RN_PICU

If you have any articles (anything in writing) about that I would love to read them, that would totally revamp what is being done on our unit since 90% of pt's are on versed at some point for various periods of time. Thank you for bringing it up

In severe cases (usually kids who started smoking with underlying asthma) we use albuterol gtt (up to 20mg/hr) D51/2NS 20K Ketamine terbutaline mag-sulfate (until mag levels are around 4) and if needed 40meq K (just to balance off terbutaline and albuterol effects) all this with bi-pap tx for as long as needed. The youngest kid we treated with the above was, if i remember right, less than a year old. Not sure if age has anything to do with it, but i'll ask and get back to you...

I had another nurse ask me if diuretics give people diarrhea?!?!!?

I lost my sense of smell after 5-6 months and now even wide open septic tank would not get my attention... That being said, to get over the initial phase all I did was breath trough my mouth, and when even that didn't help I would used surgical mask.

I moved to US in 2000. My previous life led me over two continents and 3 languages, exposed me to different cultures and I can tell you one thing, no one likes to feel like a foreigner in his own country!!! I remember how it felt when I did not speak the language of a certain country and all I wanted is to learn it and become one that belongs... When ever I am in company of someone who's speaking one of the other languages I know, we would never converse in it in presence of others who do not, no exemptions. Many, so called minorities tend to forget how isolating it felt when they could not be a part of conversation. That being said, d/t PC Police and other nuisances at any work place, just bringing this issue up would label you as a bigot and force upon you all kinds of "sensitivity training." As you can see, I've learned my lesson and would never ever even blink twice when such an instance happens in the future

When I was in service, after a little while I realized how true the line is "you can't handle the truth!!" And that is the same approach I use when people ask me about the work on PICU floor. Give them what they want to hear and what will make them happy. Quick recovery story, happy parents that got their child back etc. No terminology, no brain tumors on 7yo, no suicide attempts by 13yo girls, no abuse and distraction of perfectly healthy kids who would never be able to see/walk/talk again, and certainly no dying babies... I have found that any of the above will make your friends feel very uncomfortable, and in the future they will avoid you all together.

This is horrible example of labeling... such a shame

Every time my hospice pt I grew attached to died on my watch I would cry for him/her on my drive home. Now, working with peds of which some have died, I find my self shedding a tear in the same way. I'm not a great talker, so for me remembering that person, who entrusted me with his/her care, for one more time is a great way to vent my emotions and start once again the next day...

I graduated in 05/2010. Even before my NCLEX I have found a job as a summer camp nurse. Two weeks into the camp and number of sleepless nights I had passed my boards and earned the title RN. During that same period relentless pursuit after more permanent job has landed me only one interview and an opportunity to work as correctional nurse!!! Need I say, probably something I never wanted to do but at the same time beggars can't be choosers. I've learned as much as could from that job, even saved a female inmate from dying d/t DKA and moved on to a new job; psych nurse at one of the crisis centers. All along I worked second and third jobs per-diem, mostly nights for hospice and LTC. Learned even more about nursing at each one of them... It was more than a year and four months when I finally landed my dream job on PICU floor in the biggest hospital in my area. I am grateful for the job and the opportunity given to me, but even more for all of the experiences,patients, people and coworkers that helped in the process. My current manager told me, that the most impressive thing about my interview was the fact I mentioned how much I learned from each and every one of my jobs, even the one I didn't like so much, at a jail. The bottom line is, do not be afraid to jump on any and every opportunity. New grads can and should learn from every single nursing job. Even those not so "popular." And FYI all of you new grads in CA, state prisions and jails are paying anywhere from $7,000 to $8,500 per mo for a nurse (it might go down 4.25%) but it's still a great way to provide and learn a thing or two about nursing. To this day I am receiving 2 or 3 letters a month from them offering me a job... Go get them!!!!

I have a noonan's baby, female 8 mo with exactly the same issue. We were getting ready to send her home after finally adjusting to LTV vent and getting her high capacity concentrator since she's on 5 L base line... and then she got temp of 104 with no bacteria in blood or sputum. One day after she was back to 96 range where she's the most comfortable but still had to stay over for the weekend. Parents were heart broken as were we, but the bottom line is no one had an answer why did she spiked so high and then came back just as fast. Our girl is also 99% of the time in her diaper only since any cover or clothing gets her to 99 range and her just vegals on us with HR of 60 and under. I know this doesn't help you but if someone can put those two together I would be glad to know. Thanks

Thanks Ashley, I am working with our lactation specialist on this right now... Mom pumps into plastic bags, that are sealed and frozen, brought to us and we use them for each feed. Per mom, she never knows how much is in a bag "only eyeballing." It is very unusual, at least in our setting to have this "old" baby (and this kind of circumstances eg almost two months stay, vent and trach...) being on breast milk, but every one supports it. So, we're gonna figure out the best and safest way and help them grow :)

Thank you janfrn too!!! BTW its mother's 9th child... and she breast fed them all!!! LOL Good for her and all of them :)

Thank you for the quick reply, very much!!! We do give it in kangaroo bags... If you have anything in writing, resources, articles or even hospital policies could you please share them with me. I have decided to make this topic my nursing residency project and make the change if need be :)

A stupid question to some, and me being new to PICU, kinda afraid to ask and maybe upset someone about this at my work... We have a kid, 6mo who is receiving 135ml/hr Q3hrs breast milk. It's stored in freezer on the unit, labeled and all the bells and whistles are in place. But since his mother "submits" more than 135ml to each bag, approximately 160-180mls, we end up with residual after each feed. After 3 or 4 feeds there is enough for entire bolus of 135 mls to be delivered. Needles to say, it looks "not pretty" but that's what they "have been doing" for last two months of his hospitalization since breast milk from his mother "doesn't come easy."There is also an issue of GT bags and tubing being changed only every 24hrs, which I secretly change more often when no one is looking more often... I've been looking for some research about breast milk and it's "autoimmune qualities" half life, it going bad in room temperature etc. I forgot to mention, but kid has diarrhea which I believe is directly related to bad breast milk being fed, but yet again me being new and all, I need more scientific reasoning in order to bring this point up. Any advice would be more than welcomed at this point. Thank you all :)

I've learned on my skin that "beggars can't be choosers..." My first job was in correctional facility, I hated it but did what I had to do and even saved one inmate from dying d/t DKA. When an opportunity came I took a job on psych floor, while working part time with kids on ventilators in home care with one agency and hospice with another. After a job for a PICU nurse was posted I had experience in all of the above and was given an opportunity over many other new grads with 1 year or less of experience. My nurse manager told me that when I said "I've learned from each and any one of the opportunities" is what landed me the job I was the happiest nurse in the world. I love nursing and the variety of opportunities it has and ways it provides us with knowledge. There is a saying in Hebrew "from all of those who taught me I have become wiser..."