ATI Pediatrics NCLEX

Test	Age/Gender/Reference	Normal Ranges Conventional Units
Acetaminophen	Toxic concentration	>200 mcg/ml
Carbon Dioxide	Cord	14-22 mEq/l
	Premature 1 week	14-27 mEq/l
	Newborn	13-22 mEq/l
	Infant, child	20-28 mEq/l
Chloride	Cord	96-104 mEq/l
	Newborn	97-110 mEq/l
	Child	98-106 mEq/l
Conjugated direct Bilirubin		0.0-0.2 mg/dl
Creatinine	Cord	0.6-1.2 mg/dl
	Newborn	0.3-1.0 mg/dl
	Infant	0.2-0.4 mg/dl
	Child	0.3-0.7 mg/dl
	Adolescent	0.5-1.0 mg/dl
Digoxin	Toxic concentration	>2.5 ng/ml
Glucose (Serum)	Newborn, 1 day	40 to 60 mg/dl
	Newborn, > 1 day	50 to 90 mg/dl
	Child	60 to 100 mg/dl
Hematocrit	1 day	48-69%
	2 day	48-75%
	3 day	44-72%
	2 month	28-42%
	6-12 year	37-49%
	12-18 year Male	37-49%
	12-18 year Female	36-46%
Hemoglobin	1-3 day	14.5-22.5 g/dl
	2 month	9.0-14.0 g/dl
	6-12 years Male	13.0-16.0 g/dl
	6-12 years Female	12.0-16.0 g/dl
Iron Serum	Newborn	100-250 mcg/dl
	Infant	40-100 mcg/dl
	Child	50-120 mcg/dl
	Fatally poisoned child	>1800 mcg/dl
Platelets	Newborn (after 1 wk, same as adults)	84-478 x 10 3/mm3 (ul)
Potassium	Newborn	3.0-6.0 mEq/l
	Child	3.5-5.0 mEq/l
Salicylates	Therapeutic	15-30 mg/dl
Sodium	Newborn	134-146 mEq/l
	Infant	139-146 mEq/l
	Child	136-145 mEq/l
Leukocyte count (WBC count)	Birth	9.0-30.0
	24 hour	9.4-34.0
	1 month	5.0-19.5
	1-3 years	6.0-17.5
	4-7 years	5.5-15.5
	8-13 years	4.5-13.5

Expected Blood Pressure Ranges for Both Girls andf Boys:

Ages	Girls Systolic	Girls Diastolic	Boys Systolic	Boys Diastolic
1 year	83-114	38-67	80-114	34-66
3 years	86-117	47-76	86-120	44-75
6 years	91-122	54-83	91-125	53-84
10 years	98-129	59-88	97-130	58-90
16 years	108-138	64-93	111-145	63-94

Average Temperature Ranges:

Age	Temperature in Celsius/Fahrenheit
Birth to 1 year (Axillary)	36.5 to 37.2 C (97.7 to 98.9 F)
1 to 12 years (Oral)	36.7 to 37.7 C (98.1 to 99.9 F)
12 years and older (Oral)	36.6 to 36.7 C (97.8 t 98.0 F)

Average Resting Heart Rates:

Age	Beats Per Minute (BPM)
Birth to 1 week	100-160/min with brief fluctuations above and below this range, depending on activity level (crying, sleeping).
1 week to 3 months	100 to 220/min (2 month-old 121-179/min)
3 months to 2 years	80 to 150/min (90 or below in an infant is considered bradycardia and needs further evaluation.)
2 to 12 years	70 to 110/min
12 years and older	70 to 110/min

Average Resting Respiratory Rates:

Age	Respirations Per Minute
Newborn	30 to 60/min with short periods of apnea (less than 15 seconds)
Newborn to 1 year	30/min
1 to 2 years	25 to 30/min
2 to 6 years	21 to 24/min
6 to 12 years	19 to 21/min
12 years and older	16 to 18/min

Pain Assessment by Age:

Age	Pain tool
2 months – 7 years	FLACC
3 years and older	Faces
3 years to 13 years	Oucher
5 years and older	Numeric Scale
3 years to 18 years	Non-communicating Children’s Pain Checklist

Family Composition:

Type	Members
Traditional Nuclear	Married couple and their biological children (full brothers and full sisters).
Nuclear	Two parents and their children (biologic, adoptive, step, foster.
Single-parent	One parent and one or more children
Blended (also called Reconstituted)	At least one stepparent, stepsibling, or half-sibling
Extended	At least one parent, one child, and other individuals either related or not
Gay/Lesbian	Two members of the same sex who have children and a legal or common-law tie
Foster	A child or children who have been placed in an approved living environment away from the family of origin - usually one or two parents
Binuclear	Parents who have terminated spousal roles but continue their parenting roles
Communal	Individuals who share common ownership of property and goods and exchange services without monetary considerations.

Stressors in Hospitalized Children:

Age

Stressors

Behaviors

Infant

Birth - 1 year

Interrupted routines

Parental separation

Lack of stimulation

Poor feedings

Irritability

Crying

Altered sleep patterns

Toddler

1-3 years

Interrupted routines

Separation from parents

Loss of control

Fear of being hurt

Protest stage (Crying, fighting, tantrums)

Despair stage

Developmental regression

Refusal to eat, sleep pattern disturbance

Pre-Schoolers

Pain/bodily injury

Separation from parents

Loss of control

Passiveness

Withdrawal

Poor appetite

Sleep disturbances

Magical thinking

Bed wetting

School Age Children

Guilty feelings

Fear of pain

Loss of control

Body image changes

Falling behind in school

Missing school friends

Decreased self esteem

Anxiety

Fearfulness, stalling, bargaining

Stoicism, boredom, withdrawal, sleep disturbances

Acting out, anger, crying

Adolescents

Body image changes

Self-concept disturbances

Social isolation

Personal identity issues

Anger

Aggression

Demanding

Frustration

Withdrawal

Stages of Development:

Infant (Birth to 1 year)

Theorist	Type of Development	Stage
Erikson	Psychosocial	Trust vs. mistrust
Freud	Psychosocial	Oral
Piaget	Cognitive	Sensorimotor

Toddler (12 months to 3 years)

Theorist	Type of Development	Stage
Erikson	Psychosocial	Autonomy vs shame
Freud	Psychosocial	Anal
Piaget	Cognitive	Sensorimotor transition to preoperational

Pre-schooler (3 to 5 years)

Theorist	Type of Development	Stage
Erikson	Psychosocial	Initiative vs guilt
Freud	Psychosocial	Phallic
Piaget	Cognitive	preoperational

School-Aged (5 to 12 years)

Theorist	Type of Development	Stage
Erikson	Psychosocial	Industry vs inferiority
Freud	Psychosocial	Latency
Piaget	Cognitive	Concrete operations

Adolescents (12 to 18 years)

Theorist	Type of Development	Stage
Erikson	Psychosocial	Identify vs role confusion
Freud	Psychosocial	Genital
Piaget	Cognitive	Formal operations

Acute Otitis Media:

What is it? Inflammation and accumulation of fluid in the middle ear along with signs of illness. Often preceded by illness due to respiratory syncytial virus or influenza. Appears more commonly in children less than 7 years of age.
What does it look like?
- Pain and pressure in ear
- Fever: can be high
- Enlarged postauricular and cervical lymph nodes
- Loss of appetite
What actions does the nurse take?
- Administer analgesics/antipyretics
- Apply heat over the ear and position child with the affected ear downward.
- Clean external ear canal with sterile cotton swabs with topical antibiotic ointment if draining.
- Reinforce need to complete the prescribed course of antibiotics.
- Reinforce education to reduce reoccurrence:
  - Feed infant in upright position.
  - Eliminate the infant's exposure to tobacco smoke.
  - Avoid forceful nose-blowing during an upper respiratory infection.

ADHD:

Amphetamines are used to reduce the symptoms of ADHD in children.

The nurse should include the following information in the teaching for the parents:

Administer the medication at least 6 hr before bedtime to avoid insomnia.
Limit the child's caffeine intake.
Administer the morning dose after breakfast.
Notify the provider if palpitations or hypertension occurs.

DKA:

Kussumal respirations (deep, rapid breathing)
Rapid heart rate
Sunken eyeballs