Cardiac Rate- Peds

Remember: 311

(Fetal HR 120-160) RR -30 90-130 Infant 30-60

-10 80-120 Toddler 20-30

-10 70-110 Preschooler 16-22

Temperature

F = (1.8 * C) + 32 (Think of them as being ~ 2 apart)

37C = 98.6 F 38C=100.4 F 39C=102.2 F 40C =104 F

Labs

BUN/CR = Dehydration BUN/CR = Overhydration

El: Na (135-145) K (3.5-5) Mg (1.5-2.5) Ca (9-11) Cl (96-106) Phos (3-4.5)

Endocr:

BUN (7-22 or to remember put the buns in the oven for 10-20 min) Cr (0.5-1.5) Urine Spec Gravity (1.005-1.030)

Glucose:

Nml 70-120 Fasting <110 Infant BG 50-90 (<45=hypoglycemia-high pitch cry)

HgbA1c= 4-6% (or <7%)

Thyroid:

T3 (60-180) T4 (5-11) TSH (0.5-5) or 0.5-2 for hypothyroid pts Free T4: 0.8-2.7 ( I remember it .8-2.8 easier to memorize)

Hypothyroid: TSH ;q T3 & T4 Hyperthyroid: q TSH ; T3 &T4

ABGs: PH 7.35-7.45 pO2 80-100 pCO2 35-45 HCO3 22-26

ROME: With Acidosis the PH is always q and PH is always in Alkalosis Respiratory Opposite; Metabolic Equal

RESP OPP:

PH q PCO2 = Resp Acidosis PH PCO2 q = Resp Alkalosis

METABOLIC = PH q HCO3 q= Metabolic Acidosis PH HCO3 = Metabolic Alkalosis

Blood:

RBC 4.2-6.1 million WBC 5000-10000 (or 4500-11000) Plt 150,000 450,000

Hgb F: 12-16 M: 14-18 Hct F: 37-47% M: 42-52%

Amylase: 53-123 Albumin: 3-4.3 Alk Phosphate: 14-100 NH3 (35-65) Blood Osmol 280-300 Lipase 14-280

Bilirubin (Total: 0.3-1; Indirect: 0.2-0.8; Direct 0.1-0.3) Phenylalanine: Newborn < 2 Adult < 6

Antidotes

Digoxin p Digiband Tylenol p Mucomist (17 doses + loading dose) Heparinp Protamine Sulfate Benzodiazepine p Flumzaemil (Romazicon) CoumadinpVit K

DI pq ADH, u/o, q Urine Specific Gr, Na (think Na = urine spec gr) SIADHp think syndrome of ed diuretic hormone ADH, q u/o, urine spec gr

Insulins

Rapid Reg Interm Very Long Long Acting

5-15m 30-60m 1-3h 1h 6-8h

1-2h 2-4h 6-12h peakless action 12-16h

4-6h 5-7h 16-20h 18-24h 20-30

Novolog Novolin R NPH Lantus Ultra Lente \

Humalog Humulin R Lente

Vaccines

Hep B 0, 1-2, 6-18mo

Hib 2, 4, 6, 12-15

Pneumo 2, 4, 6,12-15

Dtap 2, 4, 6, 15-18, 4-6yrs; Td q 10 yrs

IPV 2, 4, 6-18, 4-6yr

Varicella 12-15, 4-6yr

MMR 12-15, 4-6yr

Hep A 12-23 mo (2 doses, 6 mo apart)

Mening 9-11 yrs

Rota 2, 4, 6

Influenza at 6 mo and then yearly after

Random Stuff

Thiazides BG Neupogen = Neutrophil Epogen = RBC/Erythocyte Lofenalac Formula = for PKU infants Ototoxic drugs = loop diuretics (Lasix) and Platinol-AO

TB Meds (RISE)

Rifampin

INH Streptomycin Ethambutol

GCS

Eyes (4 points)

Verbal (5 points)

Motor (6 points) Max = 15 (<8=coma)

APGAR Score

At 1 and 5 min after birth (1st score is the transitional score and 2nd is planning care of newborn) 8-10 = ok 210 Appearance [All pink, pink&blue, blue/pale]

Pulse [> 100, < 100, No Response] Grimace [cough, grimace, no response] Activity [flexed, flaccid, limp]

Resp [strong cry, weak cry, no cry]

INFECTION CONTROL

Contact Precautions:

MRS WEE

VCHIPS Alex Hez 5 Coins HeRe

M-MRSA R-Resp Infections (those not listed in other categories below) S-Skin Infections W-Wound Infections

E-Enteric Infections (C.Diff, Shigella) E-Eye Infections (Conjunctivitis)

SKIN INFECTIONS:

V-Varicella C-Cutaneous Diptheria H-Herpes Simplex I- Impetigo P- Pediculosis (lice) S-Scabies

Alex = AIDS Hez= Herpes Zoster 5=5th Dx Coins=Croup HeRe= Hepatitis and RSV

Droplet Precautions:

SPIDERMAN

Sepsis Scarlet Fever Streptococcal Pharyngitis

Parovirus B19 (virus that causes 5th dx) Pertussis Pneumonia Influenza Diptheria Epiglottidis Rubella (Measles) Measles Meningitis Mycoplasma AdeNovirus

Also Rhinovirus and RSV

FETAL k Strips

REMEMBER: VEAL CHOP

Variable is Cord Early is Head

Acceleration is Ok Late is Placental Insufficiency

Hypoventilation => Resp Acidosis ( CO2) Retain CO2 Hyperventilation=> Resp Alkalosis (q CO2) Blow off CO2 (think of preg breathing)

Lasix/Bumex = K+ Wasting (can cause hypokalemia) Aldactone = K+ Sparing (can cause hyperkalemia)

Tx of DIC = Heparin (safe during preg)

Post Masectomy Care: BREAST

BP NOT on affected side

Reach Recovery Elevate affected side Abduction and external rotation no initial exercise (initial is extension/flexion) Self Breast Exam (1x month 7 day after period) Try to promote a (+) self-image

Autosomal Recessive: Cystic Fibrosis, PKU, Tay-Sachs, Albinism, Sickle Cell Dx, Alpha

Anti-Trypsin Deficiency, Galactetsemia

Autosomal Dominant: Huntingtons Disease, Marfans, Polydactly, Achandrophic Dwarfism, Polycystic Kidney Disease

X-Linked Recessive: Duchennes Muscle Dystrophy, Hemophilia A (Females are carriers in these diseases and males are affected by the disease)

At Term:

Nml = wt: 6-9lbs, head circumference: body length, 13-14 in, chest: 12-13in Umbilical cord falls off in 1-2 weeks Stool: 1st stool (Mecconium) black + tarry (passes w/in 12-24 hrs), thin/green/brown day 3, formula feedings (1-2 pale yellow/light brown stools) or breast feeding (loose golden yellow stools with sour milk odor)

Hypokalemia: Flat T wave, Depressed ST, and Prominent U wave Hyperkalemia: Tall T wave, Wide QRS, Long PR Wave

5 Ps of Fracture: Pain, pallor, pulseless, paresthesia, paralysis

Cushings Triad: (Indicates ed ICP) q HR, qRR, BP

CONVERSIONS:

1 lb = 16 oz 1 T = 3 tsp = 15 mL 1c = 8 oz = 240 mL 1 t = 5 mL 1 lb = 454 g = 16 oz 2 c = 1 pt = 16 oz 1 oz = 30 mL= 8 drams 1 mg = 1000 mcg 2 pt = 1 qt= 32 oz 1 g = 15 gr 4 qt =1 gal=128 oz 1 gr = 60 mg

Med Trivia

Talwan and Stadol=> Avoid (opoid agonist antagonists) much less effective then opoid agonists No Tagamet with Warfarin Erogostat => For Migraine No Quinolones/Tetracyclines with pregnancy No ASA/NSAIDS in Hemophilia A patients Lipitor = PM ONLY, no grapefruit juice tPA= dissolves clots (heparin does not) SLE Tx o Cytotax, Imuran (Immunosupressants) o NSAIDs o Plaquinil (also an anit-malarial drug)

More Maternity

Fundal Height o Top of Symphis Pubis to top of fundus o Gross estimate of dates o Use a non-stretchable tape measure o 12-14 wks (at level of symphis) o show after week 14 (can tell preg) o 20 wks (~ 20cm) at level of umbilicus o rises 1 cm/wk till 36 weeks then varies Quickening = fetal movement; 16-20 weeks Fetal Heartbeat = 8-12 weeks (by Doppler) and 18-20 weeks by auscultating with stethoscope Preterm: 20-37 weeks Term: 38-42 weeks Post-term: 42 weeks plus Total preg weight gain: 11-14 kg (25-35 lb)  300 cal during preg (DAILY) and 200-500 cal during breastfeeding (DAILY) Caffeine < 300 mg/day (500-750 mL/day => risk of spontaneous abortion or fetal intrauterine growth restriction Uterine contractions can be felt after 4th month = Braxton Hicks Contractions facilitate uterine blood flow through placenta and promote O2 delivery to fetus

Amniotic Fluid: o Nml: 800-1200 mL (transparent/clear, no odor) o <300 mL = Olighydrimanos (low amniotic fluid) Kidney problems o Polyhydrimanos (too much amniotic fluid) Umbilical Cord: 2 arteries and 1 vein Placenta: Fetal lungs in utero Alcohol, caffeine, nicotine, meds = easily cross placenta (viruses can cross, bacteria cannot; exs of viruses (HIV, AIDS, Herpes, Measles, Toxoplasmosis, Hep) AFP Test: measured at 16-18 weeks o ed Levels = risk of neural tube/abd wall defects (ex. spina bifida) o qed Levels: risk of Down Syndrome Fetal Distress o HR < 110 or > 160 o Fetal hyperactivity or no activity o Fetal Blood pH < 7.2

Other Stuff

Immed after put pt on a Mech Vent check BP (hypotension) Lesions of midbrain = decerebrate positioning Morphine Toxicity = Pinpoint pupils Corticosteroid Effects: Acne, Hirituism, Mood Swings, ostoporosis and adrenal

suppression (in kids = delayed growth) No Paxil with MAOI) Beta Blockers = Mask Effect Of Hypoglycemia SOMogyi Effect = BG sometimes up and sometimes down Dawn Phenomenon = high BG in DAWN hrs (5-8am) AFTER o Post tracheostomy: keep O2 and Suction at bedside o Post pleural biopsy: chest tube and drainage system at bedside o Post parathyroidectomy: tracheostomy at bedside o Tonic Clonic Seizures: Suction apparatus at bedside o Paracentesis: BP Cuff at Bedside RACE-Priority in a fire o R-Rescue o A-Alarm o C-Confine o E-Extinguish PASS To use a fire extinguisher o P-Pull Pin o A-Aim at Base Fire o S-Squeeze Handle o S-Sweep fire from side to side Folic Acid Rich Foods (FOL) o F= Fish

o O=Organ Meats, Oranges o L=Leafy green veggies K+ Foods (ROYGBIV-Rainbow colors) o Red= Strawberries, Tomatoes (not apples) o Orange= Oranges o Yellow=Banana o Green= Avocado, green veggies o Blue= Fish from the BLUE sea o Indigo/Violet= Raisins Cretenism = Congential Hypothyroidism (appears 3-6 mo in bottlefed infants and later in breastfed infants) Hepatitis: low fat, high cal/carbs/protein, no alcohol Hypothryoid: High Protein, low cal diet Cystic Fibrosis: High Protein Diet and Pancr enzyme replacement Hital Hernia: Fundopliction (tighten cardiac sphincter on stomach) dont lie down for 1 hr after meals, HOB 4-8 in when sleepy, no food before bed Papable olive shaped tumor in epigastrim = pyloric stenosis (projectile vomiting) o In adults from peptic ulcers; in infants from hypertrophy of pylorous (symp 2nd-4th wk after birth) Toddler: Fear of separation (give simple directions) Preschooler: Fear mutilation (Allow to play with equipment) School Agers: Fear loss of control (allow to play with equipment) Adol: Fear loss of independence

Pneumothorax Symp (P-Thorax) o P-Pleurtic Pain o T-Trachea Deviation o H-Hyperresonance o O-Onset Sudden o R-Reduced breath sounds (dyspnea) o A-Absent Fremitus o X-X-Rays show collapse Pul Edema Tx (MAD DOG) o M-Morphine o A-Aminophylline o D-Digitalis o D-Diuretics o O-O2 o G-Gasses in blood (ABGs)

Cholecystisis: Gallbladder inflammation (RUQ pain) Cholelithiasis: Gall Stones Pancreatitis o TURNERS SIGN: Flank echymosis o CULLANs SIGN: Bluish periumbical (around the belly button)

Who needs Dialysis?

Vowels: AEIOU

A: Acid/Base Problems E: Electrolyte Problems I: Intoxications O: Overload of fluids U: Uremic Symptoms

Cushings Dx o (Cushion too much Cortisone) o (3 Ss = high Steriods, high Sugars (hyperglycemia), high Sodium o Moon Face, Buffalo Hump, Trunkal obesity, thin skinny extremities, slow wound healing, osteoporosis, HTN, muscle wasting o q K+ Addisons Dx o Need to ADD steroids o (3 Ss = Low Steroids, Low Sugars, Low Sodium) o Low vascular volume (Not holding salt and H20 like in Cushings), low BP o Hyperkalemia ( K+)

o Bronze Skin, Hyperpigmentation ALLEN TEST o B4 drawing ABGs do an Allens Test o Compress both radial and ulnar arties (wrist) at same time on 1 hand o Release the ULNAR side (pinky side) and hand should turn discolored and should be able to see blood flow back into it (Radial is located on the thumb side and ulnar is on the pinky side) o Minutes of press on the ABG site after drawing blood? 5-10 min or 15-20 min if on anti-coagulants After a liver biopsy place patient on the RIGHT Side Mobility o Cane COAL = Cane Opp Affected Leg o 2 point gait One leg and 1 crutch touch ground at same time Weight bearing o 3 point gait Both crutches and 1 foot are on the ground Non-weight bearing o 4 point gait Both legs and both crutches touch the ground Weight bearing o Swing through gait

Advancing both crutches, then both legs, and requires weight bearing Not as stable as other gaits Laminectomy = removal of 1 or more vertebral laminae need straight back after = LOGROLL and KEEP BACK STRAIGHT (so flat bed) Intussceptation o Seen in Non-Hodgkins Lymphoma o Hot dog mass in RUQ o Red Currant Jelly Like mucous and bloody stool Sweat Chol o > 60 = CF o 40-60 = Borderline CF Ostomy = pouch opening 1/8 in larger than stoma

Macule = flat and round Papule = rounded and red Vesicle = filled with fluid

Impetigo = 1:20 Burrows Soln, honey colored crusts Permethrin [NIX] => 10% for lice tx and 5% for Scabies tx o (Scabies = mites bury under skin)

RUQ: Right upper quadrant

Cholelithiasis (gallstones) Cholecystitis (inflamm of gallbladder) Hepatitis Pancreatitis (severe knifelike pain; worse with eating/lying down; some relief with fetal position)

RLQ:

Crohns Dx (Ileum, Rt Colon; pain after meals) Appendicitis o Pain at McBurneys Point (1/2 b/w umbilicus and right iliac crest)

LLQ:

Ulcerative Colitis (Rectum, left colon; pain pre-defecation) Diverticulitis o Relieved by passage of stool/flatulus

Duodenal Ulcer: Pain 2-3 hrs after meals and nighttime (relieve pain with FOOD INTAKE)

Gastric Ulcer: Pain 1 hr after meal/when fasting; relieve pain with vomiting, not with food

intake

(Starve the gastric ulcer and feed the duodenal)

Diverticular Dx: Cramping in LLQ relived by passage of stool and flatus (constipation alternates with diarrhea (from def in diet fiber) high fiber diet

Meckels Diverticulum: congen sac or pouch in ileum, symp seen by age 2; painless rectal bleeding, abd, hematechezia, (currant jelly like stool), s/s of appendicitis (tx = remove diverticulum)

Cirrhosis: Biliary obstruction, alcohol, Hepatitis Early stage: high protein/carbs and Vit B Adv stage: low fiber/salt/fat/protein, high cal, fluid restriction Esophageal Varices o Sengstaken Blakemore Tube or Minnesota Tube Balloon on Esophagus and stomach to apply direct press on bleeding veins o TIPS (transesophegal intrahepatic post systemic shunt) Balloon Catheter inserted via jugular vein with angiography to create a metal stent b.w portal vein to vena cava channel (provides a pathway for blood b/w portal vein and hepatic vein = bypasses cirrhotic liver) and relieves press on esoph varicies

Jaundice (Icterus)

Hemolytic o RBCs are destroyed (release bilirubin) Hemolytic transfusion rxn Hemolytic Anemia Sickle Cell Crisis Hepatocellular o The impaired liver cell (hepatocyte) doesnt allow bilirubin to convert from the unconjugated to the conjugated form Obstructive o Bile flow is obstructed Cholelithias (Gall Stones) Tumors EKGS

Nml Sinus o 60-100 o PQRST nml EKG Strip Sinus Brady o < 60 o Tx: Atropine

o (can be nml in physically fit/trainer person = then no tx needed) 1st degree AV k Block o Prolonged PR interval o Nml PR interval: 0.12-0.20 o Conduction Problem o Drugs (Dig, Beta Blockers, Ca Channel Blockers) can cause by slowing conduction system (slows conduction from SA node to AV node to Purnjee Fibers = see slowed PR (Atrial Response) o Usu dont see symp, so usu not treated Atrial Flutter o Saw Tooth Appearance o Atrium racing away, blood pools and can throw a clot => stroke o Treat with Cardioversion 20-50 Jules (NURSE must hit Synchronize button) o Ventricle beats are regular Atrial Fib o Ventricle beats are irregular o Atrium quivers, not good pump o Cardiovert 50-100 Jules o If in hospital and were stable b4 going into a fib = give cardizem drip and beta blockers b4 cardioversion V-Tach o Wide QRS complexes o V Tach and awake drugs I must take (Amiodarone or Lidocaine)

o V Tach and a nap (unconscious) zap zap zap (defibrillate) o Can only stay in for 2-3 min (can die) V Fib o Irreg makes no sense o Only way to tx = defribillate start at 360 Jules o Epi (to HR)

Stroke

Right Sided: Impatient, easily distracted, impulsive, less concerned about life events, safety is a big issue (impulse)

Left Sided: Slow, cautious, particular, very aware of deficits, greater depression/anxiety

(Think rt brain = creative, left brain = logical, math, science)