Thursday, September 30, 2010

Thursday's Tip

It is an interesting phenomenon to see the two different kinds of parents that exist out there: The one calls their pediatrician...scratch that...goes straight to the ER for the slightest little cough. The other has a crazy sick kid at home and doesn't take them into their pediatricians office until they are which case they needed to stay at home at call 9.1.1!

So here's my best Thursday PICU nursing advice if you fall into the latter category: if your child has asthma and you are giving albuterol nebs every 3-4 hours a your pediatrician.

If your child has asthma and you are giving albuterol nebs every 3-4 hours for FOUR days.....PLEASE GO to your pediatrician.

However, know that once you get there, your poor little man may need way more albuterol than they can safely give in the office.

SO, he will be admitted to the PICU....most likely b/c he needs continuous albuterol!!

This is the interesting cycle I was able to witness having clinicals in the pediatricians office, and then working in the PICU. While the kid didn't get sent to my PICU, he was sent to the local one nonetheless.

Despite education and re-education from the pediatrician, this mom has brought her 3 year old in too late several times in the past 2 years...requiring 6 hospital admissions!!

While it was a great office clinical experience....and while I love taking care of cute little asthmatic kiddos (see previous post for another asthma cutie!) this is NOT the path kids should have to go down.

So for parents in category 1: Your childs cough (that he did ONCE, without ANY other symptoms) does not mean that he has swine flu or a horrible pneumonia or is dying of some terrible disease that warrants a trip to the ER....he probably swallowed the wrong way, or licked something dusty off the floor, or did one of the other insanely gross things that toddlers do that you would die (but not them!) if you knew about! : )

And for parents in category 2: for the love, yes, when your child has a cough that is not stopping...and you know they have asthma....and you are giving tons of albuterol....YUP, take them in to see the office Nurse Practitioner....otherwise you'll be having an unwanted adventure with the nurse in the PICU!!!

Wednesday, September 29, 2010

"I'm so boring" ....

My lack of blogging is reflective of my lack of anything outside of school and work right now!! My friends feel like I've abandoned them (though they totally understand!) and my husband re-introduces himself to me several times a week ("hello, I'm your husband, so nice to see you!) Ha!!

This week I have a break from clincials b/c I did double time last week. I thought I'd party on my 2 days off this week, but realized, nope, not with 2 papers due Monday and a test Wed! Hello! So it's paper writing time!

BUT First, 2 funny stories from work:

1.) I had a 3 year old asthmatic who had to be on continuous albuterol. Now, if you've every taken a puff of albuterol from an inhaler, you may remember feeling a bit jittery, or like your heart is speeding. So imagine a 3 year old getting this CONTINUOUSLY!!! Poor guy's heart rate was WAY up and he wanted to "run around like a race car" all day. And of course, I kept having to tell him no. By the afternoon, he kept saying "I'm boring...I'm so boring" ... to which I kept having to remind him, the word is "bored" not "boring" : ) So cute!

2.) I was trying to get some homework done at work yesterday when it was naptime for both of my patients. I was in an area of the unit that we like to call "The Alley" because there are no doors to the rooms....just 7 rooms on each side of the hallway facing each other. Great place to be when you need help b/c there are nurses so close by. BUT- not so great when the website you pull up is SO not appropriate for work....and a 4 year old is walking by with his parents and grandparents!! Hello!! I am writing a paper on breastfeeding and had to do some research....what I thought would just be an "educational" site (it was a required reading for this assignment!) was the picture book style education. Right as the kid was walking by, Hello nipples!!!... ALL over the screen!!! I scroll down to get to the "word" section of the article, but nope....more boobs!! Finally I realized, just X out!!! But not before I was thoroughly embarrassed....who knows what this family thinks I was trying to look at!!! Ahh! : ) Just gotta laugh!

Sunday, September 19, 2010

Using my Brain

I walked into the PICU last Thursday having NO idea what kind of patient(s) I would be taking care of. After 4 months of taking care of my chronic kids, it was all up in the air!!! So I walk into taking care of the sickest kid on the unit. Correction: sickest MAN on the unit! I had a 37 year old male who had a huge heart surgery the day prior and was sick....really sick!! I was super busy all day....I didn't sit down the entire shift! He had blood pressure issues, arrythmias, and sedation problems. I had to contact numerous docs to get the answers that I wanted. It was tiring. It was mentally exhausting. And it was AMAZING!!!

I left work remembering why I truly love the PICU!! Being able to use my brain, to critically think, to act quickly in response to the slightest little's so exciting!! People walked by throughout the day and said, "Wow, they really didn't ease you back in, huh! They just threw ya back in there!" Oh yeah, they did. And, oh yeah, I loved it!!

And then the next day came my first day of clinicals. Clinicals in a primary care office setting. Could not be any more opposite of my exciting, amazing, PICU setting.

And yet, it was WONDERUL! I truly cannot say enough great things about it!

I mean, I really surprised myself with how much I learned and how much I LOVED it!!! The idea that office work is boring is just plain wrong! In fact, it was just as busy as many days in the PICU....without the stress of having to keep patients alive! SO nice...go figure!

My "preceptor" is a Pediatrician, and although medical students receive very different training than Nurse Practitioner students, this doc is one amazing teacher!! She had me come in and observe the first two patients of the day...and then threw me out on my own! Hello!! She figured that since I have had PICU training/experience, that this should be a cake walk for me. She was more excited that if someone came through those doors super sick, she'd have someone with her knowing exactly what to do!

It was honestly so great! I would go in and see the patient, take a history and do a physical....then I would go present the patient to the MD who would then go do a follow-up exam...and we would send them off together. I am learning SO much about basic, healthy kids (ie: immunization schedules, basic developmental milestones, skin disorders/rashes etc) and it's awesome!! Those are things that are clearly not of importance when a kid is on life support in the it gets pushed to the back burner.

And what's great is with my PICU experience, I'm able to give parents so much information on disorders and diseases from an inpatient perspective that the pediatrician is not able to give.

SO- on my first day here's what I got: a TON of well patient check ups ranging from 2 weeks (SO cute!), a few 6 and 9 months, a few 12 months, and a few back to school check-ups. Then, we got an asthmatic that we admitted to the hospital, a football player with a broken finger, a cross country runner with shin splints, and a 16 year old who was self diagnosed as pregnant....and sure enough was (that test came back positive in less than a 3-5 minutes of waiting necessary!)

I think the biggest reason that I love this setting is the amount of patient and family education that is involved...and I'm realizing more and more what a passion I have for teaching. I always know that eventually I would want to teach at the college level, but this shows me more that whatever job I take once I graduate, a big component needs to be revolved around teaching!

On the job front, I haven't been back since my last post, but I have had several people call and text me: the boy I just sent up came right back down : ( Apparently he got a mucous plug in his trach which occluded his airway...which caused him to "brady"(heart rate go down too low), which caused him to get compressions, which bought him a one way ticket to the PICU. So, I know where I'll be on Tuesday at work!

So while I may not be "using my brain" as much as last Thursday when I go back to work this week, I know I'll be giving some great PICU care to a boy who probably needs a familiar face right now....and that makes this PICU nurse ready for the adventure chill as that may be : )

Wednesday, September 15, 2010

Long time...Long Post!

Wow- it has definitely been awhile since my last post. Part of that was because we went on vacation, and then I had 2 weeks off of school (SO needed!)

But I've been back at it now and work has been CRAZY!!! One day last week the code button went off 5 times before 10:30am. One little baby was getting a bath and her heart just stopped (she is in the hospital because she just had heart surgery)- so she was crashed onto ECMO (think heart and lung bypass machine similar to what is used in surgeries). A second kid decided to stop breathing and had to be intubated. The third kid was a liver transplant who started having arrythmias (funky heart rhythms), lost her pulses, and needed compressions. The other 2 were farther from me so I didn't get involved. But, let me tell ya, one true code is enough for a day....5 is out of control!!

We have had 3 kids die in the past 2 weeks which has been hard (2 had cancer, one was waiting for a liver transplant). Like I said, crazy at work.

On a more positive note, I sent my other boy up yesterday to the general floor which was bittersweet...probably more bitter than sweet! It's great to see him getting better, but so sad to see him go : ( 4 months is a long time to take care of a little kiddo. So I've made my way out of my corner and will (hopefully) find another nice little assignment with a great family to take care of. I told the nurse in charge yesterday if I come in Thursday and am put in 218/219 I will not be laughing! I need a break from that corner...especially now that my boys aren't there!

One day last week I took care of the cutest little 15 month old boy- blonde curly hair and wildly blue eyes!! He had croup and was working pretty hard to breath (ok, really hard, we thought we were going to intubate him for awhile, but he got better!) and so he couldn't eat. BUT- the next day I was there he looked tons better and all he kept asking for was "ham"- He said it in the cutest little high pitched voice. So he got his ham....ate a bunch of it, and then promptly threw up all over his moms lap! No later than the second he closed his mouth after barfing up his whole dinner, did he say "ham!" hello, kids crack me up! I'm pretty sure when I throw up, the last thing I want to do immediately is eat....especially the same food I just threw up! YUCK!!

On school: Clinicals start this week- I'll be going once a week to a primary care office, so I'm looking forward to it. I'm sure it will be lovely being in an office setting during cold and flu season....oh boy!! Classes don't look too hard....Peds Pharmacy is writing intensive so I'll have to write a 4-6 page paper each week but that's not so bad....and then Pediatric Primary Care has 3 projects and 3 tests, so again, not so bad. My 3rd class goes along with the clinicals and will just involve short write ups, so piece of cake! This will be the busiest class schedule for me until I graduate, so I just have to get through the next 10 weeks. I can do anything for 10 weeks (my mantra over the past 2 years!!)

I'll post an update this weekend to let you know how my first day of clinicals went!! Exciting!!