MOTOR DEVELOPMENT

Chin up 1 month

Chest up 2 month

Knee push and “swim” 6 month

Sits alone/stands with help 7 month

Crawls on stomach 8 month

Stands holding on furniture 10 month

Walks when led 11 month

Stands alone 14 month

Walks alone 15 month

AT THE PLAY GROUND

* Stranger anxiety: 0 -1 year * Separation anxiety: 1 - 3 years * Solitary play: 0 – 1 year * Parallel play: 2 – 3 years * Group play: 3 – 4 years

PSYCHOLOGICAL DEVELOPMENT

AGE ERIKSON FREUD PIAGET

Infant 0 – 1.5 Trust vs. mistrust

Oral (trust & dependence sensorimotor

Toddler 1.5 -3 Autonomy vs. shame

Anal (holding vs. letting out) preoperational

Pre-school 3 - 6 Initiative vs. guilt

Phallic (Oedipus complex) preoperational

School age 6 - 11

Industry vs. inferiority latency Concrete operational

11 - 20Identity vs. role confusion genital Formal operational

20 – 25 Intimacy vs. isolation

25 – 50Generativity vs. stagnation

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50 - ? Integrity vs.despair

LABORATORY VALUES2

ELECTROLYTES

Sodium (Na+): 135 – 145 meq/L (increase-dehydration; decrease overhydration) Potassium (K+): 3.5 - 5.0 meq/L Magnesium (Mg++): 1.5 – 2.5 meq/L Calcium (Ca++): 4.5 – 5.8 meq/L Neonate : 7.0 to 12 mg/dL Child: 8.0 to 10.5 mg/dL Phosphorus (PO4): 1.7 – 2.6 meq/L Chloride (Cl-): 96 – 106 meq/L

COAGULATION STUDIES

Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator used

Prothrombin time(PT): male: 9.6 – 11.8 seconds Female: 9.5 – 11.3 secondsInternational Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy 3.0 – 4.5 for high-dose Coumadin therapyClotting time: 8 – 15 minutesPlatelet count: 150,000 to 400,000 cells/UlBleeding time: 2.5 to 8 minutes

SERUM GASTROINTESTINAL STUDIES

Albumin: 3.4 to 5 g/dLAlkaline phosphatase: 4.5 to 13 King-Armstrong units/dLAmmonia: 15 to 45 ug/dLAmylase: 50 – 180 Somogyi U/dL in adult 20 – 160 Somogyi U/dL in the older adultBilirubin: direct: 0 - 0.3 mg/dL Indirect: 0.1 – 1.0 mg/dL Total: less than 1.5 mg/dLCholesterol: 120 – 200mg/dLLipase: 31 -186 U/LLipids: 400 – 800 mg/dLTriclycerides: Normal range: 10 – 190 mg/dL Borderline high: 200 – 400 mg/dL High: 400 – 1000mg/dL Very high: greater than 1000mg.dLProtien: 6.0 – 8.0 g/LUric acid: male: 4.5 – 8 ng/dL Female: 2.5 – 6.2 ng/dL

GLUCOSE STUDIES

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Fasting blood sugar: 70 – 105 mg/dLGlucose monitoring (capillary Blood): 60 – 110 mg/dL

RENAL FUNCTION TEST

Creatinine: 0.6 – 1.3 mg/dLBlood urea nitrogen (BUN): 5 – 20 mg/dL

ERYTROCYTES STUDIES

Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on ageHemoglobin: male: 14 – 16.5 g/dL Female: 12 – 15 g/dLHematocrit: male: 42% - 52% (increased in hemoconcentration, fluid loss and dehydration) Female: 35% - 47% ( decreased in fluid retention)Red blood cell (RBC): male: 4.5 to 6.2 million/uL Female: 4 to 5.5 million/uL

White blood cell (WBC): 4500 to 11,000/uLErytrocyte Protoporthyrin (EP) : <9ug/dLPhenylalanine Level: <2 mg/dLPKU: >25 mg/dL

CRANIAL NERVES

MAJOR FUNCTIONS

I. Olfactory (S) smell

II. Optic (S) vision

III. Oculomotor (M)IV. Trochlear (M)

Eye movement

V. Trigeminal (S-M)Facial sensationJaw movement

VI. Abducent (M) Eye movement

VII. Facial (S-M)Taste

Facial expression

VIII. Acoustic (S) Hearing and balance

IX. Glossopharyngeal (S-M)Taste

Throat sensationGag and swallow

X. Vagus (S-M)Gag and swallow

Parasympathetic activity

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XI. Spinal Accessory (M)Neck and back muscles

XII. Hypoglossal (M) Tongue movement

On Old Olympus’ Towering Tops, A Finn And German Viewed Some HopsSome Says Marry Money, But My Brother Says Bad Business Marry Money

ARTERIAL BLOOD GAS (ABG)

pH: 7.35 – 7.45 PCO2: 35 - 45 mmHg PO2: 80 - 100 mmHg HCO3: 22 - 27 mEq/L O2 saturation: 96% - 100% Acid-base “RAMS”(Respiratory Alternate, Metabolic Same)

GLASGOW COMA SCALE

Eye opening response Motor response Verbal response

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC/ ADRENERGIC

PARASYMPATHETIC/ CHOLINERGIC

HeartIncreased heart rateIncreased conductionIncreased force

Decreased heart rate

Bronchi dilation constriction

GI tract Reduced motility Increased motility

Rectum Allows fillingEmpties rectumRelaxes internal sphincter

Bladder Allows fillingEmpties bladderRelaxes internal sphincter

Erection Maintains erection

Ejaculation Triggers ejaculation

Pupils of eye Big (mydriasis) Small (miosis)

Salivary glands Secretion

Depends on receptors

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Blood vessels -a contrict-b dilates

FLOW OF BLOOD THROUGH THE HEART

Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle – pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral) – left ventricle – aortic valve aorta – systemic circulation

CARDIAC IMPULSES

Sinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s fibers – ventricles contract.

Blood volume: 5000mLCentral venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration)Pressure within the right atrium: 2 to 7 mmHgCapillary refill time: <3 secondsNormal sweat chloride: <40 mEq/LNormal pupil diameter: 3 to 5mmNormal ocular pressure: 10 to 21 mmHgNormal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhgNormal cardiac output : 4 to 8 L/min.

THERAPEUTIC SERUM MEDICATION LEVELS

Acetaminopen (Tylenol) 10 – 20 ug/mLAmikacin (Amikin) 25 – 30 ug/mLAmitryptyline (Elavil) 120 -150 ng/mLCarbamazepine (Tegretol) 5 -12 ug/mLChloramphenicol (Chloromycetin) 10 – 20 ug/mLDesipramine (Norpramin) 150 -300 ng/mLDigotoxin ( Crystodigin) 15- 25 ng/mLDigoxin ( Lanoxin) 0.5 – 2.0 ng/mLDisopyramide (Norpase) 2 -5 ug/mLEthosuximide ( Zarontin) 40 – 100 ug/mLGentamycin (Garamycin) 5 – 10 ug/mLImipramide (Tofranil) 150 – 300 ug/mLLidocaine (Xylocaine) 1.5 – 5.0 ug/mLLithium (Lithobid) 0.5 -1.5 ug/mLMagnesium sulphate 4 -7 mg/dLNortriptyline (Aventyl) 50 – 150 ng/mLPhenobarbital (Luminal) 10 – 30 ug/mLPhenytoin (Dilantin) 10 -20 ug/mLPrimidone (Myoline) 5 – 20 ug/mL Procainamide (Pronestryl) 4 – 10 ug/mLPropranolol (Inderal) 50 – 100 ng/mLQuinidine (Quinalaglute, Cardioquin) 2 – 5ug/mLSalisylate 100 -250 ug/mL

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Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mLTobramycin (Nebcin ) 5 -10 ug/mLValproic acid (depakene) 50 -100 ug/mL

Pulmonary capillary wedge pressure: 5 to 13 mmHgPulmonary artery pressure: systolic: 16 to 30 mmHg Diastolic: 0 to 7 mmHgSpinal pressure: 70 to 200mmH2OMorphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour

INSULIN For treatment of IDDM

PEAK DURATION

Regular Fast acting 30 min. 120 min.

NPH Intermediate acting 8 -12 h 18 -24 h

PZI Long acting 24 h 36 h

SULFONYLUREAS For treatment of NIDDM

Sulfonylureas should not be given to patients with liver or kidney failure. Accummulation of drug will increase risk of hypoglycaemia.

DURATION

tolbutamide 8 h

Glycburide, glipizide 20 h, most potent

chlorpropamide 48 h

CONVERSION

Metric SystemMeter – m 1 mg = 1000ug or 0.oo1gLiter – L 1gm = 1000mg

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Gram – g, gm, Gm 1mL = 0.001L or 1 ccMilligram – mg, mgm 1kg = 1000 gMicrogram – ug, mcg 1ug = 0.000001 gKilogram – kg, Kg 1kg = 2.2 lbMillilitre – mL 1L = 1000mLCubic centimetre – cc

Apothecary and Household System

Grain –gr 1 gr = 60 mgDram – dr 5 gr = 300 mgOunce –oz 15 gr = 1000mg or 1gMinim – min, M, m 1/150 gr =0.4 mgQuart – qt 1 oz = 30 mLPint – pt 1 dr = 4 mLDrop – gtt 1 T = 15 mL or 3 tspTablespoon – T or tbs 1 min = 1 gttTeaspoon – t or tsp 15 min = 1mLPound – lb 60 min = 1 dr 8 dr = 1 oz 1 qt = 1000mL or 1L 1 qt = 2 pt or 32 oz 1 pt = 16 oz 16 oz = 1 lb 2.2lb = 1 kg

Fahrenheit to Celcius (F – 32) divide 1.8 = C

Celcius to Fahrenheit 1.8 C + 32 = F

Formula for Calculating a Medication Dosage

D (desired ) = the dosage that the physician orderedA (available) =the dosage strength as stated on the medication labelQ (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL

D X Q = XA

Formulas for Intravenous Calculations

Flow Rates: Total volume x gtt factor = gtt per min Time in minutes

Infusion Time: Total volume to infuse = Infusion time mL per hour being infused

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IMMUNIZATION

Birth Hepatitis B1 months Hepatitis B2 months OPV, DPT, HIB4 months DPT, HIB, OPV6 months DPT, HIB, hepatitis B12 months HIB, OPV15 months MMR18 months DPT12 – 18 months Varicella vaccine4 -6 years DPT, OPV, MMR11 – 12 years MMR ( if not administered at 4 -6 years)11 – 16 TD booster

SPINAL CORD INJURYCervical Injury:

C2 to C3 injury usually fatal C4 is the major innervation to the diaphragm by th phrenic nerve Involvement above th C4 causes respiratory difficulty and paralysis of all the four

extremities C5 or below client may have movement in the shoulder

Thoracic Level Injury: loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of

injury Leg paralysis (paraplegia) Autonomic dysreflexia with lesions above T6 and in cervical lesions Visceral distention from a distended bladder or impacted rectum may cause reactions such as

sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh

Lumbar and Sacral Level Injuries: loss of movement and sensation of the lower extremities. S2 and S3 center on micturation; therefore below this level, the bladder will contract but not

empty (neurogenic bladder) Injury above S2 in males allows them to have an erection, but they are unable to ejaculate

because of sympathetic nerve damage. Injury between S2 and S4 damages the sympathetic and parasympathetic response,

preventing erection and ejaculation.

RULE OF NINE

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Head and neck 9% Anterior trunk 18% Posterior trunk 18% Arms (9%) 18% Legs (18%) 36% Perineum 1%

NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

Neutrophils 56% or 18000 – 7800/uL Bands 3% or 0 – 700/uL Eosinophils 2.7% or 0 – 450/uL Basophils 0.3% or 0 – 200/uL Lymphocytes 34% or 1000 – 4800/uL Monocytes 4% or 0 – 800/uL

THYROID STUDIES Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Thyroxine (T4): 5.0 to 12.0 ug/dL Thyroxine free (FT3) : 0.8 to 2.4 ng/dL Triiodothyronine (T3): 80 to 230 ng/dL

Normal Fribrinogen level: for men: 180 to 340mg/dL Women: 190 to 420mg/dLFribrinogen is used up in the clotting process.

Erythrocyte Protoporhyrin (EP): < 9ug/dLPhenylalanine level: < 2mg/dLPKU: >25 mg/dLUrine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndromeNormal CSF pressure: 5 – 15 mmHg, 50-180 mmH2ONormal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration; Decrease in over hydrationNormal scalp pH: 7.26 and above Borderline acidosis: 7.20 to 7.25 Acidosis: < 7.15

HERBAL MEDICINE

Aloe vera Gel – abrasionsand dermatologic conditions American Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve concentration and

enhance physical or cognitive performance.Ashwagandha (Withania somnifera) – stress arthritisAsian gingseng (Panax ginseng) – enhance health and combat stress and diseaseBilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as antioxidant

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Black Cohosh (Cimicifuga racemosa) – menopausalBlack Currant and Borage oil (Ribes nigrum and Borago offinalis) – anti-inflammatory,

rheumatoid arthritisCapsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatmentChamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and anxietyChaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgiaChodroitin – osteoarthritisCoenzyme Q10 – antioxidantColtsfoot ( Tussilago farfara ) – cough and other respiratory disodersCranberry (Vaccinium macrocarpon) – UTIDevil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesicEchinacea (Echinacea spp.) – acute viral URI symptomsEderberry (Sanbacus nigra) – respiratory tract infectionEphedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrineEvening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS and

inflammatory conditionFenugreek (Trigonella foenum-graecum) – lowering blood glucoseFeverfew ( Tanacetum parthenium) – migraine headache prophylaxisGarlic (Allium sativaum)- help prevent cardiovascular disease and cancerGinger (Zingiber officinale) –nausea and motion sickness, anti-inflammatoryGinkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and

treatment of vertigo nad tinnitusGlucosamine – osteoarthritisGoldenseal ( Hydrastis Canadensis) – tonic and antibioticGotu Kola (Centella asiatica) – mental support, wound healing and venous disordersHawtorn ( Crategus species) – CHF and related cardiovascular conditionsHorebound (Marribium vulgare) – primary cough suppression and expectorationHorse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency Ivy (Hedera helix) – coughs, rheumatic disordes and skin diseaseKava ( piper methysticum) – mild psychoactive and antianxiety propertyLemon Balm (Melissa officinalis) – sedative and for dyspepsiaLicorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and

infectionsMelatonin – insomia, jet lagMilk Thistle – hepatitis, liver deseaseMints (Mentha species) – minor calcium channel antagonists, used for upper respiratory problems,

irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritantNettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diureticPapaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to

woundsPassion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herbPokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/catharticPygeum (Pygeum africanum) – mild symptoms of BPHRed Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s healthSt. John’s Wort (Hypericum perforatum) – antidepressant effectTea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterialTurmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidantUva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic Yohimbe – erectile dysfunction

FOUR STRATEGIES:1. If the question asks what you should do in the situation. Use the nursing process to determine

which step in the nursing process would be next?

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2. If the question asks what the client needs. Use maslow’s hierarchy to determine which need to address.

3. If the question indicates that the client doesn’t have urgent physiologic need, focus on the patient safety.

4. If the question involves communicating with a patient. Use principles of therapeutic communication.

REMEMBER:AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS)

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