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
Infant
0 1.5
Toddler
1.5 -3
Pre-school
3-6
School age
6 - 11

ERIKSON

FREUD

PIAGET

Trust vs. mistrust

Oral (trust &

dependence

Autonomy vs. shame

Anal (holding vs. letting

out)

preoperational

Initiative vs. guilt

Phallic (Oedipus
complex)

preoperational

sensorimotor

Industry vs. inferiority

latency

Concrete operational

genital

Formal operational

Identity vs. role confusion

11 - 20
20 25

Intimacy vs. isolation

Generativity vs. stagnation

25 50
50 - ?

Integrity vs.despair

LABORATORY VALUES
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
Prothrombin time(PT): male:
9.6 11.8 seconds
Female: 9.5 11.3 seconds
International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy
3.0 4.5 for high-dose Coumadin therapy
Clotting time:
8 15 minutes

type of activator used

Platelet count:
Bleeding time:

150,000 to 400,000 cells/Ul

2.5 to 8 minutes
SERUM GASTROINTESTINAL STUDIES

Albumin:
3.4 to 5 g/dL
Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL
Ammonia:
15 to 45 ug/dL
Amylase:
50 180 Somogyi U/dL in adult
20 160 Somogyi U/dL in the older adult
Bilirubin: direct: 0 - 0.3 mg/dL
Indirect: 0.1 1.0 mg/dL
Total: less than 1.5 mg/dL
Cholesterol: 120 200mg/dL
Lipase:
31 -186 U/L
Lipids:
400 800 mg/dL
Triclycerides: Normal range: 10 190 mg/dL
Borderline high: 200 400 mg/dL
High: 400 1000mg/dL
Very high: greater than 1000mg.dL
Protien:
6.0 8.0 g/L
Uric acid: male: 4.5 8 ng/dL
Female: 2.5 6.2 ng/dL
GLUCOSE STUDIES
Fasting blood sugar: 70 105 mg/dL
Glucose monitoring (capillary Blood):

60 110 mg/dL

RENAL FUNCTION TEST

Creatinine: 0.6 1.3 mg/dL
Blood urea nitrogen (BUN): 5 20 mg/dL
ERYTROCYTES STUDIES
Erytrocyte sedimentation rate(ESR):
0 30 mm/hr depending on age
Hemoglobin: male: 14 16.5 g/dL
Female: 12 15 g/dL
Hematocrit:
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/uL
Erytrocyte Protoporthyrin (EP) : <9ug/dL
Phenylalanine Level: <2 mg/dL
PKU:
>25 mg/dL
CRANIAL NERVES
MAJOR FUNCTIONS
I.

Olfactory (S)

smell

II.

Optic

vision

III.
IV.

(S)

Eye movement

Oculomotor (M)
Trochlear

(M)

V.

Trigeminal

(S-M)

VI.

Abducent

(M)

VII. Facial

(S-M)

VIII. Acoustic

(S)

Facial sensation
Jaw movement
Eye movement
Taste
Facial expression
Hearing and balance
Taste
Throat sensation
Gag and swallow
Gag and swallow
Parasympathetic activity
Neck and back muscles

IX. Glossopharyngeal (S-M)

X.

Vagus

(S-M)

XI.

Spinal Accessory (M)

XII.

Hypoglossal

(M)

Tongue movement

On Old Olympus Towering Tops, A Finn And German Viewed Some Hops
Some 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

Heart

Increased heart rate

Increased conduction
Increased force

Decreased heart rate

Bronchi

dilation

constriction

GI tract

Reduced motility

Increased motility

Rectum

Allows filling

Empties rectum
Relaxes internal sphincter

Bladder

Allows filling

Empties bladder
Relaxes internal sphincter

Erection

Maintains erection

Ejaculation

Triggers ejaculation

Pupils of eye

Big (mydriasis)

Small (miosis)

Salivary glands

Blood vessels

Secretion
Depends on receptors
-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 purjinjes fibers ventricles
contract.
Blood volume: 5000mL
Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration)
Pressure within the right atrium: 2 to 7 mmHg
Capillary refill time: <3 seconds
Normal sweat chloride: <40 mEq/L
Normal pupil diameter: 3 to 5mm

Normal ocular pressure: 10 to 21 mmHg

Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg
Normal cardiac output : 4 to 8 L/min.
THERAPEUTIC SERUM MEDICATION LEVELS
Acetaminopen (Tylenol)
10 20 ug/mL
Amikacin (Amikin)
25 30 ug/mL
Amitryptyline (Elavil)
120 -150 ng/mL
Carbamazepine (Tegretol)
5 -12 ug/mL
Chloramphenicol (Chloromycetin)
10 20 ug/mL
Desipramine (Norpramin)
150 -300 ng/mL
Digotoxin ( Crystodigin)
15- 25 ng/mL
Digoxin ( Lanoxin)
0.5 2.0 ng/mL
Disopyramide (Norpase)
2 -5 ug/mL
Ethosuximide ( Zarontin)
40 100 ug/mL
Gentamycin (Garamycin)
5 10 ug/mL
Imipramide (Tofranil)
150 300 ug/mL
Lidocaine (Xylocaine)
1.5 5.0 ug/mL
Lithium (Lithobid)
0.5 -1.5 ug/mL
Magnesium sulphate
4 -7 mg/dL
Nortriptyline (Aventyl)
50 150 ng/mL
Phenobarbital (Luminal)
10 30 ug/mL
Phenytoin (Dilantin)
10 -20 ug/mL
Primidone (Myoline)
5 20 ug/mL
Procainamide (Pronestryl)
4 10 ug/mL
Propranolol (Inderal)
50 100 ng/mL
Quinidine (Quinalaglute, Cardioquin) 2 5ug/mL
Salisylate
100 -250 ug/mL
Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL
Tobramycin (Nebcin )
5 -10 ug/mL
Valproic acid (depakene)
50 -100 ug/mL

Pulmonary capillary wedge pressure:

5 to 13 mmHg
Pulmonary artery pressure:
systolic: 16 to 30 mmHg
Diastolic: 0 to 7 mmHg
Spinal pressure:
70 to 200mmH2O
Morphine 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

8h

Glycburide, glipizide

20 h, most potent

chlorpropamide

48 h

CONVERSION
Metric System
Meter m
Liter L
Gram g, gm, Gm
Milligram mg, mgm
Microgram ug, mcg
Kilogram kg, Kg
Millilitre mL
Cubic centimetre cc

1 mg = 1000ug or 0.oo1g
1gm = 1000mg
1mL = 0.001L or 1 cc
1kg = 1000 g
1ug = 0.000001 g
1kg = 2.2 lb
1L = 1000mL

Apothecary and Household System

Grain gr
Dram dr
Ounce oz
Minim min, M, m
Quart qt
Pint pt
Drop gtt
Tablespoon T or tbs
Teaspoon t or tsp
Pound lb

Fahrenheit to Celcius
Celcius to Fahrenheit

1 gr = 60 mg
5 gr = 300 mg
15 gr = 1000mg or 1g
1/150 gr =0.4 mg
1 oz = 30 mL
1 dr = 4 mL
1 T = 15 mL or 3 tsp
1 min = 1 gtt
15 min = 1mL
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
(F 32) divide 1.8 = C
1.8 C + 32 = F
Formula for Calculating a Medication Dosage

D (desired ) = the dosage that the physician ordered

A (available) =the dosage strength as stated on the medication label
Q (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL
D
A

Formulas for Intravenous Calculations

Flow Rates:
Total volume x gtt factor
Time in minutes
Infusion Time:
Total volume to infuse
mL per hour being infused

= gtt per min

= Infusion time

IMMUNIZATION

Birth
1 months
2 months
4 months
6 months
12 months
15 months
18 months
12 18 months
4 -6 years
11 12 years
11 16

Hepatitis B
Hepatitis B
OPV, DPT, HIB
DPT, HIB, OPV
DPT, HIB, hepatitis B
HIB, OPV
MMR
DPT
Varicella vaccine
DPT, OPV, MMR
MMR ( if not administered at 4 -6 years)
TD booster

SPINAL CORD INJURY

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

9%
18%
18%
18%
36%
1%

NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

Neutrophils
Bands
Eosinophils
Basophils
Lymphocytes
Monocytes

56% or
3% or
2.7% or
0.3% or
34% or
4% or

18000 7800/uL
0 700/uL
0 450/uL
0 200/uL
1000 4800/uL
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/dL
Fribrinogen is used up in the clotting process.
Erythrocyte Protoporhyrin (EP):
< 9ug/dL
Phenylalanine level:
< 2mg/dL
PKU:
>25 mg/dL
Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus
Normal CSF protein: 15 45 mg/dL increase in Guillain-Barre syndrome
Normal CSF pressure: 5 15 mmHg, 50-180 mmH2O
Normal serum osmolality: 285 295 mOsmlkgH2O increase in dehydration;
Decrease in over hydration
Normal 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 arthritis
Asian gingseng (Panax ginseng) enhance health and combat stress and disease
Bilberry (Vaccinium myrtillus) vision and peripheral vascular disorders and as antioxidant
Black Cohosh (Cimicifuga racemosa) menopausal
Black Currant and Borage oil (Ribes nigrum and Borago offinalis) anti-inflammatory, rheumatoid arthritis
Capsicum Peppers (Capsicum spp.) arthritis, neuralgia and other painful treatment
Chamomile (Matricaria recutita) manzanilla- skin inflammation, colic, or dyspepsia and anxiety
Chaste tree (Vitex agnus-castus) menstrual related disorders, PMS, cyclical mastalgia
Chodroitin osteoarthritis
Coenzyme Q10 antioxidant
Coltsfoot ( Tussilago farfara ) cough and other respiratory disoders
Cranberry (Vaccinium macrocarpon) UTI
Devils Claw ( Harpagophytum procumbers) anti inflammatory and analgesic
Echinacea (Echinacea spp.) acute viral URI symptoms
Ederberry (Sanbacus nigra) respiratory tract infection
Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrine
Evening Primrose Oil (Oenothera biennis) eczema, breast pain associated with PMS and inflammatory condition
Fenugreek (Trigonella foenum-graecum) lowering blood glucose
Feverfew ( Tanacetum parthenium) migraine headache prophylaxis
Garlic (Allium sativaum)- help prevent cardiovascular disease and cancer
Ginger (Zingiber officinale) nausea and motion sickness, anti-inflammatory
Ginkgo (Ginkgo biloba) dementia and intermittent claudication, memory enhancement and treatment of vertigo nad tinnitus
Glucosamine osteoarthritis
Goldenseal ( Hydrastis Canadensis) tonic and antibiotic
Gotu Kola (Centella asiatica) mental support, wound healing and venous disorders
Hawtorn ( Crategus species) CHF and related cardiovascular conditions
Horebound (Marribium vulgare) primary cough suppression and expectoration
Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency
Ivy (Hedera helix) coughs, rheumatic disordes and skin disease
Kava ( piper methysticum) mild psychoactive and antianxiety property
Lemon Balm (Melissa officinalis) sedative and for dyspepsia
Licorice (Glycyrrhiza glabra) respiratory disorders, hepatitis, inflammatory diseases, and infections
Melatonin insomia, jet lag
Milk Thistle hepatitis, liver desease
Mints (Mentha species) minor calcium channel antagonists, used for upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic
spasm and as a topical counterirritant
Nettle (Urtica dioica) arthritis pains, allergies, BPH, or as diuretic
Papaya (Carica papaya) digestive aid, dyspepsia, and for inflammatory, topically applied to wounds
Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb
Pokeroot (Phytolacca Americana) inflammatory conditions also as an emetic/cathartic
Pygeum (Pygeum africanum) mild symptoms of BPH
Red Clover (Trifolium pratense) used as a natural estrogen substitute for womens health
St. Johns Wort (Hypericum perforatum) antidepressant effect
Tea Tree Oil (Melaleuca alternifolia) antifungal and antibacterial
Turmeric (Curuma longa ) anti-inflammatory, anti-arthritis, anti cancer, and antioxidant
Uva 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?
2.
If the question asks what the client needs. Use maslows hierarchy to determine which need to address.
3.
If the question indicates that the client doesnt 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)