Precepting in pediatrics

pedi_nurse · Dec 13, 2018

I'd recommend reviewing your developmental stages. It helps to know the best way to talk to kids. Learn/review vitals for ages groups as these are very different in kids. Review respiratory distress in children. Respiratory is one of the biggest issues in peds. 80% of cardiac arrests in peds is because of respiratory issues, not cardiac. Get familiar with signs of upper vs lower obstruction. Learn about how to move peds patients (for example, you don't pick up a cardi baby with your hands around the chest - its a good policy to just always pick up infants using a "scooping" technique with a hand under the bottom and the other hand under the shoulders/head.)

Also, always remember to view the parent as a vital member of the care team. They know their kid best. Ask them the best way to do a procedure with their child or how they would like to do a bath/change sheets for the day, especially with the parents who have chronic/complex care kids. Nothing is ruder than to have a nursing student/nurse try to tell them how something is done. And remember to be cheerful and calm. Kids pick up on that stuff so well and they really live in the moment. And that's the beauty of working in peds - you can help their day be a little bit brighter even if they feel awful.

Source: Certified Pediatric Nurse, former acute care Pediatric Pulmonology.

pedi_nurse · Dec 13, 2018

Oh! And it's SUPER important to remember that kids compensate for a LONG time before their vitals start reflecting a problem. Look at the patient, not just the vitals. And if a kid seems to be "working" a little bit but for an extended period of time (couple hours or so, but it depends on the patient), tell someone.

Also, again, listen to the parent. If they say, "my kid never desats with asthma attacks until it's bad" then pay attention. I once had a 12yo kid outpatient who was like this. He would sat 98% and no wheezing, some air movement, intermittent cough, reported chest tightness. Easy to mistake as "adequate" aeration and a mild asthma flare, but NOPE. Without proper, attentive treatment, kid would close up out of nowhere and would suddenly have sats in the low 70s and nearly require intubation. Because I listened to mom and kid, he got 3 back to back treatments of albuterol (20 min apart) and only then did I start to hear wheezing (as the airways began to open some). He was that clamped down already with perfect sats, talking and walking.

OldDude · Dec 13, 2018

As I entered my last semester of nursing school, I realized I had made a mistake and nursing wasn't for me. I was determined to finish, get the paper, and move on to something else. My last semester was our pediatric rotation and that changed everything. Everything came together and I haven't left kidlet nursing since.

You don't have to know much as a nursing student so don't worry about that because you'll pick it up fast. My advice is to do every cardio/respiratory assessment you can possibly squeeze into your clinical time. In peds, you have to know what normal is, as it relates to age, or you can't identify what abnormal is; only a zillion assessments will get you there.

Best of luck to you!!