Nursing Student
Pediatric Reference Manual
Children’s Hospital Colorado
at Memorial Hospital
May, 2014
NURSING STUDENT PEDIATRIC REFERENCE MANUAL
Table of Contents
Welcome ...................................................................................................................................................... 1
Map .............................................................................................................................................................. 5
Nursing Student Clinical Practice Parameters and Student Responsibilities .................................. 6
Joint Commission Mandatory Information for Students ....................................................................... 7
Orientation Checklist ................................................................................................................................. 8
Pediatric Floor – Fourth Floor ................................................................................................................ 10
Pediatric Intensive Care Unit (PICU) – Fourth Floor ......................................................................... 11
Pediatric Emergency Department ......................................................................................................... 12
Daily Nursing Guide ................................................................................................................................ 13
Guidelines for Effective Transfer of Care ............................................................................................ 14
Additional Information for Pediatric Unit .............................................................................................. 15
Student Information for RN Preceptor .................................................................................................. 16
Where You Get Your Patient Information ............................................................................................ 18
Clinical Preparation Worksheet ............................................................................................................. 19
Clinical Preparation Worksheet Sample .............................................................................................. 20
History and Pathophysiology of Present Illness ................................................................................. 21
Medication Information Worksheet ....................................................................................................... 22
Medication Information Worksheet Examples .................................................................................... 23
REFERENCES
Developmental Stages ........................................................................................................................... 24
Pain Assessment Tools: Oucher and FLACC ..................................................................................... 31
Guidelines for CPR & ECC .................................................................................................................... 33
Lab Values and Clinical Implications .................................................................................................... 34
Vital Signs Normal Ranges .................................................................................................................... 38
WELCOME TO CHILDREN'S HOSPITAL COLORADO at Memorial Hospital
We are looking forward to working with each of you in the pediatric setting. Children's Hospital
Colorado at Memorial Hospital is a wonderful teaching environment and embraces nursing students
with a caring and professional attitude. We are confident that you will meet both personal and clinical
objectives.
PARKING
All Week Day Shifts: Memorial Employee Lot
All Weekend Shifts: Parking Ramp Levels 4 and higher
At no time are students permitted to park in the Visitor Parking Structure Level 3 and below. Students
violating this policy will be dismissed from clinical at Children’s Colorado. See map on page 4 for
parking lot locations.
SUPPLIES
The best place to put backpacks and coats is in the locker room – which is down the hall close to
the PICU. We have lockers which you can utilize while you are here. The locker combinations will be
given to your instructor and can be obtained from the Charge RN on the Pediatric Floor.
The staff lounge is where report takes place in the morning. It is also where the staff eat lunch and
take their breaks. Please be respectful of the staff and allow plenty of space during lunch and breaks.
DRESS CODE
You need to wear your school picture ID badge and the Memorial Children’s ID badge at all times on
all units when you are in the hospital. Please do not wear other ID badges or have the badges on top
of each other. Both badges should be visible at all times. Students must wear their school uniform.
You must return your Memorial Children’s badge at the end of each clinical day to your
clinical instructor.
CLINICAL ATTENDANCE IS MANDATORY
Clinical attendance is mandatory. Your scheduled time for clinical hours is limited. If you are ill and
unable to attend clinical, please notify your clinical instructor within one hour prior to your expected
reporting time.
PATIENT ASSIGNMENTS
You will be assigned a primary RN who will work directly with you on the unit. It is the responsibility of
the student and clinical instructor to select the most appropriate assignment based on the student’s
level of experience. Collaboration with the primary RN may occur in order to make the best patient
selection.
A pattern of behavior showing a lack of preparation will result in dismissal from the floor.
Report begins promptly at 0710. An informational ‘huddle’ takes place in the break room prior to staff
receiving report on their patients. Students are to use the “huddle” time to become familiar with their
assignment and be ready to meet their primary nurse outside of the staff huddle room. Patient
information is largely received from the SBAR form with any updates received from the off-going RN.
A bedside ‘safety check’ is expected of all on-coming and off-going RNs. Things such as IV fluid
3
checks, equipment checks, presence of emergency med sheet, and presence of ID bands are
assessed at this time. The primary RN and student will participate in report and rounding together.
1. An example of student scripting for introduction to their patients and family would include: “My
name is ______. I am a student nurse who will be working with (staff RN) today. I am looking
forward to working with your child and family. I will place my name on the dry erase board so
you will more easily be able to contact me throughout my time here”.
MEDICATION ADMINISTRATION
All medication administration by a student will be supervised by the clinical instructor. The student
and instructor will be expected to follow all department safety expectations. For example, the two
patient identifiers are the patient name and medication record number. The medication process is to
include discussion about the medication, observation of safe removal and checks of the medication
and documentation of the medication after administration. At no time is the student to administer
medications without supervision. Students are expected to find their clinical instructor prior to each
medication pass.
If it is anticipated that the clinical instructor will not be able to pass all the medications with the
students there should be communication with the primary RN about what medications they will need
to administer.
STUDENT DOCUMENTATION
The students will complete their own patient assessment. The RN assigned to the patient will
document his/her own assessment. When working with the student, the primary RN will collaborate
with the student to assist them in documenting an accurate assessment and to assist in areas such
as PEWS. If anything is determined to be incorrect, the RN can refer this to the instructor or ask the
student to modify their charting. The only time that the primary RN will modify student documentation
is if the student is no longer on the unit that day. This is not ideal, but know that the chart will reflect
this modification. The clinical instructor will document that the student’s charting has been reviewed,
VS and weight are accurate, (and appropriate for age), medications were given as scheduled, I&O is
accurate and all tasks have been signed off.
There are quite a few computer charting stations around the outside walls of each pod. We
encourage you to NOT utilize the computers inside the nurse’s stations. There is also a computer in
the lounge and two computers in each physician workroom. We do ask that if you are using the
physician workrooms that you give up this space promptly when a physician arrives.
CLINICAL CONFERENCES
Clinical conferences are usually held at the end of each clinical day. The purpose of clinical
conference is to provide students with a forum to openly discuss patient care issues, review specific
pediatric theory, review pathophysiology as it relates to nursing care, and identify developmental
issues and approaches, and announcements. It is expected that you will be on time for conference
and that you have handed off care to your preceptor before the conference. Student space will be
made available and determined by the facility.
INJURIES
In case you are injured, you must report the incident immediately to your Clinical Instructor and
complete the appropriate documentation of the incident. If it is an emergency situation, you will be
treated in the Emergency department at University of Colorado Health, Memorial Hospital.
The injury must be reported within 24 hours to student health personnel at your school.
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NURSING STUDENT CLINICAL PRACTICE PARAMETERS AND STUDENT
RESPONSIBILITIES
The primary RN assumes all responsibility for patient care and will only delegate appropriate
nursing care tasks to students based on their clinical level. The appropriateness of delegated
tasks will be determined by the primary RN and/or Clinical Instructor. Students will perform all
nursing care with appropriate supervision of primary RN or Clinical Instructor.
STANDARDS OF BEHAVIOR AND CLINICAL COMPETENCY
Students are accountable for their behavior related to professional conduct. Students may be
dismissed from clinical for unprofessional behavior as identified by their school or any
disrespectful interactions with patients, families, or staff. Students are to meet minimal clinical
competency in caring for children. Students may be dismissed from clinical if they are unable to
perform skills such as articulating integration of pathophysiology, medical and nursing
therapeutics, correct calculation of medication dosages, completion of Clinical Prep worksheet,
and document patient assessment and care in an accurate and comprehensive manner. HIPAA
violations will result in immediate dismissal. Accessing patient records from any remote location is
cause for immediate dismissal.
SAFETY
Safety is of utmost importance when working with children. Please be sure that the crib rails are
raised and secure (push down on the rail to assure it is engaged) before walking away from the
crib. In addition, please be cognizant of choking and ingestion hazards with children. Place
objects out of the child’s reach and avoid placing any small objects in the child’s crib. We’ve
found many potential choking hazards in cribs – and even found a child choking on one once!
CONFIDENTIALITY
Confidentiality cannot be emphasized strongly enough. Please refrain from discussing your
patient in the hallway, elevator, cafeteria or anywhere that other patients or visitors may overhear.
And remember, it is a HIPPA violation to discuss patients (when including names) with others
who are not directly involved in their care.
CLINICAL INSTRUCTORS
The clinical instructor will carry either their cell phone or a spectralink phone at all times. They
will make each student and the charge nurse aware of his/her number as well as documenting
the number on the census board. When student issues arise the clinical instructor can be
contacted at all times via this route.
STUDENT RESPONSIBILITIES
Students are responsible for the nursing cares of the patient they are assigned to (under the
direction of the clinical instructor and primary RN). With permission, they may also observe the
care of patients whom their primary RN is assigned to. Students may spend time with and
observe patients in order to provide cares and promote learning, but are not to be utilized as
sitters for behavioral health patients.
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JOINT COMMISSION MANDATORY INFORMATION FOR STUDENTS
CODE BLUE
Nursing students must initiate the following interventions: initiate CPR, call for help, dial x811 to
inform operator of type of emergency and location. Review BLS guidelines (page 29).
FIRE SAFETY
At Children’s Memorial Central, "Code Red" 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."
R
escue the patient / evacuate the area.
A
larm and call x811 in the hospital. Give your location as accurate as possible.
The alarm box is hooked into a computer system that identifies the box and its
specific location to the operator as well as the Power Plant and the Fire
Department.
C
lose the doors. 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
INFECTION CONTROL
ISOLATION CATEGORIES
Contact - Yellow gown and gloves (e.g., diarrhea, draining wounds)
Droplet - Gown, gloves and mask (e.g., respiratory illnesses)
Airborne - Gown, gloves, N-95 mask and a negative pressure room (e.g., chickenpox, measles,
TB, SARS).
Note: Students may not care for patients with suspected or confirmed TB or SARS.
Remember, isolation precautions apply to ALL personnel
7
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Pediatric Floor
Fourth Floor - East Tower
PHONE NUMBERS:
719 365-5271
CLINICAL DIRECTOR: Debbie Meilcarek BSN, RN
CLINICAL MANAGER: Stefanee Courtright BSN, RN
FAMILY CENTERED CARE:
Parents are encouraged to participate fully in the care of their hospitalized child.
NUMBER OF BEDS: 31
PATIENT POPULATION:
General surgical and complex medical patients ages newborn to 21 years. Complex
medical/surgical patients. Surgical population includes General Surgery, ENT, Plastics, Trauma,
Urology, Orthopedics and Oncology. Patient population also includes children with a variety of
medical conditions. These include pulmonary (asthma, bronchiolitis, croup, pneumonia, pertussis,
cystic fibrosis, stable tracheostomies and long-term ventilators), gastrointestinal (diarrhea, GE
reflux, failure to thrive, ulcerative colitis), neurologic (seizures, apnea, sleep disorders, nonaccidental trauma), metabolic (growth hormone deficiency, diabetes, endocrine problems) renal
(HUS, nephritis, failure), hematological (HS Purpura, Anemia), infectious disease (R/O sepsis,
meningitis, cellulitis, Kawasaki’s disease), and immune deficiencies (HIV, systemic lupus
erythematosis).
DEVELOPMENTAL AND BASELINE HEALTH PROFILE:
The majority of patients (approximately 80%) demonstrate appropriate developmental abilities.
The remaining patients have delays in one or more developmental areas due to prematurity,
and/or central nervous system insult (i.e. cerebral palsy, genetic syndrome, NAT, trauma).
Approximately 40% of patients are hospitalized for an emergent/acute medical problem, 45% are
admitted for elective surgery, and 15% are admitted for exacerbation of a chronic illness.
The Pediatric Floor is an exciting and dynamic unit. It is a great unit for a nurse who desires
variety, challenges, opportunities and support from an enthusiastic and cohesive pediatric team.
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Pediatric Intensive Care Unit (PICU)
Fourth Floor - East Tower
PHONE NUMBERS: 719 365-5274
CLINICAL DIRECTOR: Debbie Meilcarek BSN, RN
CLINICAL MANAGER: Claudia Degani, BSN, RN
FAMILY CENTERED CARE:
Parents are encouraged to participate fully in the care of their hospitalized child.
NUMBER OF BEDS: 12
PATIENT POPULATION:
The PICU cares for patients from newborn to 21 year of age. Nursing care is provided for
patients experiencing the following conditions:
Pre/post-surgical care
Heart catheterizations
Arrhythmia monitoring
Pediatric Trauma
Head Injuries
Endocrine (DKA)
Medical Emergencies
DEVELOPMENTAL AND BASELINE HEALTH PROFILE:
PICU is a dynamic unit with a cohesive nursing staff that provides excellent family-centered care.
Cares for the newborn, infant, toddler, school age, adolescent, and young adult as appropriate.
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Pediatric Emergency Department
PHONE NUMBERS: 719 365-8321
CLINICAL MANAGER:
FAMILY CENTERED CARE:
Parents are encouraged to participate fully in the care of their hospitalized child.
NUMBER OF BEDS: 12
PATIENT POPULATION:
General surgical and complex medical patients ages newborn to 21 years. Complex
medical/surgical patients. Surgical population includes General Surgery, ENT, Plastics, Trauma,
Urology and Orthopedics. Patient population also includes children with a variety of medical
conditions. These include pulmonary (asthma, bronchiolitis, croup, pneumonia, pertussis, cystic
fibrosis, stable tracheostomies and long-term ventilators), gastrointestinal (diarrhea, GE reflux,
failure to thrive, ulcerative colitis), neurologic (seizures, apnea, sleep disorders, non-accidental
trauma), metabolic (growth hormone deficiency, diabetes, endocrine problems) renal (HUS,
nephritis, failure), hematological (HS Purpura, Anemia), infectious disease (R/O sepsis,
meningitis, cellulitis, Kawasaki’s disease), and immune deficiencies (HIV, systemic lupus
erythematosis)
DEVELOPMENTAL AND BASELINE HEALTH PROFILE:
The Pediatric Emergency Department is an exciting and dynamic unit. It is a great unit for a
nurse who desires variety, challenges, opportunities and support from an enthusiastic and
cohesive pediatric team.
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DAILY NURSING GUIDE
0630-0700
Pre-conference and review of assigned patient’s Kardex in EPIC before report
0710-0730
0715-1000
Bedside Report
Safety Check – working O2 and correct flow rate; working suction; CODE sheet
Correct IV solution and rate with site and date check, presence of ID bands (parents too)
Head-to-toe assessment:
Vital signs (include Temp, HR, RR, BP)
Weight (if ordered)
Straighten room and remove trash
Chart patient safety to Nursing Shift Tab
Medications and treatments as ordered
Bath, oral care, linen change
Assist with feeding patient and remove used trays
1000-1200
Catch up on charting. Chart items that require hourly assessment.
Chart I & O as needed
Meds and treatments as ordered
Nutritional support with age-appropriate choices of food and liquids
Developmental support
Play room activities prn
1200-1400
1400– 1415
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 (for 8 hour clinical shifts only).
Report to Preceptor before going to conference
Developmental support. Playroom activities pm.
Report to Primary RN – Chart care hand-off to EPIC
1415 – 1515 Post-Clinical conference (may vary with clinical group)
Activities are similar for the day and evening shifts.
ADDITIONAL CARE THROUGHOUT SHIFT
*
Hourly IV site assessment/maintenance and recording of I & O.
*
Plan linen, bed change, bath around treatments and rehab schedule. Needs to be completed by
end of shift.
*
Continually update Primary RN on status of your patient, and report any changes.
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Guidelines for Effective Transfer of Care
Nurse providing care introduces oncoming nurse to patient and family. Encourage patient and family to
participate in report. Avoid using medical jargon and communicate at an appropriate level for patient and
family.
Provide the following information to the oncoming nurse:
SITUATION:
Name
Age
Diagnosis
Team Patient is on
BACKGROUND:
Signs and Symptoms of present illness (chief complaint)
IV location and assessment
Significant lab findings/test findings
Radiology Results (if there are any or if they are abnormal)
Last time respiratory treatments done-(especially for asthma pts)
ASSESSMENT:
Vital signs (report abnormal findings)
Assessment findings (report abnormal findings)
-neurological
-respiratory
-CV
-GI/GU
-etc
Oxygen requirement
Social issues/language barriers (if pt needs translator)
Concerns/signs to monitor
PEWS score
RECOMMENDATION:
Consults that have occurred or may occur
Discharge status
Concerns/questions
Education that has been completed and/or needs to be completed
Perform the following safety checks:
ID bracelet on patient (two patient identifiers)
Safety equipment (Bag/Mask, Code sheet, alarms, suction set up)
Pumps: rates set correctly, tubing/bags labeled, pump checks completed
CLINICAL EVALUATIONS
Final clinical evaluations will be based on your adherence to standards of behavior and clinical
competency as noted in the guidelines stated on page 6 and will be performed by the Clinical Instructor
with input from the primary nurse(s).
GUIDELINES FOR OFF UNIT EXPERIENCES
Any time a student accompanies a patient off the unit for a procedure or treatment, he/she is responsible
for reporting off to the RN who is caring for any other patients the student is assigned to so that
cares/medications are not missed.
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Additional Information for Pediatric Unit
Parents:
Parents have 24/7 visiting privileges: will wear ID bracelet
Sleeping arrangements: one bench seat OR recliner
Patient must sleep in bed or crib
NO:
Patient sleeping on the bench seat with parent
Family sleeping on the floor
Siblings allowed to stay overnight
Visitors: hours 0900 to 2100
Must check in at Family Waiting Area
Must wear “Apple” sticker
Visiting Policy available in brochure form
Quiet Time: 1300 -1500 and 2100-0900
No riding of toys in hallway during quiet time
Safety:
No patient information given out over phone except to parent (caller must provide 4 digit code)
Patients are not allowed off the unit
EXCEPTION: may visit Family Waiting Area for special event
Nutrition:
Pediatric menu for room service
Pts. 12 and older may use adult menu
Parents may order guest tray: payment with voucher from cafeteria
Breastfeeding moms receive 2 meal vouchers a day
Food on unit for pts ONLY: orange sherbet, popsicles, string cheese, graham crackers, saltines,
peanut butter, milk, apple & grape juice, jello, applesauce
Family Waiting Area:
0800-1000: light breakfast available for parents
Coffee, tea, ice & water available all day
Microwave
Refrigerator: for pt./family with name & date on all items
For checkout: i-pads, DVD’s, books
Child Life and Volunteers:
Available to staff playrooms
Activities to do in room
Portable game systems
Sit with patients
Assist with procedures (child life only)
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Student Information for Ped RN Preceptor
Student Information for Ped RN Preceptor
Student Name
____________________________________
Student Name ____________________________________
School Name
____________________________________
School Name
____________________________________
Year in program ____________________________________
Year in program ____________________________________
Instructor’s name & phone #
________________________
________________________
Instructor’s name & phone #
________________________
________________________
________________________
# of patients student can take
________________________
# of patients student can take
Time/Shift student is on the unit ________________________
Time/Shift student is on the unit ________________________
Total of days student is on the unit
Total of days student is on the unit_______________________
__________________
Student goals for clinical experience:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Student goals for clinical experience:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Patient care student will be involved in:
____________________________________________________
____________________________________________________
Patient care student will be involved in:
____________________________________________________
____________________________________________________
_________________________________________________________
_________________________________________________________
________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Additional information student would like to share with Preceptor:
Additional information student would like to share with Preceptor:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
For any additional questions or concerns, please call the
Lisa Baske - Lead Clinical Educator 719-365-5760
For any additional questions or concerns, please call the
Lisa Baske - Lead Clinical Educator 719-365-5760
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End of shift review of student charting
(instructor verification):
End of shift review of student charting
(instructor verification):
1. VS reviewed
2. I&O reviewed
3. Meds given are documented
4. Spot check of initial assessment
5. IV Assessment, Humpty Dumpty, Fall Risk
interventions, PEWS score, appropriate Braden
score, education documented appropriately
1. VS reviewed
2. I&O reviewed
3. Meds given are documented
4. Spot check of initial assessment
5. IV Assessment, Humpty Dumpty, Fall Risk
interventions, PEWS score, appropriate Braden
score, education documented appropriately
Resources
a. Lippincott (M-Net)
b. CHCO policies on my Children’s Colorado
website
c. Micromedex (M-Net)
d. Up-to-Date (M-Net)
e. Drug Dosage Handbook (each nursing station)
f. Redbooks (doctors' dictation and Prairie)
g.Teddy Bear Book (IV meds) each nursing
station
h. Icon at each computer workstation for peds info
“Shortcut to Pediatrics”
i. manuals at mountain nurse’s station:
*Medfusion pumps
* Epidural pumps
Resources
a. Lippincott (M-Net)
b. CHCO policies on my Children’s Colorado
website
c. Micromedex (M-Net)
d. Up-to-Date (M-Net)
e. Drug Dosage Handbook (each nursing station)
f. Red books (doctors' dictation and Prairie)
g.Teddy Bear Book (IV meds) each nursing
station
h. Icon at each computer workstation for peds info
“Shortcut to Pediatrics”
i. manuals at mountain nurse’s station:
*Medfusion pumps
* Epidural pumps
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WHERE YOU GET YOUR PATIENT INFORMATION
1. Pathophysiology: Intranet Library (Micromedex, Up to Date, M-net)
Be sure to review your pathophysiology. Your textbook contains lots of information, but you may need to
use the library on the 2nd floor of the hospital or resources on intranet library. You will encounter many
unusual diagnoses, and you will need to know your patient's pathophysiology. If you receive a new patient
assignment, you will be expected to learn about the pathophysiology during the course of the clinical day.
2. History of Present Illness: EPIC – chart review, (Tab: Notes). In Notes (Tab: All Notes, H & P, Prog.
Notes, Consults)
This information is important to understand the sequelae of events that brought your child to the hospital.
This information is to be noted on your Clinical Preparation Worksheet.
3. Abnormal lab data: EPIC – chart review (Tab: Lab, micro) Results review
Use the computers (EPIC program under labs, micro and imaging) to access lab and other diagnostic data
for your patients. Note any abnormal lab values and try to find rationale in your laboratory and diagnostic
reference book. Some of the common values and abnormal lab rationales are in your manual (page 31)
4. Medical Orders From the Kardex: EPIC – patient summary, can use spyglass and type in Kardex
Nursing or Overview Summary
Use the nursing Kardex to summarize the medical orders. This will give you an idea of what your nursing
interventions will include during your clinical day. If there are procedures or tests noted on the Kardex,
take some time to look them up in a reference book or the Policy and Procedure manual located on the
intranet.
5. Vital Signs, Norms, Ranges: EPIC – patient summary, use spyglass, type in comprehensive
vitals/data or Overview Summary
From assessment data 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 to problems/potential problems. The norms
may be found on page 37 of your manual.
6. Growth Parameters and Percentiles: - More Activities bottom left of screen link to growth chart
Growth parameters are very important in pediatrics, especially for children under two years of age. Most
growth occurs in the first two years of life. If there are growth problems, it is important to detect changes in
growth parameters and to intervene as soon as possible. You will find growth percentiles on EPIC under
“more activities” at the bottom of the main menu.. Document the values and percentiles on the homework.
7. Intake and Output Calculations: EPIC – Intake/Output, patient summary, comprehensive vitals/data
Once you know your patient's weight, you can use the formulas on page 36 to calculate hourly intake and
output rates. Compare the ideal 24-hour totals to the actual totals (if actual data are available) of the
previous 24 hours. Are there any I/O discrepancies or concerns?
8. Developmental Norms
Refer to pages 22-28 on developmental norms and theories.
9. Nursing care needs
After you have completed the Clinical Preparation Worksheet and researched the pathophysiology, think
about potential, important nursing care considerations for your patient and the patient's family.
List 3 Nursing Diagnosis that you think will be important nursing care issues for your patient as well as
three interventions for each diagnosis. Prioritize and individualize these care needs as much as possible.
Your initial list of care needs will help alert you to possible care concerns for your patient, but you may
need to re-prioritize during the shift. Your Clinical Instructor will help you learn clinical reasoning to
constantly assess, plan, implement and re-evaluate what is happening with your patient.
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CLINICAL PREPARATION WORKSHEET
Student’ Name:
Date:
Child’s Age:
Gender:
Patient’s Dx:
Isolation: yes / no
Type:
Allergies:
History of Present Illness and Pathophysiology:
(Write information on reverse side of page)
Medical Orders from Kardex:
Most Recent Vital Signs
Temp:
Pulse:
Resp:
BP:
Norms for Age
Significant Trends
Child’s Values
WT:
HT:
HC*:
* < 2 yrs.
% on Growth Curve
INTAKE AND OUTPUT CALCULATIONS:
Calculated hourly fluid intake needed
Calculated hourly urine output needed
Calculated 24 hour fluid intake needed
Calculated 24 hour fluid output needed
Actual (Past 24 hours)
Actual (Past 24 hours)
ABNORMAL LAB DATA (Past 24 hours) / MICRO (Past 72 hours):
Child’s Value
Test
Normal
Rationale (Related to Diagnosis)
DEVELOPMENTAL NORMS FOR AGE:
Expected
Age Appropriate?
Implications for Care
Gross Motor:
Yes
No
Yes
No
Yes
No
Yes
No
Fine Motor:
Language/Cognitive:
Personal-Social:
NURSING CARE NEEDS: Prioritized 3 needs you will need to address and one to two interventions:
1.
2.
3.
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(Revised 08/12 Children’s Hospital Colorado)
Author: Roxie Foster PhD,RN FAAN
CLINICAL PREPARATION WORKSHEET SAMPLE
Student’ Name: Jane Doe
Date: 07/04/11
Child’s Age: 13 months
Patient’s Dx: Asthma
Gender: male
Isolation: yes / no
Type: droplet
Allergies: Amoxicillin
History of Present Illness and Pathophysiology: (Write information on reverse side of page)
Medical Orders from Kardex: VS q1h while on continuous nebs. Call HO for T> 38. 5, RR > 60. Strict I&O. C-R monitor.
Keep O2 sats > 90%. Reg diet. Bedrest while on cont. nebs. IV: D5 ¼ NS + 20 mEq KCL. IV + PO =36ml/hr
Most Recent Vital Signs
Temp:
38.8 Ax
Pulse:
136
Resp:
56
BP:
92/50
Norms for Age
Av 37
80 – 180
26 – 34
76 – 122/37 - 85
Significant Trends
38.0+ in pm
NA
NA
10 pt hypotensive in am
Child’s Values
WT:
9 kg
HT:
74 cm
HC*:
44 cm
* < 2 yrs.
% on Growth Curve
~ 10th %ile
~ 10th %ile
< 5th %ile
INTAKE AND OUTPUT CALCULATIONS:
Calculated Hourly Fluid Intake Needed:
0 – 10 kg needs 4 ml/kg/hr
9 kg x 4 ml = 36 ml/hr
Calculated 24 Hour Fluid Intake Needed: 36 X 24 = 864 mls
Actual (Past 24 hours)
920 ml
Calculated Hourly Urine Output Needed:
1ml/kg/hr
1 ml x 9 kg = 9ml/hr
Calculated 24 Hour Fluid Output Needed: 9 x 24 =216 mls
Actual (Past 24 hours)
250 ml
ABNORMAL LAB DATA (Past 24 hours) / MICRO (Past 72 hours):
Test
K+
Child’s Value
5.7
Normal
3.5 – 5.5
Rationale (Related to Diagnosis)
? hemolyzed blood sample
DEVELOPMENTAL NORMS FOR AGE:
Expected
Gross Motor: Takes a few steps, can hold cup, finger
feeds, likes pull-push toys
Age Appropriate?
Implications for Care
Yes
No
Pulls self up; keeps removing neb mask
Need to keep mask on; help from mom
Need to safety proof room.
Fine Motor: Can manipulate potentially dangerous
objects; good pincer grasp
Yes
No
Language/Cognitive: Understands simple commands
Knows name, one word vocals, uses gestures
Yes
No
Continue interaction, knows mom, point to objects
and name them.
Personal-Social: Plays by self, selective attachments,
stranger anxiety
Yes
No
Keep teddy bear and blanket from home in crib.
Mom to help with care and treatments.
NURSING CARE NEEDS: Prioritized 3 needs you will need to address and one to two interventions:
1. Respiratory Distress – monitor respiratory status, O2 sats, nebs as ordered.
2. Fever – monitor temperature, administer Tylenol as ordered.
3. Stranger Anxiety – Keep familiar objects in room; enlist the help of the parents.
(Revised 08/12 Children’s Hospital Colorado)
Author: Roxie Foster PhD RN FAAN
20
11
History of Present Illness
This patient is a 13 month old male previously healthy, who has had a persistent cough for the past 3
days. He has had increased work of breathing as reported by MOC. He has had a temperature of
38.5°C the past two days. He is not eating his normal diet for the past two days. He was seen by his
PCP on 7/15 and was referred to Children’s Hospital Colorado for further evaluation. Patient was
admitted on 7/15 for treatment.
Pathology of Present Illness
Asthma is a disease of diffuse airway inflammation, caused by a variety of triggering stimuli resulting
in partially or completely reversible bronchoconstriction. Symptoms and signs include dyspnea, chest
tightness, cough, and wheezing. The diagnosis is based on history, physical examination, and
pulmonary function tests. Treatment involves controlling triggering factors and drug therapy, most
commonly with inhaled b2-agonists and inhaled corticosteroids. Prognosis is good with treatment.
Asthma is one of the most common chronic diseases of childhood, affecting more than 6 million
children; it occurs more frequently in boys before puberty and in girls after puberty.
Asthma is the leading cause of hospitalization for children and is the number one chronic condition
causing elementary school absenteeism.
Severity is the intrinsic intensity of the disease process (ie, how bad it is). Severity can usually be
assessed directly only before treatment is started, because patients who have responded well to
treatment by definition have few symptoms. Asthma severity is categorized as:




Intermittent
Mild persistent
Moderate persistent
Severe persistent
The term status asthmaticus describes severe, intense, prolonged bronchospasm that is resistant to
treatment. Diagnosis is based on history and physical examination and is confirmed with pulmonary
function tests.
21
11
MEDICATION INFORMATION WORKSHEET
Medication:
Weight of Child ______ KG
Amount Ordered
Frequency/Schedule:
Route:
1. Calculate Safe Dosage Range (mg/kg/dose or day):
Is the dose SAFE: YES
NO
2. Calculate amount of medication to give (ml/suppository/tablet):
(Concentration dispensed from Pharmacy copy from MAR : _____________)
3. A: If IV calculate the amount of dilution needed for final concentration for IV Administration (show all math):
B: Recommended time for IV Administration: ___________ minutes:
C: Calculate the rate of the IV Infusion:
4. Why is the child receiving this medication related to diagnosis?
5. What are some common side effects and nursing implications?
6. What are some teaching needs the family should be aware of?
Medication:
Weight of Child ______ KG
Amount Ordered
Frequency/Schedule:
Route:
1. Calculate Safe Dosage Range (mg/kg/dose or day):
Is the dose SAFE: YES
NO
2. Calculate amount of medication to give (ml/suppository/tablet):
(Concentration dispensed from Pharmacy copy from MAR:_____________)
3. A: If IV calculate the amount of dilution needed for final concentration for IV Administration (show all math):
B: Recommended time for IV Administration: ___________ minutes:
C: Calculate the rate of the IV Infusion:
4. Why is the child receiving this medication related to diagnosis?
5. What are some common side effects and nursing implications?
6. What are some teaching needs the family should be aware of?
Jodi Thrasher, C-FNP, MS, RN rev 01/10
22
11
MEDICATION INFORMATION WORKSHEET
Medication:
Weight of Child
30
KG
Acetaminophen
1. Calculate Safe Dosage Range (mg/kg/dose or day)
Is the dose SAFE: YES
Amount Ordered
Frequency/Schedule:
Route:
325 mg
Every 4 hours prn for pain
Not to exceed 5 doses in 24h
By mouth
10mg X30kg = 300 mg/dose
15mg X30kg = 450 mg/dose
NO
2. Calculate amount of medication to give (ml/suppository/tablet): dispensed as a suspension in drops
(Concentration dispensed from Pharmacy copy from MAR: 160mg x 325mg
5ml
X=10.4ml
3. A: If IV calculate the amount of dilution needed for final concentration for IV Administration (show all math):
B: Recommended time for IV Administration: ___________ minutes: N/A
C: Calculate the rate of the IV Infusion: N/A
4. Why is the child receiving this medication related to diagnosis?
Pain relief
5. What are some common side effects and nursing implications?
Renal or hepatic injury with chronic use
6. What are some teaching needs the family should be aware of?
Do not exceed 5 doses in 24 hours. Contact PCP if fever or pain persist.
Medication:
Weight of Child
30
KG
Frequency/Schedule: Every
8 hours/02-1000-1800
1200 mg
Cefuroxime
1. Calculate Safe Dosage Range (mg/kg/dose or day):
Is the dose SAFE: YES
Amount Ordered
Route:
IV
75mgX30kg = 2250÷3 = 750mg
150mgX30kg = 4500÷3 = 1500mg
NO
2. Calculate amount of medication to give (ml/suppository/tablet):
(Concentration dispensed from Pharmacy copy from MAR: 100mg = 1200mg
1ml
Xml
12 ml
3. A: If IV calculate the amount of dilution needed for final concentration for IV Administration (show all math):
B: Recommended time for IV Administration: 15-60 minutes 30mg/ml = 1200mg = 40 ml
Xml
C: Calculate the rate of the IV Infusion for 30 minutes:
40ml x 60min = 80 ml/hr
30min
4. Why is the child receiving this medication related to diagnosis?
UTI
5. What are some common side effects and nursing implications?
May cause headache, rash, N/V.
Long-term therapy: monitor hepatic, renal, hematologic function.
6. What are some teaching needs the family should be aware of?
Instruct family to notify healthcare provider of nausea/vomiting and/or diarrhea.
Jodi Thrasher, C-FNP, MS, RN /BMC rev 01/13
23
11
DEVELOPMENTAL STAGES
INFANT 0-2 MONTHS
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
Psychosocial/Cognitive
- needs constant adult supervision
- regards face
- visually follows moving person
- visually fixes on object
- tract object
- responds to auditory stimuli
3 MONTHS
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
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
4 MONTHS
Physical Development
- 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
Psychosocial/Cognitive
- needs constant adult supervision
- reaches for familiar adult
- laughs out loud
- attempts to locate sound source for a
variety of sounds
- turns eyes
- turns head
24
11
5 MONTHS
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
Psychosocial/Cognitive
- remembering object in visual field
- initiates noise production with rattle
- smiles at mirror image
- expressive babbling
6 MONTHS
Physical Development
- 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
Psychosocial/Cognitive
- plays by banging
- attention to detail of objects
- imitates speech sounds
- stranger anxiety
7-8 MONTHS
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
Psychosocial/Cognitive
- needs constant adult supervision
- 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
25
11
9-10 MONTHS
Physical Development
- 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
Psychosocial/Cognitive
- needs constant adult supervision
- says first words
- uses expressive jargon
- responds to verbal requests and
gestures
- imitative play
11-12 MONTHS
Physical Development
- 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
Psychosocial/Cognitive
- needs constant adult supervision
- extends to show without release
- plays pat-a-cake
- says mama or dada specifically
- social games
- separation anxiety
13-15 MONTHS
Physical Development
- points with index finger
- spontaneous scribbling
- builds tower of 2 blocks
- walks alone 2-3 steps
- falls by sitting
Psychosocial/Cognitive
- needs constant adult supervision
- 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
26
11
16-18 MONTHS
Physical Development
Psychosocial/Cognitive
-
-
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
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
Physical Development
- circular scribbling
-
Psychosocial/Cognitive
-
builds tower of 5-6 cubes
runs stiffly
squats in play
walks up stairs holding rail
unwraps candy
finds 2 hidden objects
needs constant adult supervision
2 word sentences
begins to indicate need for toilet/change
solitary play
takes pants off
takes socks and shoes off
separation anxiety
22-24 MONTHS
Physical Development
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
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
25-30 MONTHS
Physical Development
Psychosocial/Cognitive
-
- lacks impulse control and needs constant
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
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
- doesn't share well yet
- wants own way
- separation anxiety
27
11
31-36 MONTHS
Physical Development
Psychosocial/Cognitive
-
- lacks impulse control and needs constant
adult supervision
- spontaneous greeting
- says first and last name
- holds fingers up to show age
- identifies 2 - 3 pictures and action of
pictures
- 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
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
PRESCHOOL (4-5 YEARS OF AGE)
Physical Development
Psychosocial Development
- pulse, respiratory rates and blood pressure
decrease
- 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-eye
coordination (not ready for small print)
-
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
more social awareness
- 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, describes drawings
in detail
-
28
at age 4 is very independent and aggressive
show off and tattles on others
can be selfish and impatient
greatest fear is separation from parents and
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 children
will try to follow rules but, may cheat to
avoid losing
play is very important
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 5 tends to seek out parent of same sex
improving impulse control but, still needs
constant adult supervision
11
SCHOOL AGED (6-12 YEARS OF AGE)
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
Psychosocial/Cognitive
- lacks good impulse control until around
age 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,
loss of control, loss of status
- separation anxiety decreases
- developing sense of industry and
independence
- eager to learn, school activities important
- more emphasis on emotional and
intellectual growth
- 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
test limits
Cognitive/Psychosocial
- 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 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
functions
- after age 9, understands that illness has
multiple causes
29
11
ADOLESCENTS (12-18 YEARS OF AGE)
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
Cognitive/Psychosocial
- 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 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
functions
- after age 9, understands that illness has
multiple causes
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
Cognitive
- problem-solving abilities
- Piaget-concrete thinking to formal
operations (the ability to conceptualize
and hypothesize)
- School progress
Compiled by: Judy Malkiewicz, PhD RN
30
11
Children’s Hospital Colorado
Revised 5/2014
31
11
Faces Scale
Revised 5/2014
32
11
Revised 5/2014
33
11
LAB VALUES AND CLINICAL IMPLICATIONS
Hbq
WBC
> <
HCT
Na CL
K Bi/carb
<
Segs
Monos
Lymphs
Platelets
BUN CR
Glucose
EVALUATE THE WHITE BLOOD CELL COUNT WITH DIFFERENTIAL:
Total White Blood Cell Count:
Increased = leukocytosis
Decreased = leukopenia
Hemoglobin:
Decreased = anemia
Hematocrit:
Decreased = anemia
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).
normal color = normochromic
too much color = hyperchromic
too little color = hypochromic
MCV (mean corpuscular volume = size of an average RBC).
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: Bands & Segs
Lymphocytes
Basophils (inc. in leukemia, irradiation, splenectomy)
Eosinophils (inc. with allergy, parasites)
Monocytes (inc. with TB, Rocky Mountain Spotted Fever, bacterial endocarditis, monocytic
leukemia)
LEFT SHIFT Increased Neutrophils
Bands & Segs = Bacterial
RIGHT SHIFT Increased Lymphocytes = Viral
Revised 5/2014
34
11
 - increased values
 - decreased values
LAB VALUES
Critical Values
Common Associations with each Lab Value:
(Remember all lab values are not
absolute - they are ranges!)
ALBUMIN
Infant:
(4.4 - 5.4g/dl)
Child:
(4.0 - 5.8g/dl)
Adult:
(6 - 8g/dl)
AMYLASE
60-160 U/dL


dehydration, exercise.

inflammation of pancreas / salivary glands, acute pancreatitis,
peptic ulcer.
chronic pancreatitis, liver necrosis, burns.
BICARBONATE (serum)
Arterial:
19 - 25mEq/L
Venous:
22 - 26mEq/L



BILIRUBIN
Child:
direct 0.2 - 0.4mg/dl
indirect 0.3 – 1.1mg/dl
BUN
Infant:
(4 - 16mg/dl)
Child & Adult:
(5 - 20mg/dl)




CALCIUM (total serum)
Newborn: (6 – 11.5.6mg/dL)
Child:
(6.0 - 12mg/dL)
Adult:
(9. 0- 11mg/dL)
CARBON DIOXIDE
(partial pressure - arterial)
Child:
(32 - 48mmHg)
CHLORIDE
Infant:
(97 - 110mEq/L)
Child:
(98 - 106mEq/L)

CHOLESTEROL
Adult Range: (100 - 200mg/dL)
Child:
(5 - 100mg/dL)

CREATININE (serum)
< 6 yrs:
(0.5 - 0.8mg/dL)
> 6 yrs:
(0.8 - 1.5mg/dL)
ESR
Child:
(3 - 13mm/hr)
Adult:
(0 - 10mm/hr)
GLUCOSE (serum)
FASTING
Newborn: (50 - 100mg/dL)
Child:
(60 - 100mg/dL)
Adult:
(70 - 110mg/dL)
HEMATOCRIT
Newborn:
(30 - 40%)
Child 6-12 yr: (31 - 43%)
Adult:
(37 - 54%)
HEMOGLOBIN
Newborn: (14 - 24g/dL)
Child:
(11 - 16g/dL)
Adult:
(12 - 18g/dL)












IRON (total serum)
Infant:
(40 - 100ug/dL)
Child:
(50 - 120ug/dL)
Revised 5/2014
alkalosis.
acidosis (bicarbonate ion concentration is regulated by the
kidneys).
erythroblastosis fetalis, sickle cell, hepatitis.
15
mEq/L
35
mEq/L
15
mg/dl
iron deficiency anemia, drug influence-ASA, PCN.
dehydration, impaired renal function, GI bleeding, shock.
starvation, severe liver damage, poor absorption-Celiacs, low
protein diet, overload of fluids, infancy.
too much dietary intake, hyperparathyrodism, myeloma,
metastatic carcinoma, thiazide therapy.
diarrhea, extensive chronic infection, bums,
hypoparathyroidism, (chronic renal failure pancreatitis).
decreased alveolar ventilation (acidosis).
>100
mg/dl
<6.0
mg/dL
>13
mg/dL
80
mEq/L
115
mEq/L
40
mg/dL
~ 300
mg/dL
14%
60%
6
g/dL
200
g/dL
0.9
1.1
2
3.5
increased alveolar ventilation.
diarrhea, hypernatremia, renal disease, dehydration,
hyperventilation.
prolonged vomiting, burns, ulcerative colitis, gastroenteritis,
diabetes mellitus.
atherosclerosis, nephrosis, pancreatic disease, increased
dietary intake.
poor nutrition intake.
renal failure, shock, urinary tract obstruction, lupus,
acromegaly.
muscular dystrophy, pregnancy, eclampsia, severe liver
disease.
collagen disease, infections, cell destruction.
polycythemia, sickle cell, rheumatic fever.
diabetes mellitus, pancreatitis; Cushings, Tepinephrine
intake.
adrenocortical insufficiency, hepatic necrosis.
dehydration, hypovolemia, diarrhea, stress, burns.


dehydration, polycythemia, stress, burns.
acute blood loss, anemias, malnutrition, leukemia.
iron; deficiency anemia, cirrhosis of liver, hemorrhage.
* Ratio of Hgb to Hct = 3:1
Increased value could result in bleeding tendencies.
Therapeutic ranges, if on an anticoagulan =


(High)
liver disease, severe malnutrition, diarrhea, burns, starvation.


International Normalized Ratio
(INR)
(Low)
hematochromatosis, excessive iron intake, liver necrosis.
anemia, hereditary immunodeficiency, leukemia, lymphoma,
nephrotic syndrome.
35
300
ug/dL
11
LAB VALUES
Critical Values
Common Associations with each Lab Value:
(Remember all lab values are not
absolute - they are ranges!)
PCO2
Child & Adult:
(34 – 45mmHg)
PH ARTERIAL
Newborn:
(7.11 - 7.36)
Child & Adult: (7.3 - 7.45)
PO2 SATURATION
Child & Adult: (75 - 100%)
POTASSIUM
Infant:
(4. 1 - 5.3mEq/L)
Child & Adult: (3.5 - 5.0mEq/L)
MAGNESIUM
Child:
(1.4 - 2.9mEq/L)
Adult:
(1.5 - 2.5mEq/L)
PLATELET
Newborn, Infant & Child:
150 – 400,000 / ml
Adult: (280 - 400,000 / ml)
PT / PTT
PT:
(11- 1 5 seconds)
PTT:
(30 - 45 seconds)
RETIC COUNT
Child:
(0.5 - 2.0%)
Adult:
(0.5 - 2.0%)
SODIUM
Child:
(135 - 145mEq/L)
Adult:
(136 - 146mEq/L)
TOTAL PROTEIN
Child:
(6.2 - 8.0gm/dL)
Adult:
(6 - 8gm/dL)
TRIGLYCERIDES
Child:
(5 - 40mg/dL)
Adult:
(10 - 190mg/dL)
WBC
Child: (6,000 -17,000) l wk - 4 yrs
Older Child: (5,000 - 15,000) 5-15 yr
PRBCs
PLATELETS
WBCs
FFP
ALBUMIN
Revised 5/2014

























acute respiratory acidosis, hypoventilation.
respiratory alkalosis, hypoxia, hyperventilation, anxiety.
(High)
20
mmHg
75
mmHg
7.0
7.6
metabolic alkalosis, GI loss-vomiting.
metabolic acidosis, renal tubular acidosis, hypoxia, diarrhea.
breathing oxygenated enriched air.
carbon dioxide exposure, anemias, pulmonary disorders.
oliguria, anuria, renal failure, acidosis, massive tissue damage
(bums).
vomiting, diarrhea, malnutrition, stress, injury, dieuretics.




severe dehydration, renal failure, leukemia.





SLE, deep thrombocytopenia, salicylates, steroids, trauma.







(Low)
malnutrition, cirrhosis of the liver, chronic diarrhea.
60%
2.5
mEq/L
6.5
mEq/L
1
mEq/L
5.0
mEq/L
20,000
ml
1,000,000
ml
Polycythemia
leukemias, aplastic anemias.
immune thrombocytopenia, anemias, pneumonia, allergies.
hemolysis, hemolytic anemia, hemorrhage.
>20%
red cell aplasia, renal disease, drug ingestion.
dehydration, low total body sodium from excessive sweating,
glycosuria, mannitol use) coma, Cushings, DI.
burns, diarrhea, vomiting, severe nephritis, CHF, SIADH.
120
mEq/L
160
mEq/L
2,000
50,000
dehydration, chronic inflammation.
over hydration, hepatic insufficiency, malnutrition.
familial hypertriglyceridemia, nephrotic syndrome.
malnutrition.
UTI, bacterial infections, toxic states, tissue damage.
infectious typhoid fever, systemic lupus, drug reactions.
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
Rh positive may receive negative, but Rh negative cannot receive positive.
A cross match is unnecessary.
 Platelets can be given push or drip.
Negative should receive negative.
 The dose is 0.2 units/kg to a maximum of 10 units.
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
Code Cart close by.
Pre-wet the filter and hang over 20 - 60 minutes. Observe closely.
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.
Comes in 5% and 25% from pharmacy.
If undiluted use within 4 hrs.
Administer slowly and observe for shock.
36
11
RBC
Newborn:
Infant:
Child > 2 Yrs:
4.8 - 7.1
3.8 - 5.5
4.6 – 5.5
MCH
Newborn:
Infant:
Child > 2 Yrs:
36
30
25
MCV
Newborn:
Infant:
Child > 2 Yrs:
103
90
80
Normal Urine
ph - Newborn: 5.0 - 7.0
Child:
4.8 - 7.8
Specific Gravity: 1.001 - 1.030
Sugar:
None
Normal Arterial Blood Gas
Neonate
7.32 - 7.42
30 - 40mmHg
20 - 26mEq/L
60 - 80mmHg
PH
PCO2
HCO2
PO2
Child
7.35 - 7.45
35 - 45mmHg
22 - 28mEq/L
80 - 100mmHg
Cerebrospinal Fluid
Pressure:
Appearance:
WBC:
Glucose:
Protein:
Chloride:
Sodium:
40 - 200mm H20. (Avg = 120)
Clear.
Neonates:
8-9
> 6 months: 0
> 6 months:20 - 80mg/dL
> 6 months: < 40mg/dL
110 - 130mEq/L
138 - 150mEq/L
Cavanaugh B. (2003) Nurse's Manual of Laboratory and Diagnostic Tests, 4th Ed. Philadelphia: FA Davis.
HCO3 
Pt. Attempting to Compensate
Respiratory
PaCO2 
< 35mm Hg
HCO3 Normal
No Pt. Compensation
Alkalosis
pH > 7.45
PaCO2 
Pt. Attempting to Compensate
Metabolic
HCO3 
> 26 mEq/L
Acid Base
Imbalance
Respiratory
PaCO2 
> 45mm Hg
PaCO2 Normal
No Pt. Compensation
HCO3 
Pt. Attempting to Compensate
HCO3 Normal
No Pt. Compensation
Acidosis
ph < 7.35
Metabolic
HCO3 
< 22mEq/L
PaCO2 
Pt. Attempting to Compensate
PaCO2 Normal
No Pt. Compensation
REF: Cavanaugh. 2010 Nurses guide to laboratory and diagnostic tests. 4th ed. FA Davis: Philadelphia
Revised 5/2014
37
11
VITAL SIGNS NORMAL RANGES
Pulse
Age
Respiratory Rate
Average
Premature Infant
0 - 24 Hours
1 - 7 Days
1 Month
1 Mo to 1 Year
2 Years
4 Years
6 Years
10 Years
12 - 14 Years
14 - 18 Years
135 / min
120 / min
140 / min
160 / min.
125 / min
110 / min
100 / min
100 / min
90 / min
85 - 90 / min
70 - 75 / min
Range
110 - 160 / min.
70 - 170 / min
100 - 180 / min
110 - 188 / min
80 - 180 / min
80 - 140 / min
80 - 120 / min
70 - 115 / min
70 - 110 / min
60 - 110 / min
50 - 95 / min
Age
Range
Premature Infants
Birth
1 Month to 1 Year
2 Years
2 - 6 Years
6 - 10 Years
10 - 18 Years
35 - 60 / min
30 - 60 / min
26 - 34 / min
20 - 30 min
20 - 30 / min
18 - 26 / min
15 - 24 / min
Blood Pressure
Age
(Years)
Systolic
Mean
Range
Diastolic
Mean
Range
0.5 - 1
1-2
2-3
3-4
4-5
5
6
7
8
9
10
11
12
13
14
15
90
96
95
99
99
94
100
102
105
107
109
111
113
115
118
121
65 - 115
69 - 123
71 - 119
76 - 122
78 - 112
80 - 108
85 - 115
87 - 117
89 - 121
91 - 123
93 - 125
94 - 128
95 - 131
96 - 134
99 - 137
102 - 140
61
65
61
65
65
55
56
56
57
57
58
59
59
60
61
61
42 - 80
38 - 92
37 - 85
46 - 84
50 - 80
46 - 64
48 - 64
48 - 64
48 - 66
48 - 66
48 - 68
49 - 69
49 - 69
50 - 70
51 - 71
51 - 71
Temp Conversion Chart
°C
°F
°C
34.2
93.6
38.6
101.5
34.6
94.3
39.0
102.2
35.0
95.0
39.4
102.9
35.4
95.7
39.8
103.6
35.8
96.4
40.2
104.4
36.2
97.2
40.6
105.2
36.6
97.9
41.0
105.9
37.0
98.6
41.4
106.5
37.4
99.3
41.8
107.2
37.8
100.0
42.2
108.0
38.2
100.8
42.6
108.7
Temperature: 36 – 375; Fever = 385C (101.5F)
Intake and Output
Maintenance Fluid Intake
0 - 10kg weight needs 4ml/kg/hr
11 - 20kg weight needs 2ml/kg/hr
additional
21kg plus weight needs 1ml/kg/hr
additional
(E.g.: 23kg child needs 10kg x 4ml plus
10kg x 2ml plus 3kg x 1cc = 63ml/hr)
Daily Calorie Requirements
Age
Premature
Revised 5/2014
Kcal/kg/24 hrs.
110
Birth – 6 Months
117
6 Months - 1 Year
1 -10 Years
10 - 18 Years
108
80
50 - 80
Minimum Urine Output
1 – 2ml/kg/o
Normal Stool Output
Less than 20gm/kg/24 hrs
38
°F