New to Peds

I'll try to respond to your questions:

HEllo All,

So I am very close to getting a PRN job….the question is……what tips or social interaction differences will I need to be aware of when working with peds?

Be aware of the child's developmental level, including pts with special needs, and intellectual and physical functional levels; become familiar with those differences and make sure your assess the child's developmental level; parents and caregivers usually have that wealth of info.

I am really nervous..I love children but you can't go into the room like a cheerleader but you can't be too serious either?

Take cues from the child; sometimes having a calm, direct approach can go far in keeping a pedi pt calm when they are anxious.

Since the parents will be there…how much care do you provide? I am ready to do all the care..but it is confusing for me…?

Since I have worked in a variety of settings with kids, and you haven't listed if this is a hospital position, sometimes assisting the family to properly hold or cover IV areas properly is ll that's is needed and then they can do or assist their child with ADLs; check with your facility's policy with assisting with ADLs.

How often do you check on your patients? What do you say when you go in the room?

I would suggest that you check your facilities policy; most places have hourly rounding; where I work I usually check depending on acuity (I work in a Pedi ED); so it could be 15, 30, sometimes 60 mins; frequent assessing how the pt is performing after pain medication vs. ADL performance-ie feeding-will have a different way of follow-up; it will also depend on the pt's status and interventions-a child may need quiet, resting periods, so making sure you check on them without disrupting the atmosphere is key.

As long as you are frequently assessing pts, and making sure you are aware of their stability, vs compensating and potential to crump, and being aware of those cues, you will be fine.

Best wishes.

My advice is this: Your patient's parents know them better than anyone. If they tell you something's not right with their kiddo- something's not right and you need to pursue it.

I've never had a concerned parent steer me wrong.

Why can't catheterizations be delegated to parents? When I worked in the hospital we had a LOT of chronically cath'd kids due to myelomeningocele. Their parents ALWAYS did their cathing. They do it 6x/day at home. The only time when it raised an issue was a teenager (with myelomeningocele) who'd had some sort of bladder surgery and was on our floor because her shunt had to be externalized and we were the only floor who would take kids with EVDs. Mom was straight cathing her into the toilet so we couldn't get accurate output (which Urology didn't like) but once we told her to do it into a urinal or a hat, she obliged.

We usually didn't have parents touch IVs at all, unless it was in the process of teaching, even if they're flushing the line independently at home. I did once bring everything into the room to do a port needle change for a child whose mother was completely independent with everything (he got weekly factor transfusions at home that she did herself so always accessed him herself) and by the time I came back she'd already deaccessed and reaccessed him though.

OP, make it a habit to talk to the parents at the start of your shift. Most parents will change diapers and feed their kids, you will have a few rare ones who won't help because being in the hospital is a break for them but that has been exceedingly rare in my experience. If you need strict I&O, ask the Mom to leave the diapers for you or the aide and to write down how much the child eats.

As Pervious posters have stated, all depends on the age of the child and what area you are working in.

Toddlers I tend to walk in the room and talk with parents 1st, I usually bring bubbles or some other toy to distract and play with while the child warms up to me.

Teenagers I talk to them 1st then parents, want to let the teen have as much control as they can.

Newborns with 1st time parents there is a lot of teaching and hand holding.

The amount of care that is left to the parents...depends what unit you are in.

I have worked rehab where we are training the parents on tracks, g-tubes, and cathing and I have worked PICU where staff dose all the care. And med-surg a mix of both, but you have to ask parents comfort level.

You might have a chronic kid and the parent might need break or you might have a parent who lacks the cognitive or emotional maturity to provide care to their child (sad, but happens).

KelRN, of course kids who are being straight-cathed at home for myelomeningocele/spinal cord injury/whatever would be delegated to parents. In the same way that kids with long-term trachs have their trach care and suctioning done by mom or dad. Kids with chronic health care needs are always the exception.

Ok, I get you. Yeah, your average post-op appy who hasn't voided post-op of course you're not going to be like "hey Mom, Suzy needs to be straight cath'd, go for it."

I frequently have concerned parents be completely wrong. However, I never dismiss thier concern until I've verified that it is unwarrented. Always listen to what the parents are telling you, but don't let their opinion cloud your nursing judgement. Many parents get the medical lingo down and they sound like they know what their talking about if you don't know better. I have seen new nurses put too much reliance on what the parents are saying, instead of having confidence in their own assessment skills and nursing knowledge. Learning the art of the pediatric exam and how to work with all of the many parents is the hallmark of an excellent pediatric nurse!