Crazy Pupil Day

I love my capstone and I love my preceptor!  We have so much fun and she is a big jokester.  I have now worked 40 hours out of 225 for my capstone internship.  The last two full days I was there was very eventful. 

One of my patients had Acardi Syndrome and had off centered pupils that related to the neurological problems associated with this disease.  She was 23 months old and was born with no corpus callosum, which connects the two hemispheres of the brain.  Because of this, she has 3 different kinds of seizures numerous times per day (like 20 a day), is unable to see, speak, eat or walk.  The doctors did a scope on her and determined that she would need surgery to remove her tonsils, adenoids, and possibly shave her tongue in order to fix her current problem which was periods of apnea.  The obstruction in her throat was causing her to go severely hypoxic many times throughout the day.  Unfortunately, I did not see her after the surgery because she went to PICU, but hopefully everything was successful.

The second day was the day of respiratory illnesses, which is very prevalent at this time of the year.  Two of my patients had RSV, but one little boy was 4 months old and weight just over 4 kilograms.  He was born with hydroencephaly and some genetic disorders that they were doing biopsies for to figure out what exactly it was.  His pupils are described as 'Cat Eyes' which are asymmetrical in shape and a lot longer than a normal pupil.  He had a VP shunt placed 2 weeks before, but was back in the hospital because of respiratory issues.  They diagnosed him as having metapneumovirus, but were also trying to rule out pertussis and Chlamydia as possible causes of his respiratory issues.  The nursing staff mainly ensured his oxygenation and respiration rate, which at one point got up to 100 breaths/minute and was unable to eat because of his risk for aspiration.

This little boy’s parents were difficult to work with at times.  The mother was in her early 50’s and the father looked to be in his late 20s and they both lived at the Road Home, a local homeless shelter.  The mother has four other children, but all were taken from her by the state for reasons I am unaware of.  It was evident that the parents were very nervous about the health of their child and wanted to be notified of any changes in his care.  For example, they wanted to be called in the middle of the night if his oxygen needs changed from even .2 L to .3 L/minutes.  When they were not notified, they got very angry and patient relation services came and we all had a sit down conversation about how the staff and the family can work together.  The parents were mentally delayed and very emotional over the situation, but the PCMC employees were very patient and took a lot of time answering questions they had and in the end, everyone was happy with the plan of care for the child.

These are the main stories of the Infant Unit thus far because psychiatric rotations have been consuming my time.  Ha. Psych rotations.  Stories on that momentarily....