Important things to review

systoly · Nov 27, 2011

There are several online forums for parents of kidz with Mickeys and trachs (sry I don't have the www off hand). I always found the info much more educational than what I got from most text books. One of the important things is to be prepared to replace a Mickey should it come out or to replace a trach in case of decannulation. Understand the A&P of trachs, especially cuffed trachs. Chances are you'll encounter Bivonas (no inner cannula) or Shileys so it's not too overwhelming.

wecan11 · Nov 27, 2011

There are several online forums for parents of kidz with Mickeys and trachs (sry I don't have the www off hand). I always found the info much more educational than what I got from most text books. One of the important things is to be prepared to replace a Mickey should it come out or to replace a trach in case of decannulation. Understand the A&P of trachs, especially cuffed trachs. Chances are you'll encounter Bivonas (no inner cannula) or Shileys so it's not too overwhelming.

Thank you for the good advice!

:up: :up:

dirtyhippiegirl, BSN, RN · Nov 27, 2011

There are several good youtube videos of people replacing both gtubes and trachs, so please don't underestimate youtube!

The cough assist machine was something that I'd never even heard of until I started doing ppd. You'll probably run into a few kids (esp. trach kids) who use one.

Troubleshooting feeding pump errors is probably one of the most aggravating things that I've personally experienced. (Next to troubleshooting vents, of course.) I regularly use both Infinity and Kangaroo pumps. Like systoly mentioned, reading up on forums meant for parents is a great way to learn little tricks.

Generally a good idea to review pediatric CPR procedures and maybe print out a copy of the current guidelines to carry around with you.

I carry around a pocket size medication reference book -- you can also get digital copies for your smart phone.

For my regular clients, I usually put together a sheet with important phone numbers. Parents cell/work. Home number. Number(s) of the equipment provider(s) - usually includes who to call to order supplies, who to call if something is broken, etc. Kiddo's primary care doc during hours and after hours. Any sort of PT/OT/Speech therapy numbers that might be relevant. This info is usually THERE, somewhere, but often gets lost when you actually need it.

The parents of the kiddo are almost always your best resource. They usually know what's normal and what isn't. I remember the first time I had a trach'd baby who had the hiccups. I was like OMG SHE CAN'T BREATH!111eleventy epic level of freaking out. Dad walks into the room and is like "Isn't that cute? She has the hiccups!"

caliotter3 · Nov 28, 2011

You should have been provided a copy of the 485, Plan of Care, for your patient. It lists the meds and all orders for treatment, care, ADLs, etc. that are required during your shift. Sometimes there will be a new procedure that you can look up, or a med that you are not familiar with. Anything that you have questions about can be clarified by asking the nursing supervisor, the primary nurse who is orienting you, or the family members, before or after you have done your own research. You can get a 'feel' for the case by reading the POC. I once read one and immediately turned down the case. I was able to explain my reasoning to the staffing personnel and we didn't even bother sending me to the home for a wasted orientation visit. You should be given a copy of the 485 before you start each new case. It is your starting point.

systoly · Nov 28, 2011

You should have been provided a copy of the 485, Plan of Care, for your patient. It lists the meds and all orders for treatment, care, ADLs, etc. that are required during your shift. Sometimes there will be a new procedure that you can look up, or a med that you are not familiar with. Anything that you have questions about can be clarified by asking the nursing supervisor, the primary nurse who is orienting you, or the family members, before or after you have done your own research. You can get a 'feel' for the case by reading the POC. I once read one and immediately turned down the case. I was able to explain my reasoning to the staffing personnel and we didn't even bother sending me to the home for a wasted orientation visit. You should be given a copy of the 485 before you start each new case. It is your starting point.

That is good advice in theory, but oh my gosh Caliotter, that sounds like something an instructor at school would have said.

caliotter3 · Nov 28, 2011

Heavens, nobody has ever accused me of sounding like an instructor. Don't know if it is a compliment or not! I always get a copy of the 485. Of course it might mean I have to go to the office to get it before I go to the case, but I don't start a case without this info. I used to work for one agency that gave me a separate copy of the MAR, but I found that to be unnecessary, as I need to get the actual times when I am at the home. Since the nurse is required to follow the Plan of Care, it only makes sense to read it when starting the case.

systoly · Nov 28, 2011

I'm just teasing you. It's the smart thing to do (looking at the 485). Unfortunately the 485 has been terribly out of date on some of my cases and it would take 2 months to get it fixed. BTW, I had excellent instructors when I went to school.

caliotter3 · Nov 28, 2011

Even an out of date 485 is good to start with, since you are supposed to be following it. One of our nurses admitted to the client's mom that she didn't bother looking at it, so that is why she is charting med errors every time she works. This is done in spite of the changes on the MAR. I guess some nurses don't have to read the 485 any more than they need to sign the MAR. Don't know how they get away with it. I constantly spend time trying to get the 485 updated. Depends on whoever is working with the paperwork in the office. As long as I have copies of the supporting documentation, I am satisfied.

dirtyhippiegirl, BSN, RN · Nov 28, 2011

Even an out of date 485 is good to start with, since you are supposed to be following it. One of our nurses admitted to the client's mom that she didn't bother looking at it, so that is why she is charting med errors every time she works. This is done in spite of the changes on the MAR. I guess some nurses don't have to read the 485 any more than they need to sign the MAR. Don't know how they get away with it. I constantly spend time trying to get the 485 updated. Depends on whoever is working with the paperwork in the office. As long as I have copies of the supporting documentation, I am satisfied.

Now I feel bad because I've run into a lot of out-of-date 485s but spent the time complaining instead of trying to fix it.

I have, however, run into MARs (and our agency combines medications and treatments into one record) that were sometimes 5-6 months out of date. Nurses were signing but not updating and the 485 was hopelessly out of date. I'd usually figure it out after reading the various orders and talking to the parents but I had one situation in particular where I didn't realize something was wrong until I went to a doctor's appointment with mom and kiddo. The vent settings in the MAR were wrong and they'd never been written down in the orders. :eek:

systoly · Nov 28, 2011

Don't feel bad. Even if you fixed the current one, it doesn't do any good if it's not fixed at the source.

systoly · Nov 28, 2011

Don't feel bad. Even if you fixed the home copy, it still needs to be fixed at the source or you'll be back to square one a couple of months down the road.