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My particular experience occurred on the very first day of my pediatric rotation, where I
was assigned to the pediatric intensive care unit (PICU). I was extremely nervous to start the
assignment because I hadnt had much experience with children, especially not children dealing
with medical illness. The nurse I was assigned to was extremely nice, however, and put me a
little more at ease with the nursing process and the procedures on the unit.
On that day, our assignment included a 17 year old boy that Ill call T.J. At a very young
age, T.J. was involved in a pedestrian versus auto accident that made him quadriplegic and the
recipient of a permanent tracheostomy. Ever since then, his parents have shouldered most of the
responsibility for his care; I recall being amazed at how well they cared for him. T.J.s mother
was very in-tune with her sons medical needs, his baselines, and his mannerisms. I watched her
and T.J.s father converse with him as they might anyone else and T.J. responded back with
smiles and eyebrow movements. Overall, the entire family was very sweet and so gracious to the
nursing staff.
T.J. was admitted to the PICU after his mother noticed that he had some abnormal oral
and tracheal secretions. She indicated that something just didnt feel right and that she wanted to
get him checked out at the hospital. Prior to my assignment, he had already been in the hospital
for at least a week or so. The medical and respiratory teams suspected that T.J. might need a
different sized tracheostomy tube because, apparently, there was some difficulty placing a new
tube at some point during his hospital stay. Also, most importantly, on this admission T.J. had
already coded about four or five times in the PICU, with at least one of the codes stemming from
the suctioning of his trachea. Ultimately, it was not quite apparent what exactly was wrong with