Ped’s rotation, I’ve been assigned to a pediatric ward with 18 beds and all pediatric aspects including some interdisciplinary beds (pediatric trauma/orthopedic surgery)
Due to the summer vacation in my part of germany, not many children get sick. The admission-rate is far low, the ammount of work you have to do is enjoyable small and everybody says, it is the last time you get so much time for your patients.
Todays lateshift statistics
Patients in my direct care: 3/4
Diagnoses:
- 16 year old girl with suspected commotio cerebri
(Biggest nursing problems: Beeing herself; Electrolyte inbalance)
- 3 year old boy with suspected commotio –> subarachnoidal bleeding –> commotio
(Biggest nursing problems: Stabilizing the patient, monitoring the patient
- 9 year old,heavily disabled child with pneumonia suffering seizures
(Biggest nursing problems: Handling perfusors and infusion-pumps without getting the I.V. blocked)
- 14 year old girl with abdominal pain –> suspected appendicitis –> ovarial cyst
(Biggest nursing problems: Communicate with the patient, Pain management
Punctual at 13:30 the new patients arrived from one to each other, which wasn’t good for our staff settings. Our pediatric clinic is half shut down and there is only one pediatrician in the lateshift. The chief of pediatrics is usualy avaiable but far to busy for doing things the intern has to handle.
Commotio cerebri, which was the main actor starring in our todays shift is a diagnose you have to handle very carefully! It is nothing popular among nurses because the patient needs to be monitored frequently (hour per hour, in acute care every 15minutes with complete monitoring and pupil check which is very unpleasant during night) and the patient does not like this. The problem with commotio is its quickness, if symptomes of a brain-bleeding occur, they occur very quick and hump over each other. If you see a dilated pupil or a pupil difference, the other symptoms like speech problems or neurologic symptoms are in a quick reach. I personally saw a pupil difference twice only, and in one case it was hard to see. Today was the third time and I felt the child factor. If you see a lovely 3 year old boy with pupil difference, you react different than on adults. I cannot explain this, because it was a mistery for me and it still is.
The boy needed and emergency MRI and CCT, which revealed nothing special, the next tryout was meningitis, the following lumbar puncture was scene of agony and misery because he was something different than cooperative. The final diagnosis is still not given, and maybe it wont be given anyday.
My ICU like doing was interupted by my other patient, which is highly depenent and seriosly ill.The perfusors and infusion pumps need to be monitored frequently and this patient was particular bitchy about I.V. lines (Which are very hard to get on children, I learned this very hard) because if they were not blocked with heparine they got clotted in minutes, which is something you need to avoid if you know how hard it is to get a needle in this patient.
The next hard rule of pedi-nursing is: You always got two patients..the child and the mother/father which are more agitated and more full of problems. Children are a product of their parents ability to teach and guide, children are not responsible for their parental-induced faults, but they got many years to deal with it so they become not such a bunch of idiots like their parents…a mission many will not archieve.
After 5pm the whole workflow was gone…everything done
Stephan
["If liberty means anything at all it means the right to tell people what they do not want to hear!"]
August 23rd, 2009 von 
Daniel 
Yesterday’s philosophical BBQ round brought up the evergreen of ridiculous topics: ELVIS.
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