Peds patients in PACU?

brownbook · Jun 6, 2015

I have never taken care of "critically" ill children in peds or in PACU. I have taken care of pediatric patients post op.

Do you an idea what kind of surgeries your hospital routinely does on children? I assume if a child is critical they would go to a PICU post op? Once you know what type of surgeries you will be dealing with, the Internet or Allnurses is a good resource for information and routine post op care.

Personally I would worry more about peds in ER...you have no idea, not much of a heads up, when a pediatric patient comes to you in the ER. In PACU you know way ahead of time about the patient. I think your ER training, colds, airway issues, is great preparation for you since airway issues are the main concern with children.

In PACU the anesthesiologist is your best friend and go to person. As a new PACU nurse (even with ER experience) ask them what to watch for.

norabow · Jun 8, 2015

Thank you, your reply gave me some info. I like the idea of asking the anesthesiologist what to look for. I will find out what surgeries we do with peds probably this week, so I can work on that. I also have a colleague who was a peds nurse and will take her out to lunch to ask her about it. Thanks again for your reply, really appreciate it!

Collor · Jun 10, 2015

Our PACU does a lot if ear tubes, hernias,circumcisions, orchipexies, kids cath lab, sedated MRI, ortho casesand Tonsillectomy /adenoids. T&A's in my experience will give you LOTS of practice in airway management. Jaw holds, pain management,etc. And just because you know what is coming through the door...doesn't mean squat. I have a kid with some tooth extractions that ended up being one of the messiest airway cases I have ever had!

Mavrick, BSN, RN · Jun 12, 2015

Broselow bag at bedside.

Collor · Jun 13, 2015

Forgot to mention we also get peds ICU cases. Mostly on evening shift.

wannabecnl · Aug 26, 2015

Take PALS, PEARS, and any other pedi courses you can, especially if you don't have a lot of pedi cases over the course of a week.

Find out what pts come to your PACU and which ones go to NICU/PICU. I've taken care of babies as young as 4 weeks; younger than that tend to go to our NICU to recover.

Also, if you're going to be on call, you need to establish where you will recover peds and find out what your backup support will be. We've started the discussion of recovering kids after hours in the PICU, and I think it's 100% necessary; I adore my ICU backup RNs for adults, but they and I would be more comfortable with peds nurses at the ready if the situation went south.

azhiker96, BSN, RN · Aug 28, 2015

Airway is critical in kids. I learned to love the sound of a crying child, that indicates a patent airway.

Watch for confusion on emergence. I've heard it called sevo psychosis. It seems to hit toddlers the worst. I've seen toddlers crying to be picked up, then hitting and kicking to be let down. They really don't know what they want because they're still confused by the anesthesia.

Distraction and popsicles are your friends. At a children's hospital, our PACU had televisions in each bay. The Disney channel or teletubbies was as good as 2mg Morphine for calming a child.

Speak to the child as much as possible and give them realistic choices. When I have a child who doesn't want a popsicle or drink I ask what they do want. Usually it is to go home. Then I tell them that once they eat half the popsicle or drink half the juice, I must let them go home. They are in charge. When they want to go home they can take a drink and I have to let them go.

Be patient. Sometimes the child wants to stay and sleep. I let the parents know when a child has met criteria for discharge. Usually, the parents will ask a few minutes later if they can go home.

Engage the parents. They know the child and can help calm the child. This is especially true with special needs kids.

Never turn your back on a sleeping child or an airway.

Have fun and find a mentor to help in your PACU.