Preparing for Heart Surgery

Parents' Booklet for Your Child's PICU Stay

Introduction

Welcome to the Pediatric Critical Care Center at The New York Hospital-Cornell Medical Center. Our Pediatric Critical Care Center provides the most advanced medical and nursing care available for critically ill children.

You are the most important people in your child's life. While your child is in our Center receiving specialized care, your attention, love and concern are essential. The Pediatric Critical Care staff understands that hospitalization is stressful for you and your child. We have prepared this booklet to familiarize you with the personnel, equipment, and policies of the Center and hospital. Please do not hesitate to ask questions. We will talk with you frequently to help you and your child in every way we can during your child's hospital stay.

Description of the Pediatric Critical Care Center

The Pediatric Critical Care Center is located on the 6th floor of the Greenberg Pavilion.

The Pediatric Critical Care Center consists of 20 beds designed for the care of the critically ill child who requires intensive monitoring. In addition, the Center includes step-down beds designed for children requiring less intensive monitoring. Frequently, children in this area are being prepared for transfer from the Center.

The bed assigned to your child is based on your child' s condition. Your child may be moved within the Pediatric Critical Care Center or transferred to one of the general pediatric units at any time. The physician in charge and the nurse manager or her designee will determine the area in which your child will receive care.

We care for people ranging from infancy to young adulthood.

Your Child's Needs

Each day your child is assigned a nurse who is responsible for his or her care. Your child's doctor and nurse will share with you whatever information is available and try to answer your questions clearly.

We encourage you to participate in your child's care. Please feel free to ask the nurse how you may participate (e.g. feeding, bathing, diaper changing). There will be times when the nurse must concentrate on what needs to be done for your child and may not be able to answer your questions right away. In situations of stress, parents sometimes forget what they want to ask when they meet members of the health care team. For these reasons, it is a good idea to jot down some of your questions.

Safety

The safety of your child is our primary concern. To ensure safety, side rails must be fully raised at all times. Please check to see that they are secure. Sleeping in the bed with your child is not permitted.

Flowers and balloons are not permitted in the Pediatric Critical Care Center for safety reasons. Please inform friends and family of this policy. Suggested gifts are stuffed animals and posters.

Cellular telephones are not permitted in the Pediatric Critical Care Center.

Maintaining the privacy of all our patients is a priority. We request you do not visit other patient's rooms or give patients food or drinks, as these may not be included in their special diets.

Smoking

Smoking is not permitted anywhere within The New York Hospital-Cornell Medical Center.

Visiting Policy

Regular contact with those close to your child is an important part of your child's care in the Pediatric Critical Care Center. We encourage you to participate in the care of your child whenever possible. Parents are welcome in the Pediatric Critical Care Center any time, day or night, for as long as they wish. However, we will ask you to step out of the room for the following activities:

• Morning and afternoon rounds
• Procedures
• Special circumstances, as indicated by the health care team

General visiting hours are from 12 noon to 8 pm. Visiting is limited to no more than TWO individuals at any given time.

Comfortable sleeping arrangements are available for one parent or parent designee in the quiet room. Due to the limited space in the Pediatric Critical Care Center and the parents' lounge, we request that you do not sleep on the chairs.

Your children need to feel part of the family, even in a crisis, and can benefit from being included in ways that are appropriate to their level of development. School age children can visit a sibling in the Pediatric Critical Care Center. Please notify your nurse prior to the visit. Siblings need to be well prepared beforehand for what they will see and hear. There are many ways that your children can be involved, for instance by making and sending cards and drawings to their sibling in the Pediatric Critical Care Center.

Environment

There is a television at each patient's bedside. A VCR and video games are also available. Tapes and games may also be brought from home.

We request that all jewelry, cameras, radios, expensive toys and clothes be taken home with you. We are not responsible for your valuables.

Parents may call the Pediatric Critical Care Center at any time. The number is:

212-746-0308

To ensure privacy, nurses and other members of the health care team will ONLY release information to parents. Please advise relatives and friends not to call the Pediatric Critical Care Center for information.

A parents' lounge is available for your use. We encourage you to use this room to take a break or have your meals. As a courtesy to the families of children in The Pediatric Critical Care Center, we have provided a telephone in the parent's lounge for outgoing local calls and 1-800 credit card calls. We ask that you be considerate and limit your calls on this phone.

Pay telephones are located adjacent to the elevators.

Bathroom facilities are located outside the parents' lounge.

Vending machines for soft drinks and snacks are located adjacent to the lounge. The Patio Cafe is located on the first floor near the information desk and a full service cafeteria is located on the B-level of the main building.

The Interfaith Chapel is located on the first floor by the main entrance to The New York Hospital. It is open 24 hours a day for prayer. A chaplain is available for bedside visits upon request.

Your Child's Pediatric Critical Care Stay

Children in the Pediatric Critical Care Center are monitored in various ways. Your child will be placed on a cardiac monitor which displays your child's heart rate and rhythm (EKG). Your child will also be placed on a pulse oximeter which monitors the concentration of oxygen in your child's blood (02 sat. monitor).

Many children also have arterial or venous pressure monitoring (A-lines and CVP's). Your child's nurse or doctor can explain the various monitors and devices to you as well as the variations that may occur with movement, crying, etc.

Many of our patients require intravenous catheters (IV). These can be placed in several different locations, including veins in the arm, neck, leg or groin, or the scalp in small infants. Medications, glucose or other electrolyte solutions are given through the IV.

Many diagnostic tests are performed in the Pediatric Critical Care Center. Special tests may require moving your child to a laboratory or scanner in another part of the hospital. We will accompany your child to these tests.

Preparing Your Child for Transfer/Discharge

During your child's hospital stay, the Social Worker will meet with you to discuss transfer/discharge plans, as well as any social or emotional issues that may arise.

Your child may either be discharged home from the Pediatric Critical Care Center or transferred to the general pediatric unit. Prior to transfer, a tour of the general pediatric unit can be arranged.

If your child was referred by a community hospital closer to your home, you may discuss the possibility of transferring to that institution with your child's physician.

This booklet is not meant to replace person-to-person contact between parents and staff. We encourage you to share your concerns and to ask questions often.

The staff of the Pediatric Critical Care Center is committed to providing the highest quality care for your child and to support you and your family during this difficult time.

Pediatric Critical Care - Patient Accounts

The bill to you for the services of the Critical Care physicians is distinct from the bill you will receive from The New York Hospital or other subspecialists. Care in the Pediatric Critical Care Center is rendered on a fee-for-service basis in which charges are submitted both for time and procedures. Our physicians are committed to providing the highest quality care for your child and we charge what is usual and customary for our area.

For your convenience, you may use your credit card or discuss your bill with our Accounts Administrators, in Room 6 South 6-329. Any questions you may have concerning your insurance benefits should be directed to your insurance representative. If you have no insurance, it is your responsibility to file the necessary papers to obtain Medicaid for your child. Please ask to speak with our Social Worker, Drisdy Kee.

The Critical Care Team

Your child will be cared for by members of a highly skilled health care team consisting of physicians, nurses and other health care professionals.

Attending Physician A physician who is Board-certified in Pediatrics and Pediatric Critical Care Medicine and who is responsible for the coordination and supervision of your child's care.	Nurse Manager The primary nurse responsible for the management of the unit and the coordination of your child's care.
Fellow A physician who has completed specialty training in Pediatrics and is specializing in Pediatric Critical Care Medicine	Assistant Nurse Manager A nurse who assists in the management of the unit's activities and the coordination of your child's care.
Resident A physician who is training to be a specialist in Pediatrics.	Critical Care Nurse A registered nurse specially trained in caring for critically ill children.
Certified Social Worker A person experienced in assisting children and their families with the stresses of serious illness and hospitalization.	Respiratory Care Professional A technician who is state-licensed in the operation and maintenance of various types of equipment, administration of oxygen therapy and ventilator management.
	Patient Care Technician A technician who is specifically trained to assist the nurse in caring for critically ill patients.

Definitions of Terms You May Hear Frequently

Ambu bag and Mask

A piece of equipment consisting of a rubber bag and face mask which, when squeezed by hand, fills the lungs with oxygen and assists breathing.

Antibiotics/Antimicrobials

Drugs which either destroy microorganisms (bacteria, viruses, fungi) or slow their growth. These drugs are used in treating infections.

Arterial Catheter (A-Line)

A special catheter that is placed in an artery and used to check blood pressure and draw blood samples. These catheters reduce the number of needlesticks for blood tests that your child may require.

Assessment

A periodic examination of your child by the physician or the nurse.

Blood Gases (ABG's)

A laboratory test to determine the amount of oxygen and carbon dioxide in the blood. This test helps in the assessment of lung and heart function.

Chest Physical Therapy (chest PT)

Therapy done by patting on the chest to loosen secretions.

Chest Tubes

Tubes inserted through the skin, into the space around the lungs to drain fluid or air.

Chest X-Ray

An x-ray picture of the chest showing the heart, lungs, and tubes or catheters that have been placed.

Electrocardiogram (EKG)

A graphic picture of the heart rhythm

Endotracheal Tube (ET tube)

A tube inserted through the nose or mouth into the windpipe (trachea) to maintain an open airway and permit removal of secretions. This tube is usually connected to a ventilator.

Foley

A catheter placed in the bladder to drain urine.

Intake and Output (I&O)

An accounting of fluid taken in, lost or secreted.

Nasogastric Tube (NG Tube)

A tube placed through the nose into the stomach to remove or administer medications or fluids .

NPO

An abbreviation meaning no food or drink by mouth.

O.R.

An abbreviation used for the operating room.

Oxygen (O2)

A colorless, odorless gas found in air and required to sustain life. The oxygen content of room air is about 21%.

Pulse Oximeter

A sensor that is placed on the hand or foot to monitor the concentration of oxygen in the patient's blood.

Respirator or Ventilator

A machine used to deliver oxygen into the lungs to assist breathing.

Sepsis

Infection in the blood or other tissues.

Spinal Tap (LP-Lumbar Puncture)

Insertion of a small needle through the skin of the lower back into the spinal canal to obtain a sample of spinal fluid.

Suction

Removal of mucous and fluid from the nose, mouth or endotracheal tube.

Vital Signs

Temperature, heart rate, respiratory rate and blood pressure.