Best PICU reference/patho book

There are several excellent text books on pediatric critical care out there. AACN's Core Curriculum for Pediatric Critical Care Nursing is one, Curley's Critical Care of Infants and Children 2e is another and Hazinski's Nursing Care of the Critically Ill Child 3e is a third. They're all available through Amazon.

I work both pediatric cardiac ICU and PICU. Our unit admits about 1200 children a year. For new PICU nurses, the day starts with getting your assignment (1 or 2 patients, depending on acuity) and getting report from the nurse going off. My primary survey (visual and auditory assessment from a distance) is happening while I'm listening to report. I usually do my safety checks (allergies, emergency drug sheets, ID band, some form of bagging device, oral airways, suction, oxygen, pump settings and drug concentrations and any other safety-related item specific to the patient) and a quick look at the care plan to see if I have any tasks (blood gases, meds, treatments) due in the first hour of the shift. While I'm doing my safety checks I usually also level and calibrate my pressure lines. Then I'll do my secondary survey, a head-to-toe, comprehensive assessment of the patient. This type of assessment is done every 4 hours and documented, plus focused assessments may be carried out more frequently (neurovitals in the trauma patient, respiratory assessment in the asthmatic etc). Once I've completed my assessment and documented it plus the hourly vital signs and fluid data, and carried out any tasks that may be required in the first hour, I might then read the progress notes or operative reports for a more complete picture of the patient. Many kids in the ICU will require frequent observations and interventions, such as titrating infusions to meet vital signs parameters, checking blood gases or blood sugars and adjusting therapies accordingly, monitoring urine output, bleeding and level of consciousness, administering meds and blood products. Your shift will be partly routine, partly observation, partly planning for the unexpected and occasionally partly pure terror... Most days are reasonably predictable, but not all of them. You may start out with two very stable kiddos, transfer them both to the ward and then admit a kid in septic shock who requires your every resource. Just remember that you're part of a team and you're never going to be totally alone with a very unstable patient. Experience is the best teacher so don't expect to know everything about everything or that you'll function at the same level as more experienced nurses around you do. Ask lots of questions, ask for help when you need it, offer help when you're able and you'll be fine.

I'm happy to help. This forum can be a great resource for you, so make sure you come back from time to time!

Psychosocial care is nearly as important as physical care is for families with a child in PICU. If you review growth and development it'll be a big help. It's also good to have a reasonable understanding of coping mechanisms, both healthy and unhealthy, so you'll be able to respond accordingly when you see them. There's a lot you can do to alleviate fear and anxiety simply by active listening and reflecting when parents voice concerns. One thing to always remember is that those parents know their child much better than you ever will, and they're your best resource when it comes to understanding behaviour and their past history. Including them wherever possible into your care of their child is a hugely appreciated gesture.

Neuromuscular blockers should be covered as part of your orientation education. If you skim the entry in Hazinski and know which safety measures are necessary, have an idea of the difference between depolarizing and non-depolarizing NMBs and when it's appropriate to use which, that's a good start. Never give a NMB to a child who isn't adequately sedated... they'll be terrified when they're unable to breathe or move. A good rule is always give a sedation bolus before a NMB unless the interval has been too short for the last dose of sedation to have worn off.

Keep in mind that children are typically in respiratory failure before they arrest. Know that hypotension is a VERY late and ominous sign of impending arrest. Tachycardia is a sign that something's wrong, as is tachypnea. Temperature may be high OR low in small children with sepsis. The only intervention that will absolutely save the life of someone with sepsis is prompt administration of broad-spectrum antibiotics. ALWAYS check a blood glucose when your patient starts looking off... hypoglycemia can kill. Never, ever be reluctant to say you don't know the answer to any question, as long as you also remember to say that you'll find it and then follow through. It's a thousand times better to admit you don't know something than it is to guess and be wrong. After you've been on the unit for a few days, you'll be able to pick out the people who will support you to learn and grow... and which ones you only smile and nod at. And last but not least, AN is always going to be there for you. Best wishes!!