Week 5 Narrative

Targeted Learning Outcomes

1. Demonstrate clinical information gathering and assessment skillsets as applicable to

specific patient scenarios and pathology.

2. Perform basic and advance therapeutics related to airway and drug management

and ventilator management as applicable to the pediatric patient care setting.

February 14, 20170645-191512 hours

During this shift, the I continued to perform basic assessment gathering that include

patient-ventilator assessment, and CBG/arterial line sampling and analyzing. I performed

extubation a two-year-old female who was intubated as an airway protection mechanism. The

patient was not able to effective cough or maintain oral secretions. Upon assessment for

extubation, the patient was able to produce a strong cough upon stimulation. This is important to

assess as a cough or gag reflex is indicative of the ability to protect the airway from aspiration.

Her RSBI was 75 when place in CPAP. RSBI is indicative of the patients ability to

spontaneously breath adequate tidal volume with a normal breath. If the RSBI is greater than

105, the patient is at risk for respiratory muscle fatigue if extubated. This could lead to an

increase in PaCO2 causing the patient to have respiratory acidosis. Once the patient was

extubated. She was placed on BNC at 2 lpm.

Targeted Learning Outcomes

1. Demonstrate clinical information gathering and assessment skillsets as applicable to

specific patient scenarios and pathology.

 Week 5 Narrative

2. Collaborate with patients, patients families, and other disciplines of the health care

team to educate the patient/family on disease management via the used of

therapeutic modalities related to the patient.

3. Perform basic and advance therapeutics related to airway and drug management

and ventilator management as applicable to the pediatric patient care setting.

February 16, 20170645-1915-12 hours

During this shift, I continued to perform basic assessment and data gathering skills such

breath sound auscultation, blood gas sampling and analysis, and CXR interpretation. I assisted

in the initiation of a patient 5-week-old patient on a high flow nasal cannula. A high-flow device

is indicated for patients who need a given oxygen concentration at a flow equaling or exceeding

the patients peak inspiratory flow rate. High flow can be achieved with an air entrainment

device or a blending system. A true high flow device must provide 60 lpm of total flow. High

flow systems can achieve and FiO2 of .21 to 1.00. This patient displayed the cardinal signs of

respiratory distress in pediatric patientsretractions, nasal flaring, and grunting. The patient

was placed on high flow to aid in increasing his PaO2 levels and to improve the signs of air

hunger. This scenario allowed me to reinforce my knowledge about the indications for high

flow oxygen delivery devices and educate the patients family on why the system was chosen.

Targeted Learning Outcomes

1. Demonstrate clinical information gathering and assessment skillsets as applicable to

specific patient scenarios and pathology.

 Week 5 Narrative

2. Collaborate with patients, patients families, and other disciplines of the health care

team to educate the patient/family on disease management via the used of

therapeutic modalities related to the patient.

3. Perform basic and advance therapeutics related to airway and drug management

and ventilator management as applicable to the pediatric patient care setting.

February 17, 20170645-191512 hours

During this shift, I continued to perform basic assessment gathering skills such as routine

patient-ventilator assessment and CBG sampling and analysis. I performed nasal tracheal

suctioning on a 2-year-old patient who presented with adventitious breath sounds in all lung

fields (course crackles). Upon suctioning, the patient had copious amount of think green mucus

that required the used of normal saline to act as a thinning agent. This scenario allowed to be to

gain and reinforce knowledge about the technique of suctioning a pediatric patient with the nasal

suction catheter. Prior to suction, I preoxgenated the patient for at least 30 seconds. Throughout

the process I made sure to take no longer than 15 seconds from beginning to end. Between each

catheter pass I flushed the suction tubing with saline to prevent mucus plugged, as well as

reoxygenating the patient.