Welcome to the bed. We'll go ahead and give you
the story. This is all going to happen super
fast. Welcome to the emergency room. Today we
are stepping into the storm. Hey, that's one
way to put it. It really is the only way to describe
it. We are tackling one of the most dynamic,
chaotic and biologically aggressive periods of
human development. You're talking about adolescence.
Exactly. That shaky bridge between childhood
and adulthood spanning roughly ages 11 to 20.
It was a bridge, but if we're being honest, it
feels like a bridge that's being built while
someone is sprinting across it. In the dark.
In the dark, yeah. You have these massive physiological
changes, a desperate, sometimes frantic search
for identity, and a brain that is literally rewiring
itself in real time. It's a fascinating mess.
And for our listeners today, specifically the
nursing students and the pros gearing up for
the NCLEX or those intense clinical rotations,
this isn't just a trip down memory lane to our
own awkward high school years. No, no. We have
a very specific mission. We are conducting a
high yield, exam focused review. Exactly. We've
pulled from the 2025 CDC immunization schedule,
the gold standard charts for pediatric vital
signs, and, you know, the heavy -hitting chapters
on adolescent growth and development. Our goal
here is to apply the Pareto Principle. The famous
80 -20 rule. Right. We want to identify the 20
% of the information, the absolute core concepts
that will help you answer 80 % of the exam questions
and, frankly, keep your patients safe when you're
on the floor. And that's so important because
the role of the nurse really shifts here. It
totally does. You aren't just managing the parent
anymore like you would with a toddler or an infant.
Right. You are empowering a patient who looks
like an adult but is still very much under construction.
So let's dive right into the numbers. Let's start
there. Segment one is our baseline. Vital signs
and pain assessment. The fundamentals. The fundamentals.
When you walk into a room to assess a 15 year
old, the landscape has changed significantly
from early pediatrics. What are we expecting?
The general rule of thumb, and if you need a
mental anchor to keep you grounded during an
exam, this is it, is that by late adolescence,
so usually age 13 and up, the vital signs align
very closely with adult norms. Okay, so they're
basically adults, physiologically speaking. Pretty
much. The physiology has matured enough to resemble
a full -grown adult. which is a relief in some
ways, less memorization. So we're done with the
rapid -fire heart rates of infancy. Oh, long
gone. We are. If we look at the charts, the heart
rate for an adolescent, say ages 13 to 18, it
settles into that familiar adult range of 50
to 100 beats per minute. And what's the why behind
that? Why does it slow down so much from, say,
a two -year -old? It's all about efficiency.
The heart muscle itself is larger. It's stronger.
So the stroke volume, the amount of blood pumped
with each beat is much more efficient. It just
doesn't need to beat as fast to perfuse the body.
Makes sense. And respirations follow the same
trend. They do. They slow down, too. We're looking
at a pretty calm 16 to 20 breaths per minute.
Yeah. Now, compare that to a toddler who might
be breathing at 24 to 40 times a minute. It's
a significant drop. But, you know, there is one
number that trends in the opposite direction.
It goes up. blood pressure. Right. Correct. And
it's really important for your clinical practice
to understand the why here, not just memorize
the number. So what's happening? As the child
grows into an adolescent, two things happen.
Muscle mass increases dramatically, and the size
of the entire vascular bed, all the arteries
and veins, it just gets bigger. Yeah. It's a
larger system. Like going from a small town's
plumbing. to a CITES. That's a great analogy.
To pump blood through that larger, more complex
system, the pressure naturally has to go up.
So for an adolescent, we want the systolic to
be less than 120 and the diastolic less than
80. So basically standard healthy adult limits,
no special charts to memorize there. Precisely.
And here's the clinical pearl, the high yield
takeaway. OK. If you see a systolic over 120
in a calm teenager, that warrants rechecking.
Do not just assume it's white coat syndrome or
stress from the visit. You really have to investigate.
You have to. Hypertension in adolescence is becoming
increasingly common due to diet, lack of exercise,
all the modern lifestyle factors. Treating a
high reading as a red flag is absolutely crucial.
And what about temperature? Anything special
there? Not really. The mean is around 36 .6 degrees
Celsius or 97 .9 degrees Fahrenheit. Pretty standard
stuff. OK, so that's the vitals. Pretty straightforward.
Let's unpack pain assessment. This is always
a tricky one on exams because you have to pick
the right scale for the right cognitive level.
It is, but for this demographic, it's actually
simpler than with younger kids. The gold standard,
the one you should reach for first, your default,
is the numeric scale. The zero to ten scale.
The zero to ten scale. If the patient is five
years or older, and certainly by adolescence,
they have the cognitive capacity to understand
that abstract concept and rate their pain from
zero to ten. Can we trust them? I mean, what
if a kid is on their phone laughing with a friend
but tells you their pain is a nine? We trust
them. Self -report is the most reliable indicator
of pain, period. That's a big one. I cannot stress
this enough for the exam and for practice. If
a 16 -year -old is playing on their phone but
tells you their pain is an 8 out of 10, you treat
the pain as an 8. So you ignore the behavior.
You don't judge the behavior. You treat the report.
That phone could be their only coping mechanism,
their only distraction from that 8 out of 10
pain. Document the behavior? Sure. But treat
the number they give you. That's a fantastic
point. But what if you have an adolescent with,
say, a cognitive impairment or maybe a severe
language barrier? Then you have to adapt. Of
course, you might fall back on the faces scale,
the one with the six cartoon faces. That's still
valid for ages three and up, and if they have
trouble with numbers or just prefer it, it's
a great tool. And if they're completely non -communicating.
Then you're moving to an observational checklist.
Often it's the FLACC scale face, legs, activity,
cry, consolability adapted for older children.
You observe them for a set period, usually about
10 minutes, and score them based on what you
see. but for your typical neurotypical 16 -year
-old. Just ask them the number. Don't overcomplicate
it. Give them the agency to report their own
experience. Got it. 010 is the way to go. Let's
move to segment two. This is the big one. Puberty
and physical development. The biological sequence.
Yes. And I feel like exams love to ask about
what happens first. They absolutely do. And this
is where you need to separate. the boys from
the girls, literally. The timelines are different,
the markers are different, and the social implications
are really different. It all starts in the brain,
though, right? Always. It's a hormonal cascade.
The hypothalamus wakes up and starts releasing
GnRH, that's gonadotropin -releasing hormone.
And that's the starting pistol. That is the starting
pistol. It tells the pituitary gland, hey, time
to go. And the pituitary releases FSH and LH
follicle stimulating hormone and luteinizing
hormone. Which then travel down to the gonads.
Exactly! And the gonads ovaries in females, tests
in males, start pumping out estrogen and progesterone
or testosterone. And that's when you start to
see the visible signs. Okay, let's start with
females. What is the absolute first high -yield,
gotta -know -it -for -the -test sign a nurse
should look for? It's called thelarch. T -H -E
-L -A -R -C -H -E. Thelarch. That's breast -butting,
a small, tender lump under the nipple. It typically
happens between ages 9 and 11. This is the herald
of puberty for girls. And menarche, the first
period. That comes later. Right. And this is
a super high yield timeline to memorize. Menarche
usually occurs roughly 2 to 2 .5 years after
breast development begins. The average age in
the U .S. is around 12. So if a parent brings
in their 10 -year -old who has started developing
breasts, you can give them some anticipatory
guidance. You can and you should. You can say
this is perfectly normal and you can expect your
period to start in about two years. It prepares
them, reduces anxiety, and makes you look like
a superstar. Is there a connection between getting
your period and growing taller? I hear this question
a lot. A huge one. And this is a classic exam
trap. Once Menarche hits, the estrogen levels
cause the growth plates, the epithelial plates
in the long bones, to start to close. So the
window for growth starts to shut. Exactly. Height
growth usually ceases about two to 2 .5 years
after that first period. They might get another
inch or so, but the major growth spurt is over.
So let's make that a clinical scenario. A mother
asks, my 15 year old daughter started her period
at 12. Will she get any taller? The evidence
-based answer is likely no. She has probably
reached her adult height. That can be a tough
conversation if the expectations aren't managed,
but physiologically, the window has closed. That's
fascinating and incredibly useful. Now, what
about the boys? Males mature later. The whole
process is delayed by about two years compared
to females. What's the very first sign for them?
Testicular enlargement. This is considered tanner
stage two. And that's not something a parent
is likely to notice? Usually not. It's often
subtle, but it's the first thing that happens
and it precedes the big growth spurt. A provider
will assess this during a well child check. And
when does their growth spurt hit? Later than
girls. Usually between 10 .5 and 16 years old,
but it peaks much later around 13 .5 to 17 .5.
Which creates that classic awkward middle school
phase. The phase where all the girls are towering
over the boys at the school dances. I remember
that phase well. We all do. And then over one
summer the boys shoot up and their voices drop.
That voice deepening is from laryngeal growth.
caused by testosterone. OK, there's one specific
thing for boys that I know nurses need to be
prepared to discuss. Nocturnal emissions. We
had dreams. Yes. This is a normal physiological
event that happens during late puberty. It's
a sign the reproductive system is maturing. But
it can be incredibly embarrassing for them. Extremely.
And confusing. And they won't ask about it. That's
why anticipatory guidance is key. During a checkup,
you find a private moment and you tell them,
hey, as you're growing, you might start waking
up sometimes and notice your pajamas are wet.
This is totally normal. It has a name. And it
means your body is working the way it's supposed
to. You normalize the biology before the biology
happens. Exactly. You remove the shame and confusion
before it even has a chance to set in. That's
excellent nursing care. We also see skin changes
across the board, right? This affects everyone.
Yes. This is where deodorant becomes non -negotiable.
The apocrine glands, mostly in the armpits and
groin, wake up. So you get body odor. And then
there's the face. And then the face. The sebaceous
glands go into overdrive, which gives us acne,
face, back, shoulders. It can be anywhere. And
we shouldn't dismiss acne as just cosmetic. Absolutely
not. For a teen whose entire world revolves around
pure acceptance and identity, severe acne can
be a major psychosocial stressor. It can lead
to depression and social isolation. So we take
it seriously, we assess it, and we refer to dermatology
when needed. OK, so we've got the body changing
at a breakneck pace. Let's shift to the mind.
Segment three, cognitive and psychosocial development.
Who are the big theorists we need to know for
our exams? You cannot pass a nursing exam without
knowing Eric Erickson. Erickson, of course. For
adolescents, the stage is identity versus role
confusion. Who am I? That is the central question.
Exactly. The primary developmental task is developing
a sense of self that is separate from their parents.
They're trying to figure out where they fit in
the world, what they believe, who they want to
be. And this doesn't happen all at once. It happens
in phases, right? It does. We can break it down
into early, middle, and late adolescence, and
the focus shifts in each stage. So let's start
with early adolescence, say 11 to 14. What's
their main focus? The body. They are preoccupied
with the physical changes of puberty. Am I normal?
Am I growing too fast? Too slow? And critically,
they are focused on conforming to peer norms.
Fitting in. Fitting in is everything. They want
to look, talk, and act exactly like their friends.
Being different is the worst possible thing you
could be at 13. Then what happens in middle adolescence?
Middle adolescence. So ages 15 to 17, this is
the peak of peer reliance. The peer group is
more important than family for social and emotional.
And this is also where we see the most conflict
with parents. Yes, this is the struggle for emancipation.
They are pushing boundaries, testing limits,
trying to establish their independence. They're
also exploring romantic interests and trying
on different roles. You know, the athlete, the
musician, the rebel, trying to see what fits
their identity. It's a period of experimentation.
A huge period of experimentation. They form a
group identity first, and through that, they
find their individual identity. And finally,
late adolescence. 18 to 21. By now, emancipation
is nearly complete. They've hopefully developed
a more stable sense of self. They're thinking
about realistic career goals. They have a more
developed moral compass. And the relationship
with parents often shifts from authority figure
to something more like a partnership or mentorship.
OK, so that's Erickson, identity versus role
confusion. Now, what about Piaget? How are they
thinking? They're entering the final stage, formal
operations. Which means they can think abstractly.
This is a huge leap. They can think about the
future, about possibilities, about concepts like
justice and morality. They're not just stuck
in the concrete here and now like a younger child.
They can hypothesize. But there's a huge catch,
isn't there? Because we know teenagers don't
always make the most logical forward -thinking
decisions. That is the great paradox of the adolescent
brain. They can use deductive reasoning, but
it is often completely clouded by what developmental
psychologist David Elkine called the invincibility
fable. The invincibility fable. It's the deeply
held egocentric belief that Bad things happen
to other people, not me. I can text and drive.
I won't crash. I can vape. I won't get addicted.
I can have unprotected sex. I won't get pregnant.
Everyone else might, but I'm different. I'm special.
Exactly. And that is what drives so much of the
high -risk behavior we see. It's not that they
don't understand the danger intellectually. It's
that they don't believe it applies to them personally.
And that brain science is so key. The prefrontal
cortex, the judgment and impulse control center,
it's just not fully developed. Yeah. It's the
last part of the brain to mature, not fully online
until the mid -20s, but the limbic system, the
emotional reward -seeking part of the brain.
That's firing on all cylinders, fueled by hormones.
So you have a powerful engine with weak brakes.
The perfect metaphor. A powerful engine, weak
brakes, and a driver who thinks they're invincible.
It's a recipe for, well, for adolescents. Which
segues perfectly into our next segment because...
One way we as nurses can act as external breaks
is through preventative care. Absolutely. Segment
four, the vaccine schedule. This is pure high
yield. Got to know it for the exam material.
It is. And the CDC 2025 schedule is very specific
here. There are two major milestones for vaccines
and adolescents that you absolutely have to know.
Let's start with the first one, the 11 to 12
year old visit. Right. I like to call this the
three at 11. It helps you remember there are
three routine shots they need at this visit.
OK, what's number one? First, Tdap. This is a
booster for tetanus, diphtheria, and pertussis,
or whooping cough. Why do they need a booster?
Didn't they get this as a baby? They did, but
immunity wanes over time. And pertussis is particularly
nasty. A teen might just get a bad cough, but
they can pass it to a newborn baby who can't
be vaccinated yet. And for a baby, pertussis
can be deadly. So it's for community protection
too? Hugely. And it's almost always required
for middle school entry in most states, so it's
a high -yield topic for that reason alone. OK,
that's one. What's the second of the three at
11? Menacewy. This is the first dose of the meningococcal
conjugate vaccine. And what does that protect
against? Bacterial meningitis, specifically types
A, C, W, and Y. This is a devastating disease.
It's an infection of the lining of the brain
and spinal cord. It can kill within hours or
leave survivors with deafness, brain damage,
or amputated limbs. And it spreads easily in
close quarters. Exactly. Think dorm rooms, summer
camps, military barracks. This first dose at
11 or 12 starts to build that protection. OK.
Tdap and menonase C. What's the third shot at
this visit? HPV human papillomavirus. The cancer
prevention vaccine. That's what it is. It prevents
the HPV strains that cause most cervical, anal,
throat, and other types of cancers. Here is where
it gets really interesting and really tricky
for testing purposes. The dosing. The dosing.
It depends entirely on the age they start the
series. So let's break that down. This is the
before 15 versus after 15 rule. Correct. High
yield. Write a down fact. If the child starts
the HPV series before their 15th birthday, they
only need two doses. And the timing on those
two. You give the first one today and the second
one six to 12 months later. Simple. OK, but what
if they wait? What if they start on or after
their 15th birthday? Then they need three doses.
The schedule is more packed, given at zero, then
one to two months later, and then the final one
at six months. So why the difference? Why do
the younger kids get off easy with just two shots?
It's all about the immune system. Younger adolescents,
for whatever reason, mount a much stronger and
more robust immune response to this particular
vaccine. So they get more bang for their buck.
Exactly. Two doses at age 11 are just as effective
as three doses at age 16. The body just learns
better when it's younger. That a great teaching
point for parents who might be hesitant. If we
do it now, it's one less shot for your child.
Absolutely. It frames it as a clear benefit.
You also emphasize that we give it now, long
before they're ever sexually active, to build
protection well in advance. OK, so that covers
the 11, 12 year visit. Now, fast forward a few
years, there's another key vaccine milestone.
Yes, at age 16. This is the second milestone,
often called the Sweet 16 booster. And what do
they get then? They get their second booster
dose of MENACWY. The meningitis vaccine again?
Why a booster? Because that protection from the
first dose starts to wane and their risk is about
to spike. Ages 16 to 21 are the highest risk
period for meningococcal disease. Because they're
heading off to college? They're heading off to
college, living in dorms, sharing drinks, you
know, being teenagers. That booster is absolutely
essential to bridge that high risk gap. Now,
I see MenB on the schedule, too. For men in Jadis
B, is that routine? This is a very common exam
trap. Men A C W Y is routine for all adolescents.
Men B is not. Okay, so what's the recommendation?
It's based on something called shared clinical
decision making for healthy adolescents age 16
to 23. Meaning the nurse, the doctor, the patient,
and the parents talk about it. Exactly. You discuss
the risks and benefits. MenB is not as common
as the other strains, but there have been outbreaks
on college campuses, so it's not mandatory for
everyone. But it is preferred for administration
between 16 and 18 if the patient and provider
decide the risk warrants it. Got it. So for the
test, routine is MenACWI. Share decision as men
be. You got it. And last thing on vaccines. Always
check for catch up. Don't assume anything. Never
assume they're up to date just because they made
it to high school. Did they finish their three
dose hep B series as a baby? Did they get two
doses of varicella for chicken pox? Did they
get their hep A series? If they missed those
as kids, you catch them up now. Moving on to
segment five, and this is a heavy one. Safety
and mortality. We talked about the invincibility
fable. What is actually killing adolescents?
If you look at the CDC mortality data, it is
tragic, but it is crystal clear. The number one
cause of death for this age group is unintentional
injury. And that's a broad category. It is. But
the vast majority of that is one thing. Motor
vehicle accidents? MVAs. Is it just inexperience?
Speeding it's a combination. It's inexperience.
It's speed. It's alcohol and it is Overwhelmingly
distracted driving phone phones, of course But
the single biggest risk factor even more than
their own phone use is having other teens in
the car the peer passengers Yes, the data is
shocking the risk of a fatal crash increases
Exponentially with each non -family peer passenger
in the car with a teen driver. It's the ultimate
distraction so the nursing guidance here is What?
It's all about anticipatory guidance. You talk
about seatbelts, no texting. But you also talk
to the parents and the teen about graduated driver
licensing rules. Most states have them. Rules
that limit night driving or the number of passengers.
Exactly. We enforce those rules because we know
that passengers kill teen drivers. It's that
simple. OK, that's number one. The next two causes
are grim. They are homicide and suicide. According
to our source text, homicide is the second leading
cause of death for this age group, and it primarily
involves firearms. What's the nurse's role there?
It's assessment. You're screening for risks.
Is there gang involvement? Are there weapons
in the home? Is the child being bullied or showing
signs of aggression? It's about identifying risk
and connecting families with resources. And suicide
is third. Correct for the 10 -19 demographic.
Though we all know that anecdotally and from
the news, those rates are trending sharply upward.
As nurses, we are on the front lines and we must
assess for this. What does that assessment look
like? It feels... uncomfortable to ask about.
It can be, but you have to push past the discomfort.
You have to ask directly. You cannot use euphemisms
like, are you feeling sad? You have to say, have
you had any thoughts about hurting yourself or
ending your life? Just be direct. Be direct.
It does not put the idea in their head. It opens
the door for them to talk. You look for red flags,
a sudden drop in school performance, withdrawal
from activities they used to love, giving away
prize possessions, drastic mood swings. And we
know certain populations are even higher risk.
Yes. We know that LGBTQ plus youth are at a significantly
higher risk, often due to social stigma, family
rejection and isolation. It's our job to create
a safe, affirming space for them to talk. OK,
let's talk about substances. Vaping and e -cigarettes
seem to be everywhere. It is the new epidemic
for this generation. And the marketing is so
insidious, making it look harmless and fun. But
it's not. It is not. Nicotine is a neurotoxin,
and it profoundly affects the developing adolescent
brain, specifically the parts responsible for
attention, learning, and impulse control. It
literally primes the brain for a lifetime of
addiction. And there's the old standby alcohol.
Alcohol, of course. The big risk there is binge
drinking. Again, that prefrontal cortex isn't
working well, so they don't have that off switch.
So how do you talk to a 16 -year -old about this?
Telling them you'll get liver failure when you're
50? Doesn't seem to work. No, because they are
invincible. Remember, 50 is a million years away.
You have to focus on the immediate socially relevant
consequences. Like what? Vaping gives you bad
breath and stains your teeth. Alcohol makes you
lose control and do something embarrassing in
front of your friends that could end up on social
media forever. You appeal to their vanity and
their social standing. That works far better
than long term scare tactics for this age group.
That is a brilliant tip. Leverage the peer pressure
for good. Let's lighten it up a bit with segment
six, health promotion and the nice -to -know
details. Let's talk food. Nutrition is huge because
they are in a period of growth second only to
infancy. They need increased calories, they need
increased protein for all that new muscle. And
any specific minerals? Two are absolutely critical,
calcium and iron. Okay, why calcium? Bone density.
About 45 % of a person's total skeletal mass
is added during adolescence. This is the one
and only window they have to build strong bones
for life. If they don't get enough calcium now,
their risk for osteoporosis later in life is
much, much higher. And iron. For two different
reasons. For females, it's because of menstruation.
They are losing iron -rich blood every single
month. They're at high risk for iron deficiency
anemia. And for males. For males, it's because
of the massive increase in muscle mass. Muscle
requires iron to function properly. So both sexes
need more, but for different physiological reasons.
What about sleep? I feel like every teen is famous
for sleeping in until noon on Saturdays. And
biologically, they need to. Their circadian rhythm
actually shifts during puberty. It's a real documented
phenomenon called a sleep phase delay. Their
brains don't start producing melatonin until
later at night. So they naturally want to stay
up later and sleep later. Yes, but school starts
at 7 .30 a .m. So there's a huge mismatch. They
still need, on average, about nine hours a night.
Which basically no teenager gets. Almost none.
And chronic sleep deprivation impacts everything.
Their mood, their school performance, their risk
-taking behavior, their immune system. So what's
the nurse's role here? Encouraging sleep hygiene.
Number one rule. No screens in the bedroom. That's
a tough song. It is, but it's critical. The blue
light from phones and tablets suppresses melatonin
production, making it even harder for them to
fall asleep. So consistent bedtimes, a cool,
dark room, and no phones. Great advice. Okay,
let's hit our final segment. Second seven, common
exam traps and clinical pearls. These are the
things that trip students up every time. Trap
number one, and it's a big one, confidentiality.
Ah, the parent in the room problem. Exactly.
The rule is this. You must, at some point during
the visit, interview the adolescent without the
parent present. You need to ask about sensitive
topics, sexuality, drugs, alcohol, mental health.
They will not be honest with mom or dad sitting
there. But there's a limit to that confidentiality.
Yes. And this is the key. If they disclose that
they are a danger to themselves or to someone
else, if their suicidal or homicidal confidentiality
must be breached to ensure safety, you have to
tell the parent and get them help. Safety always
trumps privacy in that case. OK, trap number
two. Growth cessation. We talked about it, but
it bears repeating. Don't expect a 16 year old
female to grow much taller if she had menarche
at 12. The growth plates are likely closed. Don't
give false hope. Trap number three. HPV dosing.
I see students miss this all the time. Just burn
it into your brain. Before 15 equals two doses,
after 15 equals three doses. It is a simple cutoff,
but it's so easy to forget under pressure. Remember,
Menace CWY is routine for everyone. MenB is a
shared decision, risk -based conversation. Do
not get them swapped on the test. They will absolutely
try to trick you on that. So if you remember
nothing else from this entire deep dive, what's
the one thing you want our listeners to take
away? If you remember nothing else, remember
this. The adolescent brain has a powerful engine
but very weak brakes. Their emotional, reward
-seeking limbic system is fully developed, but
their prefrontal cortex, the center for judgment,
impulse control, and long -term planning is still
under major construction until their mid -20s.
So what does this all mean? We've covered the
numbers, the hormones, the risks, the shots.
How do we tie it all together? Adolescence is
a perfect storm. You have the rapid physical
growth of an infant, the emerging hormonal drive
of an adult, and the dangerous risk -taking behavior
driven by that invincibility fable. And it all
comes back to that brain development. That prefrontal
cortex just isn't online yet. Exactly. The emotional
center, the amygdala, is fully firing. But the
control center, the CEO of the brain, is lagging
way behind. So as a nurse, you have a unique
role. What's that? You act as the external prefrontal
cortex. I love that. We provide the judgment
they don't have yet. Yes. Through our anticipatory
guidance, we are the ones saying, wear your seatbelt.
We give them the vaccines to protect them from
future harm they can't conceptualize. We screen
for depression they might not recognize. We guide
them safely across that very shaky, very stormy
bridge to adulthood. And that wraps up our deep
dive into adolescent nursing care. Check the
show notes for the vaccine tables and the vital
signs chart we talked about. Good luck on your
exams, and remember, treat the patient, not just
the parent. And stay curious.