New to pediatrics

Specialties Pediatric

Published

I have been working in long term care for three years and have now taken a job in home health care for children. I have to admit that although I am excited to try something new, I am terrified at the same time. As part of my orientation packet there is a test and I am amazed at how much I have forgotten in school. I have been on the internet now for the last two hours and can't find the answers to some of the questions that I should probably know anyway. I guess what concerns me the most is that maybe if I don't know some of this, I probably should just stay in the field that I am comfortable with. Does anyone know of any sites that give direct answers to questions dealing with peds?

Up Vote Up Vote ×
Specializes in NICU, PICU, PCVICU and peds oncology.

This one.

What kinds of questions are hanging you up?

Up Vote Up Vote ×

Ok for one, which way does the ear canal of a child slant or is it horizontal? And here's another: Careful regulation of an IV infusion on a six month old protects her from___? I think it is Alkalosis but I'm not sure. Choices are local skin infection, heart failure, abdominal distention, and Alkalosis. I am so accustomed to dealing with geriatric patients and in the LTC facility I have worked at for three years we dont do IVs or even blood draws. We have a lab come in to do them and if they need an IV, they go to the hospital. I have only had one PEG tube since I've been there. Now in this job they are talking about mickey buttons, trachs, and all kinds of things that I really dont remember anything about. Oh and then there are pediatric dosage calculations, oh my goodness. I did find some things that helped jog my memory about the calculations but I am beginning to feel incompetent and I haven't even started yet.

Up Vote Up Vote ×
Specializes in Pediatrics, ER.

Do you have any trach experience? I just wanted to warn you to be very careful with home health companies that deal with pediatrics. There are very very few reputable ones. I was offered two positions, one as a new grad, and one very recently...one was VNA visits, and one was to sit with the pt as a private duty nurse for 8-12 hour shifts. I was so excited, I couldnt wait. Come to find out there is minimal training involved, they expect you to be ready in about a week. You need to be able to handle vents on your own, change the batteries, know how to troubleshoot the vent, know what to do if a patient decannulates themself, pulls their g-tube out, know how to handle a seizure on your own at home, suction, use a home neb system, manage PICC lines. Kids who need home care are generally very complex kids with multiple congenital anomalies requiring 24 hour care. You are the only one in the home, their only resource so you have to be able to pull out every stop. The nurse manager I recently interviewed with for home health told me most pedi home health RNs come from pediatric ICUs or post ICU rehab hospitals, and that she strongly encourages acute care experience first because of the acuity of the kids. I dont mean to discourage you, I just wanted to let you know the truth about most home health places. For all I know youll be getting a very thorough orientation. I just know I was very disappointed when I went for my first day all ready to go, paperwork in hand, and then found out what they expected of me knowing I had limited pediatric experience.

Up Vote Up Vote ×
Specializes in NICU, PICU, PCVICU and peds oncology.

I agree with SarahBeth that you might find yourself in over your head. Her assessment of pediatric home care is bang on. After 15 years in PICU I could certainly do it but I don't want to!

But in the interest of staying on topic, a child's ear canal (external auditory meatus) slants down and toward the the mandible. In order to visualize the tympanic membrane you have to retract the pinna upward and and back. Their Eustachian tube on the other hand is very short and straight. This is why infants and small children are so prone to otitis. They lay on their backs, suck on a bottle and the fluid flows almost directly into the middle ear where it sits and grows stuff. As for the IV fluid question, in my mind there are two possible choices, alkalosis if the volume is inadequate (but not typically related to inadequate IV fluid administration, see: http://www.merck.com/mmpe/sec12/ch157/ch157d.html) and heart failure if the volume is overly generous. The population I work with, infants and children with cardiac defects, are always fluid restricted to about 50% of maintenance to reduce the risk of overwork on the heart. See: http://books.google.ca/books?id=rwc8wOrMj_gC&pg=PT90&lpg=PT90&dq=hypervolemia+in+infants&source=bl&ots=9XPPTZKN_6&sig=j1niagOf0XijVYgP534cIWxzN8Q&hl=en&ei=HCZES7GZB4HaNpfUjfwI&sa=X&oi=book_result&ct=result&resnum=4&ved=0CBsQ6AEwAzgK#v=onepage&q=hypervolemia%20in%20infants&f=false

Up Vote Up Vote ×
+ Add a Comment