Advice & Tips for working with pediatric er patients

  1. 0
    I love kids, but this is my first time working with them. My preceptor is awesome and has been giving me tips to try (eg getting a rapid strep swab on a 5 yo and asking her if she has a dog, can you pant like your doggy to reduce the gag reflex and distract her). Do you guys have any other ideas? If there's already a thread out there please let me know
  2. 18 Comments so far...

  3. 5
    Wow......get the ENPC course book and read it. Pediatrics is a specialty all it's own. their airways are different....smaller and structurally....they can eat and breathe. Remember that 1mm of swelling on an adult airway that is 5mm wide is completely than 1mm of swelling on a 1mm airway. Vital signs are not a predictor of how sick a kid is for they can compensate forever and by the time they reflect it in their vitals....they are in critical trouble. The cap refill/urine output is a great indicator on the younger pedi population as an indicator of distress and end organ perfusion.

    So when did they last pee and how many wet diapers in x any of time is huge!!!! Using accessory muscle is a huge sign of distress.

    They need fluid, O2, and keep them warm. A crying and screaming kid is a stable kid....it's the quiet ones that will/should scare you. If the child has a congenital/chronic illness listen to the parent.....they have done this before and can help you.

    Rhythms for kids....slow, fast, and absent. familiarize yourself with the normal vital signs for the age group!

    Infants....was the baby full term, what was birth weight, weigh all babies regardless of what the parents say...emphasize how important it is as that is how the medicines are given. Small mistakes have huge consequences for the pedi population. If they are small so should the dose be as all doses are weight based.

    The enpc (emergency nursing peds course) has a terrific pets triage standard that should be used by all eds.
    ciiamppedds: cis chief complaint, i is immunizations, i is isolation (has the child been exposed to any communicable diseases), a is allergies, m is medications, p is past medical history, p is parents impression of the child's condition, e is the event surrounding the illness or injury, d is diet, d is diapers (voids) and s is signs and symptoms

    great power point triage assessment
    http://webmedia.unmc.edu/bioprepare/...c%20triage.pdf

    age group respirations heart rate systolic blood pressure
    newborn 30-50 120-160 50-70
    infant (1-12 mo) 20-30 80-140 70-100
    toddler (1-3 y) 20-30 80-130 80-110
    preschooler (3-5 y) 20-30 80-120 80-110
    school age (6-12y) 18-25 70-110 85-120
    adolescent (13y +) 12-20 55-110 100-120
    adult 16-20 70-100 < 120



    Read through this...it is very informative.
    triage course - nursing continuing education (ce) - nurse ce -

    PEWS.....the pediatric early warning (pew) score system can help nurses assess pediatric patients objectively using vital signs in the pediatric intensive care unit. the scoring system takes into account the child's behavior, as well as cardiovascular and respiratory symptoms. http://academics.ochsner.org/uploade...0PEWS%20v2.pdf

    ahrq innovations exchange | pediatric early warning (pew) score system

    this is another great assessment tool for assessment short and sweet but informative.

    http://www.ucdenver.edu/academics/co...m_pews_tch.pdf

    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.

    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......

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

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

    http://allnurses.com/emergency-nursi...se-742288.html
    Last edit by Esme12 on Apr 15, '14
  4. 1
    Wow, thank you so much for your time and effort with your reply! I really appreciate it I've started in the "minor care" part of our ER (soft 3's, 4's, and 5's) and will take PALS Monday, and am required to get my ENPC within 2 years (starting to think doing this sooner will be better).

    I love kids, but I hate giving the shots and feeling like I'm torturing them (even though it's to make them feel better!), so I thought I'd see if anyone had any tricks up their sleeves when doing the procedures that are particularly unpleasant!

    I agree with brushing up on my kids' shows. Phineas and Ferb? Never heard of them until now!!
    Esme12 likes this.
  5. 1
    I took ENPC with 6 months of experience under my belt and found it invaluable. Because I was taking it so soon, my job didn't pay for it, but I think it was well worth it. More helpful than PALS for sure!
    Esme12 likes this.
  6. 4
    [QUOTE="lvnlrn"]

    I love kids, but I hate giving the shots and feeling like I'm torturing them (even though it's to make them feel better!), so I thought I'd see if anyone had any tricks up their sleeves when doing the procedures that are particularly unpleasant!/QUOTE]

    I worked with some really awesome peds nurses who taught me a lot of awesome insider tricks.
    1: carry stickers of several popular cartoon characters, and let them think about which one they want.
    2: Being knowledgeable about kids' developmental stages is really important. At around 3 or 4, I let them "test out" my ears (stethoscope) to listen to my heart before I use it on them. Never refer to "taking temperature" or any other vital signs because kids often take you literally I usually say "checking".
    3: I've had a lot of success placing IVs in kids who enjoy imaginative play. I tell them that I have a really thirsty butterfly who wants to hang out with them for a little bit, and even though it's gonna be a quick ouchie, they get a brand new buddy to keep them company while they're both getting better. Works like a charm
    4: When possible, let the kids pick which med they want to take first (red, pink, bubble gum, etc).
    5: Glove turkeys can be endless sources of entertainment even for infants.
    6: Remember that as much as it hurts them and you for them to hurt, you're the hero because you're helping them to feel better

    There are plenty more, but these are ones that come to mind right away.
  7. 1
    Flu swabs are explained as "I'm gonna get a boogie on a stick, but it won't hurt." 3 yo and up think the idea of a grown up picking their boogers is HILARIOUS! Follow by the standard joke- "How do you make a hanky dance? Put a little boogie in it!" Urine specs with little boys- draw a crayon smiley face on the back of the hat and make a game of him seeing if he can pee on it. I actually wore a urine hat on my head last night (A clean one!) If you can get them to laugh, it's half the battle. BRIBE them! Popsickles and crayons and coloring books are WONDERFUL!
    sweetlilwolf likes this.
  8. 0
    Quote from JDougRN
    Flu swabs are explained as "I'm gonna get a boogie on a stick, but it won't hurt."
    Have you ever had a nasal swab done? I wouldn't describe it as pain free at all. And when I tried it on myself I didn't get up as far as you're supposed to go for a good flu/RSV swab.
  9. 0
    Quote from hiddencatRN
    Have you ever had a nasal swab done? I wouldn't describe it as pain free at all. And when I tried it on myself I didn't get up as far as you're supposed to go for a good flu/RSV swab.
    Yes I have, and no, it didn't hurt-
    Last edit by Esme12 on Jan 21, '13 : Reason: TOS
  10. 0
    Please don't call me a **** simply because I disagree with you. Aside from being rude, it's a violation of TOS.
    Last edit by Esme12 on Jan 21, '13
  11. 0
    I didn't call you anything- it was used as a verb, and you were insinuating i was being untruthful with my peds patients- you don't ever lie to any patient about the probability of causing them pain.
    Last edit by Esme12 on Jan 21, '13


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