Adult ER nurse....advice on Pedi patients

Robublind · Jun 15, 2012

Great post Esme, ENPC and TNCC are great courses.

Only thing I would add to peds assessment are they making tears: if they are making tears they are hydrated.

As for basic care, I find that getting below the level of the youngster, on your knees is a great way to start.

Then just do want you have fast, be prepared before you enter the room, get help to hold if you need to.

Giving a shot or iv start on kid is like shooting a gun. It is always hard to do the first time, make sure you have a good hold on it, then there is a lot of noise, kicks like hell and then it calms down after. Once you do it a couple times the shock is over and you are good to go.

Esme12, ASN, BSN, RN · Jun 15, 2012

Parents welcome....sitting in a in a chair, without wheels, only. Parents like Gomers will go to ground.

(I couldn't resist "The House of GOD" reference)

If they have tears have no fears.....If the pacifier's wet they're all set. :lol2:

Learn nursery rhymes and learn the popular kids shows.... NOW!

They are going to cry from the moment you begin to hold them...forage on! YOu and the parents will remember it much longer than they will.

Beads will find places where no bead has gone before...... :eek:

The art of calming a parent that although their child is bleeding and it's important to everyone.....

the child will survive the injury.:hug:

OP you are already doing what you should....educate yourself. :yeah:

canned_bread · Jun 16, 2012

Also their blood results (haemoglobin etc) has different reference ranges in the paeds population. Remember to focus on family centered care, not just the kid.

patriciarrn · Jun 25, 2013

I just started a new job in an ER that cares for a mixed population of both adults and pediatrics. My entire career (13 years various med/surg/tele 4 years ER) has been spent caring for adult patients. I'm enrolled in PALS and ENPC but they won't be given until late in the fall. I'm scared to death of babies and kids! The unit educator had absolutely zero advice for me (she's kid phobic too). So... I was wondering if anyone could recommend a resource to get a crash course in pediatric/infant ER care (our youngest has been 6 weeks old!). Just looking for the basics all in one place if possible...a book, a website. Any input would be greatly appreciated! Thanks.[/quote']
I remember caring for my first peds patient. I was scared too. I have to tell you that I read the PALS and ENPC books, took notes watching other nurses care for ped patients, and continually asked questions. I also had an experienced nurse with me at the beginning in case I needed help with anything until I was more comfortable.
Check the ENA web site, book stores, and U tube. I have found many references through them.

ewere · Feb 11, 2014

In my experience wit pead u just have to be careful with them and take things really very slow. for u get things from a child will take a long time which u have to play a longtime and be friendly with them to achieve ur goal

ewere · Feb 11, 2014

in pead in a bigger child always say the truth in stylish way when doing a painful procedure and communicate with parents

EMnurse10 · Sep 2, 2015

Having worked in a general ED I completely understand how you are feeling. I am now working in a pedi only ED and love every minute. With kids, don't surprise them. One thing I have learned is to be honest. If you have to start an IV, sit with a set of supplies and show them how it works (retract the needle from the IV) and let them play with it. Google child life videos. We have child life specialists where I work and they are amazing. I have learned so much about how to prep kids from them. For instance, we don't call them IVs but special straws. Also, never tell them not to cry. I have been able to talk many kids into holding still and they still cry. I will straight up say "the most important thing is for you to hold really still. You can cry and that is ok, but hold your arm as still as you can." Always make sure you have someone helping to hold, but life is much easier, for the majority, if you are honest with them.

Anna Flaxis, BSN, RN · Sep 3, 2015

I love this:

http://www.health.ny.gov/professionals/ems/pdf/pediatricreferencecard-04.pdf

As far as providing care, learning about developmental stages could be helpful. For example, toddlers are often shy of strangers, so I focus most of my direct attention on the parents during the initial assessment- I don't zoom in on the kid right off the bat. With school aged kids, you can explain things to them and offer choices, such as which arm to insert the IV, which site for the IM injection, etc. And as someone else mentioned, I never tell them not to cry/yell/scream if they want when I need to do a painful procedure- in fact, I invite them to. Also, and this is very important, know where all the popsicles/stickers/crayons/stuffed animals are stashed.

Kristenlaurenw · Dec 17, 2015

Popsicles are a great way to get back on their good side after you've been the mean nurse and given a shot (as long as it's okay with doc and mom, of course)!

**NickiLaughs, ADN, BSN, RN** · Dec 23, 2015

In my experience, nurses unfamiliar with pediatric patients are sometimes just as freaked out by more routine pedi presentations as they are by the prospect of dealing with a really sick kiddo in crisis.
OP - suggest you ask your preceptor or educator or other staff how common pedi situations are handled in your ER.
1. Fevers in kids > 6 months old: is your group of docs aggressive? Do they order labs and urine specimens on virtually every patient who is febrile? Do they insist on straight cath urine specimens or are u-bag collections acceptable?
2. Beads and other misc. items up the nose. (just an aside -- this was my brother's specialty when we were growing up -- we have an endless supply of family stories related to this)
3. What is your docs' approach to otitis media?
4. The art of administering oral meds with a syringe.
5. The art of holding thrashing kiddos (of various sizes) securely. (hint: you might consider taking off shoes)
6. The art of recognizing in a snap which parents are going to be helpful in holding during a procedure, which are going to be passive but make you out to be the bad guy, and which are going to freak out themselves to such an extent that things are going to be 12 times more difficult.

I didn't think this was true but as I am still getting used to peds. But we had a kid in status and I was totally calm for the intubation process. It's the kids who just need some mess and an I and O cath that freak me out. Go figure.... I'm still terrible at pedi IVs and I can't seem to cath those babies, but I've only had the opportunity to attempt 3 infant IVs in the last year and two caths.