Published Feb 27, 2014
I will be consolidating at a peds hospital's cardiac intensive care unit. I heard the patients are high acuity and very young. While I have some pediatric experience, I have never had a cardiac patient and don't know a lot about cardiac nursing or critical care in general. I am wondering what topics I should review, or if there are any books (pocket sized even better :)) or any tips that I should keep in mind for this placement? I am hoping to secure a job there after since they do have a really good training/orientation program for new nurses. Thanks!!!
Since peds cardiac ICU pays my bills, I might be able to help. You've heard correctly that the acuity is high and the patients are generally neonates or infants. Most cardiac defects are corrected early in life; older children may need internal pacemakers, valve repairs or replacements or dilatation of vessels. Some repairs in older patients (those approaching adulthood) may need revision. But most of the patients will be little. The American Association of Critical-Care Nurses Core Curriculum for Pediatric Critical Care Nursing (2nd Edition)is a fabulous resource, as is Nursing Care of the Critically-Ill Child (3rd Edition) by Mary Fran Hazinski. Amazon has a good selection of reference books for Kindle, which could be a good alternative to a pocket manual.
Review fetal circulation. This has an impact on pretty much every cardiac patient in one way or another. For children with cyanotic defects, it's desirable to maintain their fetal circulation until they can get to the OR.
Review the anatomy of the most common defects: hypoplastic left heart, pulmonary atresia, transposition of the great arteries, tetralogy of Fallot, coarctation of the aorta, atrial septal defect, ventricular septal defect and atrioventricular septal defect. This will help you understand the underlying circulatory impairment and what might be a consideration post-operatively. Think about how mechanical ventilation (positive pressure) and oxygen therapy may affect the different defects and what might have to be adjusted for optimal treatment. Even if you don't totally get it, asking intelligent questions will make you look like a rock star!
Review the commonly-used drugs: alprostadil, nitroglycerin, epinephrine, norepinephrine, milrinone, amiodarone, nitroprusside, captopril, furosemide, ethacrynic acid, sildenafil, nitric oxide (inhaled), epoprostinol, sotalol, digoxin and carvedilol. Have a general knowledge of what they do and when they're used. Don't expect to know them inside and out though. You should also think about analgesia and sedation - they're vital to successful critical care.
I hope you enjoy your consolidation and that you get the job in the end of it all!
Hi Janfrn, thank you! you are wonderful!! What about any specific nursing skills? I figured I might keep updating this thread as I go through my consolidation. Might be useful for other students later on.
Skills... All of your patients will have a chest tube... or four. Some of them will have open sternums. All of your patients will have both arterial and central lines, and most will have intracardiac lines. You'll be giving a lot of IV meds. As a student you probably won't be giving them IV push unless your hospital includes that on the list of permitted skills. Some of your patients will be on tube feeds and some will be on TPN. They don't come back from the OR with any sort of gastric tube, so you'll be dropping a bunch of them. You may also have the opportunity to place nasojejunal tubes. They'll all come back with foley catheters, but the smaller ones (6Fr, and sometimes 8Fr) may become clogged with crystals about 12-24 hours after admission, especially if they have long bypass times. (I'll let you figure out why.) And so you'll be putting in new ones. About half of them will be on anticoagulants, most often enoxaparin or aspirin. As you're already aware, there will be LOTS of med calculations. There are lots of dressings to change. That's a pretty good list for you to think about. We'll save discussions about ECLS, ECPR and ventricular assist devices for another time.
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