy (66lbs) is brought to the emergency department. The child has had a rash
for one day and fever and vomiting for 2 days. In the ED, he reports that his head and neck hurt. At
times he seems confused and his answers to questions do not make sense.
Orders:
Complete Bed Rest

Vitals signs Q hour until stable
NPO
IV NS 20 ml/kg bolus via rapid infusion. Repeat if perfusion does not improve.
Vancomycin (Vancocin) 40 mg/kg/day IVPB divided into 4 equal doses
Ampicillin (Omnipen 25 mg/kg/day IVPB divided into 4 equal doses
Cefotaxime (Claforan) 200 mg/kg/day IVPB divided into 4 equal doses
Acetaminophen (Tylenol) 480 mg PO Q4 hr PRN Temp > 38.3
Ranitidine (Zantac) 3mg/kg/day IVPB divided into 3 equal doses
1.
The PCP prescribes Vancomycin (see above) to be added to 100ml NS divided into 4 equal doses.
Available is vancomycin 50 mg/ml. How many ml should the health care provider add to the 100 ml?
2.
The PCP prescribes Ampicillin (see above) to be added to 100 ml of D5W. Available is Ampicillin
20mg/ml. How many ml should the health care provider add to the 100 ml?
3.
The PCP prescribes IV NS bolus (see above). How many ml should the Health Care Provider administer?
4.
The PCP prescribes Cefotaxime (see above) to be added to 50 ml of D5W. Available is cefotaxime 180
mg/ml. How many ml should the health care professional add to the 50 ml D5W?
5.
The PCP prescribes Acetominophen (see above). Available is 325 mg/tablet. How many tablets will the
health care provider administer?
6.
The PCP prescribes diphenhydramine (Benedryl) 40 mg IVP for the clients rash. Available is Benedryl
10mg/ml. How many ml will the RN give?
7.
The PCP prescribes albumin 25% (Albuminar 25%) 0.5 g/kg IVPB one time, after four NS boluses did not
improve the clients perfusion. Albumin 25% is available in 250 mg/ml. How many ml will the health care
provider administer?
8.
The PCP prescribes furosemide (Lasix) 32 mg IVP to follow the albumin. Available is furosemide 10
mg/ml. How many ml will the RN give?
9.
The PCP orders dexamethasone sodium phosphate (Decadron) 0.15 mg/kg IVP, Q6hr. Available is
Decadron 4mg/ml. How many ml will the RN give?
58
SAMPLE NURSING CARE MAP/PLAN

(AVAILABLE ELECTRONICALLY
ON CANVAS NURS 126)
59

PEDIATRIC CLINICAL CARE MAP AND LOG FOR NURSING 146A
STUDENT NAME______________________________________________DATE OF CARE________________
INSTRUCTOR________________________
(FACESHEET)
Childs Initials:
Weight (kg)
Religion/Birthplace
Childs Age:
Gender:
Ht. (cm)
Ethnicity
Allergies
Date of Admission
DESCRIPTION OF DISORDER/DISEASE PROCESS
Chief complaint: (What specific signs and symptoms caused the child to be brought in for medical attention?)
History of present illness:
Past history, including previous illness and injuries, hospitalizations, and medications taken at home prior to admission:
Family medical history:
Immunizations:
Cultural/religious practices:
Home/community environment:
Occupation/education of family member:
Patient Diagnosis:
Isolation: yes/ no
ASSESSMENT
Objective Data:
Laboratory Tests
Abnormal:
Allergies:
V/s:
Subjective Data:
Report:
Intake:
Rationale related to DX:
Parents:
Output:
Other:
Diagnostic Procedures
Risk Factors
60
Physical Examination:
3. HEENT (head,
ears, eyes, nose,
throat)
1. General appearance,
posture, gait, behavior
2. Skin
6. Cardiac
7. Respiratory
8. GI
11. Musculoskeletal
12. Peripheral
Vascular
13. Neurologic
4. Lymph nodes
5. Breast
9. Urinary
10. Genito-reproductive
Collaborative Care
Medications (see separate med sheet)
Surgical Interventions
NURSING CARE NEEDS: Prioritized 3 needs you will need to

address and 3-4 interventions:
1.
Interdisciplinary Care
Client Outcomes
2.
3.
Care after Discharge
61
PATHOPHYSIOLOGY
In this section, please explain in scientific depth the pathophysiology of your patients disease or condition.
MEDICATION TEMPLATE FOR PEDIATRIC NURSING CARE MAP****

MEDICATION:
Expected Pharmacological Action:
Therapeutic Uses:
Side/Adverse Effects:
Medication/Food Interactions:
Nursing Interventions/Client Education:
Nursing Interventions/Client Education:
Nursing administration:
Evaluation of Medication Effectiveness:
****Please use above template for all meds administered on the day of care;
including PRN meds (REPEAT ABOVE FOR EACH MED)
62
GROWTH AND DEVELOPMENT TEMPLATE FOR

PEDIATRIC NURSING CARE MAP**
Client Name: (First Name; Last Initial)
Chronological age (and Corrected Age if applicable)
Developmental Stage
Physical Development:
Cognitive Development:
Age-Appropriate Activities:
Health Promotion:
Immunizations
Health Screening
Nutrition
Injury Prevention
Reference/Tool:
**Please use above template for your client on the day of care.
63
IMMUNIZATION SCHEDULES
2012
64

Preview of "Microsoft Word - N146APedsReaderFall13 (1) .Doc" PDF

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Preview of "Microsoft Word - N146APedsReaderFall13 (1) .Doc" PDF

Caricato da

Copyright:

Formati disponibili

NURSING 146A

NURS 146A, Pediatric Nursing, Fall 2013 Page 1 of 74

The Professional Safe Practice Policy ------------------------------------------

ANA Professional Behavior Objectives-----------------------------------------

Tips for Success---------------------------------------------------------------------

Fluid Management and other measurements---------------------------------

Example of a Narrative Note-----------------------------------------------------

Developmental Stages: Infancy To Adolescence-----------------------------

Pediatric Assessment: Guidelines And Information-------------------------

Understanding Lab Values--------------------------------------------------------

NURS 146A, Pediatric Nursing, Fall 2013 Page 2 of 74

San Jos State University

During Clinical days and by Appt.

NURS 146A, Pediatric Nursing, Fall 2013 Page 4 of 74

Demonstrate successful completion of all course objectives.

The student is expected to be prompt, to be present, and to participate during

Unexcused absence or tardiness limits full participation required to evaluate, thus

Successful completion of Pediatric Clinical Calculation Exam with a 90% or greater.

Participation in Clinical Simulation Scenarios as scheduled

NURS 146A, Pediatric Nursing, Fall 2013 Page 5 of 74

NURS 146A, Pediatric Nursing, Fall 2013 Page 6 of 74

NURS 146A, Pediatric Nursing, Fall 2013 Page 7 of 74

SAN JOSE STATE UNIVERSITY

SAN JOSE STATE UNIVERSITY

SAN JOSE STATE UNIVERSITY

Final Revised 5.12.13 RR

Final Revised 5.12.13 RR

Final Revised 5.12.13 RR

Revised/adapted 12/9/95; Revised updated11/5/07

Final Revised 5.12.13 RR

Final Revised 5.12.13 RR

PROFESSIONAL BEHAVIOR OBJECTIVES:

Demonstrates Internalization of Professional Behavior.

Provides Safe Care Based on Scientific Principles

Prepares a written nursing care plan prior to initiating nursing care.

Demonstrates Ethical Behavior

Maintains confidentiality of all client, family, and agency information.

Demonstrates Critical Thinking

Final Revised 5.12.13 RR

TIPS FOR SUCCESS

Final Revised 5.12.13 RR

NURSING STUDENTS TIPS FOR SUCCESS

OTHER HELPFUL HINTS

Final Revised 5.12.13 RR

ADDITIONAL HELPFUL INFORMATION

Fluids and Electrolytes

GREATER % of total body weight that is water

HIGHER basal metabolic rate

HIGHER body surface ratio to weight ratio

GREATER water turnover per kilogram of body weight

SEVERE dehydration is a pediatric emergency

Rapid volume expansion to treat shock and restore perfusion

Continuation of Deficit replacement

Provision of maintenance requirements

Replacement of Ongoing Losses

Final Revised 5.12.13 RR

Final Revised 5.12.13 RR

Check most recent weight in Kg or grams (example: 35# = ~ 16 kg)

cc/kg/day = 1600 divided by 16 kg = 100cc/kg/day

cc/hr = 1600 divided by 24 hrs per day = ~ 67 cc/hr

Document hourlyespecially if NPO.

Final Revised 5.12.13 RR

Conditions Modifying Daily Fluid Requirements