ECUPirateRN

I would assume that since breast buds develop about 2 years prior to the start of menarche, it would be important for a physician to examine the breasts of a 7th grader who would be approximately 11-13 years old. If there was no evidence of breast buds, that would be a pertinent clinical finding that would need to be further investigated.

My story is kinda long...kinda odd... When I was 4, I decided to be a doctor. I was going to be a pediatric oncologist. I was dead set on being a doctor. Until my senior year of high school. I started to think about what the role of the doctor is and what I wanted to do. I realized that I wanted so much to be the person who spent time with patients and was directly involved in care. I also wanted to be the one who did the procedures versus spending 15 minutes a day with a patient. That is when I decided I wanted to be a nurse. I went to college when I was 17 and started as a pre-nursing major. When I took my health class, I met my instructor who was a Health Educator. She would tell me, "You don't want to be a nurse, you want to be a health educator!" I remember reading some nursing journal and getting completely freaked out. I looked into it and thought health education seemed cool. So I changed my major. My junior year of college, I was looking online for jobs in health education. I really wanted to do patient education; diabetes, asthma, childbirth, something like that. All of the jobs I was interested in required having an RN license. So I thought I would go to nursing school, get my license, and then teach. Later that year, I took an EMT-Intermediate class and had to do 50 hours of clinicals in the ED. I really loved it and did 150 hours. I decided that I really enjoyed the clinical side and thought I would like bedside nursing. I graduated from ECU with my degree in Community Health Education (although at a certain point I almost dropped out b/c I really didn't like my major and wanted to go to nursing school) and immediately went to nursing school. I couldn't be happier that I made this decision. And after all is said and done, I am glad I took this long trip around. Having an education background makes it so much easier to provide education to my patients about disease management and lifestyle modifications.

I really respect you guys who can do home health. I just know it isn't for me. I was an EMT for about 5 years and one of the reasons I left (besides the fact that I much preferred my work as an RN!) is that I was tired of going to nasty people's nasty houses! I know that not all home health assignments are not in these types of homes just like not all of my EMS calls were there either (just about 90% though!) but just the thought of the potential for bugs crawling all over the place...ugggh. The people I know though that do it absolutely love it. I really like being on the floor. In fact, I really love being in a teaching hospital. There is always the opportunity to learn and to teach. And it really is as much your team as your work. I don't know if it is because people who work in Peds (nurses, residents, attendings, RT, PT, OT, and everyone else!) is just different but we all get along together in a team and really collaborate. I have heard so many stories from other nurses that say that they never talk to their residents and attendings for fear of being yelled at. I have experienced some of that, of course, but for the most part it is great. I have enough autonomy to satisfy me but also have the support of my peers and my team.

You know, a few weeks ago I had an infant admitted for respiratory distress, ended up in the PICU for the night b/c I couldn't keep his sats above 90% on 3L HFNC. Turns out, he tested positive for RSV! Doesn't he know RSV season is over??

I gotta say...I work in pediatrics where I take care of sick infants all the time and I don't think I could ramble off infant or peds vitals off the top of my head! Every kid is different. Some kid is going to have a low HR due to physiological issues or meds. Some my be fast. Some kids can sat in the 70's and that is fantastic. And while I don't have the exact ranges memorized, I am pretty good at looking at the monitor and saying, "Well that isn't quite right." or, "Hey, thats pretty good." And yes, I also carry a "cheat sheet" of normal peds vitals ranges on my badge. I don't know how all NICUs operate but in the one at my hospital, the nurses sit in pods directly facing their patients. They can see monitors and all the monitors are linked so if there is an alarm, everyone can see it. In your pod is all the supplies you need so you don't ever have to leave. Therefore, there is always a nurse around and they are constantly in the rooms. Those babies are never left unattended. And to repeat, CNAs, techs, Care Partners, whatever you call them DO NOT ASSESS!!! EVER!!! Even if they are nursing students. It is out of their scope of practice. If something is abnormal, they report to the primary RN and then DOCUMENT that they relayed the information. Good luck in school. None of the schools I went to based admission soley on GPA though.

A few months ago, I was taking care of a 15 year old who had an extensive psych history who had just come out of PICU after drinking 2 bottles of vodka. I was preparing to leave at the end of my shift when one of the peds residents told me that she was going to tell the kid that he had to go back to the psych hospital that he had previously been discharged from. Knowing that he was going to be very upset about having to go back, I decided to go into the room with her. She was chit chatting with him, gaining a rapport with the kid. He all of a sudden pulls something out of his pocket, looks at it, giggles, and shoves it back in his pocket. The resident asks, "What was that?" He laughs and says nothing. Again, she asks, "What was that in your hand?" He says he doesn't know, but takes it out of his pocket and holds it in his hand. "What is that?" "I don't know." He opens his hand and puts the object on the table. It was small, had rubber spikes, and lit up. I am trying to figure out what it is and so is the resident. I ask him what it is and he still says he doesn't know, while laughing. All of a sudden, I realize what it is...a bullet shaped "love toy". I have no clue how to react. I am still a new nurse! And the resident still hasn't figured it out! She asked him one more time what it is and he says, "I think it is for a woman's lady parts." Then he turns it on and it buzzes all the way across the table while he laughs his butt off!! The resident and I just looked at each other, our faces both red, and just walked out! He bought himself a nice long stay in a psych inpatient facility. Poor kid though. He told me that he drank all of that b/c he got into a fight with his mom. He also said that he got the toy from his mom's drawer. Sad to know how he knew it was there...

I guess my thought is why stick a kid if you can get a non-hemolyzed sample from a PIV? On my peds floor we routinely draw daily labs from existing PIVs, even babies with 24s or kids with fluids running. If you flush well and get a good enough waste your results come back the same as a fresh stick. Of course, I have had hemolyzed samples from an IV but I have also had hemolyzed samples from a fresh stick. We don't have lab techs or phlebotomists to do our sticks. We the nurses do them all. If the kid has IVF fluids running, I just turn them off (at the tme of the draw, not 5 or 10 minutes), flush, waste, and draw. If I have dextrose in my fluids, my glucose level still comes back normal. If I have K+ in my fluids, my K+ doesn't necessarily come back high. In fact, many times I have been able to go into a baby's room at 3 in the morning, get my labs from the IV, and never wake up the baby or even the parent. I don't like sticking kids any more than I have to. Of course, if the lab comes back funky, I will stick them for it. As far as returning the waste, the only place I have seen that is in NICU. We don't do that on our floor.

It really is! You will quickly learn when Orientation and Open House are and know to not leave your house. You will know when move in weekend is and know to not go out to eat or to Wal Mart or Target. You will know when graduation weekend is and know not to leave your house. And all the sudden, it empties out for about 3 months and it becomes a ghost town, especially if you live closer to campus!

I went to ECU for my undergrad (before nursing school) and while I didn't go there for nursing school, I can say that ECU has a fantastic reputation nationwide for their nursing programs, both undergraduate and graduate levels. Succcess rate is very high and the staff is phenomenal. I have had the privilege of knowing several of thefaculty members personally. You will get a great education and what can be better than doing it online?

Yeah that is true...I guess I have seen our peds hem/onc doc attempt one when we were trying to get a second IV for an exchange transfusion.

I just heard a statistic on the radio that said that on TV, 75% of codes are successful whereas in real life, only about 6% of patients that go into cardiac arrest survive. Half the things the docs do on the shows are really tasks the nurses do. Have you guys ever seen a doc start an IV? The ones on my floor don't know how to, or they will ask the nurse if they can attempt it so they can get the practice. Doctors don't start Foleys (or DC them). They just have a totally different role in the hospital. Also, nurses aren't as stupid/slutty/subservient as TV shows tend to make us...well, not ALL of us are! Kidding!

Rotavirus is extremely contagious so it is highly likely that the babies caught it from one another. However, I don't think it can be transmitted by use of the dropper as rotavirus is transmitted from fecal-oral contact. While rotavirus can cause vomiting (I had to look it up!) it seems more likely that the cause is reflux, due to history. Does the baby get continuous feeds or bolus feeds? I have taken care of babies who have NG tubes who get continuous feeds about as often as ND continuous feed. Then again, if the baby has rotavirus, who knows what other infection they could have too. That could also cause vomiting.

Amen!!

Unfortunately, I think you can set yourself up for disappointment if you think peds nursing is always clowns and balloons and games and happiness and laughing. Sometimes you have to do some pretty horendous-seeming things to kids, like when you have to hold down a 3 day old baby with a fever while they attempt an LP and it takes multiple attempts to get fluid. Or when it takes 4 nurses to hold down a 5 year old to restart an IV. All the Synera in the world won't take away the scarinesss to that kid. Or when you hve to code a 3 month old b/c he pulled out his NG AGAIN and is aspirating on his feeds. It can be stressful. Not all the kids will love you. Some will say they hate you.

I don't work in an ED but I can say it can get tedious, especially in RSV/Flu season. Sometimes it is almost like "If I have to put on one more isolation gown or suck the snot out of one more nose...". I am sure there are different levels of burnout too. I know some peds nurses who have said that they have been burned out from our oncology popuation. I guess you can only see so many kids die before it gets to you. We just recently had about 5 deaths in a week. I guess to me, everyone has the potential to be burned out after a while, even when you get to work with the coolest population ever!