Week 4 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 8, 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 was allowed to

assist in initiating HFOV on an infant whos PaCO2 and PaO2 did not respond to CMV despite

VV-ECMO cannulation. HFOV is indicated as a lung protective strategy for pediatric patients

who have air leak syndrome and diffuse alveolar disease. It is a mode of ventilation that has Paw

(acts as PEEP), Delta P (acts as tidal volume), Hz (acts as breath rate), and FiO2 as the set

parameters. Upon reviewing the patients chest x-rays, I recognized bibasilar atelectasis and

bilateral apical pneumothoracies. Because his lungs were underdeveloped, the patient was

placed on HFOV to improvement oxygenation without causing more damage by inducing

ventilator related lung injury. This scenario allowed me to reinforce and gain knowledge about

HFOV and its indications as it related to the pediatric patient.

Targeted Learning Outcomes

1. Demonstrate clinical information gathering and assessment skillsets as applicable to
specific patient scenarios and pathology.
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 9, 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 was
 Week 4 Narrative

allowed to assist in intubating a patient who was RSV+. The patient had a history of a vascular

ringoccurs when one of the great heart vessel wraps around the tracheathat caused her to

have constant adventitious breath sounds. Upon assessment, the two year old female was

tachypneic, nasal flaring, retracting, and grunting. This reinforced prior knowledge of the

cardinal signs of respiratory distress in pediatricsnasal flaring, to increase surface area to

inhale more oxygen, gruntingthe closing of the glottis over the trachea to increase lung

pressure during exhalation to allow alveolar opening, and retractionsthe inward moving of the

thorax as a result of low lung compliance. These characteristics all aid in increase WOB, which

in turn leads to poor gas exchange.

Targeted Learning Outcomes

1. Demonstrate clinical information gathering and assessment skillsets as applicable to
specific patient scenarios and pathology.
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 10, 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 extubation on paitent

after a successful CPAP trial. This tasks allowed me to reinforce knowledge about the criteria

that should be met for extubation. This patient had a gag reflex upon suctioning, indicating that

he could protect his airway, as well as a RSBI of less than 105. The patient was able to maintain

spontaneous exhaled tidal volumes within normal ranges for his weight while maintaining an

acceptable SaO2. Because the patient was a child and not able to follow instruction, instead of
 Week 4 Narrative

telling the patient to cough or take a deep breath, I initiated a deep breath during while

simultaneously removing the ETT.