What is different about peds? How to adjust to each unit?

[kukukajoo, LPN]

I am getting ready to do a clincal day on peds and wonder how different it is than a med-surg floor with adults.....

The reason I ask is that I felt totally blindsided the other day on the maternity floor and could not keep up. There were other events, but I wonder if my time management could have been better. I just felt that I could not keep up and started out behind and it seemed the clincal instructor was on me all day and nothing I did was right.

The chart said 0700 vitals were done and recorded, but I got in trouble for not doing them. Then I got in trouble for not doing a second one at 1200 even though I had done them at 0900 and then 1/2 hr after giving a med that could decrease her already low BP. AND she was on Vitals Qshift which I don't understand why I was reuired to do them again.... It seemed that the floor was less organized and supplies and meds were everywhere- more floor stock that was not in any particular order and you had to search for it... I know maternity is a lot like this due to the nature of the care, but I want to avoid any missteps on the peds and not have a bad day again.

I figure as soon as report is done I will do vitals, and again 4 hours later wether required or not but looking for other tips as well. Thanks!

[debthern]

The biggest difference between peds and adults is that you mostly have to do your teaching with the parents and try to keep things on a level kids will understand. If it is a med surg floor it should be pretty much the same as the adult floor you were on before. I know though that at our hospital we have a play room that is off limits for procedures of any kind.

[kukukajoo, LPN]

I would assume their meds are all seperate and not so much floor stock as in maternity? I HATED having to search for everything becuause there was no real order to it at all and I think I am finding I need more organization. I am sure I would be fine after time, but not being on the floor enough and a week between clinical days is rough to remember where everything is.

[MissJoRN, RN]

Our meds are seperate but we keep pretty much back-up stock. Not nearly as much as Mat though where most pts get the same meds. Not only is everyone on different meds for a variety of dx, the dose is tailored to weight- so forget grabbing stock antibiotic or even tylenol and just giving it!

VS and assessments/ charting q4 hrs is pretty much standard on peds- a shocker for some used to adults where it might be qshift or even BID. Daily weights are common as are daily BPs- not BP with each set of VS. Post op kids, shocky older kids, etc may get more BPs. (remember low BP is a LATE shock sign in young kids) Make sure you have the right cuff when you do do them. Also expect to see quite a few kids on CR (cardio-resp) monitors and pulse ox. Impress your instructor by not taking VS off them (I see that so often!) Expect to see the resp rate pick up burping and bouncing of the infants (and warn their parents to expect high rate false alarms) and expect to be retaping those leads! LOL

[TazziRN, RN]

If there is a procedure room expect to do everything in that room, not the child's room. The bed and room should be the safe haven if possible. I don't know if this is actually done now but when I was in school we were taught to not have parents in the room during procedures and especially do not let them help, so that the parent is the safe person.

Also, even if most of your teaching will be to the parents, always explain your procedures to the child, even the toddlers, in language they can understand. Not "I'm going to change your dressing now" but "I'm going to take this old bandage (boo-boo patch, whatever) off and put a new one on." Explain to them what they are going to feel: "This BP cuff is going to hug your arm for a minute and then let go, can you hold still?" Whatever you do, do NOT tell them to look away and do something painful without warning the child that it's going to be painful. I had a dentist do that to me once before injecting my mouth.....before dentists started numbing up the mucosa before injecting...and I've never trusted dentists since.

[purplemania, BSN, RN]

EVERY medication needs to be double checked. Be good at your math and keep a cheat sheet nearby. You will do growth charts probably as well. You need to know a little about growth and development so that when you assess you can decide if what you see is "normal". I think you will improve your assessment skills since you cannot depend on the patient to tell you any history or symptoms, at least not much.

[AliRae]

I am getting ready to do a clincal day on peds and wonder how different it is than a med-surg floor with adults.....

Well, the patients tend to be a bit smaller. Really, though, the peds world is wonderful. Do expect to take a bit longer checking meds since there's really no such thing as a "standard" dose ... everything's done by weight. Do expect to spend part of your shift on the floor, if that's where your patient wants to be while being assessed. Don't expect kid poop to smell any better than grown up poop - for some reason it's not necessarily true. Most places will assess pain in kiddos Q4h, rather than the Q8 that's often required in the adult world. Oh, hand out hugs, too. They work quite well as "non-pharmacological" interventions for crying babes. Be alert to your nonverbal signs of discomfort, since a 14-month old isn't necessarily going to pipe up and say "Hey, my right knee is kind of bothering me at the moment."

Have fun. Make faces. Finger puppets and stickers are always winners.