New Grad - Peds Cardiac ICU

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    Hello all,

    I am a new graduate that landed my dream job in a Peds Cardiac ICU at an amazing hospital. I have experience as a CNA in peds ICU, but I am extremely anxious about starting in the PCICU. We do not get many heart kids, so it is not something I have learned much about over the years. I don't start until August, but I wanted to go ahead and learn as much of the basics I could. So here are some of my questions to help me with my studies...

    1) What are the most common heart defects that I should learn?

    2) What are the most common medications I will see? (I know some...dig, lasix, milrione...sp?)

    3) Are there any specific procedures I should look up?

    4) What is the best way to study ECGs? (Im not a fan of these...even though I know I will have to learn them)

    5) Are there any lab values...besides the normals....that I should learn that are specific to cardiac kids?

    6) ANY info/advice/areas to study would be GREATLY appriciated!!! I am lost as to where to begin


    Thanks in advance for your time!

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  2. 4
    Sheesh, I had a long, detailed reply to this already almost finished when my computer did an automatic Windows update and restarted without any warning! Let's see if I can recreate it...

    First off, it's a bad idea to try and learn everything there is to know about such a complex subject as peds cardiac before you even get a foot through the door. There's so much to learn and a lot of it makes much more sense when you add it to stuff you already know. A well-structured orientation will give you basic information and move to the more complex as you go along, allowing you to build on a good foundation. So I suggest you start by reading the sticky How to Prepare for that First PICU Position and all the threads it contains, except maybe the interview part, since you already have a job... I suggest this because the cardiac part is only a portion of what you're going to need to know and do.

    Next, review your fetal circulation and the changes it undergoes once the baby takes its first breath. This will help you understand everything that comes later - the things we see in kids with cardiac lesions.

    1. The list of cardiac anomalies is long and full of alphabet soup. They run the gamut from patent ductus arteriosus, simple atrial septal defect/patent foramen ovale, ventricular septal defect, atrioventricular septal defect, valvular atresia or stenosis, coarctation of the aorta, interrupted aortic arch, transposition of the great arteries, tetralogy of Fallot, truncus arteriosus, partial- or total-anomalous pulmonary venous drainage, double-outlet right ventricle, double-inlet left ventricle and hypoplastic left heart syndrome.

    2. The list of drugs is even longer: morphine, midazolam, lorazepam, ketamine, hydromorphone, fentanyl, propofol, chloral hydtrate; epinephrine, norepinephrine, vasopressin, phenylephrine, dopamine, dobutamine, milrinone, digoxin, nitroglycerine, sodium nitroprusside, esmolol; captopril, enalapril, labetalol, carvedilol, sotalol, propranolol; furosemide, bumetanide, hydrochlorothiazide, spironolactone, ethacrynic acid; adenosine, amiodarone, lidocaine, procainamide; potassium chloride, magnesium sulfate, calcium chloride, sodium bicarbonate; cefazolin, piperacillin-tazobactam, meropenem, vancomycin; ranitidine; fish oil... and if your unit does heart transplants, you can add tacrolimus, mycophenolate mofetil, ATGAM, RATGAM, methylprednisolone, prednisone, ganciclovir, fluconazole and a few others.

    3. In addition to the lists in the other threads from the sticky, you'll need to know chest tube care, pacemaker management, JP drain care, intracardiac line care, management of the patient with an open sternum, on peritoneal dialysis, on continuous renal replacement therapy and on extracorporeal life support.

    4. Pediatric dysrhythmias aren't as numerous as adults' and they're usually easier to discern. The most common ones in a PCVICU are sinus tachycardia, sinus bradycardia, junctional ectopic tachycardia, supraventricular tachycardia, premature atrial complexes and pulseless electrical activity. There are a number of good teach-yourself-12-lead-ECGs books out there but I think you should let your clinical educator teach you what you'll be expected to know.

    5. Cardiac kids are prone to electrolyte and acid-base imbalances. Potassium, ionized calcium, magnesium, lactate, creatinine, urea, hemoglobin, hematocrit and methemoglobin are all important measures.

    Welcome to our little corner of the world. We all hope you like it here!
    Last edit by NotReady4PrimeTime on Oct 31, '12 : Reason: formatting
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    PS... I just added this thread to the sticky, so don't read it again!
    Last edit by NotReady4PrimeTime on Oct 31, '12 : Reason: typo
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    I found Mary Fran Haznski's book "Pediatric Critical Care Nursing" a life saver. In our hospital one of our surgery PAs wrote a book on the most common heart defects in children. Maybe your hospital has gotten a hold of it. It's great.

    I only have 1 year of PCICU experience, but can tell you right off the top of my head that knowing your EKGs well definitely helps (there is no "best way" to learn, just keep going over them and once you see it on a real patient - you'll never forget!). Knowing how to use the equipment in your hands is almost just as important because during fast interventions it's annoying (to you more than anyone) to putz around looking for "that tube" or remembering how to hook up a pacer. Definitely know that it's impossible to know everything. Sometimes older nurses will make you feel like crap for not knowing something but don't let that get to you. You will know with time. It took me at least 7 months to become more comfortable and not worry every time I came into work. You will also get to know your peers - some are great help in bad situations and some gossip about you if you mess up or ask a "stupid" question. You will learn the good people and who not to ask questions. You don't have to "like" them, but definitely respect the 'dinosaurs' (older nurses) - they can be cocky, but are full of great tips and advice not written in any book! (but take it all with a grain of salt anyways)

    Your orientation people are wonderful resources. Sitting memorizing EKGs and defects at home isn't going to help you. Just bring the book/manuals with you and learn as you go at work while on orientation. Trust me, even the oldest people still look up stuff! It's not embarrassing, it means you know your resources and that's half the battle.

    enjoy PICU. I hope you will like it.
  5. 0
    No Advice here. Just wanted to let you know that you're not alone. I'm not exactly a new grad, I have 1yr gen peds RN under my belt and worked as a CNA of sorts in nsg school. I start PICU next month. I am sooooo excited cuz I know I want the high acuity pts, but also a little anxious/terrified if I can cut it. I'm sure we'll both be fine. And it true what blueflower77 said, even the oldest nurses look stuff up. The best nurse I know looks at least 1 thing up each night; it's probably why he's so good.

    Hopefully the jitters will dissipate, I remember having similar feelings of dread when I started in peds (although not quite as bad). We'll see how it goes. Thanks all for the study info.
  6. 0
    You guys will do great. Don't worry
  7. 0
    I was going to leave you some advise. But ECMOlogist listed everything I can think of! Good luck to you!
  8. 0
    Saving this great info for later. Thanks!


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