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 Oral (trust &
0 1.5 Trust vs. mistrust dependence sensorimotor
Toddler Anal (holding vs.
1.5 -3 Autonomy vs. shame letting out) preoperational
Pre-school Phallic (Oedipus
3-6 Initiative vs. guilt complex) preoperational
School age Industry vs.
6 - 11 inferiority latency Concrete operational
Identity vs. role
11 - 20 confusion genital Formal operational

20 25 Intimacy vs. isolation

Generativity vs.
25 50 stagnation

50 - ? Integrity vs.despair
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 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

type of activator used
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
Platelet count: 150,000 to 400,000 cells/Ul
Bleeding time: 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

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 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 (S) vision

III. Oculomotor (M) Eye movement

IV. Trochlear (M)
Facial sensation
V. Trigeminal (S-M) Jaw movement

VI. Abducent (M) Eye movement

Taste
VII. Facial (S-M) Facial expression

VIII. Acoustic (S) Hearing and balance

Taste
IX. Glossopharyngeal (S-M) Throat sensation
Gag and swallow
Gag and swallow
X. Vagus (S-M) Parasympathetic activity
Neck and back muscles
XI. Spinal Accessory (M)

XII. Hypoglossal (M) Tongue movement

3
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/ PARASYMPATHETIC/
ADRENERGIC CHOLINERGIC
Increased heart rate
Heart Increased conduction Decreased heart rate
Increased force

Bronchi dilation constriction

GI tract Reduced motility Increased motility

Empties rectum
Rectum Allows filling Relaxes internal sphincter

Empties bladder
Bladder Allows filling Relaxes internal sphincter

Erection Maintains erection

Ejaculation Triggers ejaculation

Pupils of eye Big (mydriasis) Small (miosis)

Salivary glands Secretion

Depends on receptors
Blood vessels -a contrict
-b dilates

4
 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

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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 1 mg = 1000ug or 0.oo1g
Liter L 1gm = 1000mg
Gram g, gm, Gm 1mL = 0.001L or 1 cc
Milligram mg, mgm 1kg = 1000 g
Microgram ug, mcg 1ug = 0.000001 g
Kilogram kg, Kg 1kg = 2.2 lb

6
Millilitre mL 1L = 1000mL
Cubic centimetre cc

Apothecary and Household System

Grain gr 1 gr = 60 mg
Dram dr 5 gr = 300 mg
Ounce oz 15 gr = 1000mg or 1g
Minim min, M, m 1/150 gr =0.4 mg
Quart qt 1 oz = 30 mL
Pint pt 1 dr = 4 mL
Drop gtt 1 T = 15 mL or 3 tsp
Tablespoon T or tbs 1 min = 1 gtt
Teaspoon t or tsp 15 min = 1mL
Pound 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 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 X Q = X
A

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

7
 IMMUNIZATION

Birth Hepatitis B
1 months Hepatitis B
2 months OPV, DPT, HIB
4 months DPT, HIB, OPV
6 months DPT, HIB, hepatitis B
12 months HIB, OPV
15 months MMR
18 months DPT
12 18 months Varicella vaccine
4 -6 years DPT, OPV, MMR
11 12 years MMR ( if not administered at 4 -6 years)
11 16 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 9%

Anterior trunk 18%
Posterior trunk 18%
Arms (9%) 18%
8
 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/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
9
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.

10
 4. If the question involves communicating with a patient. Use principles of therapeutic
communication.

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

11