kidznurse

I use skin prep with duoderm or allevyn adhesive on children's wounds particularly incised and drained abscesses I use hypafix or flexigrid in strips around the edges to reinforce and find that dressings stay on for 3-5 days.

A resp rate of 70 Hr r 180 and nasal flare may indicate an acute resp illness. Bear in mind Despite a reasonable sao2 the child may still have a respiratory illness brewing. Check temp an overheated baby can breathe fast and have elevated HR. Other reasons for elevated HR, RR, and slight nasal flare are: baby has just been fed, or has been crying, or has an underlying cardiac condition eg post ductal lesion once duct closes 3-6 days becomes apparent , therefore needs a 4 limb BP and Sao2, or maybe has thyroid condition check Guthrie done , or an obstructed airway eg mild choanal atresia broncho or trachomalacia , or just mild mucous plugging of nares- try clearing nostrils. ask mum what she thinks may be a family or infant Hx you aren't aware of . There is insufficient info in the question to make a sound clinical decision so in the real world you keep options open and keep mum informed . There is no indication that a 6 day old neonate would have a tracheostomy . There is no suggestion that there are any indications for suctioning the trachea remember that there are both oral and naso tracheal suction techniques (trachea is not the same as tracheostomy). Checking the Pao2 would give additional clinical information and wouldn't harm the child. Why a 6 day old infant is on oral meds is important and relevant to the clinical decisions (eg if on hypothyroid or cardiac meds would reflect in vital signs). Giving H2o is of limited clinical signifiance since if the child is aspirating -a swallow study needs to be done. Only useful clinical indication is that H2o is less irritating to lungs if an aspiration and Sao2 can be monitored during admin. If the child is breast fed though may have difficulty drinking H2o Doing a saturation is the best course of action given in the questions, but in real home care, answers aren't multi choice ...keep an open mind. Good luck

I managed to study, (post grad) and work3x 8 hr shift work in NICU, and breast feed . It is possible but only if that's what you want to do. I expressed ( pumped) one breast first feed in the morning, at the same time as feeding the other side to my babies. I gave the EBM feed in a bottle to the day care facility on day shifts (or varsity day care on study days), or my husband on nights shifts . I'd express (pump) mid shift when at work. If necessary- only happened twice - husband would bring baby to me at the hospital in the middle of the night (or evening if afternoon shift) if he couldn't settle him- for a 15min feed. Both babies breast fed til 18months. Once solids started at 6months less of a problem to have to express exclusively. Was a commitment on my part and its not for everyone, the bottom line is healthy baby/ healthy mum, so go with what you can manage and how ever you get there it's all good . Parenting is not a competition. I guess if I hadn't had a hang up about being a working and studying mother, I wouldn't have had to "prove" I could also be a breastfeeding mum . Go well

I have looked after 3 kids with this rare metabolic disorder , but then again have also worked in paeds around the world for nearly 30 years, so understandable. Rare metabolic disorders like MSUD and others I have nursed (eg orotic aciduria /glycogen storage disease etc) harder to identify because -as they say in medicine, need to look for horses( common) before the zebras (uncommon). Very difficult for parents with kids with rare metabolic disorders to stick with restrictive diets and frequent hospitalisations . Most difficult thing with hospital is ignorance of staff who are used to horses but ignorant about zebras, and therefore untrustworthy and likely to be blase or arrogant about a rare disorder. My best advice to all paed nurses in hospital or community ask the parents for the specific info on their child, and get as much internet info as possible on a rare disorder. It might only occur to 1 per 100,000 children but it occurs 100% to the children that cop the unlucky odds. Good luck

I did an assessment for a medical research project on a 4year old. She had severe dental caries, and was well overweight for age- 30kg plus. Had been hospitalised in 1st 4 years x 5 , for mostly acute respiratory illness. Her diet consisted of- no veges, no fruit, all high fat processed foods like McDonalds, hash bowns and fish fingers, no milk, no water, only juice and soda to drink. Loads of sugar in daily amounts of candy... Because that's what she as a 4 year old wanted . Her 19 year old mother was happy as long as the child was happy ... that the child was systematically being poisoned and would be at least seriously ill if not dead with diabetes/ heart disease/ or chronic lung disease by the age of 30 was immaterial as the mother wasonly concerned with what the child wanted today. Sometime it '"takes a village to raise a child" and nurses are ther representative of the village- we need to advocate for children.

I feel this site is too North American. I live in a country that has a stong commitment to social medicine, and so much of this site relates to a USA/ private health care/ consumerist stance. I also find that there is a much stronger right wing ethnocentric and conservative ideology on a USA site than sits comfortably with the more pluralist ideology that I am familiar with.

Basic nursing fact: "if you don't eat you don't s--- you don't s--- you die !" I've been nursing nearly 30 years and the basic a & p doesn't change! Regardless of the the latest theory or politics - Nursing is about the basics, stick to that and the patients will thank you. Anything else is ego candy.

Saw one very recently here in NZ. Parents anti immunisation so non immunised child. The tetany is horrendous and virtually unmanageable . Ventilated heavily sedated child . Last time i saw tetorifice was 20years ago older woman that had been gardening and scratched self on rose bush , saw her in ED before admission to ICU

Hi there, Not sure about some of the US collquialisms used on this website for example I had no idea what LOL meant and had to ask. Likewise I don't know how to read this reply is it scathing or in agreement?? Bit difficult to debate when you are from another culture sorry. We have at present the 5th lowest unemployment in NZ (3.8% at present ) and yet we are about 28th in the OECD for child health standards. High child abuse and Non accidental injury rates, preventable diseases like meningoccocal, Rheumatic fever, pneumonia skin infections. etc. Exceptionally disproportionate numbers of indigenous Maori and Pacific Island children in the mortalitity an morbidity stats( Samoa/ Tonga/ Cook Is etc immigrant groups)related to both socio economic disparity and cultural expectations and norms. It is a highly relevant topic to debate and seek resolve because it represents our future. Obesity is an issue amongst these groups with soaring diabetes and heart disease and early death. Fast foods are often attractive to such communities.

Thanks for that Steph I have read some of the universal health care threads but can't relate to them . I live in NZ. Health insurance is optional and generally only taken up by the wealthy and those aiming to have access to elective procedures, or on tap medicine. Just as the state schools are fine by most of us, ordinary NZers tend to use the tax funded Public health system and find the state hospitals adequate. We have feee childhood immunisation , state funded dental care until 18, state funded antenatal care, well child checks etc , . Unlike the british system we do pay privately for r adult dental and family medicine ( GP's) but there are subsidies for those with low income. We also have no fault accident compensation so we don't do medical litigation. Its a different world .I can't compehend your system just as you can't comprehend ours. Like another language not better just different. We are trying to come into line with the Tenets of the UNCROC not because we whole heartedly embrace the UN but because we are trying to create a moral and philosophical framework that is congruent with the rest of the developed world. We need to steer the path of a relatively newly colonised country. The tenets of UNCROC are that children have rights as individuals and as members of society. To this end NZ has recently repealed a law and outlawed children being physically disciplined. The law was changed about 20years ago to ban corporal punishment in schools and now extends throughout society. This brings children the same rights as dogs , women, and other adults who have already had legal protection from being physically struck. There are those who vehemently object to children having the same rights as dogs and women and have protested the repeal of the law . These people think that children are the property of parents. There was a similar outcry when NZ was the first in the world to grant votes to women since women were considered the property of men. I think it is time for children's rights to be up held. It seems strange to those of us observing the US through your prolific media output portraying the tanned toned and trim ideal, that you have skyrocketing obesity. Then again NZ doesn't "really" have Hobbits roaming around. Do the public health departments focus on childrens health mirror a general trend toward childrens rights in the US? I don't think I am alone in perceiving the US to have a history of Human rights movements or has the Bob Dylan song type of activism died in the US? Is everyone more engaged in consumerism and identifying children as a commodity and designer accessory for rock stars?

I'm interested in how children's rights to health are viewed in USA. Are the tenets of the U N convention on the rights of the child openly discussed by nurses there? What are general societal/ media views on protecting children from corporal punishment? Free health care for children? Reducing the preventable disease morbidity and mortality? Who comes first adults or children ?

i think this definition of whether your labour entails being a practice profession or work is class based. ie a professional is white collar and a worker blue collar. i think it behooves nursing to rise above such class consciousness. illness does not a respectof class. we all get sick and die sometime. nurses deal with the management and adaptation to disease. lets not pull rank and lets not waste valuable nursing education time arguing about what class of people we are. we are classless just as disease is a great leveller. let our humanity speak for itself. someone in this dicussion thread thinks it a crime that some plumbers be paid more than nurses . are plumbers less important than nurses ? where would we be without modern sanitation. every job should be valued as an integral and essential part of the social fabric including nurses. if there was less class consciousness less people would feel it more desirable to be a lawyer or computer programmer than a nurse and we wouldn't have a world wide shortage. we need a "get real, get nursing" campaign. kidznurse

Unfortunately we are not all born equal there are people born with lower cognitive abilities (Lower IQ) who cannot get a decent college education . There are many children born with in-utero alcohol and drug damage to their brains, there are people who have genetic predisposition to mental illness, in short there are people who have special needs. What do you suggest punishing them ,or providing for them? Or perhaps we are back to a Hitlerian view of Eugenics.

i live in a country that has free health and education for its citizens- nz . i have worked in the us, and in the uk, and australia . every system has its issues but i did not find the system in the us superior in quality.i think it is important to be self critical and reflective . i for one am looking at the quality of life and health indicators for children in all scandinavian countries (see who unicef reports) as the most significant for us in new zealand to explore - not the us.

Emotionally and spiritually I could nurse for nothing. I am drawn to nursing because of my need to care. Yes, I am aware this can be seen in negative terms or positive terms and I won't go into the psychology of Martyr Vs Saint delusions. I get the greatest personal satisfacion when I nurse for nothing when I look after friends and family 24/7 when they have babies or are sick or dying. I take time off from paid employment and move in with them. Today is my day off and I'm off to do the housework for a friend who's exhausted from Chemo. This is what drives me and is part of my personal makeup, criticise it if you like but I am comfortable in my own skin. I would love to spend some time working for a charity nursing children affected by war or natural disaster. However, politically and economically I am driven by market forces to sell my desire to help people. My nursing skills are a marketable commodity. I had no compunction about being a "mercenary" nurse. When I bought my first house in NZ and needed to make more money I travelled to the US and earned more, was frugal, and with the then exchange rate, paid off my house loan. I ratify and support our Nursing unions pay rise deals with the government . I believe in pay parity and believe that the job we do is on par with other social professions such as police, fire, teaching. I don't believe that as a predominantly female profession we deserve less. I have children to educate, a household to run and ongoing education to fund. Realistically nursing is my source of revenue .

It's obviously a societal norm thing . Circumcision is not very common here in NZ. Boys who were circumcised were called "helmet head" or "Knobby" when I was at school because their memberes looked different ie you could see the glans. Never heard of an intact member called helmet head. Adolescent culture will pick on anything especially in the change room , goes with the territory. Hygiene really isn't an issue. That again is a cultural thing. I was aware of my shock at nurses with long fingernails (and painted fingernails) at work when I worked in New York. Here, long and painted fingernails are said to harbour bacteria and a real no no for " professional" nursing. Then I remembered when we had to fight to stop wearing pantyhose and have bare legs at work. "They" said it was unhygienic until someone did a study of the organisms living in the nylon compared to those living on the skin, no prizes for guessing the colony counts of each. We are encultured to think in certain ways conditioned like Pavlovs dog . I think it was someone like Foucault who challenged these dominant discourses and said try and turn it upside down and see if you can see things through another lens... it stretches your mind. Different subjectivities, none of us are unbiased or objective when it all boils down to it. The range of appearances of memberes is quite remarkable. As there are more unc'd memberes here, I've nursed men with exceptionally long foreskins and those with next to none naturally .I can't see what the fuss is about womens labia are all quite different to each other and our breasts are all different shapes and sizes. Viva la difference .

Both of my boys had intractable foreskins one had a tight forseskin/phimosis and at age 5 I used a course of steroid cream to help loosen it as directed by a paediatrician. Neither boy required circumcision neither boy had any balanitis as the area beneath the intractable foreskin maintained health naturally. The instruction I got was not to try and retract, as this damages and causes scarring and infection. Both boys can now fully retract. One achieved this at 12 years the other at 10 years. Hope this helps. There are few routine circumcisions done in New Zealand,we have small Jewish and Moslem populations and they are not in vogue. Our paediatricians tend to recommend conservative treatment of phimosis and will respond to balanitis with surgery under general anaesthetic if indicated. I understand they were popular in the 60's which marked an era of increased medicalisation.I haven't checked but as far as I am aware our STD rates show no correlation to countries with high circumcision rates. I think if you look at studies and research stats you have to look at them with some scepticism since other factors need to be taken into account. J ust as Steven Levitt in "Freakonomics" challenged liberal thought when drawing the correlations between crime and poor and uneducated people breeding. There are multiple ways of viewing research stats. If for example the sample drawn is of a group of circumcised educated middleclass people then compared with uncircumised lower education lower class the correlation may have nothing to do with circumcision but everything to do with promiscuity. Perhaps correlations between monogomous individuals and those with multiple partners would have more relevance than circumcision than for example circumcision and HPV cervical cancer rates. It is puported that jewish women have less Cervical cancer because of their mens circumcision but perhaps there is a higher correlation for monogamy... just a thought not "proven ' or "scientific" but a warning that the "truth " is not as black and white as people like to believe. Science is all about educated guess nor "proof"

The roting process of a cord is slowed by pickling them with antiseptics and alcohol. Recently following up newborns in the community I have had to treat some very large umbilical granuloma with silver nitrate. I think there is a correlation with use of plastic coated disposable nappies and warm humid weather we are currently having. i would be tempted to go back to treating moist cords with alcohol to prevent granuloma.

We used to use iodine but then were told a few years ago that due to absorption bad for prem thyroids.

Reading many postings on this website have made me realise just how prevalent religious ideology is in nursing in the States. It is obviously a cultural element . Here in New Zealand, we are reluctant and ill advised to bring beliefs from the private domain into professional nursing care. Political, philosphical, and religious beliefs are considered personal and do not transgress the public domain which as nurses we represent . Likewise our political leaders do not utter public proclamations of their private beliefs (no God bless our country or we have a God given duty as a nation to act in a certain way). I would no more offer to pray for a patient than offer them a Buddhist chant, read them sections of Das Kapital, offer an incantation or spell, sell them Amway or whatever might be my personal belief. I would however, respect any patients desire to pray, or meditate, or face Mecca, or hold a crystal , or whatever the patient needs to do to help them through. I would ensure the appropriate space, time, and support, to do what they need to do. I believe spirituality in nursing is in genuinely " being with" a patient and making a loving connection . Spiritual nursing 'moments' occur when I massage a patient, hold their hand, laugh with them, cry with them ,hold them when they die, respect their bodies,treat the dead with reverence, understand and accept them .

Sadly death is seen as a failure of health care not a natural progression of life. Shame the death discourse is not more openly discussed amongst health professionals an the public. So many parents write birth plans very few write deah plans. I spent months discussing death with my grandmother after her cancer was diagnosed and how she would like to go , and guess what it was how she envisaged it. She had the strength to say no to treatment and to die with dignity peacefully surrounded by her families love and in her own home . Western Society puts pressure on for everyone to live at all costs . particularly in hospital. it's a terible place to die. Poor son in your story is a Doctor so feels even more pressure to perform " miracles" Irony is that death is also a miracle and a good death is as beautiful as a good birth or a life well lived. Grief counselling might help him but sadly doctors often are considered to be the last to need this. Live and let die.

My friend had an abortion at 18 weeks last year. Her baby was wanted but not at any cost . She had trisomy 13 on amniocentesis, was very small and had a major cardiac defect. The syndrome is generally incompatible with life . I would have supported my friend whatever choice she made because there is no perfect solution. I have nursed families torn apart by the pain and suffering of their little ones, who have lived for weeks or years with syndromes. They have not been able to live with out intrusive unnatural medical science , I have nursed mothers who have suffered major depression nursing children like this for the first few months of their lives. I have also known those who have felt that the experience strengthened them. We as nurses should never judge but be there for those we care for . My friend had wonderful nurses there for her when she gave birth to her aborted baby. I helped by being a support person for the childs death and delivery and helped by making suggestions for her funeral. I always refer to my friends dead baby by name. Although they grieved at the loss I know this friend and her other children would have suffered more through nursing a dying infant. My friend faints at the sight of blood and hates hospitals and medicines . It would have torn her apart and I think for her she made the right decision and that is all that matters.

Im 45 and been nursing 28 years am also a mum of 2 .I'm considering moving out of nursing soon because I'm just not handling it physically. Maybe my body is old for its age and maybe its because 28years of shift work and stress has taken its toll. How do you think your body will handle the physical nature of the job. Maybe you still have the body of a 30year old because you haven't been nursing all this time I don't know. If you can handle the heat stay in the kitchen . Good Luck with your decision

Yes I've heard that HPV is implicated in prostate cancer. Could the vaccine be targeted at females because of some old sexist ideology men not being considered promiscuous when having multiple sex partners but merely virile. Treat the girls then they won't infect the boys. I don't know. What do you think the meaning is?

I agree the pharmaceutical companies agendas are as suspect as the petro-chemical companies agendas. The big businesses do however seem to have governments in their pockets.Or am I just a dumb conspiracy theorist?