PICU Nursing LaurenTurnerRN, MS, CCRN, CCNS February 5, 2014
“Pediatric critical care nurses create an environment in which critically unstable, highly vulnerable infants and children benefit from the vigilant care and the coordinated efforts of a team of highly skilled pediatric healthcare professionals”. -Curley
PICU Patient Population • Neonates to Young Adults and their families • (ages I day to up to 21 years of age) • Patients with a congenital or childhood disease • Most diverse unit in the hospital
Baby sick at birth? They will go to the NICU with Dani If Baby is healthy they go home! Family has a new baby! Once baby has gone home and then gets sick, they will come to the PICU Welcome to the PICU!
Sample PICU Diagnosis By System • Neurologic: • Seizures • Traumatic Head Injury • Drug Overdose/Depression/Suicide Attempt • Hydrocephalus, VP Shunt Failure • DI/SIADH • Aneurism • AVM
Sample PICU Diagnosis By System • Respiratory: • Pneumonia • Respiratory Failure • Asthma • RSV • Croup • Flu! • Cystic Fibrosis • Surgery: Tonsillectomy & Adenoidectomy • Facial reconstruction
Sample PICU Diagnosis By System • Cardiovascular: • Heart defect • Heart Transplant • Cardiogenic Shock • Abnormal heart rhythms (SVT, V Fib, flutter)
Sample PICU Diagnosis By System • GI/GU: • Transplant (Liver, Small Bowel, Pancreas) • Kidney Failure • Organ Rejection • Complicated UTI • Toxic Shock Syndrome Complications due to: Diabetes Cancer Lupus Trauma (Child abuse, accident)
Common Pieces of Equipment in the PICU • Monitor • Ventilator • IV Pump • Suction • Crash Cart • Central IV Line • Surgical Drains
You can have patient’s that you can pick up, hold and interact with
You will also have very unstable patients who require diligent monitoring
Family Centered Care • …“recognize the vital role that families play in ensuring the health and well-being of patients. They acknowledge that emotional, social, and developmental support are integral components of health care. They promote the health and well-being of individuals and families and restore dignity and control to them.”Institute for patient and family-centered care. (2012). Retrieved October 20, 2012, from http://www.ipfcc.org/advance/topics/family-presence.html • What are some examples of family centered care?
Role of the PICU Nurse • You are being hired by Webster’s Dictionary as a new writer. They ask you to write your definition of a PICU Nurse… • The Day of a PICU Nurse
Role of the PICU Nurse Many days on the job I see myself being a… • Nurse • Social Worker • Physical and Occupational Therapists • Mediator • Housekeeper • Respiratory Therapist • Chaplin • Friend
Review Question #1 • A child admitted to the PICU can be treated for all of the following: (Choose all that apply) A: Asthma B: Low blood pressure C: Cardiac Surgery D: Diabetes
Mary, a 5 year old female was just admitted to the PICU due to an asthma attack. She used her home nebulizer, but it did not relieve her breathing difficulties. Her parents took her to the emergency room where the ER team treated her with 3 albuterol treatments. Mary continued to have respiratory distress and wheezing so she was placed on a continuous breathing treatment and admitted to the PICU. While in the PICU what does she need to be attached to?
Oxygen! • Cardiac monitor • Continuous pulse ox • IV placed with IV fluids • What tests will be performed? • Blood work • Flu and RSV
Who will help in her care? • Nurse • Doctor • Respiratory therapist • Nursing assistant • Child life specialist • Unit secretary • Family!
John, a 13 year old boy was skateboarding after school with his friends when he fell and hit his head on the cement. He was not wearing a helmet and at first said he felt ok. A few minutes later his friend said that he started to mumble and wasn’t making much sense. His friend called John’s mom, who took him to the emergency room.
When John got to the emergency room, his breathing was really slow and he was very lethargic. The ER team decide to sedate John and place a breathing tube. They then took John to get some CT images of his brain. The results were that John had multiple skull fractures and a brain bleed. He was them immediately transferred to the PICU for further care.
What kinds of things would John be attached to? • Cardiac monitor • Pulse ox • Ventilator • IV Fluids, sedation medication • May still be under spinal precautions • May have an ICP bolt to monitor brain swelling Who would be involved in his care?
Nurses • Doctors (PICU and Neurosurgery) • Respiratory therapy • Nursing assistant • Unit secretary • Chaplin • Child life specialist • PT/OT when awake and able to move.