1. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level PICU Nursing Lauren Turner RN, MS, CCRN, CCNS February 5, 2014

2. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level What is the PICU?

3. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level “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

4. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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

5. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Family has a new baby! Baby sick at birth? They will go to the NICU with Dani If Baby is healthy they go home! Once baby has gone home and then gets sick, they will come to the PICU Welcome to the PICU!

6. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Sample PICU Diagnosis By System Neurologic: –Seizures –Traumatic Head Injury –Drug Overdose/Depression/Suicide Attempt –Hydrocephalus, VP Shunt Failure –DI/SIADH –Aneurism –AVM

7. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Sample PICU Diagnosis By System Respiratory: –Pneumonia –Respiratory Failure –Asthma –RSV –Croup –Flu! –Cystic Fibrosis –Surgery: Tonsillectomy & Adenoidectomy –Facial reconstruction

8. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Sample PICU Diagnosis By System Cardiovascular: –Heart defect –Heart Transplant –Cardiogenic Shock –Abnormal heart rhythms (SVT, V Fib, flutter)

9. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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)

10. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Common Pieces of Equipment in the PICU Monitor Ventilator IV Pump Suction Crash Cart Central IV Line Surgical Drains

11. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level You can have patient’s that you can pick up, hold and interact with

12. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level You will also have very unstable patients who require diligent monitoring

13. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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.htmlhttp://www.ipfcc.org/advance/topics/family-presence.html What are some examples of family centered care?

14. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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

15. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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

16. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level QUESTIONS?

17. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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

18. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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?

19. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Oxygen! Cardiac monitor Continuous pulse ox IV placed with IV fluids What tests will be performed? Blood work Flu and RSV

20. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Who will help in her care? –Nurse –Doctor –Respiratory therapist –Nursing assistant –Child life specialist –Unit secretary –Family!

21. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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.

22. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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.

23. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 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?

24. Click to edit Master title style Click to edit Master text styles –Second level Third level –Fourth level »Fifth level Nurses Doctors (PICU and Neurosurgery) Respiratory therapy Nursing assistant Unit secretary Chaplin Child life specialist PT/OT when awake and able to move.