Pediatric vs. Adult OR?

canesdukegirl, BSN, RN · Mar 26, 2011

I work in both. Adults are typically easier, but it is MUCH more fun to take care of the kids. You get to act all goofy to try to make them laugh (do this with an adult and they will ask you if you dipped into their Versed), and then you get to use your sing song voice when they wake up. OK, so my sing song voice sounds like gulls screeching overhead, but you get the point. Kids can crash faster than adults, and you have to really be on point in order to detect the first signs of southerly motion. The instrumentation that we use for peds is small (very cute, if you can imagine instrumentation being cute) and so the cases tend to be easier to prepare. For example, if you are setting up for a big lumbar decompression, fusion and instrumentation for an adult, you need a double decker table to hold all of the instruments and the trials. With peds, you just need one table.

I have found that when I float to peds, I am such a good mood at the end of the day. These kids have some very sad stories, but the fact that you are involved with their care to hopefully improve their lives makes it worthwhile.

Kids emerge from anesthesia differently than adults. They emerge in stages, so it can take a long time for them to finally wake up fully. They are sedated from narcs, of course, but I am always a bit nervous during emergence because kids are more apt to have laryngospasms.

Adults emerge in unpredictable ways. If they are heavy drinkers, they wake up swinging. Some wake up just fine, and some wake up and ask you if you have set the table with Mom's holiday table cloth. Just the other day, I had an adult murmur something like, "can't breathe". I was instantly concerned, but it turns out that she was saying, "green beans". Apparently, green beans are one of her favorite veggies....and she wanted to share that with the surgical team.

Both are great specialties. It depends on what you like and what you want to do. Some nurses outright refuse to work with peds because it scares them. Some peds nurses don't want to work with adults because they can be unpleasant.

brownbook · Apr 7, 2011

I work pre and post-op, not in the OR. Peds are usually scared in pre-op. We try not to force anything if they are really scared. They don't have to wear their patient ID bracelet, they don't have to change into a gown, we go real slow, work with the parents, when taking temperatures, O2 sats, usually don't bother with BP's. If they are really scared the anesthesiologists orders versed PO pre-op.

Often in post-op they are crying. Not from pain, usually it is not too hard to assess painful crying from I'm scared and hate it here crying. They wake up feeling drunk, disoriented, irritable, hate the feeling and don't understand why they feel that way.

We keep Popsicle's handy, have parents back to post-op ASAP, have the parents lie in the bed or sit in padded lounge chairs and hold the child. Get them out the door ASAP because they hate it, hate Dr's, nurses, IV's, etc. not because we don't want to be bothered with them.

MsLeylaBar · Apr 8, 2011

"They don't have to wear their patient ID bracelet"

:confused: Wow, really? That's a safety issue. They are really allowed to get into the OR without it?

I used to work in an adult OR but have been doing Peds for about 6 years now. I understand that there are children really fuzzy and doesn't want anything to do with their ID bracelet, but our preop nurses must be very persuasive because not having a patient ID bracelet is a total No-No in our facility. We make it sound fun too. A lot of kids bring their favorite stuffed animal with them to the OR, and on we make sure to have the patient ID bracelet on the stuffed toy and that usually persuades a fuzzy kid to have it on them too, because "Snuggles" didn't mind having it on. It's funny sometimes on kids that are frequent flyers, when it is time to check their bracelet, we usually say it loud, full name, date of birth and medical record number, we find out these kids have even memorized their own medical record numbers. Kind of tragic.

Back to the topic, I must admit I miss doing some adult cases like total knees and hips but I don't miss doing any of those gynecologic and prostate procedures. I love peds. Yes, we do get silly at times to help them get to sleep, we sing lullabies, we tell silly jokes, we hold their little hands. I have taken care of a one day old premature baby the size of my palm, as well as the 21 year old who has been coming in to our peds hospital since they have been babies, undergoing numerous procedures.

I also find that a lot of pediatric surgeons are just awesome, and I also work a lot with the neurosurgeons who I think are the best. Some new staff who have worked at other hospitals cannot believe they are neurosurgeons, because they are so nice. Haha.