Peds Part I

I read a great blog (510 Medic) about the importance of taking vital signs in pediatric patients. The author cites great research on how often vital signs are not taken, especially blood pressure which puts our patients at risk if we are unable to properly assess and measure vital sign data. This issue cannot be underscored and is applicable to all providers in the emergency services - both pre-hospital and in the hospital. I often get asked about pediatric assessments (including vital signs) from nurses and paramedics alike. My answer is always the same...what does the child look like and do the vital signs match the rest of the clinical picture?

For instance, some years ago I had an ED nurse tell me that an infant had a respiratory rate of 8 - 10 and was in no distress. Apparently I had an alarmed look on my face as she questioned my concern. I asked, "what does the child look like - color, skin temp, capillary refill, respiratory effort, etc.?" She proceeded to tell me the child was comfortably sitting in the mother's lap, skin very warm, flushed cheeks, but taking Pediatlyte from a bottle. Obviously I reassessed the child including vital signs and found that the respiratory rate was in fact almost triple the original rate and the heart rate was quite tachycardic due to fever.

It is important that we synthesize all the patient data and evaluate what we are hearing or seeing. Does it make sense with the clinical picture?

Thanks to 510 Medic for addressing a topic near and dear to my heart! Stay tuned for Part II with a discussing breaking down the numbers and correlating to the pediatric assessment.

Celebrate Clinical Nurse Specialists!

2nd Annual National CNS Week September 1st - 7th

Clinical Nurse Specialist Facts from NACNS:

• Hildegard Peplau, RN, Ed.D. (9/1/1909 – 3/17/1999), is the founding mother of the CNS role. Rutgers University School of Nursing is the birthplace of the CNS role.
• Dr. Peplau was a nursing theorist who published a landmark work in 1952 titled, "Interpersonal Relations in Nursing." She emphasized the nurse-client relationship as the foundation for nursing practice, and the important partnership model that focused on shared experience through observation, description, formulation, interpretation, validation and intervention. This theory was considered "revolutionary", since at that time clients or patients typically were passively receiving treatment and nurses were merely acting out doctor’s orders. In 1956, Dr. Peplau established the first nursing Master’s Degree program with a focus exclusively on clinical practice. Graduates of this program were called "clinical specialists."
• Health systems across the nation are commemorating this recognition week. Plans include community activities and public lectures, receptions honoring Clinical Nurse Specialists, wellness fairs, community outreach, and fundraisers promoting the spirit of nursing, such as organized walks or golf outings which in turn support underserved communities or particular health concerns.
• An estimated 72,521 Clinical Nurse Specialists practice in the U.S. They are licensed registered nurses who hold masters or doctorate degrees in nursing.
• CNSs are expert clinicians in a specialized area of nursing practice. The specialty may be identified in terms of a population (i.e. Pediatrics), a setting (ie. Emergency Dept.), a disease or medical subspecialty (i.e. Diabetes), type of care (ie. Psychiatric), or type of problem (i.e. Pain).
• CNS practice improves the healthcare environment and outcomes by influencing: direct care of patients/clients, nursing standards and personnel, and care delivery systems. In other words, as leaders CNSs drive innovation in their environments from care at the bedside to system-wide improvements.
• Examples of outcomes of CNS practice: reduced medical complications in hospitalized patients, reduced hospital costs and length of stays, improved pain management practices, increased patient satisfaction with nursing care, reduced frequency of emergency room visits.