CVICU to Peds CVICU...any advice?

umcRN, BSN, RN · May 15, 2013

Welcome!

As I'm sure you know, peds is going to be VASTLY different from adults. Starting with the basics - vital signs. Pediatric vitals are quite different from adults and different ages have different normals. Then you bring in the cardiac side of it and different defects have different normals, your patients normal might be an o2 sat of 73, and it's never going to get any better, in fact, depending on the defect, you might get worried if the sat is too HIGH.

Meds - back to nursing school calculations, all day, every day. A decimal point off could kill a 2kg newborn, check everything and if you're not sure double check with someone else.

Kids go downhill and they go downhill fast. They will compensate and try to fool you but when their itty bitty reserve is up, it's up and they're crashing in the blink of an eye.

You don't know what you don't know. Ask questions and lots of them. There is no stupid question when it comes to kids.

Families play a huge role in peds. No more restricted visiting hours. Parents will hover and watch every touch you make, med you give, IV poke you attempt, they will cry when their baby cries and they will lash out their frustrations at the closest person to them, which unfortunately, is usually the nurse. They will also teach you. They will tell you how their child acts when well and when sick. If a mom is concerned that her child doesn't look right, listen to her, tell the doctor mom is concerned. These parents, especially the ones who have spent months in the hospital or who have had their child at home for any amount of time, are usually right and pick up on things faster than we can. Parents need a lot of support and a lot of teaching. I love having that kind of time to be with them and comfort them during difficult times.

Peds can be sad and scary but it can also be fun! These kids rarely ever complain, the could teach that 65 year old man s/p a cabbage a lesson or two. They can be having the worst day and yet still manage to smile or laugh. With these kids anything you can do to improve their quality of life is important, especially for the older ones. We will let intubated patients be awake as long as they are comfortable and not interfering with care. I've had two year olds intubated for months who are able to sit up in bed and color, play and still get what they want out of everyone who comes by.

This job is very emotionally draining. I've had days where I've literally been helping out with my neighbor next door, doing compressions on her kid and when that kid didn't survive, having to go back to my own patient and smile, sing and dance for his enjoyment, it's emotionally exhausting at times but I wouldn't trade it for anything I don't think!

As far as other sources to take a look at, you will learn a lot during your orientation but there are a few places I like to check out when I'm trying to brush up on a defect or procedure.

http://pted.org/

http://www.heartbabyhome.com/

http://www.amazon.com/Illustrated-Field-Congenital-Disease-Repair/dp/0979625246/ref=sr_1_1?ie=UTF8&qid=1368579377&sr=8-1&keywords=field+guide+to+congenital+heart+disease+and+repair

peaches1213 · May 15, 2013

Wow! That is exactly the kind of feedback I was hoping to get here! Thank you so much for your insight. I am thrilled to get started. I know it is going to be a challenge and an immense change but hope I can rise up to this challenge. I will most definitely check out those links. Thank you, again.

meanmaryjean, DNP, RN · May 15, 2013

The other really critical thing to consider is the actual plumbing of the hearts you will be dealing with. In the adult world, I bet you've never encountered a patient with a single ventricle or transposition of the great arteries. In the PICU world, that's going to become your bread-and-butter. You will likely NEVER care for a CABG in the PICU - but you will soon come to know the hundred and one ways a baby can be born with a jacked up heart.

Oh, and then there's the absolute panic of an undiagnosed heart defect being plopped into the warmer in front of you juuust as their ductus arteriosus is closing. (And no IV access!) Mostly, we get interrupted aortic arches and coartations that way. Always fun when the outlying OB units miss that one. Because it's a two-fer, a brand-new mom AND a critically ill baby.

One thing PICU is not---- boring. It is NEVER boring!

umcRN, BSN, RN · May 16, 2013

Yes. The hearts. That's something else entirely. The best advice I can give you for that is that while you're on orientation (and after) get a picture drawn of every heart you care for, because odds are, you will rarely find two that are alike. I still print out the cath pictures of kiddos whose combination of defects I just can't put together in my head, seeing the picture and being able to trace the blood flow really helps.