Peds +

I'm so happy - I'm watching Bones. My very favorite show. I missed the season premiere last week - I'm sure that's why it was such a crappy week - except for all the other crappy things that happened.

So for this week. Scott and I went up to Mt. Lemmon on Sunday night - no, we're not dating - this is me we're talking about! But it was certainly nice to get out of the city.

The past weeks have brought me to a very disturbing conclusion, I think I may be destined for peds. I spent the past two weeks in a peds clinic and an elementary school. I actually really like the kiddos and I kind of think they like me. I'm sure this is no surprise to most of you but working with kids is not all popsicles and stickers. I'm worried about working with crazy parents, sending kids home with crazy parents and teenagers but I wonder if the potential for good outweighs the frustration. No decisions yet just some ideas. But so you can get an idea of what I have been doing during my rotation I'm posting my peds journals. Enjoy.

Overall Activities:

In the morning I discussed my goals with the nurse and we agreed I would focus on intake assessments. I was able to complete assessments, including rooming and documentation, on three infants and two children. Of the five children I assessed, two were in the clinic due to illness. All but one of my patients spoke English. My Spanish speaking patient brought her sister to translate. I felt comfortable obtaining histories – with my older patients (ages 9 and 12) I spoke directly to the patients and then asked the parent if I needed more information or clarification. I did feel awkward asking about domestic violence but I’m sure I’ll be more confident with practice. One patient had a suspicious story which I noted and then discussed with the physician. The parents and patients I worked with today were cooperative and, except for the patient cited above, forthcoming with needed information and were patient with me. I observed one of the residents unpack, assess, clean and repack a MRSA abscess. I gave two immunization injections and performed a genetic disease blood test.

Personal Reactions/Issues/Concerns:

I got off to a slow start – I don’t think I was clear enough the nurse I was working with regarding my goals and what I could do. While I didn’t perform much patient care in the beginning of the day I did get a better idea of the paperwork and organization involved in running a clinic. Once I clarified my goals I was given more opportunities to participate in patient care. I learned today that at times I will have to speak up more when I want learning opportunities.

Overall Activities:

We didn’t have very many patients in the morning so I shadowed the nurse as she went through her morning routine and performed intake assessments as patients came in. In the afternoon we had three extra doctors in for their private patients so I was busy doing intake assessments and documentation. I didn’t get a chance to learn the vision and hearing tests as the one patient that needed it was sent home before I was given the chance.

Personal Reactions/Issues/Concerns:

I enjoyed the people that I got to work with and the patients, however, I found clinic work to be slow and repetitive. It seemed to me the RNs mostly do paperwork and intake assessments but besides that have little patient contact. There weren’t many opportunities to do procedures as they aren’t normally done in the clinic and shots/immunizations/etc are given by a CNA (who wasn’t allowed to supervise me). It was interesting to see the difference between a clinic setting and a hospital setting but I think, for now, a clinic is too slow and limited for me.

Overall Activities:

The plan was for me to do hearing and vision screening for the majority of the day; however, so many children came in sick today that I ended up working with nurse. I was able to do evaluations of fevers, sore throats, scrapes, stomachaches, headaches, asthma and a few minor head injuries (I was very excited to use my penlight!). I sent a few kids home with fevers and sore throats. I even got to help clean up a couple of “spills” and “accidents”. I did learn how to do a hearing test – and the child we practiced on failed his hearing test in his left ear. I was able to look into his ear with the otoscope – very cool. He was sent home to have x-rays of his wrist (his chief complaint) and to see his pediatrician about his hearing. After talking to the nurse about my peds project I decided to focus on one of the children with asthma. The nurse told me there has been an increase in the number of children with asthma so I thought it would be good to research and teach on (besides, maybe I’ll learn more about how to treat my own symptoms).

Personal Reactions/Issues/Concerns:

The children that came in were really sweet. I enjoyed working with them. It took me a little while to warm up to them but after observing Dr. Chapman’s interaction I was more comfortable and better at getting them to talk to me. By the end of the day I was able to care for children on my own while the nurse was working with others (of course she always checked my evaluations). I thought the nurse was good at her job, needed more help and a better organization system. The kids really love her though and it’s obvious how much she cares for them.

Overall Activities:

This morning I helped with the children that came in sick – lots of scrapes, bruises and bumps. Midmorning I started on vision and hearing exams. One of the children (kindergarten age) I tested was undiagnosed color blind, which was interesting. What he saw and what I saw were completely different. I tried to be very encouraging and not let on that there was anything different about his test. During my afternoon testing I had a child who wanted glasses (he told me) and then tested 20/200 on his eye exam. I think he’s going to have to be retested. Unfortunately the boy who comes in for nebulizer treatments came in while I was testing so I didn’t get to do any teaching with him nor did I get to set up his treatment.

Personal Reactions/Issues/Concerns:

I really enjoyed my experience the elementary school. The children were delightful to work with and the staff was helpful and grateful for all that I did. I don’t think I want to be a school nurse anytime soon but possibly later in my career. I like that as a school nurse you can influence a child to be healthier and teach parents. I think it could be a very rewarding position.