firegenie

Thank you Baby RN for your reply. I boxed on and found a few answers to the questions. Q Why do we not usually measure an A I think the Paeds do the initial BPs before they arrive on our unit. We send seriously sick children to Starship in Auckland. So our main admissions are those with Respiratory tract infections etc who often are just monitored overnight and sent back to the wards. Blood pressure is not accurate in infants under 5yrs and can be painful and distressing. Taking a baseline is sufficient if necessary. Regular measurements are not required. The blood pressure is lower in babies than adults because of low peripheral resistance. Children can compensate for a 25% blood loss by increasing heart rate and peripheral vascular resistance, which maintains a normal systolic blood pressure, therefore, blood pressure is an unreliable indicator of shock. Q What differences in children make intravenous access a challenge? A * Short neck and chubby arms * Veins are easily damaged * Tiny vessels with generous fat covering Q How much blood in total, will be required for a culture, biochem, haematology and coag on a child? A I estimated 5-6 mls. I guess the blood culture popped up the amount significantly. Q A child's head is large and it's neck often unable to support it. In an unrestrained road crash how does this affect the mechanisms of injury? A * Can be propelled head first into front passenger, seat back , dashboard or ejected from vehicle. * Because the head is larger in proportion to the rest of the body children usually have head and neck trauma. Cervical injury The cranium is thinner yet more pliable but can predispose to penetrating injury. Q What cervical spine issues are significant in children trauma? A * C Spine swelling may be seen as retropharyngeal swelling * 55% of all cord injuries have neurological involvement without a fracture Q Panadol was the first treatment in a febrile child - Why has this changed? A Panadol is for pain not for temperature under 38.C. I was surprised to discover this because the flight nurse manual on our unit states that paracetamol was given for temperature control and to ease discomfit in children. (Those with normal LFT's). Q Focal seizures are more significant than generalised seizures. What are the signs of seizures in a paralysed patient? A Spiked ECG, repetitive episodes of tonic sustained eye deviation and clenched hands, hypertension, tachycardia, increased body temp and increased end tidal CO2 are from one study I perused on the net. Another source was sharp increases in HR and Blood Pressure accompanied by pupil dilation. Oh well I'm nearly finished my assignment it has taken a few weeks with all the heavy shift work and being so tired. I've only got approx 60 questions to go :)

Hi I'm currently working on a paediatric study day assignment. I haven't any experience with neonatal ICU just general ICU with occassional paed admissions which I don't usually take. Could some kind knowledgeable souls help me with a few questions. I'm sorry if they are a little basic. Here goes: Q Why do we not usually measure an A Is it because of the blood pressure is lower in babies than adults because of low peripheral resistance? Or is it more than this ? The internet is a nightmare with my slow computer. Q What differences in children make intravenous access a challenge? A Is it because of smaller peripheral veins? Chubby limbs? Do they want more of an answer than that? Or is that the wrong answer. Q How much blood in total, will be required for a culture, biochem, haematology and coag on a child? A God knows ... Ivé checked a few tubes out ... can't seem to find any unit resource on the subject. Q A child's head is large and it's neck often unable to support it. In an unrestrained road crash how does this affect the mechanisms of injury? A I'm too embarrassed to tell you what I think it might be . Actually I'm unsure what they want from this question:o Q What cervical spine issues are significant in children trauma? A Is it the same as Adult trauma issues ? Q Panadol was the first treatment in a febrile child - Why has this changed? A Has it? Is it because of masking? I mean why not after taking blood cultures? Q Focal seizures are more significant than generalised seizures. What are the signs of seizures in a paralysed patient? A Spiked ECG ? Repetitive episodes of tonic sustained eye deviation and clenched hands? Hypertension, tachycardia, increased body temp and increased end tidal CO2 ? I'm not really sure. Oh well I better box on with the other hundred questions:rolleyes: ... these ones above I've skipped so far because they are holding up the works and Ivé got a lot to do. I may post some more if I get to my wits end with any of them.:)

Thank you so much for all your replies and kind advice. So many of your replies have reflected the problems I have experienced on the ward and it was good to feel so supported by you all. I have discovered that the answer to these problems really lies with me and my reaction to being bullied at work. Unfortunately there are no other departments I can transfer within the hospital as their is only two wards managed by the same persons. I think things have improved a little as I no longer wish to dedicate my life to nursing and I have completely accepted that I'm not ever going to be treated fairly on this ward. I take comfort that one day I may be able reduce my shifts to minium hours and build my life away from nursing.

I have worked shift work for 6 years in a small rural hospital. I recently had a terrible appraisal that focused primarily on the negative me in my interpersonal professional staff relationship category. There were only a few passable mediocre one liners about my general performance. I am a nervous, sensitive, caring person and I love nursing. Most of the team are lovely people and I do enjoy working with them.Yet there is a lot of bitchiness and unprofessional behaviour on our ward. The staff have a tendency to sit around backstabbing and gossiping when we're not busy. Sometimes the air is thick with unfriendliness and some mornings staff have turned their backs and refuse to reply to a cherry good morning. I am still evolving at work from being bullied in the past by a couple of my colleagues. I get mixed messages from these people. I feel sometimes so threatened by these women. I become nervous around them. My appraisal also accuses me of isolating myself from my colleagues and that the success of my duty depended on whom I was working with, wether I was having a good day or bad day and how much I participate. Participation is an interesting word when there are only three nurses per shift and two perfer to work together thereby declining your help. So I find myself excluded and am often in the sluice room or restocking and doing compulsory equipment checks during patient care. I also volunteer for the heaviest patient load or willingly do jobs some won't touch to try to get along with my colleagues. I don't mind been busy and am not resentful doing these duties but find it makes no difference. It said I wasn’t a team player and that my nervousness has an unsettling effect on the team and affected patient care. In my defence because I regularly recieve feed back from appreciative patients, I was surprised by this comment. I am feeling mixed up and downhearted. I don't think I could change the way my boss feels about me even if I were the perfect nurse. I realise I am powerless to change the way people feel about me though I know I can change the way I feel about myself....but it's not easy. I am trying to improve by being more positive, not complain and focus more on my work than worrying what they will cook up next to railroad me out. I am not rich. Well paid jobs in rural towns are rare as hens teeth. I would like to stay and overcome these problems. Are rural hospitals toxic enviroment for some new comers to the area? Why are some nurses who care for people be so nasty to their colleagues? Why are some team members unable to help themselves to scrutinise, convey and misconstrue every word and action you say and do and run with it to the boss?. Is this just small town rural hospital phenomenon or simply just 'WELCOME TO NURSING' ? I would appreciate any tips or advice from anyone who has worked in a small town hospital and have overcome similar problems.

I have been doing 12 hour night/day shifts for 5 years now. Best food to keep me awake and ticking along: Apples Yoghurt nut bar Soup Dates Fruit and nut mix Coffee (I know... not so good but I love a cuppa coffee) I find bread/toast or heavy meals the worst.