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Profile of Leaning Opportunities PICU/WARD 12 GNCH

Pat Milne Jan 2012

Ward Profile

Ward 12 GNCH/PICU

WARD 12 GNCH/PICU is a lead centre for the provision of

intensive care to children 16 yrs and under. We take patients with a wide

variety of conditions, both medical and surgical. The Great North

Children’s Hospital is a Supra-Regional Centre for Bone Marrow

Transplantation and Regional Neurosurgery, Neurology, Immunology,

Immune Deficiency and Infectious Disease Respiratory Disease and

Paediatric Surgery.

WARD 12 GNCH/PICU takes patient from these specialities and

from other departments and District General Hospitals requiring High

Dependency, or Intensive Care level 1, 2, or 3.

There is a Retrieval service, staffed by the unit that undertakes

inter-hospital transfer of critically ill children.

We work a 12 hour shift pattern shifts beginning at 7:30 ending

8:00. Breaks are morning coffee, lunch and tea, totalling one hour per

shift.

Twelve shifts are to be worked in a four-week period.

Students are expected to wear uniform on this placement

The off duty is partially self-rostered, staff entering their preferred

shifts but this can be subject to change if the ward is not adequately

covered

During this placement students will be given a named mentor and

co mentor, and will be closely supervised.

There are opportunities to gain experience and skills in the

assessment and care of the High Dependency and Critically Ill child.

There are many disciplines involved in the care of the critically ill

child and opportunities are available to liaise with other members of the

multi-disciplinary team.

The work of the unit is interesting and varied, and no two days are

the same.


Pat Milne Jan 2012

Paediatric Intensive Care Offers opportunities for the student to

observe and take part (under supervision) in the assessment, treatment and nursing care of critically ill children.

We take infants and children with a variety of medical and surgical

problems. All of who require close monitoring and/or the medical support of one or more body systems.

In Intensive Care treatment involves many different specialities and

our multi-disciplinary team is extensive. The student will have opportunities to see joint decision making in

action. Involving families, medical and nursing staff. Ethical issues crop up frequently and there will be opportunities to discuss ethics, you may also be able to experience the issues at first hand.

Learning Opportunities Resource/Personnel/Department

Assessment of the critically ill child

Normal and abnormal parameters

Use of invasive and non-invasive monitoring

Accurate recording of findings

Reporting findings to other members of the multi-disciplinary team

Nursing and Medical staff

Airway protection Not intubated

Assessing the airway

Positioning the patient for optimal airway protection

Use of airway adjuncts geudel airways, nasal stents, tracheostomy

Replogle suction apparatus Intubated

Assessment

Secure tube fixation

Moving an intubated patient



Pat Milne Jan 2012


Breathing Non ventilated

Assessing breathing rate pattern work of breathing

Secretions, requirement for physiotherapy/suction

Oxygen saturations

Blood gases Ventilated

Understanding the function of a ventilator (invasive and non-invasive)

Setting up ventilator circuit

Observations of the ventilator

Assessing the patient response to ventilator

Secretions, requirement for physiotherapy/suction

Oxygen saturations

Blood gases

Nursing and Medical staff Physiotherapist Nursing and Medical staff Physiotherapist

Using devices to increase inspired oxygen

Facemasks plain and high flow

Nasal cannulae

Using humidity to loosen secretions


Using resuscitators Bag valve mask (Ambu bag) Rebreathe circuits



Pat Milne Jan 2012


Circulation

Assessing cardio-vascular status using skin colour and temperature, invasive and non invasive blood pressure, central venous pressure, ECG and urine output

Trouble shooting medial devices for monitoring circulatory status

Accurate recording of observations

Communicating information to the multi-disciplinary team


Providing fluid resuscitation

Recognising the fluid depleted child using assessment skills

Administering prescribed fluids safely and accurately

Recording fluid balance


Inotropic support

Understand the mode of action of inotropes

Observe the calculation and administration of continuous infusions of inotropes to support circulation

Observe the precautions needed to change syringes of drug safely


ECG

Recognise normal rate/rhythm on ECG

Recognise potentially lethal changes in ECG



Pat Milne Jan 2012


Neurological

Assessing conscious level using the Glasgow Coma Score

Knowledge of normal developmental milestones

Applying the Glasgow Coma Score to young children

Applying the Glasgow Coma Score to sedated/paralysed patients

Nursing the patient with Traumatic Brain Injury

Care of the Post-Op neurosurgical patient

Care of the patient having seizures

Invasive monitoring of Intracranial Pressure

Care of the patient with an External Ventricular Drain in situ

Care of the patient with Meningitis/encephalitis/brain abcess

Nursing and Medical staff Specialist nurses Epilepsy/Neurology Occupational therapist Speech therapist

Care of patients with a neurological deficit

Hemiparesis and other motor impairments

Sensory deficits

Speech problems

Poor cough and gag reflexes

Nursing and Medical staff Physiotherapist Occupational therapist Speech therapist


Pat Milne Jan 2012


Nutrition and Elimination

Assessing the calorific requirements of patients with various medial problems

The importance of establishing enteral feeds as soon as practical

The provision of parenteral feed/fluid if the gut is not functional

Specialist care of trans-anastomotic tubes

Accurate recording of fluid balance to ensure adequate calorie/fluid given

Monitoring blood glucose

Assessing the need for special types of diet/feed according to patient condition

Nursing and Medical staff Dietician Occupational therapist Speech therapist

Routes of feeding

Oral

Breast & Bottle

Nasogastric

Nasojejunal

Gastrostomy

Intravenous

PEG Feeds

Nursing and Medical staff Dietician Speech therapist Pharmacist


Pat Milne Jan 2012


Elimination

Monitoring urine output, weighing nappies/urinary catheterisation

Accurate recording of stool

Use of aperients/ suppositories/enemas

Urinary catheter care

Renal Replacement Therapy

Monitoring blood chemistry Care of Stomas

Ileostomy

Colostomy

Oesophagostomy

Nursing and Medical staff Dietician Pathology Laboratory Speech therapist

Infection

Infection control protocols, hand washing clean tidy environment

Obtaining specimens for culture and recording them

Monitoring patient temperature invasively and non-invasively

Calculation and administration of medications

Liaison between medical specialities Microbiologist/Infectious Disease/ intensivist

Nursing and Medical staff Pathology Laboratory Infection Control Nurse Domestic Staff Support workers


Pat Milne Jan 2012


Sleep and Activity

Assessing patients need for sedation or stimulation according to condition/age

Promoting normal activities as far as possible to promote development of the child

Administering medication to ensure adequate levels of rest, assessing the effects of medications given

Recording activity and periods of sleep/rest

Nursing and Medical staff Physiotherapist Occupational therapist

Hygiene Comfort and Safety

Assessing the hygiene needs of the child

Providing assistance with hygiene needs, mouthcare, eye care and skin care in a critical care area

Providing pressure relieving devices according to need

Positioning patient comfortably, ensuring good posture and joint protection

Nursing and Medical staff Physiotherapist Occupational therapist Tissue Viability Nurse

Wound Care

Assessing wounds

Dressing technique

Care of a patient with silo bag in situ

Wound drains

Nursing and Medical staff Tissue viability nurse


Pat Milne Jan 2012


Family Centred Care

Liasing with patients and their families

Offering support and information to relevant family members

Aspects of confidentiality

Child protection

Liase with other agencies, social worker, chaplain, police, community teams.

Nursing and Medical staff Social worker Parent accommodation Manager Community teams

Physiotherapist

Occupational therapist

Dietician

Nursing

Health visitor

GP

Intensive care provides an opportunity to practise patient care on a

one to one basis. Care is delivered using some basic guidelines but each patients care is tailored individually.

The care planning and assessment take place in view of the patients changing condition and prioritising the needs of the patient is reviewed constantly.

The student nurse will be able to observe the dynamic process of nursing the critically ill child.

Although supervised at all times there may be opportunities to undertake care planning and delivery for the more stable patient.


Pat Milne Jan 2012

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