Adult Vital Signs Oral 37C Axillary 36.4C Rectal 37.

37.5C Pulse 60 to 100 beats per minute Respiration 12 20 breaths per minute Blood Pressure 100 to 140mmHg (systolic) 60 to 90mmHg (diastolic) Temperature

Age
Prematur e 3-6 Mos 6-12 Mos 1-3 Yrs 3-6 Yrs 6-12 Yrs 12 Yrs

Child Vital Signs Heart Rate Beats per Minute Awake: 100-180bpm S: 55-75 mmHg Sleep: 80-160bpm D: 35-45 mmHg Awake: 120-180bpm S: 70-90 mmHg Sleep: 80-100bpm D: 50-65 mmHg Awake: 120-160bpm S: 80-100 mmHg Sleep:80-180bpm D:55-65 mmHg Awake: 80-150bpm S:90-105 mmHg Sleep: 70-120bpm D:55-75 mmHg Awake: 80-110bpm S:95-110 mmHg Sleep: 60-90bpm D:60-75 mmHg Awake: 70-110bpm S:100-120 mmHg Sleep: 60-90bpm D:60-70 mmHg Awake: 50-90bpm S:110-135 mmHg Sleep: 50-85bpm D:65-85 mmHg

Respiratory Rate 40-70 breaths per minute 30-45breaths per minute 25-40 breaths per minute 20-30 breaths per minute 20-35 breaths per minute 14 -22 breaths per minute 12-18 breaths per minute

Normal Temperature Ranges Oral 97.6 - 99.6F 36.5 - 37.5C Axillary 96.6 - 98.6F 35.8 - 37C Rectal 98.6 - 100F 37 - 38.1C Tympanic 98.2 - 100F 36.8 - 37.9C

Crackles or Rales Wheezing Stridor Rhonchi

Lung Sounds Crackling or rattling sounds High-pitched whistling expirations Harsh, high-pitched inspirations Coarse, gravelly sounds

Range Normal Mild Hypoxia Moderate Hypoxia Severe Hypoxia

Pulse Oximetry Value 95 to 100% 91 to 94% 86 to 90% < 85%

Treatment None or placebic Give oxygen Give 100% oxygen Give 100% oxygen w/ positive pressure

IV Calibration Hours = Volume/Rate Rate = Volume/Hours Total Volume x drop factor/ hours x 60 = gtts/min *Abbot = 15 gtts/ml *Bebraun = 20 gtts/ml *Microdrip = 60 gtts/ml *Blood/KVO = 10 gtts/ml

Electrolyte Values Sodium 135 148 mEq/L Potassium 3.5 5 mEq/L Calcium 4.5 5.3 mEq/L Chlorine 98 106 mEq/L Magnesium 1.3 2.1 mEq/L

Electrolyte Disturbances Hyponatremia Na < 135 mEq/L Hypernatremia Na > 145 mEq/L Potassium Hypokalemia K < 3.5 mEq/L Hyperkalemia K > 5.3 mEq/L Calcium Hypocalcemia Ca < 4.5 mEq/L Hypercalcemia Ca > 5.5 mEq/L Magnesium Hypomagnesia Mg < 1.5 mEq/L Hypermagnesia Mg > 2.5 mEq/L
Sodium Acid-Base Values Normal Imbalance 7.35-7.45 pH below 7.35=acidosis pH above 7.45=alkalosis 35-45mmHg PaCO2 above 45=resp. acidosis PaCO2 below 35=resp. alkalosis 22-26mEq HCO3 above 26=meta. alkalosis HCO3 below 22=meta. acidosis 80-100mmHg PO2 below 80=hypoxemia

pH PaCO2 HCO3 PaO2

Acid-Base Imbalance Chart Imbalance pH HCO3 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

PaCO2

Glasgow Coma Scale ADULT INFANT Eye opening E Eye opening Spontaneous 4 Spontaneous To speech 3 To speech To pain 2 To pain No response 1 No response Best motor response M Best motor response Obeys verbal command 6 Normal movements Localizes pain 5 Localizes pain Flexion-withdraws from pain 4 Withdraws from pain Flexion- abnormal 3 Flexion abnormal Extension 2 Extension No response 1 No response Best verbal response V Best verbal response Oriented and converses 5 Coos, babbles Disoriented and converses 4 Cries but consolable Inappropriate words 3 Persistently irritable Incomprehensible 2 Grunts to No response 1 pain/restless No response E + M + V = 3 to 15 90% less than or equal to 8 are in coma Greater than or equal to 9 not in coma 9 is critical score Less than or equal to 8 at 6 hours 50% dead 9-11 = moderate severity Greater than or equal to 12 = minor injury

Medication Color Coding Color Coding Time OD 8 White BID 8-6 Blue TID 8-1-6 Green QID 8-12-4-8 Pink Q4 Orange Q6 Yellow Q8 Violet Q12 Light Green PRN Red IV Fluid Color Coding IV Fluid Color D5LRS Pink PNSS Green D5IMO Violet D5NM Orange D5 Water Red PLRS Blue D5NSS Yellow D5NMK Dark Yellow D5NR Light Pink D10W Blue Green 0.9NaCl Dark Green