Advice on working with CP patient

[thelittlenurs]

I am new to private duty nursing, I have not been assigned my first case yet but I had a visit with the parent and patient. The pt is a 12 yr old with cerebral palsy, wheelchair bound, G-Tube fed , pretty much total care. I have no experience working with medically fragile pedi patients, but I think will be able to manage. What kind of advice do you guys have about working with a similar patient? Also I am small and need assistance with getting her to the bed for diaper changes. The parent has a lift assistive device that she will show me how to use (if they decide for me to be the PDN). I would only be working with this patient once a week. The parent mentioned she felt other nurses wouldn't interact with her as much.

[SDALPN]

If you are a new nurse, PDN isn't for new nurses. You will be putting your license at risk. Some states require a minimum of a year of nursing experience. Agencies will overlook it, but if you get caught you could be charged with fraud.

Sounds like a picky parent who only scratched the surface with complaints. If they talk bad about the current nurses, what do you think the parents will say about you? The parents who complain about interaction usually micromanage and insist on constant interaction.

As far as the nursing side of things, you should be discussing your lack of skills with your supervisor. Your supervisor should be aware.

[RNtoACGNP]

If you are starting PDN I would definitely choose patients with conditions in which you are familiar with.

[thelittlenurs]

I am not a new nurse, sorry forgot to mention that , I graduated in 2008, have done telemetry,postpartum, and school nurse. I am working PDN PRN and during my breaks.

[DFLPN]

I would find out as much about the pt (personality, likes/dislikes, baseline, medical background) from the parents if you can. My experience is that they appreciate this. I didn't read that the mom was insulting other nurses-perhaps she was letting you know what she expects which is a lot of interaction as opposed to doing ADL's, tx and med's and then leaving pt. alone.

What type of lifting device does the patient have?

PDN absolutely can be for new nurses or those not experienced with medically fragile kiddos-it all depends on the agency, training and support.

[SDALPN]

It sounds like you have experience to handle the case. Sounds like the pt will be fairly easy. But sounds like there is a reason the case is wide open. Typically agencies put new hires on the worst cases because that is all that is available. Nobody wants to work those cases so they get the new hires to do so before they find out.

I would suggest floating to easier cases and work your way up to more complex. Floating will keep your skills up and you will experience the different dynamics of every case which will help you gain experience in PDN.

[thelittlenurs]

I hope not, I am available mostly on weekends and this is a Saturdays-only case. The manager mentioned they don't have many nurses available for weekends.

[SDALPN]

Weekends are typically hard to staff. Especially weekend nights. Being that we tell them when we work, most nurses don't want to work those shifts.

[Kitiger, RN]

Is the patient alert and able to talk? Is she developmentally delayed? If so, at what level does she function? What type of interaction does she need?

If she is wheelchair bound due to the cerebral palsy, she is sure to need a lot of PROM (passive range of motion). At least once in a shift, all joints should be put through their paces. It doesn't have to be all done at the same time. PROM/hips and legs in bed, before getting up. Arms/shoulders are usually easier to do while in the wheelchair, etc. She will benefit from frequent position changes: wheelchair, bed, couch? recliner? By "lift assistive device", I assume you mean a type of Hoyer Lift. Do use it, and use it every time. Protect your back. And use good body mechanics when doing PROM.

When transferring, watch out for that G-tube. Even a Mickey button can get caught. Do you know how to replace the button? It's easy to do, very similar to a foley cath. Know whether KY jelly is used, or saline. Know how much water should be in the balloon. A Mickey button that comes out can be cleaned, the balloon deflated, and reinserted. Some families use tap water for the balloon, some use distilled. There's more than one right way to do things, so try to always do it the way that they are used to doing it. Do know where the spare GT is, in case the balloon breaks and the button falls out? You do not want to leave one out too long, as the stoma will shrink over time.

I make it a practice to check the Go Bag shortly after I arrive. It should have everything you might need for an emergency. I can give you a sample list, if you want. Also, be sure machines are plugged in. I'm thinking Hoyer lift spare battery, portable suction machine, oximeter, feeding pump, vent, and spare vent batteries. If she has a power wheelchair, that should be plugged in at least at night. (Since you mention interacting with her, I assume you're talking about a day shift.)

I hope this helps.

[Andy1rn]

The previous posters have given good advice (especially Kitiger). My limited experience with CP did cause me to sign in to write this: Never forget there is a 12 year old in there! Explain what you are about to do so she knows. The body's condition may be completely different from the brain's. One of the smartest kids I've ever met had cerebral palsy. Make eye contact. Treat her as a person, not a sickly child or (worse) an object to be dealt with. Include her in conversations, even if only non-verbally. It won't hurt and it may be as important as the physical nursing you'll be doing.