Child Diabetes Guidelines

Pediatricians issue the first Diabetes guidelines for Children.

All Good Things Come To An End

Last Day of clinicals today! Mrs. Moore made yummy cookies, and the peds clinical sites got their treats! Bondys are done, so now all that's left is a few careplans left to grade, and the semester is over right? WRONG! FINAL EXAM TUESDAY!!!! Study Session at my house 1-6pm. Bring a snack to share, and your own drink. Also, would probably be good to bring your notes and book as well! I will have multiple children here for you to learn on during breaks, including the best murmur ever (bring your stethoscope), eczema, severe asthma, and a sick foreign exchange student with broken feet! LOL. If you were given any type of study guide, if someone wouldn't mind sending it to me, I can base our discussions on that. Now is the time to ask that question you've been afraid to ask (no Carly you still can't spend the night), or to put that final piece in your puzzle. Some of you are sitting just on the edge right now, so you better soak it up like Spongebob to avoid doing this all over again without me next semester... Here's a map to my house!!!
View Stacy & Dak's place in a larger map

Okay, so it bears repeating...

Please put your patient's weight on your drug cards, and please give the prescription somewhere on the drug card as well. Haven't been able to do as much grading this weekend as I had hoped, a 5 month old in our family was admitted to the hospital with new onset seizures, and I spent quite a bit of time there over the weekend. He is on a continuous EEG, has premature closure of the fontanels, clear CT scan, and will get an MRI Monday. They started him on Phenobarbital yesterday, and hopefully that will help prevent him from having more seizures.

Duty to Protect

Many people are confused about reporting child abuse or negligence. Who has an obligation to report? In Oklahoma, as well as the majority of state,make it a mandatory duty to report child abuse or neglect, including suspected child abuse or child neglect. In Oklahoma, every adult falls under this legal obligation to report. There are no exceptions. This does not mean that just because you have no proof or all of the details that you don't take the steps necessary to protect a child who is possibly the victim of abuse or neglect. Err on the safe side. It is important to know that the law also protects the good-faith reporter. There can be no legal retaliation against persons who make good faith reports of child abuse or even suspected child abuse. The intent of the law is clear: Think first of the child and protect the child!

So you know about the obligation to report, but how? First: Call the Oklahoma Department of Human Services (DHS) hotline: 800-522-3511. Be prepared — identify yourself, tell them all that you know, and ask for a case number. If a reporter of abuse needs to call back, then having the case number is very helpful. How the DHS will handle the matter can vary. If they believe the child might be in imminent danger, then they may ask the reporter to call the local police or sheriff. If you make a report and are asked to call the police, then do so immediately. Even though making a report twice may seem burdensome, think first of the child and protect the child.

The reports of abuse that we hear about with such frequency are deeply troubling. The sexual abuse of children is a serious problem in our society. Health and education professions have a commitment to protecting children which is absolutely firm, but it takes all of us to make the child protection policies that have been put in place, work. Please advocate for your patients, and especially those who do not have the power to make their own voices heard... Link to Oklahoma Reporting Brochure

Something to Ponder...

“I exist not to be loved and admired, but to love and act. It is not the duty of those around me to love me. Rather, it is my duty to be concerned about the world, about man.” ― Janusz Korczak, Warsaw Ghetto Memoirs of Janusz Korczak For any of you interested in Pediatrics, the story of Janusz Korczak is definitely one you should check out. He was a physician who turned down a promising & lucrative career to care for orphaned children. Janusz Korczac ran an orphanage (a very child-friendly and democratic one) in Poland before and during the Holocaust. He was given opportunities to flee the country, but he would not leave his children. When his 200 children were told to walk to a train to take them to Treblinka death camp, he walked with them. They boarded the train and weren't heard from again. His book "How to Love a Child" is one of my favorites, and full of his quotes and insights. Once you're sick of looking at textbooks, you might give it a try :-)

Feel free to comment

Love it? Hate it? Link not working? Feel free to comment and interact. Sometimes I feel like I'm talking (typing) to a wall ;-)

Be Prepared - Not Scared!

Over the course of the first group's clinicals, I noticed a few things that needed to be addressed for Pediatric Clinicals.  Children are not just little adults.  They are unique creatures whose care requires consideration of several important aspects.  

1.  A "risk for" diagnosis should not really be a primary diagnosis (unless your're in OPAD/PACU and the main problem has been addressed), because all of these patients are in the hospital, and have a concern greater than a risk.  Don't forget that the "related to" part of the diagnosis should be something you can effect, and if they have a medical reason for that diagnosis, it's the "secondary to" part.  Really think about your nursing diagnoses and nursing process.  This approach to treating patients is a type of thinking unique to nurses, yet it helps us to be able to take care of patients across the spectrum.  Finally, don't forget in your careplan maps that you need to evaluate your outcomes AND interventions.

2.  Your focus for this clinical rotation is pediatrics!  I want you to focus on the fact that your patient is a child, and what is unique about pediatric patients with that diagnosis.  Include weight based dosage information, give me the percentages of your patient's weight & height, along with their BMI.  Include head circumference for children under two.  This isn't picky, it's critical for pediatric patients!  Size does matter in medicine!  Developmental level is also critical.  You will not approach a 2 year old the same way as a 13 year old.  Think about their developmental level when you interact with them, choose your words and actions carefully, use the therapeutic communication techniques you've learned and SPEND TIME WITH THEM!  If you're in the hall every time I do rounds, then you're not spending the time you need with your patient.

3.  On your drug cards, focus information to your patient.  Don't worry about information for a use that is not for your patient, focus on how this medication helps this patient, how it fits into their medical care, or what the intention is.  I want you to understand these medications as relates to your patient.  For example, if you have an infant who is taking sildenafil for pulmonary hypertension, I don't want to see that the expected outcome of the medication for your patient is an erection.  Also, if your patient is on a heparin drip for clotting reasons, that's an entirely different scenario/risk/focus than having an occasional heparin flush through a central line.  So, where the medication name goes, put the entire medication order.  If the med is Tylenol - Tylenol, 325mg PO Q4 PRN.  Also, put the weight of the patient on the drug cards in the slot that asks if this is an appropriate dose for your patient.  Give their range if applicable.  That way, if you are miscalculating the dose, or it doesn't fall within range, I can help you to understand why.  Finally, don't make drug cards for things that don't matter.  I don't need heparin or saline flushes, maintenance IV fluids, carriers, nor PRN medications which the patient hasn't had in the last 3 days.  They're not relevant to the patient's care.  Example - you may need to indicate that your patient is on maintenance IV fluids in your assessment for fluid/electrolyte purposes, but you don't need to fill out a drug card for it.  

4.  Children with congenital heart defects intimidate most nurses.  Understand that pediatric hearts are generally not bad hearts, but rather bad plumbing.  There are holes where there shouldn't be, the blood doesn't flow where it should along a pre-set path, and there may be too few, too many, or improperly placed vessels.  Get to know the path of bloodflow through the normal heart, and if your patient has a heart defect, get to know how their heart differs from normal.  The website at Cincinnati Childrens has great information, and videos to show the differences.  Use it! (link available right side of blog)

5.  Our mutual goal is to make you all the best nurses you can be.  I have made child health, education and wellness my life.  Therefore, MY goal is to make sure that if you take care of a child in any scenario that you know what you're doing.  I hope to make the most of your clinical time, and for you to learn as much as possible relating to each scenario you encounter.  If you don't understand, feel lost, or need guidance at any time please let me know, I'd be happy to help.