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Double-Helix, BSN, RN 36,633 Views

Joined Apr 5, '11. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,364 (54% Liked) Likes: 6,614

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  • Feb 13

    It's normal, but there is definitely a psychological component that triggers the physiologic reaction. I've never heard of consulting a psychologist, but it's possible they may have some good techniques.

    I always find it helpful to first tell the person sticking me that I have had issues before. That prepares everyone and makes me feel less pressure to NOT have a reaction, if that makes sense. Then, during the stick, I ask that they don't tell me what they are doing or when they will stick. I talk about something unrelated and keep talking. The talking keeps me breathing, which helps prevent that kind of vasovagal reaction.

  • Feb 2

    Normal pulse oximetry readings are going to vary significantly for patients with congenital heart defects.
    The type of defect, size of the defect, age of the patient, any previous surgeries or procedures, and supplemental oxygen are all going to affect what a "normal" pulse oximetry reading is.

    Basically, the pulse oximetry reading is a reflection of how much mixing is taking place between oxygenated and deoxygenated blood. The more deoxygenated blood that is flowing to the body, the lower the O2 sat will be. A child with HLHS prior to completion of surgical revision is going to have more mixing of blood then a child with a VSD.

    I've had patients that had "normal" saturations between 70-80. Others remain in the low-mid 80's. Still others may be in the low 90's. It's really impossible to say what the normal sat would be without knowing more about the patient and their physiology.

    The important thing to remember is that you should not give supplemental oxygen to a patient with a congenital heart defect until you have discussed it with the cardiologist. Oxygen is a pulmonary vasodilator. Dilating the veins in the lungs can decrease pulmonary vascular resistance and shift the balance of pressures between the lungs and the body. Since blood follows the path of least resistance, this can cause flooding of the lungs and send the child into CHF.

  • Jan 20

    I've only been a PICU nurse for three months, but I have gained a huge perspective in that time! Being a PICU nurse is exciting, heart-breaking, frustrating, scary, and wonderful all at the same time.

    Imagine taking care of a child on ten seperate medication drips who is on a ventilator, has three central lines, arterial line, a CVP and a foley. You're drawing hourly blood gases and blood glucose levels, counting all of your I&O's hourly, monitoring the ventilator settings, constantly alert for any changes in vital signs, making sure your syringes of pressors don't run out, hanging so many medications that you are running out of lines to use. You're giving updates to the docs and making adjustments to your drip rates based on their orders. You need to turn your patient every two hours, which requires two other nurses to help move the patient and keep the breathing tube in place. To top it all off, you have angry family members scrutinizing everything you do and demanding that certain non-essential things be done immediately.

    Being a PICU nurse is never boring. There is always something new, something that needs to be done. I've taken care of kids with so many different diagnoses that I couldn't possibly list them all. Our unit is a 19 bed PICU that takes all different kinds of kids. Our hospital has a pediatric cardiac surgery program, so we always have at least a few cardiac patients with various congenital cardiac defects. Depending on the season, we usually have a couple kids with viral illnesses, particularly RSV in the winter months, one or two babies on observation for apnea, asthma exacerbations, ex-preemies with chronic medical issues and heme-onc patient. Most of the pediatric surgical cases bypass the PACU and we receive them directly from the OR. So we get tonsillectomies, thoracotomies, traumas, amputations, appys, cardiac cath's, neuro surgeries, etc, etc. Our general peds floor does not have monitoring systems, so any patient that requires continous monitoring of any kind (HR, rhythm, O2 sats, respiratory) comes to PICU.

    Skills:
    Solid assessment skills are crucial. Kids can't tell you when something is wrong. You have to know what's normal and what isn't and be alert for any changes that might indicate the child is deteriorating.
    Critical thinking: why is this patient presenting like this and what does it mean? What am I going to do if this kid goes south? What do I need to have on hand in the room in case of an emergency?
    Prioritization and time management: You've got a lot to do. You need vital signs on all your kids at noon time and you also have three IV meds to hang, several po/GT meds, one kid needs an enteral feed and the other needs labs drawn and another has an infiltrated IV. What's most important? What can you get done early?
    Communication: With docs, with parents, with the kids. Parents of sick kids are nervous wrecks. They have a lot of questions. You need to be able to explain what is happening in terms that they can understand. You need to explain things to the child. You need to convince a sick and scared child to swollow their medications. You need to explain to the doctor why you think one of your kids needs a different type of treatment. A big part of your job is communicating. And don't forget giving and receiving report.

    My day begins at 6:45am and on a good day I leave at 8pm. Most days I eat lunch at the nurses station in five minutes so I am never far away from my patients. If I use the bathroom once I am lucky. But these are "my" kids, as I refer to them. They are my responsibility and whether I've taken care of them for an hour or three shifts, I love them. There is no other specialty like PICU, and there is no other place I would rather be working.

  • Jan 14

    Quote from .CJ.
    I agree with some of what you said, but it's as if you're saying that you serve a God that doesn't care about your personal wellbeing or doesn't hand out blessings. If I were to go on to become a competent nurse, that would have a positive impact on my wellbeing as far as finances go, and I would like to believe God is concerned with that. It would just be a huge blessing from God to get through nursing school despite all the challenges that come with it. You're saying praying for that is futile or asking for any discernment regarding my livelihood is pointless? I don't know about you, but I believe in Mathew 21:22. It may or may not be in God's will for me to be a nurse but I do believe that as long as I have faith in him, he'll look out for my best interest.
    I don’t want to turn this into a religious debate- I’m happy to discuss further through private messages. God can certainly care about your well being and livelihood. However, we live in an imperfect world. Tragedy can, and does, befall good, unsuspecting people every single day. When I became a nurse and started working in PICU, it was a true crisis of faith when I would see church-going, Bible-believing, praying families have a child diagnosed with cancer, or drown, or die from some freak surgical complication. There’s a pretty pervasive Christian believe that as long as we are doing things the “right” way, God will bless us. While I do believe there can be miracles and blessings, I also believe that we weren’t promised a smooth ride here on Earth (John 16:33). Above all, God gives us peace, and He can work all things together for good.

  • Jan 2

    I know what you mean. I work in pediatric intensive care and you wouldn't believe the number of parents, family members and friends of the family who think it's out job to supply them with food, drinks, toiletries, the works.

    Our dietary services bring up bagels, pastries and fruit for the families in the mornings and sandwiches at lunch time. We also have some sodas and juice in the fridge and tv dinners in the freezer. You think that would satisfy most people, but nope. I've had so many families say, "Aren't me and her dad going to get a meal tray too?" "When are they going to bring more soda?" (This is after each family member has already taken two.) "Is this all they are bringing for lunch?" "I'm hungry, can you order X and Y from the cafeteria for me?" "Hey, can I get a toothbrush, and toothpaste, and a comb, and soap, and shampoo, and lotion, and chap stick too? And can you bring one for my boyfriend?"

    I even explained to one family (who nearly cleaned us out of soda, juice and pastrys in a a couple of hours) that the food that was brought to the floor was to share with all the patients and family members on the unit and to please be respectful of that. Yep... don't think I'm getting any customer service points for that one. Sometimes we even have to move soda and juice into our staff room fridge just so we will have some for when our patients ask for it.

    When a family member was asking me for chips, snacks, soda, etc I directed her toward the vending machine. She said, "I don't have no money for a vending machine!" Since I don't always carry cash myself, I explained our cafeteria where she could purchase food with a credit/debit card or use the ATM. She insisted she didn't have money for any of those either. So my next response was, "Then I suggest you do what you would do if you were home and not in the hospital. Because we are here to take care of your child, and we don't supply meals for families."

    Don't even get me started on the families who stockpile diapers, wipes, formula and bottles before they leave. There have been several times when I have gone through the closets when the family steps out of the room and removed 5-6 packages of daipers and wipes, and 10-20 bottle of our ready to feed formula that the families were hiding away for when they left.

  • Dec 31 '17

    I'm trying to quote your post but this browser isn't cooperating, so please bear with me:

    and then I decide that a strep test is in order. I gather my swab and tongue blade only to be met with resistance by the parent. Not that the parent doesn't want the test done, but they don't want to make their child hold still for the test.

    Parents are going to be resistant to putting their already sick child through something uncomfortable if they aren't certain it's necessary. Deciding yourself, as a nurse, to perform (essentially ordering) a strep test is outside of your scope of practice unless you have standing orders. Even if it's done routinely- even if you know it's what is going to be ordered. After consulting with a provider, you can then tell the parents what uncomfortable or painful procedure needs to be done. They will be more willing to comply if they know the doctor wants it done.

    As a result, I try to coax the child into allowing me to do the test by telling that that it's fast and I promise it won't hurt. I even demonstrate by letting another nurse do the test on me. Also, I'd bribe the patient with things like "if you let me do this test I'll get you a popsicle"

    These are all valid attempts at educating the patient and family about the test. Demonstrating is good, when possible. Avoid "bribing", but you can offer rewards. Just try not to phrase it like the child has a choice. You can say, "If you let me do this, I'll get you popsicle." But that gives the child the choice to say "no." Say something along the lines of, "Once we swab your mouth I'll get you a popsicle to help your throat feel better. The child doesn't have a choice about getting the test done, but you can give them options when they have them. "Would you like to sit on mom's lap while we swab your mouth or on the bed?".


    (we even had our guy nurse come-in to use as a threat in order to get the child to agree to the test though this did not help)

    You addressed this already, but please do not threaten or allow yourself to be used as a threat to a child. When it happens in front of a family, correct it immediately. Say, "No, I am not going to hold your child down, but I can help you work with her to get this test done in a way that is easiest for all of us and gets her the care she needs to get better." To the nurse who does it, say, "I am not going to be used to threaten children to cooperate. I am a professional and children shouldn't be made afraid of me anymore than you would want them afraid of you."

    I blame the parent for allowing their children to get out of hand. They are children, they need to be told what and how to do things.

    Do you have children? Let me let you in on a not-so-secret emotion that we parents have called "helplessness". Those tiny little humans are the most important thing in the world to us. It's our job to take care of them. When we can't- when they are sick or hurt or they have to experience pain and discomfort in order to get better- we are overwhelmed by helplessness. It terrifies us. It frustrates us. It makes us angry, and emotional, and feel inadequate. And in that hospital room, when we need to ask- make- our child to do something we know will cause discomfort or pain- we are lost. They may be our child, but we have much less experience in that area than you do. Sometimes parents need some direction. Please do not blame parents for not knowing how to respond in a situation that they are entirely unfamiliar with. (Unless they are actually being belligerent in which case you escalate and get the provider in the room to talk to them.) They need you to tell them what to do, and how to help you AND their child. Asking the parent and child to do something is very different than telling them what needs to be done. This can be done professionally, and gently. Saying something to the mother like, "The easiest way to do this is usually with Sally sitting on your lap. I'm going to have another nurse come in to help remind her to keep her arms still, since it's normal for her to want to reach for her mouth." To Sally, "Sally, Mom is going to give you a hug. My friend Jane is going to come into help you hold your arms still. Then you're going to open your mouth for me and say "AHHH" while I count to five. Then I'm going to swab your mouth and you'll be all done and can have some juice or a popsicle."

    I'm going to disagree with jrt4's statement that parents should not hold children. However I think he/she was unclear. Parents shouldn't be asked to restrain a child (hold them down), however there are wonderful things called "comfort holds" that can be used to facilitate many various tests and procedures. These involve the caregiver holding the child in various ways that provide both safety and comfort. I suggest looking them up, as they can be very helpful tools.

  • Dec 30 '17

    Read up on comfort holds for medical procedures. Comfort holds can be a very effective, therapeutic way to reduce the amount of restraint needed and provide safe care. http://www.nationwidechildrens.org/c...old-techniques

    I also sincerely hope you’re using physical restraint in addition to anesthetic and anxiolytic medications. Solely holding a child down to perform a painful procedure is traumatizing and cruel.

  • Dec 18 '17

    Quote from nursenick20
    We are so rude to you because you missed something clinically (Change in VS, urinary output, or mentation) that led to the patient decompensating, or directly led to it. We are also rude because you are picking at little things and not looking at the whole picture. YOU try to take care of two patients, one coding and one from an outlying hospital that needs multiple lines dropped for CRRT and central line access, and an A-Line that needs to be put in for titrating meds. Plus all of the q1hr items that we have to do. I'm sorry your 4 patients are needy and have a decent amount of interventions. But we get our butts handed to us also. The grass may not be greener. The square clamp keeps the iv line occluded when you take it off the pump, that is the point of it right? A lot of your complaints seem to be nurse/unit specific. Is there a way these can be addressed other than coming on a chat website and venting?
    I agree that ICUs are busy and stressful places to work. There is a reason we only have two or three patients. Taking an emergency admission in the middle of the day can really mess up your shift. I'm sure floor nurses feel the same when they get a sick, unexpected admission. However, none of that is an excuse for rudeness to a co-worker.

    I completely DISAGREE with your statement that the patients decompensate because the nurse missed something. That's just untrue and really does play into the "floor nurses are inferior" mentality. If its the nurse's fault that a patient needs to come to the ICU, then it must be your fault when the patient codes.

  • Dec 13 '17

    Before you even try to move forward with clinicals, you need to contact your state BON and see if they would grant you licensure with your criminal record. In many states, a felony conviction will cause your application for licensure to be denied. It would be a shame to spend the time and money to complete nursing school and then be denied a license from the BON.

    As the previous poster said, you can't just go find a clinical site. There's a lot that goes into arranging clinicals. You need permission from the hospital, there's waiver forms and HIPAA contracts, you need to have an instructor to supervise. Clinicals are done in groups. If you aren't allowed in the clinical site where the group is assigned then you won't be able to go. I can't see the school being that willing to bend over backwards to accommodate you because you have a criminal record.

  • Dec 12 '17

    It’s unlikely that anyone on this forum will be able to help you. You’re working in Saudi Arabia, where the rules and processes are completely different than the US and Canada, where most of the members here are from. Are you a citizen of Saudi Arabia or another country? I honestly have no idea where to direct you for information because I’m not at all familiar with nursing or working in Saudi Arabia.

  • Nov 28 '17

    D5% 1/2NS c 20meqKCl/L is the standard maintenance fluids we run on all of our pediatric patients who are NPO or otherwise not able to take adequate oral/enteral fluids. It’s not specific to any diagnosis.

  • Nov 28 '17

    There are nurses who don't start IVs. Like anything, it's a skill, and if you don't practice it regularly you become rusty. Residents/MDs don't typically start IVs that frequently. But they also perform other tasks more competently than I do.

    We are all equally important members of a healthcare team. I don't see why it's necessary to make fun of residents because they don't often start IVs.

  • Nov 25 '17

    Quote from Noctor_Durse
    OK. I'm a student but I will give it me best explanation. So 130ml/90 minutes. So 90 minutes =1.5hr.
    We can break up 90 minutes into 30 30 30.
    If we divide 130/3= 43. So that means the pump is going to run at 43ml/30 minutes. So let's just double that and make it 86ml/60 minutes and let it run for 90 minutes.
    Someone please stop me if I'm wrong.
    In my opinion, this is way over-complicating the problem. You have a total volume. Divide it by the number of hours you want to infuse it over and call it a day.

  • Nov 13 '17

    Quote from RegularNurse
    I think you are new to nursing. One of the things you will learn is that stuff happens. Just be cool and do your job.
    OP is not in the nursing field. He/she is a patient sitter, and has been employed as such for all of 5 days. It sounds like her employer offered very little in the way of instruction or orientation AND she is being sent to various hospitals/units with little consistency or time to develop a routine. She was placed with a patient who had needs beyond what she was trained or expected to do (and probably should have had a psych tech or security present instead of a brand new sitter) and given poor guidance from the hospital staff. I think we can cut her a break for being a little upset about the situation and wanting to take action to prevent it from happening again.

  • Nov 9 '17

    That is clearly a definition of a CVICU. It’s possible that the unit used to be called something else, or was merged with another unit, and that why two staff members refer to it differently. Without asking them specifically, it’s hard to be sure.


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