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.
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