Small complication in my pedi rotation

[jeharshman]

Yesterday in my pediatric clinical rotation my patient's parents felt that I was their child's keeper. They would send him out into the hall to find me. He wanted to go everywhere I went including the nurses station and the med room. How was I supposed to make it clear to the parents that yes he was my responsibility for nursing but not my babysitting responsibility. At the end of my day they came to find me to see if I would sit with him while they went to get lunch. If I were not a student then I would have more than one patient and would not be able to devote all of my time to one patient. How should I have handled this family?

[prmenrs, RN]

Apology accepted with my Thanks. Given the theme of this thread, I wonder if the nurses at that hospital were thinking of me as the "l" word, because @ that point in time, he was still a foster child, and I didn't have him on my insurance yet, he was on MediCal (Calif's version of "Caid")? Hmm, never thought of that angle.

The 2nd time we had to be admitted to this facility, he was 9, and it was his 1st shunt revision; they were much nicer to me! But he was easier, too. I didn't stay overnight, left about 11:30pm after getting there @ 6:30am, cried all the way home~20mi.

We were admitted on Saturday, didn't go home til Tuesday--took him a while to get used to a shunt that worked. He was a little too self-suficient this time, disconnected his own IV so he could get up and go to the bathroom!!

iv's and premies

We have IV boards as small as a large Bandaid--abt 1"x3", the smallest kids get those. I personally like to put the board so that the baby will grasp it, which often leaves some of the IV apparatus hanging out over the edge, but you can build up that end w/cotton. We use t-connecters, not the screw-on type, the slip connector that is @ right angles to the IV catheter. We usually try to thread as much catheter in the vein as possible, but we always tape them straight--we use an op-site/tegaderm to secure it and provide something sterile over the site, then 1/4" micropore tape "chevroned" over the hub; after that it's every nurse for her self! Personally, I'd staple 'em in IF I thought it'd work and that I could get away w/it! Kidding, I'm just kidding!

We have 2 other size boards, about 1 1/2" x 4" and 2"x 5"; We have to cut the Tegaderm to fit, which is a royal pain!

[nurs4kids]

Martha,

My hospital would NEVER allow a child to be left alone, I made that clear in my previous post. If a parent can not stay, they send the child to 1:1 care. This is a big deterent for the abusers, because they can not stay with their child only at their convenience. When they request to go home, we tell them they are not required to stay, but that we will have to transfer the child to another unit with 1:1 care and that if they decide to return in the middle of the night, they can visit the child in 15 minute increments, but can not stay in the room or at the bedside with the child. You'd be surprised with the number of parents that suddenly do not have to leave after all, when they find out it's not quiet as convenient to them as they'd planned. We do allow our parents to leave the unit in 15-20 minute increments to get food, smoke, etc. I apologized to prmenrs, my only intent was to show that sometimes it just isn't feasible for a nurse to sit 1:1 with a patient for twenty minutes when she's got 5-7 other patients to care for also. In 30 hours, I'm sure there had to be a time someone could have given her a break, and that time was probably in the middle of the night when she was sleeping. I work nights, but I KNOW how busy day shift is on my unit. Between midnight and 7am, I can almost always allow parents breaks, but I can understand why day shift nurses couldn't. That IS where child life and volunteers should be available. She was on a surgical unit, and the first five hours of the day are hectic, to say the least. Discharges, sending and receiving surgery patients, doctors rounding writing orders, admitting, and then the routine treatments.

Rather than edit your post, you chose to send me an email with an apology for saying YOU were THE moderator here before you realized I too was one. I had no clue what you were talking about when I received the email, as I had not been to the BB. The moderator thing here, for me, was just an attempt to help Brian, it's really not an ego thing, nor do I feel empowered.

There IS no bigger patient advocate than me. Part of being a patient advocate is protecting the patient, and sometimes the person you must protect them from is their own parent. If a parent will not care for their child in the hospital, one has to wonder who cares for the child at home. Perhaps you do not serve the same type families that I have frequent contact with, therefore you do not understand MY opinion. I never said ALL parent's are leeches, nor did I call anyone here a leech. I feel the majority of parents are very responsible. HOWEVER, do NOT tell me how to express my opinions. The term leech has been used in multiple posts on other threads. I suppose it isn't "PC", perhaps I should say "families of perpetual government assistance"..yes, that sounds much nicer. But, you see, I am not "PC", I call it like I see it, and will continue to do so.

Perhaps it's poor judgement on my part, just as it was probably poor judgement on your part to email me an apology (that obviously wasn't sincere) rather than edit your post. Without that "I am God and you will do as I say" message, I probably would have apologized and gone on without a second thought.

Thank you!

[nurs4kids]

Prme,

That's wonderful that he went 9yrs until the first revision!! How has he done since then?? It seems that once our kids have to have that first one, it's several in a row after that. You know, it sounds like you just got a bad unit that first time. I know we have some units that treat parents poorer than others. Many of our "frequent fliers" will sit in the ER 8-12 hours waiting to get a room on our unit instead of going to another floor. I hope all your future visits will continue to be as good as the last!

Tracy

[prmenrs, RN]

Tracy:

While you were answering, I was editing above!! We ought to just get a room!!

Ok, here's the long story--he got a "reservoir" @ 1st in the NICU, becasue he also had NEC and an ileostomy; eventually, (he was in for 31/2mo as a baby), they did a take down, then put the distal end of the shunt on. He weighed about 4#.

When he was 9, the distal end slipped off, and he gradually got obstructed--he even had migraines! Doesn't seem fair that a 9y/o should know what that word means! Problem also had to do w/ all the adhesions in his abd from the NEC, so reservoir and distal tubing had to be replaced. This time was @ that same hospital, same unit--they were just much nicer.

All went well till about 14--was having some h/a's, so had a CAT scan--proximal end exiting ventricle. Went in, had the proximal end replaced. He was in my hospital this time, the nurse manager used to be MY nurse manager, everybody knows me, I've been there >30 yrs... Surprise-no problems w/them, but he was in for 7 days trying to get equilibrated. Also, we stayed in the IMU, so I was happy--I wanted him w/in eyesight if he really started vomitting.

15y/o, I think, h/a's again; had another Cat Scan, ventricles enlarged, went to the Neurosurgeon, who pumped it a few times, wanted an MRI, but the next morning he comes into my room @ 6am, Mom, I have a h/a and I'm throwing up. NOT good, but he knows enough to tell me.

Called Primary peds--he said, I'll call you back. 2 hours later, he called back, told me when the MRI appt was--and to be in clinic after lunch so the resident could do the work-up. (He likes to have the house-staff see Juan because even though he has challenges, he's a nice kid, he can walk and talk, he's even funny) Next am NSg tapped the shunt, it had wbc's, they exteriorized it, and 10 days later, re-did the entire thing. An hour after they exteriorized it, he sat up and asked for a hamburger. The Neurosurgeon had the Peds gen'l surg do a mini-lap and break up the adhesions, and then put the distal end where he wanted it. The Nsurg is about 6'5, the Psurg is about 5'2--I called it the Mutt and Jeff show!

In December last year, had a routine CAT scan--no sx, but ventricles enlarged again! Did a nuclear med shunt study; he's almost full-grown now, and adults put out about 500 cc of CSF/day--I didn't know that! That's way more than HIS abd can handle, and all the adhesions had reformed.

So Mutt and Jeff went at it again, this time they put the distal end into the gallbladder! I didn't know that they could do that, either!

So far, so good, but we see the Nsurg on Tuesday--wish us luck!

Sandi

[nurs4kids]

Sandi,

Bless his heart, he's been through the mill! I hope this next scan is clear! I have NEVER heard of putting the distal into the gall bladder! That's awesome!! We have a couple kids who have pretty much the same hx as your son and they have become a nsg nightmare. The most recent one, they placed atrial, but he kept blowing it out. Then they placed it somewhere below his kidney. Haven't seen him back, so it obviously is working for now(been a month or two). I wonder if our Nsg's have heard of the gall bladder thing?? I may mention it to the residents. My best friend, who is also a nurse on my unit, had a baby back in July, born with hcp. He had a vp placed at 3 weeks and is doing great. It's so scary having a kid with a shunt because the early symptoms are indicitive of common illnesses. I can't imagine what ya'll go through! She calls me weekly, "the tract is swollen", "the reservior is swollen", "his fontanel is depressed/bulging/pulsating", "he spit up his last bottle", "he's irritible this morning"..lol, bless her heart. She actually began getting on my nerves, but my hubby quickly reminded me of the hundreds of times I called her when my healthy children were sick..with colds. Embarrassed, I told him he was right and continued to take her calls with pleasure :)

Take care, and again, I want to apologize for jumping the gun on you. I didn't assess the whole situation before becoming defensive!

Tracy

[nurs4kids]

ohhhhh, yeah..the IV thing.

Thanks for the advice. We don't routinely use tegaderm for our IV's, but perhaps I should start with my babies. We have "IV start kits" which contain 1" silk tape, and we normally use that. I try to stay away from cloth tape because so many of our kids have latex allergies, or at risk of developing. Also, our armboards are about 2" wide (pretty pathetic for a pediatric hospital to not have smaller ones, eh?). I've seen the one you're talking about, when getting patients from OSH's. They look like popsicle sticks wrapped in a white cloth?? We do use the 90degree slip tip T-connectors.

Thanks again!

Tracy

[prmenrs, RN]

Tracy:

No, the IV boards are nice, I think they're like a tongue blade, a piece of 3/8" foam, and soft knit material sewn at either end. They come in pink, blue or icky white.

The micropore tape is the clear kind that tears in both directions--I always double back it, but that might not work for more inventive kids. Also, I tape the thumb in--they're not used to using their thumbs yet, so they don't mind, and we can always give 'em a binky. Juan was a dedicated thumb-sucker at the time of that hospital stay, he liked his left thumb, which they left out of the tape job, but not enough apparently, and his blanket. He was not happy about that! Fortunately, he quit sucking w/o any help from me.

The gall bladder thing startled me, too, and Psg wasn't optimistic abt it, she said, if his belly is that scarred, I'll have a heck of a time digging out his g.b! I had every one I knew praying for him, even emailed the parish priest--he had me bring him in after Mass for the Sacrament of the Sick!! But... no sooner did she get into the abd, then the gall bladder "presented" itself into the incision--I say, the more mo-jo, the better!!

2ndary site was the pleura, tertiary was the cardoivascular; nsurg said the kidneys don't like csf! Maybe that kid you're talking about will do better now--hope so.

If the gall bladder placement works, I guess we'll never have to worry about gall stones, either--500cc of csf flushing through that puppy/day ought to take care of that problem!!

ttfn, Tracy

[KRVRN, BSN, RN]

Prmenrs,

Was the facility with the noisy air compressor, bent IV and broken banana lounger CHHC?

Kristi

[prmenrs, RN]

HOW DID YOU GUESS???

Kristi, you and I are gonna get in trouble!!

[KRVRN, BSN, RN]

Hey, at least I put their abbreviation so no one will ever know...

;-)

[krisfroggie]

Well, first of all I have found that it is important to set limits and boundries for family expectations from the beginning. I love to treat my kids and they can be a great joy, but it is impossible to answer to every patient and family needs in the way you describe. Most families I have cared for understand with a little time in the beginning to understand families needs and make yours as a healthcare provider understood. This can take a lot of practice to learn to handle some family needs, but you will become better with time. By the way, if you think this would be easier if you work in an adult hospital, it is not so! I have worked my share of adult floors and sometimes the patients kids are the most demanding:rolleyes: good luck