Concepts for New Grad in the PICU to review

Pediatric Critical Care Columnist · Jun 15, 2017

Respiratory. Respiratory. Did I mention respiratory? Most kids admitted to PICU will have an airway or breathing issue, especially in the fall and winter. Review arterial and venous blood gases so you'll know what's significant and what's not.

Have an idea about vital signs norms. Realize that kids are masters at compensating, so they'll ramp up their heart rates in response to a decrease in cardiac output. Here's a little trick for knowing if a kid's BP is within desired limits: 70+(2x age in years) is the floor, 90+(2x age in years) is the ceiling. And remember that a fall in BP is always a late sign of decompensation and is a true emergency.

Brush up on your med calculations. Everything is weight-based... everything.

Those are the big things. The rest will be taught to you over time and through experience.

SandyScrubs · Jun 19, 2017

Respiratory. Respiratory. Did I mention respiratory? Most kids admitted to PICU will have an airway or breathing issue, especially in the fall and winter. Review arterial and venous blood gases so you'll know what's significant and what's not.
Have an idea about vital signs norms. Realize that kids are masters at compensating, so they'll ramp up their heart rates in response to a decrease in cardiac output. Here's a little trick for knowing if a kid's BP is within desired limits: 70+(2x age in years) is the floor, 90+(2x age in years) is the ceiling. And remember that a fall in BP is always a late sign of decompensation and is a true emergency.
Brush up on your med calculations. Everything is weight-based... everything.
Those are the big things. The rest will be taught to you over time and through experience.

Thank you for responding! I have read a lot of your responses in this forum and have always found them helpful :)

I will make sure to look over acid base and respiratory then. I've never heard of that trick for BP, but I like it!

If you don't mind me asking, how long did it take you to start feeling comfortable as a PICU nurse? Since there is such a large variety of patients I assume it will probably take a while for me to create a good foundation, and I am a little nervous about the transition.

Pediatric Critical Care Columnist · Jun 19, 2017

The learning curve is pretty steep, I'll grant you that. If the unit where you're going to work has a good orientation program and a clinical ladder in place, you should be given assignments based on your abilities and knowledge base so that you're set up to succeed. It will take you about a year to feel like you actually know what you're doing, and that's normal. Remember that you're part of a team, and that you've always got resources. I came to my position in PICU with a lengthy background in peds and peds critical care due to my son's illnesses, so I was comfortable a bit sooner. Experience is a really great teacher; as you look after more and more sick kids, you'll develop some instincts you didn't even know would be possible. Being a good listener is also an important tool. You can learn so much and incorporate things into your practice that you can't learn from a book. But having said that... There have still been days when I've gone to work and looked at my assignment thinking there has to be a mistake... I can't look after THAT patient! Even after nearly 20 years. There is such thing as being TOO comfortable, it's called complacence. Believe me, you should always feel a little shiver of fear when things don't go the way they should. When that goes away, you start to overlook things and can become a hazard. Not what you want!