Lutheran Medical Center Peds Clinical Reference

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Lutheran Medical Center Clinical ReferenceManual

Nursing Student Information

Lutheran Medical Center is located at 8300 W. 38th Ave. several blocks westof Wadsworth. If you are coming from the east, turn west onto 38th Ave.

The second light you come to, turn left into the hospital grounds. Follow itto the visitors parking lot. If coming from the west, turn east on W. 38th

Ave. You will pass the hospital and reach a stop light on the east end of thebuilding. You can only make a right turn. Again, follow the road to the

visitors parking lot.

FIRE SAFETY

"Mr. Gallagher is wanted" is the code for an actual fire situation. Drills are always announced as drills. The

five steps to the Emergency Fire Procedure are: " R A C E."1


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R escue the patient / evacuate the area.

Alarm and call 5555 in the hospital (call 911 at other sites). Give your location as accurateas possible.

The alarm box is hooked into a computer system that identifies the box and its specificlocation to the operator as well as the Power Plant and the Fire Department.

C lose the door. Doors remain closed until the "all clear" is announced over the PA system.

E xtinguish the Fire - if possible.

For use of a fire extinguisher, remember"P A S S."

P ull the pin.

A im the nozzle.

S queeze the trigger.

S weep back and forth at the base of the fire.

ELECTRICAL SAFETY

In patient care areas, knowledge on reporting equipment malfunctions and the purpose of redelectrical outlets is required.

Do's Don'ts

1. Report malfunctioning or damaged

equipment immediately.2. Attach repair tag and remove such

equipment from service.

3. Report any equipment that is dropped,

spilled on,etc., even if it appears that theequipment is all right.

4. Visually inspect all equipment prior to use.

Pay particular attention to power cords.

5. Save parts that may break off machines.

Tape them to machine.

1. Attempt to repair equipment yourself.

2. Put liquids (drinks, IV solution, etc.) ontop of equipment.

3. Run over power cords with wheeledequipment.

4. Transport monitors or pumps on bedsidetables.

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WORKING WHILE YOU'RE SICK*Susan Dolan MS RN and James Todd MD

In a hospital setting, the patient population is a primary concern as many of these patients are alreadycompromised by their current illness. Acquiring a nosocomial infection on top of this can lead to morbidityand/or mortality. In certain instances, employees and students who are mildly ill and who do work can do

so if the appropriate precautions are strictly adhered to.

Illness Type Severe Symptoms Mild or Resolving Symptoms

Completely

ResolvedSymptoms

Respiratory Fever (>100o), productive cough,

uncontrollable secretions (e.g., unableto contain runny nose.

Mild symptoms, fever absent, able tocontain secretions.

Symptom free.

Can you work? No - you need to stay home. Yes - wear mask**, WASH HANDS. Yes - WASH HANDS.

Should you care forhigh-risk*/uninfectedpatients?

No - stay home. No - care for low-risk patients and/or

patients with like-illness, avoid touchingface.

Yes - WASH HANDS.

Gastro

intenstinal Fever (>100o), vomiting, diarrhea. *** Mild symptoms, infrequent stools. Symptom free.

Can you work? No - stay home. Yes - wash hands (esp. after usingrestroom).

Yes - WASH HANDS.

Should you care for

high-risk*/uninfectedpatients?

No - stay home. No - care for low-risk patients and/or

patients with like illness.

Yes - WASH HANDS.

Pharyngitis

(SoreThroat)

Sore throat, fever (>100o), excudate on

tonsils/throat, cough absent.

Mild symptoms, fever absent, cough absent. Symptom free.

Can you work?

- If Strep Cx (+)

No. Yes - after you have taken appropriateantibiotics for 24 hours.

Yes - WASH HANDS.

- If Strep Cx (-) orno Cx is indicated.

No. Yes - wear mask**, wash hands, avoid

touching your face.

Yes - WASH HANDS.


No. No - care for low-risk patients and/or patients with like illness.

Yes - WASH HANDS.

ColdS

ore

(HerpesSimplex)

Draining or vesicular lesion(s) on the

face or mouth.

Lesion(s) crusted. Symptom free.

Can you work? Yes - wear mask**. Yes - WASH HANDS. Yes - WASH HANDS.


No - consult with charge nurse ofnursery areas to determine if need for

employee to work if no replacementavailable and patient care would be

jeopardized.

Yes. Yes.

High-Risk Patients (with non-infectious conditions): Moderate to severe BPD.

High risk cardiac conditions.

Immunodeficiency (hypogram, chronic steroids).

Chronic pulmonary disease.

Infants < 2 months.

* Masks- need to be changed when they become moist and/or upon leaving isolation rooms.

** Diarrhea - may include one or more of the following: More frequent than normal. Blood, pus, mucous (stool culture

recommended). Fever (> 100o). Water loss.

Remember1. Handwashing is the most effective step in preventing the spread of infection.2. All staff members who are ill should report to Employee health.3. If you develop mild symptoms at work, (e.g., scratchy throat, stuffy nose):

Take appropriate precautions immediately (e.g., mask if respiratory related and WASH HANDS!!).

If symptoms worsen, notify your supervisor and go to Employee Health.. If you have been exposed toa known contagious illness (e.g., chicken pox, measles) and you do not have immunity, you need to

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contact Employee Health immediately. You will not be able to work during the incubation period. Shouldyou develop symptoms, you may not return until it is determined that you no longer are contagious.

DAILY NURSING GUIDE

0640-0645 Review changes in Kardex and medication sheets before report

0645-0715 Report

0715-1000 Head-to-toe assessment:

Vital signs (include Temp. HR., RR. BP.)

Equipment room check, stock with supplies, and straighten room

Cor equipment check

Medications and treatments as ordered

Bath, oral care, linen change

Assist with feeding patient

1000-1200 Catch up on charting. Computer charting entered each hour.

Meds and treatments as ordered

Nutritional support with age-appropriate choices of food and liquids

Developmental support

Play room activities prn

1200-1400 Head-to-toe assessment

Vital signs if q 4 hrs

Assist with nutritional support

Charting

Meds and Tx as ordered. All 1400 meds must be given before leaving for clinical

conference.Report to CTA before going to conference

Developmental support. Playroom activities prn

1400.1500 Clinical conference:

Room placement to be announced

Try to be on time as there are often guest speakers

1500-1845 Head-to-toe assessment:

Vital signs

Meds and TX as ordered

Total 8 hour I&OComplete charting

Prepare written draft for report and review with CTA or instructor

Recheck pt. room for adequate supplies

1845-1915 Report

ADDITIONAL CARE THROUGHOUT 12 HOUR SHIFT

* Plan linen, bed change, bath around treatments and rehab schedule. Needs to be completedby end of day shift.

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* IV site assessment and maintenance and recording of I & O hourly.

* Continually update CTA on status of your patient, report changes. Developmentallyappropriate interventions (comfort, play, diversional activities)

Weekly Clinical Appraisal

Raven Starr Date:

STUDENT COMMENTS FACULTY COMMENTSComment on your preparation for this clinical experience:

Comment on the quality of your written work (nursing care plan,

harting):

Comment on the technical skills you performed:

Comment on your interpersonal skills, caring and rapport

communication with peers, health care team, faculty, clients and

heir families both verbally and non-verbally.

Comment on how you applied your knowledge of growth and

evelopment in your care of the client and family:

Comment on how you set priorities and your ability to adapt to

pontaneous changes during the clinical experience and how you

ought out your own learning experiences.

Comment on any concerns you have or things you would like towork on in the future:

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WHERE YOU GET YOUR HOMEWORK INFORMATION

1. Pathophysiology:

Be sure to review your pathophysiology. Your textbook contains lots of information, but youmay need to use the units' teaching files or the library on the 6th floor of the Health Center.

You will encounter many unusual diagnoses, and you will need to know something about yourpatient's pathophysiology. If you receive a new patient assignment, you will be expected tolearn about the pathophysiology during the course of the clinical day.

2. History of Present Illness:

This information is obtained from the patient's chart. There is a specific tabbed section of thechart that will give you this information. You may want to lookthrough some of the mostrecent Progress Notes for an update on your patient.

3. Medical Orders From the Kardex:

Use the nursing Kardex to summarize the medical orders. This will give you an idea of whatyour nursing interventions will include during your clinical day. If there are procedures ortests noted on the Kardex, take some time to look them up in a laboratory reference book orthe unit's Policy and Procedure manuals. Before any test or procedure, you will be expectedto read about it in Policy and Procedure manual and review it with your CTA and or/ClinicalFaculty.

4. Vital Signs, Norms, Ranges:

Use the computer to determine what your patient's vital signs have been in the recent past.

Note any abnormal findings (use asterisk or highlight). This will alert you toproblems/potential problems. The norms may be found at the end of the manual.

5. Growth Parameters and Percentiles:

Growth parameters are very important in pediatrics, especially for children under two years ofage. Most growth occurs in the first two years of life. If there are growth problems, it isimportant to detect changes in growth parameters and to intervene as soon as possible. Ifyour patient is under 2 years of age, you should be able to find the child's growth parameterson the admission data base and/or the computer. Once you know your patient's growthparameters, determine the percentiles for weight, height, and OFC (occipital-frontalcircumference).

6. Intake and Output Calculations:Once you know your patient's weight, you can use the formulas to calculate hourly intake andoutput rates. Compare the ideal 24-hour totals to the actual totals (if the actual data areavailable). Are there any I/O discrepancies or concerns? Most infants and small children areon STRICT I/O. That means we carefully measure and record everything they take in and putout. Infants and small children can QUICKLY develop serious fluid/electrolyte problems, andthey require close I/O monitoring.

7. Abnormal lab data:

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Use the computers to access lab values and lab reference norms for your patients. Note anyabnormal lab values and try to find rationale in your laboratory reference book. Some of thecommon values and abnormal lab rationales are in your manual.

8. Developmental Norms:

Your manual has a section on developmental milestones. If your patient is developmentallydelayed, there should be a notation in the physician's admission note about the child's

approximate "developmental age." For instance, you may have a patient who is 4 years oldwith severe CP/MR (cerebral palsy/mental retardation). The physician has documented in heradmission note: "MOC states that last developmental assessment on 3/10/98 places child at 4month-old developmental level for gross motor and fine motor skills. MOC also states thatchild socially smiles, laughs at faces and enjoys being held and read to. You should use 4MONTH-OLD developmental milestones and tailor your nursing care interventions to thedevelopmental information you have about this child. During the course of your shift, you willbe able to make observations and evaluate whether you see the child behaving according tohis/her developmental age. You will also need to identify implications for care relative to yourpatient's developmental delays. Hospitalization, chronic illness, and acute illness can affectchildren's developmental performance, and you will learn how to compare norms/baselinewith your patients hospitalized behaviors.

9. Nursing care needs:

After you have done the worksheet and researched the pathophysiology, think aboutpotential, important nursing care considerations for your patient and the patient's family.List 3 needs (or more) that you think will be important nursing care issues for your patient.Individualize these care needs as much as possible. You will soon learn that care needschange over time, sometimes quickly. Your initial list of care needs will help alert you topossible care concerns for your patient, but you will have to re-prioritize during the shift.

Your CTAs and Clinical Faculty will help you learn how to use nursing process to constantlyassess, plan, implement and re-evaluate what is happening with your patient.

10. Medication Worksheets:

Use your patient's Medication Administration Record (MAR) sheet to find the medicationsordered for your patient. You are responsible for researching medication information anddoing medication calculations on scheduled and PRN medications.

EXCEPTIONS: You do not need to calculate safe dosage ranges for RESPIRATORY (markedper RTin the MAR) inhaler/nebulizer medications or safe dosage ranges for heparin flushes.The hospital uses many medications that have special dosages and applications for ourpediatric patients. The formulary is designed to give information about how to safely andeffectively administer these medications to our patients. For legal and safety reasons, thisformulary or Lexi-Comp program must be consulted for patient medication information.

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CLINICAL PREPARATION WORKSHEETStudent Name: Date:

Childs Initials: Childs Age: Gender:

Patients Dx: Isolation: yes / no

Type:

Allergies:

Brief Review of Pathophysiology and History of Present Illness: (Write information on reverse side of page)

Medical Orders from Kardex:

Most Recent Vital Signs Norms for Age Childs Range(Over the past 36 hrs)

Childs Values % on Growth Curve

Temp: WT:

Pulse: HT:

Resp: HC*:

BP: * < 2 yrs.

INTAKE AND OUTPUT CALCULATIONS:Calculated Hourly Fluid Intake Needed: Calculated Hourly Urine Output Needed:

Calculated 24-hr Needs: Calculated 24-hr Needs:

Actual (Past 24 hours) Actual (Past 24 hours)

ABNORMAL LAB DATA:Test Childs Value Normals Rationale (Related to Diagnosis)

DEVELOPMENTAL NORMS FOR AGE:

Expected

Gross Motor:

Age Appropriate?

Yes No

Implications for Care

Fine Motor:

Yes No

Language/Cognitive:

Yes No

Personal-Social:

Yes No

NURSING CARE NEEDS: Prioritized 3 needs you will need to address and one to two interventions:1.

2.

3.

Author: Roxie Foster PhD,RN (Revised 10/00 by C. San Miguel MS,RN - The Childrens Hospital, Denver) 05/03

CLINICAL PREPARATION WORKSHEET SAMPLE

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Student Name: Jane Doe Date: 04/04/02

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BASIC MEDICATION INFORMATION

For each medication know basic information (route, amount), and determine:

A. Amount to give: This will be based on the concentration used by the pharmacy. This is on the MAR

sheet. DOUBLE-CHECK the pharmacy's calculations.

B. Safety dosage range: Refer to page 27 for practice problems and answers. These are examples to

get you started. Remember: The dosage range calculations are based on your patient's WEIGHT.

The FORMULARY will provide you with necessary information for doing this calculation.

C. IV maximum concentration: If the medication is being given IV, you will need to determine the

maximum concentration or minimum dilution for the safe administration of the medication. This

information is found in the formulary under the "Nursing Implications" section.

D. Why is the child receiving this medication r/t diagnosis? Use the formulary and your knowledge

of the patient.

E. Teaching needs: This will also depend on information in the formulary and your knowledge of the

patient.

You MUST have your homework completed BEFORE clinicals unless there are special circumstances.

This preparation may take several hours the night before clinicals. Because of safety considerations, your

CTA and Clinical Faculty may send you home if you are unprepared. This could result in failure of the

clinical portion of this course.

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MEDICATION INFORMATION WORKSHEETDrug: Amount Ordered (i.e., mg/ml) / Frequency: Route:

(p. ) (If IV, over minutes)

Calculate amount to give (ml / suppository / tablet):

(Concentration from Pharmacy: )

Safe Dosage Range / kg / dose or day: Weight of Child: Kg Is the dosage safe? Yes No

(Show safe dosage and, if needed, calculation of maximum or final concentration for IV administration.)

Why is the child receiving thismedication related to diagnosis?

The nurse/family should be aware ofwhat teaching needs?

Drug: Amount Ordered (i.e., mg/ml) / Frequency: Route:


Calculate amount to give (ml / suppository / tablet):(Concentration from Pharmacy: )





Drug: Amount Ordered (i.e., mg/ml) / Frequency: Route:


Calculate amount to give (ml / suppository / tablet):

(Concentration from Pharmacy: )





Revised 05/02 Karen LeDuc, MSN RN CPN CNS The Children's Hospital, Denve

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MEDICATION INFORMATION WORKSHEET

Drug: Acetaminophen Amount Ordered (i.e., mg/ml) / Frequency: Route: PO

(p. 31-2 ) 225 mg every 4 hours PRN (If IV, over minutes)

Calculate amount to give (ml / suppository / tablet): 80 mg : 0.8 ml = 225 mg : X

80X : 180

X = 2.25 ml to administer

(Concentration from Pharmacy: 80 mg / 0.8 ml )

Safe Dosage Range / kg / dose or day: Weight of Child: 15.7 kg Is the dosage safe? 4 Yes

10-15 mg/kg/dose No(Show safe dosage and, if needed, calculation of maximum or final concentration for IV administration.)

10 mg x 15.7 = 157 mg/dose15 mg x 15.7 = 235.5 mg/dose


Pain or fever, Temperature of 38.8C (101.3F)


Rate of absorption may be decreased when given with food (increased carbohydrates).Overdose can cause liver/kidney necrosis, GI disturbances. Do not exceed 5 doses in 24hours.

Drug: Ranitidine Amount Ordered (i.e., mg/ml) / Frequency: Route:

(p. 488-89 ) 15 mg / 0.6 ml every 8 hours (If IV, over 15-30 minutes)

Calculate amount to give (ml / suppository / tablet): 25 mg : 1 ml = 15 mg : X ml

25X : 15

X = 0.6 ml to administer

(Concentration from Pharmacy: 25 mg/ml )


0.5 mg to 1.0 mg/kg/dose every 6-8 hours No(Show safe dosage and, if needed, calculation of maximum or final concentration for IV administration.)

0.5 mg x 15.7 kg = 7.85 mg/dose Dilution: final concentration not to exceed 2.5 mg/ml

1.0 mg x 15.7 kg = 15.7 mg/dose 2.5 mg : ml = 15 mg : X

2.5X = 15

X = 6.0 ml (add 5.4 ml of diluent to make a total of 6 ml)


Inhibit gastric acid secretion.


Use with caution in patients with liver or renal impairment.Monitor liver enzymes, serum creatinine, maintain gastric pH > 4.0.

Drug: Gentamicin Amount Ordered (i.e., mg/ml) / Frequency: Route:

(p. 270-71 ) 38 mg / 0.95 ml every 8 hours (If IV, over 30 minutes)

Calculate amount to give (ml / suppository / tablet): 40 mg : 1 ml = 38 mg : X40X : 38

X = 0.95 ml to administer(Concentration from Pharmacy: 40 mg/ml )


2.5 mg/kg/dose every 8 hours No(Show safe dosage and, if needed, calculation of maximum or final concentration for IV administration.)

2.5 mg x 15.7 kg = 39.25 mg/dose / every 8 hours Dilution: final concentration not to exceed 40 mg/ml

Therefore, no dilution required


Gram positive staphylococcal infection of the right hand.


Monitor urine output and serum creatinine. Draw peak & trough levels around 3rd dose. Bealert to ototoxicity.

Author: Susan B. Clarke, MS RNC- The Childrens Hospital, Denver Revised 07/03 BMC PhD RN CNS The Children's Hospital, Denver

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PEDIATRIC MEDICATION CALCULATIONS

1. Calculate safe dose (mg/kg)

mg/kg x pt. wt.

2. Calculate amount to administer (ml) Dose on hand } mg : mg ordered

ml x

3. Calculate final concentration or dilution for IV medications

concentration for administration } mg : mg ordered

ml x

4. Calculate rate of infusion

Volume x 60

Desired minutes

Remember to consider the amount of flush required to completely infuse the medication

into the patient. Children weighing 6kg or less: use the syringe pump with a tubing

volume of 1.0ml. Baxter pump tubing has a volume of 16ml plus the filter = 20ml to clear

the tubing.

The medication & dilution are infused together. When the burretrol empties, the flush isthen added to clear the tubing at the same rate.

Variables to consider with pediatric IV medications:

1. Patient weight

2. Patient fluid status/maintenance rate

3. Patient diagnosis (fluid restrictions)

4. Additional medications to administer

5. Volume of IV tubing

After all calculations are made and variables considered; a

nursing judgment is made to safely give the medication.

All pediatric medications are given with supervision!

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TIPS FOR MEDICATION ADMINISTRATION

ROUTE CONSIDERATION

Otic Children < 3 years of age, pull pinna down and back.

Children > 3 years of age, lift pinna up and back.

Nasal Have parent hold the child across their lap with the child's head down. Place thechild's arm closest to the parent around the parents back. Firmly hug the child's

other arm and hand with their arm; snuggle the head between the parents bodyand arm.

Eye Explain the procedure. Tell the child the medication will feel cool.

Have the child lie on their back with their hands under their buttocks.

Have the child look up.

Provide distractions.

Oral Infants: Administer medication in nipple, follow with 5cc of sterile water.Medication can also be administered with a syringe and dropper; place the

syringe / dropper between the gum and cheek. Administer no more than 1/2cc

of medication at one time.

Chewable tablets: Do not administer to children without teeth. Give themsomething to drink afterwards.

Caplets: Do not crush enteric-coated caplets. Capsules: Do not open up if medication is sustained - release. Check with

pharmacy before opening any capsules for administration.

Avoid mixing medications with formula as the infant may refuse the formulathereafter.

When mixing medications with food or fluids, use as little as possible, because

they may not be able to finish all the food or fluids.

Rectal Consult a pharmacist prior to cutting a suppository; the medication is notnecessarily distributed evenly through the suppository (i.e., acetaminophen

suppositories must be divided lengthwise, not widthwise).

Subcutaneous

(SQ)

Usual amount of administration is 0.5 - 1.0cc.

Sites include deltoid, anterior thigh, anterior abdominal wall, orinter/subscapular region.

Insert needle at a 90o angle.

Needle size: Infant or thin child 25 or 26g, 3/8".

Larger child 25 or 26g, 5/8".

Intramuscular(IM)

See discussion in this skill station.

For the immunocompromised child, cleanse the site with Betadine and alcohol.

Consider placing a wrapped ice cube on the site for approximately one minute

prior to injection.

Intravenous (IV) Use as little diluent as needed.

Long-termVenous AccessDevices

May require a special needle to pierce the port (e.g., MediPort requires a Huber

needle).

Certain catheters are above the skin (Groshong catheters) while others are under

the skin (Port-a-Cath, Infus-A-Port, MediPort).

May require daily or weekly flush to maintain patency (Hickman / Broviac and

Groshong catheters). Implanted ports must be flushed monthly and after each

infusion.

Above the skin catheters may be damaged by sharp instruments and are at risk

of being pulled out.

The Hickman / Broviac catheter must be clamped or have a clamp nearby; the

Groshong catheter should not be clamped (contains a two-way valve).

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DEVELOPMENTAL STAGES

INFANT 0-2 MONTHS1. Physical Development

- hands held in fisted position- lifts head 45 degrees in prone position- rolls part way to side from supine

- tonic neck reflex dominant in supine position- head lag in pulling to sit- step reflex- head droops in the prone position- roots to turns to nipple- suckling response- good swallowing pattern- lip closure present

- will bring hand to mouth

2. Psychosocial/Cognitive

- needs constant adult supervision- regards face

- visually follows moving person

- visually fixes on object- tract object

- responds to auditory stimuli

3 MONTHS1. Physical Development

- hands held in open position- maintain grasp- bilateral reaching- midline play- lifts head to 90 degrees in prone position- props on elbows- slight head lag when pulled to sitting

- curve in sitting, head bobs

2. Psychosocial/Cognitive- needs constant adult supervision

- tracts to 180 degrees

- attempts to locate sound source- good suck and swallow coordination

- regards own hands

- cuddles and conforms when held

- recognizes mother/father- responds to verbal stimulation

- smile response to smile

- vocalizes to social stimulation- some consonant sounds


- ulnar palmar grasp

- pivot prone position- symmetrical position in supine

- sits 30 seconds with support at low back

- light weight bearing in supported standing- plays with own hands

- brings object to mouth

- anticipates being picked up


- reaches for familiar adult- laughs out loud

- looks at pellet

- attempts to locate sound source for a varieof sounds

- turns eyes

- turns head

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5 MONTHS

1. Physical Development- radial palmar grasp

- wrist rotation

- volitional reach and grasp

- purposeful repetition of activity- retains one cube

- props on extended elbows

- rolls from prone to supine- assists in pull to sifting

- head control in supported sitting

- takes pureed food from spoon

2. Psychosocial/Cognitive- remembering object in visual field

- initiates noise production with rattle

- smiles at mirror image

- expressive babbling


- raking grasps

- transfers objects hand to hand

- lifts head in supine- rolls to prone from supine

- 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

2. Psychosocial/Cognitive- plays by banging

- attention to detail of objects

- imitates speech sounds- stranger anxiety

7-8 MONTHS1. Physical Development

- uses thumb in opposition on cube

- unilateral reaching

- inferior pincer picks up pellet- begins pulling apart activities

- moves from prone to sitting

- belly crawls- assumes creeping position in prone

- sits alone readily

- takes full weight in supported standing


- uncovers toys

- differentiated exploration of objects- stranger anxiety

- touches and pats mirror image

- chews crackers/semi-solid food- drinks from cup when it is held for them

- finger feeding

- holds own bottle


- reaches with forearm in mid-position

- begins isolated finger movements

- puts cube in cup- looks at pictures in a book

- creeps reciprocally

- 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


- says first words

- uses expressive jargon- responds to verbal requests and gestures

- imitative play

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- adaptive grasp of crayon- imitates scribbling

- voluntary release

- neat pincer

- bangs 2 cubes together- puts 2 to 3 cubes in cup

- pokes at holes in pegboard- creeps

- cruises

- walks with one hand held

- turns pages in book

2. Psychosocial/Cognitive- needs constant adult supervision- extends to show without release

- plays pat-a-cake

- says mama or da da specifically

- social games- separation anxiety


- points with index finger

- spontaneous scribbling- builds tower of 2 blocks- walks alone 2-3 steps

- falls by sitting


- carries or hugs doll- vocabulary of 1-3 words- uses 1 word sentences

- identifies common objects

- uses exclamatory expressions- gives toy on request

- solitary play

- separation anxiety


- uses both hands at midline- puts cover on box

- seldom falls

- walks backward and sideways with pull toy- turns pages 2-3 at a time

- uses stick to obtain objects outside of reach

- builds tower of 3 blocks- feeds self with spoon, spills

- drinks from cup unassisted

- takes off shoes

2. Psychosocial/Cognitive- needs constant adult supervision- uses gestures

- vocabulary of 6-7 words

- selects 2 - 3 common- points to body parts named

- follows simple instructions

- solitary play- separation anxiety

19-21 MONTHS

1. Physical Development- circular scribbling- builds tower of 5-6 cubes

- runs stiffly

- squats in play- walks up stairs holding rail

- unwraps candy

- finds 2 hidden objects

2. Psychosocial/Cognitive- needs constant adult supervision- 2 word sentences

- begins to indicate need for toilet/change

- solitary play- takes pants off

- takes socks and shoes off


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- holds crayon with thumb and finger- imitates vertical crayon strokes

- walks with heel toe progression

- runs well, avoids obstacles

- seats self easily- picks up object from floor without falling

- kicks stationary ball

2. Psychosocial/Cognitive- lacks impulse control and needs constant

adult supervision

- parallel play

- names object in picture 3 out of 6

- names body parts- turns pages one at a time

- undresses completely- separation anxiety


- snips with scissors

- copies circular design- copies cross

- walks backward 10 feet

- stands on either foot momentarily- jumps off floor with both feet

- throws ball overhand

- builds tower of 8 cubes


adult supervision- names 5 pictures

- understands on, under, big

- understands concept of one- understands simple pronouns

- selects picture from memory

- pretends to engage in familiar activities- doesn't share well yet

- wants own way



- cuts well with scissors

- holds pencil with adult-like grasp- walks tip toe for 10 feet- ascends stairs alternating feet

- attempts to brush teeth

- rides tricycle


adult supervision- spontaneous greeting- says first and last name

- holds fingers up to show age

- identifies 2 - 3 pictures and action ofpictures

- plays guessing games

- repeats 3 digits

- remembers 3 objects- spontaneous play

- group play

- sharing- imaginary playmates


- greatest fear is separation from parents anharm to body including fears of castration

after age 3 and punishment for wrongdoin

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PRESCHOOL (4-5 YEARS OF AGE)1. Physical Development

- pulse, respiratory rates and blood pressuredecrease

- height and weight remain constant

- first permanent teeth erupt

- right and left handedness firmly established- walks down stairs with alternating feet

- throws and catches a ball well- ties shoelace in bow by age 5

- hops on one foot

- uses scissors, pencil and simple tools well

- slight farsightedness and unrefined hand-eyecoordination (not ready for small print)

2. Psychosocial Development- at age 4 is very independent and aggressiv- show off and tattles on others

- can be selfish and impatient

- greatest fear is separation from parents an

harm to body- imaginary play very important (may have

imaginary playmate- at age 5 is less rebellious

- ready to accomplish tasks and wants to do

things right

- has fewer fears- says first and last name

- imaginary playmates

- relies on adult authority to control world- cares for self, dressing, brushing teeth, etc

- play is more cooperative with other childr- will try to follow rules but, may cheat toavoid losing

- play is very important

- development of conscience- may view forbidden activities and wishes

punishable by physical mutilation, body

damage, and castration

- more independent with strangers, lessanxiety with strangers

- at age 4 identifies strongly with parent of

opposite sex- at age 5 tends to seek out parent of same s

- 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

- may notice prejudices

- still somewhat egocentric but, developing moresocial awareness

- understands time in association with daily events

- by age 5 can follow three commands given in arow

- has a vocabulary of 2,100 words, counts, and

identifies coins- uses 6-8 word sentences, describes drawings in

detail

4. Effects of Hospitalization- feels loss of control over usual routines

when hospitalized- difficult to differentiate between reality an

fantasy because of magical thinking and f

of mutilation- may think he/she caused the illness/injury

resulting in the hospitalization

- may regress in behavior or becomewithdrawn, angry, aggressive,

noncompliant, clingy, or have tantrums

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SCHOOL AGED (6-12 YEARS OF AGE)1. Physical Development

- by age 6, height and weight gains slowly- dexterity increases

- very active

- use hand as tool, draws, prints, colors well

- by age 7, grows at least 2 inches per year- posture becomes more tense and stiff

- more graceful- repeats activities to become proficient

- loose teeth and ugly duckling stage

- by age 8, fine motor control is well developed,

movements smoother- good hand-eye coordination

- can completely dress self

- by age 12, pubescent changes begin- remainder of teeth erupt

- posture more adult-like

- enjoys hobbies, physical activities, sports

2. Psychosocial- lacks good impulse control until around ag

7 years (needs constant adult supervision

until age 7 and then can be less supervised

for short periods only)

- greatest fear is body injury, disability, losscontrol, loss of status

- separation anxiety decreases- developing sense of industry and

independence

- eager to learn, school activities important

- more emphasis on emotional and intellectugrowth

- greater capacity to express emotion

- can assume independent chores- peer group important

- playmates often same sex

- by age 12, more self-critical- develops interest in opposite sex

- family relationships important, but may tes

limits

3. Cognitive- developing concept of time and time intervals

- has 2,550 to 2,600 word vocabulary- develops complex sentence structure

- uses words to express ideas, feelings

- views world as something to experience ormanipulate

- 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 functions

- after age 9, understands that illness has multiple

causes

4. Effects of Hospitalization- loss of control, autonomy, and competence

- may interpret medical procedures aspunishment

loss of contact with peer group may be difficult

- school routines interrupted

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ADOLESCENTS (12-18 YEARS OF AGE)1. Physical Development

- adult stature by 18 years (female) and 20 years

(male)- puberty changes in females

* see Tanner Stages

* axillary and pubic hair

* labia matures* vaginal discharge

* breast development* menstruation

- puberty change in males

* see Tanner Stages

* deepening voice* gynecomastia

* axillary, pubic, facial, and body hair (coarsens)

* penile enlargement* testes enlargement

* nocturnal emission

- acne- orthodontia

2. Psychosocial Development- greater self-direction and competence

- increasing confidence and self-esteem- family group involvement

- peer group involvement

- 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 affection

- increasing leadership abilities

- Erikson's self-identity vs. role confusion

3. Cognitive- problem-solving abilities- Piaget - concrete thinking to formal operations

(the ability to conceptualize and hypothesize)

- school progress

4. Effects of Hospitalization- may struggle with dependence on parents a

need for independence

- regressive behavior

5. Anticipatory Guidance- accident prevention (drivers ed, swimming

lessons, sports)

- infectious disease (mononucleosis, URI, herpes,

condyloma, hepatitis, gonorrhea, HIV/AIDS)- 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

8/97 Compiled by: Judy Malkiewicz, PhD, RN05/03

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PEDIATRIC ASSESSMENT GUIDE

A. Physical Assessment Measurements:

1. Temperature (record type).

2. Pulse.3. Respiratory.

4. Blood pressure.5. Height or length.

6. Weight. Value and percentile for age and gender

7. Head circumference.

B. General Appearance:

1. Describe child's activity and alertness.

2. Does the child appear well nourished?3. Describe quality of voice or cry.

4. Is there anything about child's appearance which is particularly striking?

C. Skin:

1. Color and temperature.

2. Turgor (Skin has resiliency and returns to a normal position after pinching.)

3. Lesions, bruises, abrasions, rashes.4. Birthmarks.5. Hair (color, texture, sheen, distribution).

6. Nails.

D. Head:

1. Symmetry.2. Are sutures or ridges felt? (Ridges may be felt up to 6 months.)

3. Are fontanels open or closed? (Posterior closes by 2 months, anterior by 18 months.)

4. Is head clear of lesions and scaling?

E. Eyes:

1. Pupils:

a. Are they equal and round in shape?b. Do they constrict and dilate in response to light?

2. Does child follow objects side-to-side, up and down, obliquely? (By 4 months can follow

180o side-to-side.)3. Do eyes converge when an object is brought close to the nose?

4. Is there a muscle imbalance? (Strabismus may be normal for 6 months.)5. Are eyes sunken?6. Are sclerae and conjunctiva clear?

F. Ears:

1. Ears symmetrically placed and well shaped?2. Hearing appears normal to whispered voice?

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G. Nose:1. Is there nasal drainage or crusting?

2. Is bridge of the nose unusually flat or broad, considering heredity?

3. Is there pain or tenderness when pressure is applied over sinuses?

H. Mouth:

1. Mucous membranes.2. Tongue (Symmetry).

3. Condition of gums.

4. Palate.

5. Number of teeth. (Estimate of average number of teeth is obtained by subtracting 6 fromage in months up to 20 primary teeth.)

6. Are cavities apparent?

I. Neck:

1. Is there mobility and symmetry?

2. Is pain evident when neck is flexed chin to chest?

J. Chest:

1. Is chest symmetrical?2. Lungs:

a. Respiratory rate and regularity.

b. Breath sounds.

3. Heart:a. Heart rate and quality.

b. Murmurs.

K. Abdomen:

1. Symmetrical, protruding. (Children's abdomens normally protrude until puberty.)

2. Does umbilicus protrude?

3. Bowel sounds in 4 quadrants.4. Can femoral pulses be felt equally and bilaterally?

L. Genitalia and Anus:1. Male genitalia:

a. Is meatus at tip of penis?

b. Is meatus clear of any inflammation?c. Is the foreskin loose (if circumcised)?

d. Is the foreskin constricting (if not circumcised)?

e. Are both testes palpable in the scrotal sac?2. Female genitalia:

a. Is the meatus and vaginal opening visible?b. Is there a discharge from the vagina?c. Is the clitoris small?

d. Is the labia symmetrical, not enlarged or adherent?

3. Anus:

a. Does anal sphincter appear well constricted? b. Are fissures present?

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M. Extremities:1. Mobile with full range of joint movement.

2. Of equal length, strength, mobility, and temperature.

3. Legs straight. (Bowing of legs normally up to 2 1/2 years. Knock-knees from 2 to3 1/2 years.)

4. Walks easily with good balance. (Broad-based gait normally to 3 years.)

S. Hands are symmetrical with no simian crease.6. Digits of hand are in proportion and not clubbed.

N. Back:

1. Back is symmetrical.2. Spine straight and mobile.

3. No indentations or tufts of hair noted on spine.

4. Scapulas are at an equal level when standing or when child bends over to touch toes.5. Iliac crests at equal level.

O. Neurological:1. Infants:

a. Babinski reflex positive.

b. Hand grasp equal.c. Tonic neck reflex noted. (Lasts up to 5 months.)

d. Moro reflex noted. (Lasts up to 5 months.)

2. Older child:

a. Fine and gross motor coordination appears normal for age.b. Senses of touch, taste, smell are intact.

c. Demonstrates age-appropriate language skills.

d. Demonstrates appropriate long and short-term memory for age.e. Demonstrates ability to do abstract thinking.

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NEUROLOGICAL RECORD

General CommentsA coma score needs to be documented once a shift on every neuro/rehab patient. When "neuro

checks" are ordered by an MD or done on nursing judgment, the entire record should be

completed as often as ordered.

The seizure activity columns are to be left blank if there is no observed seizure activity.

In infants or toddlers with open fontanels, an assessment of the fontanel should be done every

shift, using all descriptors that apply.

Example: Fontanel 0800 - pulsatile, soft, and flat

1600 - pulsatile, soft, bulging2300 - non-pulsatile, tense, bulging

Coma ScoreReflects the child's general level of consciousness.

Maximum score = 15.

Minimum score = 3.To be documented once a shift on every patient.

Eye Opening (EO) is scored as follows:(4) Opens eyes independently when awake or to moderate touch when asleep.

(3) Opens eyes only to voice.

(2) Opens eyes only to deep pain.

(1) Does not open eyes to any stimulation.

If both eyes are swollen shut post-operatively, a CC for "cannot check" is written. If one eye isswollen shut, score based on the response with the functional eye.

Best Verbal (BV) is scored as follows:(5) Verbalization (cooing, babbling, words/sentences) appropriate to chronological age is

developmentally normal, or if delayed (i.e., signs or communicates in other fashion)

communicates to their norm per caregivers.

(4) Comprehension of directions and verbal response inappropriate or garbles for age ornorm.

(3) Unable to console or calm; child with persistent shrieking crying and agitation.(2) Moaning or grunting.(1) No verbal response.

A child who is unable to speak (e.g., tracheostomy) but who is able to communicate shouldreceive a score reflecting their cognitive ability to communicate.

A child who is crying persistently during an assessment but calms when not bothered should be

scored appropriate to their general behavior rather than to the behavior during the exam.

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Best Motor(BM) is scored as follows:(6) Withdrawal and attempt to remove stimulus.

(5) Only minimal withdrawal from stimulus.

(4) Response only to touch, pin or deep pain.(3) Decorticate posturing: upper extremities flexed to midline; lower extremities

stiffand pointed.

(2) Decerebrate posturing: upper extremities extended, pronated away from body, lowerextremities stiff and pointed.

(1) No response at all.

Pupil SizeThe column denoting "=, " is to note pupils that may both be in the same size category but

still slightly different. The actual measured size of the five size designations are: P = 1mm; S =

2mm; M = 4mm; L = 5mm; D = 7mm.

Pupil ReactionHippus is defined as a rhythmical and rapid dilation and contraction of the pupil.A CC for "cannot check" can be charted if the child's eyes are swollen shut.

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.

(Fl) 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 ActivityType is designated as either "C" for a convulsive seizure with any motor component or "N" for anon-convulsive or absence seizure with staring or unusual behaviors.

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PEDIATRIC BLS GUIDELINES

COMPONENTS INFANT ( < 1 YEAR) CHILD (1 - 8 YEARS)

Airway Head-tilt / chin-lift.

Jaw Thrust (trauma).

Head-tilt/chin-lift.

Jaw Thrust (trauma).

BreathingInitial 2 breaths at 1.0 - 1.5 sec/breath. 2 breaths at 1.0 - 1.5 sec/breath.

Subsequent

20 breaths/min.

20 breaths/min.Circulation .Pulse Check Brachial / femoral. Carotid.

Compression Area 1 finger's width below nipple

line, compress with 2 fingers

Lower third of sternum with heel

of one hand.

Compression:Depth 1/3 to 1/2 the depth of the chest

0.5 - 1.0 inch

1/3 to 1/2 the depth of the chest

1.0 - 1.5 inches.

Rate At least 100 / min. 100/min. 5:1 (pause for ventilation).

Compression / Ventilation

Ratio 5:1 (pause for ventilation).

Neonates 3:1 with interposed

compressions / ventilation.Foreign Body AirwayObstruction

Back blows (up to 5) then chest

thrusts (up to 5). Heimlich maneuver up to 5

times.

BLS for HealthCare Providers (American Heart Association) 2001Reviewed by Cindy San Miguel, MS, RN, 05/2003

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UNDERSTANDING LAB VALUES

WBC >Hbq

6 yrs: (0.8 - 1.3mg/dl)

renal failure, shock, urinary tract obstruction, lupus,acromegaly.

muscular dystrophy, pregnancy, eclampsia, severe liverdisease.

ESRChild: (3 - 13mm/hr)

Adult: (0 - 10mm/hr)

collagen disease, infections, cell destruction.

polycythemia, sickle cell, rheumatic fever.

GLUCOSE (Serum) FASTINGNewborn: (50 - 100mg/dl)

Child: (60 - 100mg/dl)Adult: (70 - 110mg/dl)

diabetes mellitus, pancreatitis; Cushings, Tepinephrineintake.

40mg/dl

~ 300mg/dl

adrenocortical insufficiency, hepatic necrosis.

HEMATOCRIT

Newborn: (30 - 40%)Child 6-12 yr: (31 - 43%)Adult: (37 - 49%)

dehydration, hypovolemia, diarrhea, stress, burns.

acute blood loss, anemias, malnutrition, leukemia.

HEMOGLOBINNewborn: (42 - 50%)Child: (30 - 35%)Adult: (30 - 42%)

dehydration, polycythemia, stress, burns.

iron; deficiency anemia, cirrhosis of liver, hemorrhage.

IRON (total serum)Infant: (40 - 100ug/dl)Child: (50 - 120ug/dl)

hematochromatosis, excessive iron intake, liver necrosis. 300ul/dl

anemia, hereditary immunodeficiency, leukemia, lymphoma,nephrotic syndrome.

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LAB VALUES(Remember all lab values are not

absolute - they are ranges!)

Common Associations with each Lab Value:Critical Values

(Low) (High)PCO2Child & Adult (34 - 45)

acute respiratory acidosis, hypoventilation. 20mmHg

75

mmHg respiratory alkalosis, hypoxia, hyperventilation, anxiety.

PH ARTERIALNewborn: (7.11 - 7.36)Child & Adult (7.3 - 7.45)

metabolic alkalosis, GI loss-vomiting. 7.0 7.6

metabolic acidosis, renal tubular acidosis, hypoxia, diarrhea.

P02Child & Adult: (75 - 100 Torr)

breathing oxygenated enriched air.

carbon dioxide exposure, anemias, pulmonary disorders.POTASSIUMInfant: (0. 1 - 5.3 mg/1)

Child & Adult: (3.4 - 4.7 mmol/L)

oliguria, anuria, renal failure, acidosis, massive tissue damage(bums).

3.0mmol/L

7.0mmol/L

vomiting, diarrhea, malnutrition, stress, injury, dieuretics.

MAGNESIUMChild: (1.4 - 2.9 meq/1)Adult: (1.5 - 2.5 meq/1)

severe dehydration, renal failure, leukemia.

malnutrition, cirrhosis of the liver, chronic diarrhea.

PLATELETNewborn, Infant & Child:

150 - 400 x 103 / mm3 (ul)

Adult: (280 - 400,000 mm3)

Polycythemia

leukemias, aplastic anemias.

PT / PTTPT: (11- 1 5 seconds)

PTT: (60 - 85 seconds)

SLE deep thrombocytopenia, salicylates, steroids, trauma.

immune thrombocytopenia, anemias, pneumonia, allergies.

RETIC COUNTChild: (0.5 - 2.0%)

Adult: (0.5 - 1.5%)

hemolysis, hemolytic anemia, hemorrhage.

red cell aplasia, renal disease, drug ingestion.

SODIUMChild: (138 - 145mmol/L)Adult: (136 - 146mmol/L)

dehydration, low total body sodium from excessive sweating,glycosuria, mannitol use) coma, Cushings, DI.

120mmol/L

165mmol/L

burns, diarrhea, vomiting, severe nephritis, CHF, SIADH.

TOTAL PROTEINChild: (6.2 - 8.0gm/dl)Adult: (6 - 8gm/dl)

dehydration, chronic inflammation.

over hydration, hepatic insufficiency, malnutrition.

TRIGLYCERIDESChild: (5 - 40mg/dl)Adult: (10 - 190mg/dl)

familial hypertriglyceridemia, nephrotic syndrome.

malnutrition.

WBC

Child: (6,000 -17,000) l wk - 4 yrsOlder Child: (5,000 - 15,000) 5-15 yr

UTI, bacterial infections, toxic states, tissue damage.

infectious typhoid fever, systemic lupus, drug reactions.

PRBC'S Blood packed at a HCT of 70%. A T&C is required.

Type A may receive A or 0. Type B may receive B or 0.

Type AB is the universal recipient.

Type 0 is the universal donor and receives only Type 0.

Positive may receive negative but negative cannot receive positive.

PLATELETS A cross match is unnecessary.

Negative should receive negative.

Platelets can be given push or drip.

The dose is 0.2 units/kg to a maximum of 10 units.

WBC'S 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, Demerol, SoluCortef, Decadron, Benedryl, Epinephrine, 02, and the

Core Cart close by.

Pre-wet the filter and hang over 20 - 60 minutes. Observe closely.

FFP ABO group necessary but cross-matching is not.

If given for clotting factors-it must by used within 4 hrs.

If given for volume expander it must be used within 24 hours.

ALBUMIN Comes in 5% and 25% from pharmacy.

If undiluted use within 4 hrs.

Administer slowly and observe for shock.

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RBC MCH MCV Normal Urine

Newborn: 5.1

Infant: 4.7 - 5.1

Child > 2 Yrs:4.6 - 4.8

Newborn: 36

Infant: 30

Child > 2 Yrs: 25

Newborn: 103

Infant: 90

Child > 2 Yrs: 80

ph - Newborn: 5.0 - 7.0

Child: 4.8 - 7.8

Specific Gravity: 1.001 - 1.030

Sugar: None

Normal Arterial Blood Gas

Neonate ChildPH 7.32 - 7.42 7.35 - 7.45

PCO2 30 - 40mmHg 35 - 45mmHg

HCO2 20 - 26mEq/L 22 - 28mEq/L

PO2 60 - 80mmHg 80 - 100mmHg

Cerebrospinal FluidPressure: 40 - 200mm H20. Protein: > 6 months: < 40

Appearance: Clear. Chloride: 110 - 128

WBC:Neonates: 8 - 9 Sodium: 138 - 150

> 6 months: 0 SG: 1.007 - 1.009

Glucose: > 6 months: .40Hazinski, M.F. (1992) Nursing Care of the Critically III Child. Mosby

From: Reese and Eland. Acid / Base Hyperland Stack, University of Iowa, School of Nursing, Iowa City, IA 1988.

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AlkalosispH > 7.45

Respiratory PaCO2

< 35mm Hg

Metabolic HCO3

> 26 mEq/L

Respiratory PaCO2

> 45mm Hg

Metabolic HCO3

< 22mEq/L

Acidosisph < 7.35

Acid BaseImbalance

HCO3

Pt. Attempting to Compensate

HCO3

Normal

No Pt. Compensation

PaCO2


PaCO2

Normal

No Pt. Compensation

HCO3


HCO3Normal

No Pt. Compensation

PaCO2


PaCO2Normal

No Pt. Compensation


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PEDIATRIC NORMAL RANGES

Pulse Respiratory RateAge Average Range Age Range

Premature Infant 135 / min 110 - 160 / min. Premature Infants 35 - 60 / min

0 - 24 Hours 120 / min 70 - 170 / min Birth 30 - 60 / min

1 - 7 Days 140 / min 100 - 180 / min 1 Month to 1 Year 26 - 34 / min

1 Month 160 / min. 110 - 188 / min 2 Years 20 - 30 min

1 Mo to 1 Year 125 / min 80 - 180 / min 2 - 6 Years 20 - 30 / min

2 Years 110 / min 80 - 140 / min 6 - 10 Years 18 - 26 / min

4 Years 100 / min 80 - 120 / min 10 - 18 Years 15 - 24 / min

6 Years 100 / min 70 - 115 / min

10 Years 90 / min 70 - 110 / min

12 - 14 Years 85 - 90 / min 60 - 110 / min

14 - 18 Years 70 - 75 / min 50 - 95 / min

Blood PressureAge (Years) Systolic Mean Range Diastolic Mean Range

0.5 - 1 90 65 - 115 61 42 - 801 - 2 96 69 - 123 65 38 - 92

2 - 3 95 71 - 119 61 37 - 85

3 - 4 99 76 - 122 65 46 - 84

4 - 5 99 78 - 112 65 50 - 80

5 94 80 - 108 55 46 - 64

6 100 85 - 115 56 48 - 64

7 102 87 - 117 56 48 - 64

8 105 89 - 121 57 48 - 66

9 107 91 - 123 57 48 - 66

10 109 93 - 125 58 48 - 68

11 111 94 - 128 59 49 - 69

12 113 95 - 131 59 49 - 69

13 115 96 - 134 60 50 - 70

14 118 99 - 137 61 51 - 71

15 121 102 - 140 61 51 - 71

Temperature: 36 375; Fever = 385C (101.5F)

Intake and OutputMaintenance Fluid Intake Daily Calorie Requirements

0 - 10kg weight needs 4ml/kg/hr Age Kcal/kg/24 hrs.11 - 20kg weight needs 2ml/kg/hr

additional

Premature 110

21kg plus weight needs 1ml/kg/hr

additional

Birth - 6 Months 117

(E.g.: 23kg child needs 10kg x 4ml plus

10kg x 2ml plus 3kg x 1cc = 63ml/hr)

6 Months - 1 Year 108

1 -10 Years 80

10 - 18 Years 50 - 80

Minimum Urine Output Normal Stool Output

1 2ml/kg/o Less than 20gm/kg/24 hrs

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GUIDELINES FOR GIVING REPORT

DURING CLINICAL ROTATIONS

These two suggested formats come from compilation of various forms from clinical faculty. Use these to guide your

"giving report." Clinical faculty will assist you and offer suggestions.

EXAMPLE 1 Speak clearly and loudly.

Summarize your patients status and care concisely, so be brief.

Introduction:

This is (Your Name) , (Name of University) nursing student.

Patient Information:

Patient name.

Room number. Age.

Medical Diagnosis (diagnoses).

Medical or surgical treatments.

Surgical treatments - helpful to give surgery date and/or post-op day.

Problem or main concern regarding your patient's course of stay:

Any changes from previous reports.

Unusual reactions.

PRN meds given - drug, time, and patient response.

Treatments or procedures carried out.

Unusual assessment findings.

Concerns with I & O.

Review of IV or other parenteral therapy:

Type of therapy (maintenance or "unusual" such as Heparin, insulin, etc.).

cc/hr ordered.

Amount of IV or other parenteral therapy that is "up" for the next shift.

Briefly review Kardex if necessary.

Dietary.

Intake and output.

Treatments.

Mobility or activity status.

Oxygen therapy.

Special procedures / lab work.

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EXAMPLE 2

Patient name_________________________ Room___________________________

Age (days, months, years)_________

Hospitalized on ___________ for (diagnosis or reason for hospitalization)_____________

BRIEF ASSESSMENT General Appearance:

- activity

- well nourished

- interactions with POC / RN

- developmental level

Neurological:

- alert

- responsive

- deficits

- neuro checks

- speech, ROM

- paresthesia

- AVPU

Respiratory:

- reg

- unlabored respiratory effort

- symmetrical

- breath sounds clear to auscultation (BS CTA)- equal aeration

any adventitious sounds (effort, aeration, color,

respiratory rate, breath sounds)

- sputum

-oxygen- pulse oximetry

Cardiovascular:

- heart tones strong and regular

- apical for 1 minute with S1 and S2

- periph pulses (+1 to +3)

- cap refill time (CRT)


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Important Remarks:

Laboratory Results:

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CLINICAL EVALUATION DIRECTIONS

Your midterm and final evaluations will be determined by your adherence to professional

standards of behavior and your weekly self-evaluations. You must complete a WEEKLY

CLINICAL APPRAISAL each week with a detailed description of what you

accomplished during the shift. The more you say about yourself, the more your facultywill be able to review with you and to comment on. This should be filled out during the

course of the shift and turned in before you leave at the end of the day. You must makeenough copies for each clinical week!

MIDTERM:

A conference may be held at the discretion of the clinical faculty.

NOTE: CU students will receive written evaluation at midterm.

FINAL:

Your Clinical Faculty and you will complete a final evaluation. Clinical Faculty may add

additional comments to your Final Evaluation sheet. Clinical Faculty will providespecific requirements for final evaluation.

Documents

Lutheran Medical Center Peds Clinical Reference