Anthony Stiles

Pediatric Nursing

19 September 2020

PICU Experience

Today, Abby and I had the opportunity to spend our clinical day in the Pediatric Intensive Care

Unit. The nurse I was originally shadowing, Courtney, was assigned to a one-to-one room with a 2-year-

old boy recently diagnosed with acute lymphocytic leukemia. The patient was admitted the day prior

with extreme fatigue was found to have three segments of infarcted bowel. The dead bowel tissue was

removed in emergency surgery, and he was left with an open abdomen to re-enter within the next

couple days. The boy had several drains connected to him, several lines, and many drips and sedatives

connected as well. Courtney gave me the ins and outs of this patient and explained thoroughly the

procedures that she is responsible for during the boy’s stay. I was then moved to Abby’s patient’s room

where an infant resided with several heart defects resulting on him being placed on ECMO. An ECMO

specialist was in the room monitoring the baby and machine and provided me with a huge amount of

information and even pulled up videos of the infant’s diseases to show me how his heart was

functioning. The final patient we visited was a 6 year-old who unfortunately was caught in the line of fire

of a drive-by shooting. The bullet had entered through her right eye and became fragmented in her

skull. I assessed her eyes; her right pupil had been blown and her left presented with a very abnormal

reflex in which the pupil constricted and then immediately dilated. We observed the neurosurgeon drain

her head to decrease her ICP, however, it soon started rising again due to her brain liquefying. The nurse

responsible for the young girl asked us questions, explained all of the procedures, and demonstrated

how to operate her vent as well.

 There are many specialized nursing procedures and care measures that the nurse must tend to

in the pediatric intensive care unit. A huge consideration is the child’s risk for infection while they are in

these vulnerable states. It is vital to keep all clean areas clean, maintain proper hygiene when the

patient is incapable, empty all drains when appropriate, and try to assist in keeping the child’s stress

levels low, and ensure cleanliness and suction of the ventilator if the patient is on one. Respiratory and

cardiac functions are constantly monitored and appropriate interventions must be acted upon promptly

in order to avoid further complications. Adequate hydration and nutrition is vital in all aspects to ensure

proper functionality of the body’s systems and an expedited healing process. It is very important for

family to be present and participate in the child’s care. The presence of family reduces the child’s stress

levels and makes the experience much less traumatizing. It is also important to consider how the parent

is feeling and to answer any questions they may have honestly. The pediatric nurse has an endless

amount of responsibilities as the primary caregiver in the PICU. They are responsible for constant

supervision, monitoring vitals, detecting trends in the patient’s condition, carrying out any nurse-related

procedures, and calling any physicians or specialists.

Ultimately, I feel as though this clinical experience has been one of most beneficial to me

throughout the entirety of nursing school. All of the nurses I spoke with were tremendous educators and

did anything in their power to explain things so that we would understand. The patient situations we

observed were very difficult to see for me due to my closeness with my 2-year-old niece and my 6-year-

old nephew; the nurses also touched on how they manage to cope with and differentiate their lives in

the PICU from their lives at home. Before today I had no idea about which nursing specialty I would like

to pursue in my future, however, the nurses on this floor have turned me to the direction of intensive

care. I would love another opportunity to spend time in the PICU.