And That's How I Almost Cried During Clinical

This week I was supposed to be in the PICU (pediatric intensive care unit) for both days. The PICU has had census problems all term and usually ends up being closed because of a lack of patients. So I was incredibally stoked when they had one Monday evening who would be there both days and who had a lot of interventions that I had never seen or worked with before (wound drains, a colostomy, a PICC [Peripherally Inserted Central Catheter] line). So, Monday night I spent about 5 hours looking up all of my patients labs and medications and brushing up on my skills to make sure I would be able to provide awesome care. And I was very excited to do all these interventions too.

But then I arrived at clinicals. And was told that I could no longer be with that patient because the newly hired nurse would be working with him. Which is understandable, and I was fine with that aspect of it but what I was not fine with was the fact that I had all this pre-clinical work completed and was being switched to a patient that needed no care and was being discharged that day. ARGH!

So, we made the decision at the end of the day to have my second day take place on the regular pediatric floor. And that was an amazing decision!

My primary patient today was a 12 year old who has a BMI of 48 (over 30 is considered obese). In addition he has ashtma, COPD, gout, multiple admissions for respiratory infections including pneumonia, and arthritis. He was admitted this time due to cellulitis on his arm (a bacterial skin infection) and possible kidney failure. Unfortunately they inserted the PICC line before I got there, which was kind of a bummer, but I did get to do a heparin flush (to keep it open and free of clots) which was kind of neat and I got to play many round of connect four (a favorite board game) with him. It was really just fun being around him but also extremely heartbreaking. Many cultural and lifestyle factors are keeping him from losing weight, but unfortunately if he keeps going the way he's going his life expectancy isn't very long.

Other big news: I got to place my first NG tube today! Probably the most traumatizing thing I've ever done to an infant. Getting the tube down the nose and into the stomach was not big deal (first try I got it in the right spot, holler!) but taping down the tube to an extremely angry infant's face and needing to use scissors to trim the tape all during crying and moving on the infants part? Traumatizing. It's good that it happened at the end of my day or I would have been on edge for the rest of the day.

So that was my week! It ended on a pretty cool note I must say. And the further into this I get the more I'm pretty sure that I was created to work in pediatrics. Hooray!

Peds Clinical >>>>>> Spring Quarter Clinicals

Today was my fourth and final day in the ISCU during my Peds rotation and while it was a tad chaotic, it was also epic too. This clinical term is so much better than the spring, mainly because I'm actually doing things now instead of awkwardly standing around.

Today I took full care of two (instead of one) patients by myself. This in itself was epic and it felt like such an accomplishment on the road to working as a real live nurse. Everything went well, I've long been accomplished at time management and multi-tasking, aside from the couple of minor incidents that were baby related.

Patient #1:
Baby Girl 1 was born at 36 weeks gestation with gastroschesis (intestines outside of the umbilicus). This was quite a fascinating pathophysiology as the surgical correction is quite simple (putting it all back in through the umbilicus) and visually the only physical difference between this baby and one not born with gastroschesis is that my patient has a very tight, very distended abdomen (it should be soft and non-distended). Baby Girl 1 is a couple days out from discharge but is having troubles holding down feedings. I kind of learned this the hard way as yesterday all her feedings went well. I thought everything was copacetic post feeding as I rocked her to sooth her fussiness. Then, out of nowhere: a contorted face and about 30cc's of formula all over herself. Luckily, none got on me and I quickly responded by laying Baby Girl 1 on her side to prevent choking or aspiration. This happened with every feeding, making it frustrating more than anything else as this usually required a new wardrobe and set of sheets. However, she's doing as well as expected and once the regurgitations are gone for sure she will get to leave and enjoy home.

Patient #2:
Baby Girl 2 was a baby born at 31 weeks gestation and really in only in the ISCU so that she can grow and develop her suck and swallow coordination so the feeding tube (NG tube) can be removed and she can either nurse on her mama or a bottle. This means I got to give her medications through her NG tube and gavage feed her. Unfortunately, as I had never set up a gavage feed on my own, it took a couple of tries to smoothly set it up on my own.

Feed #1: Everything was set up the right way (the nurse showed me how) but I didn't depress the plunger on the syringe that the food was in enough so it was awkwardly stagnant for most of the feed. Kind of embarrasing at the time, no big deal now.
Feed #2: Equipped with the knowledge of needing to give the plunger a good push, I thought I would ace this feeding effort. However, I made the mistake of not connecting the syringe to the feeding tube before putting formula in. When I took the cap off the syringe, forumla went EVERYWHERE. Awkward.
Feed #3: Success! I was pro by this point. Hooray!

All in all, it was a wonderful day and I've felt really proud of myself working in a more autonomous nursing role. Win!

Next week: Surgical Observation Day

Babies Smell Like Warm Cheese.

I blame it on the breast milk (which is all over my scrubs due to a gavage feeding mishap described alter). I never had the chance to notice this scent during my stint in L&D because most of the babies were still guzzling down colostrum (the pre-milk if you will). After my first day in the ISCU (Infant Specialty Care Unit) I had more than enough time to peg down that odor.

Here is what I find really cool so far this term during my peds rotation: I'm actually doing something for the first time. While the interventions may be simple (gavage, diaper changes, and med administration) it's the first time in my clinical experience where someones care is almost soley in my hands. And knowing what to do when and why is a pretty cool feeling.

Today my patient was a 2 week old infant born at 36 weeks. After an emergency section, the baby was hypoxic and wasn't breathing very much/well for about the first five minutes of life and about 10 hours later began having seizures. The last 2 weeks have been a time of stabilization, understanding what damage may have occured during the hypoxic period, and controlling the seizure episodes.


It's not uncommon for preterm infants to have difficulty nipple feeding as their sucking and swallowing reflexes are not properly coordinated. In addition to this, my patient isn't always the most alert baby (as in no crying or fussing what she's hungry and pretty drowsy during feeding) so the majority of her feeds are done via gavage (a fancy way of saying feeding tube + gravity). So, today I learned how to set it up, how to fortify her mom's breast milk, and how not to take it all apart in the end. Basically, the lesson of this story is don't try and unhook a feeding syringe from a feeding tube with a baby in one arm or the tube residual will likely end up all over your clothes and the floor (luckily not a great quantity but enough to be frustrating).

I also got to administer my patient's anti-seizure medications through the same  NG tube that her meals come through. Pretty simple, its just depressing a plunger slowly, but it's still a novel feeling to dispense medications almost by myself (someone still has to watch as I am still a student).

The rest of my day was spent snuggling a different patient who is a withdrawal baby and just needed some TLC and an occasional pacifier to nibble on. The only danger with this is when you are sitting in a dark room, rocking in a chair, holding a warm baby after getting up at 5:30 to get ready you find yourself nodding off occasionally. So cozy!

Tomorrow I will be with the same patient but things will go much smoother as I made the awkward mistakes today! Until next week!