Advice & Tips for working with pediatric er patients

Esme12, ASN, BSN, RN · Jan 12, 2013

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

[TABLE=class: cms_table]

[TR]

[TD=align: left]age group[/TD]

[TD=align: left]respirations[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]heart rate[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]systolic blood pressure[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]newborn[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]30-50[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]120-160[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]50-70[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]infant (1-12 mo)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]80-140[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]70-100[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]toddler (1-3 y)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]80-130[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]preschooler (3-5 y)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]80-120[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]school age (6-12y)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]18-25[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]70-110[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]85-120[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]adolescent (13y +)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]12-20[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]55-110[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]100-120[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]adult[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]16-20[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left] 70-100[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]

[/TR]

[/TABLE]

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. :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:

https://allnurses.com/emergency-nursing/adult-er-nurse-742288.html

lvnlrn · Jan 17, 2013

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!!

hiddencatRN, BSN, RN · Jan 17, 2013

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!

XmasShopperRN, ASN, RN · Jan 18, 2013

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.

JDougRN, BSN, RN · Jan 21, 2013

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!

hiddencatRN, BSN, RN · Jan 21, 2013

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.

JDougRN, BSN, RN · Jan 21, 2013

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-

hiddencatRN, BSN, RN · Jan 21, 2013

Please don't call me a **** simply because I disagree with you. Aside from being rude, it's a violation of TOS.

JDougRN, BSN, RN · Jan 21, 2013

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.

hiddencatRN, BSN, RN · Jan 21, 2013

I used to tell me patients it wouldn't hurt until I tried it out myself. Most of my coworkers have never had a flu or RSV swab, so it wouldn't be unreasonable to think you had no experience with it either. I found it painful...and have had plenty of patients who agree with me, so I no longer make that promise.

JDougRN, BSN, RN · Jan 21, 2013

I used to tell me patients it wouldn't hurt until I tried it out myself. Most of my coworkers have never had a flu or RSV swab, so it wouldn't be unreasonable to think you had no experience with it either. I found it painful...and have had plenty of patients who agree with me, so I no longer make that promise.

Well, that's your perogative. I've had flu swabs, as well as done numerous, and I've never had anybody complain. Perhaps the person who did yours was a bit rough, but that doesn't need to be the case. As I said earlier, I don't ever lie to my patients about the "Boo-boo" potential.