A neonatal intensive care unit (NICU) is where a premature or sick baby is kept until they recover and become strong enough to survive without medical aid. If you happen to pass by the unit while in a hospital, you might feel overwhelmed, looking at tiny babies covered in tubes and wires.
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If you're a new NICU nurse, here are the most common NICU terms you should know. Besides knowing what the terms mean, learn why you need to know them.
NICU terminology explained by mothers of twins, all of whose premature multiples spent time in the neonatal intensive care unit.
NICU NURSE CHEAT SHEET from dortoms NICU NOTES Download from above link or you may print for acceptable view. Remember to look at the whole baby. Numbers are just numbers!! THE HARDWARE WHERE IT SHOULD BE UAC (high-lying) Insertion depth = BW(kg) X 3 + 9cm; T6 - T10 UVC (high-lying) Insertion depth = 1/2UAC + 1cm; at or little above the diaphragm UVC (low-lying) insert 2-3cm for emergency use Endotracheal Tube Weight(kg) + 6 = cms at the lip; T2 - T4; check for chest rise, equal air entry and lack of gastric air Pulse oximeter foot, hand, great toe or thumb (large infant), wrist (micropremie); light emitter and detector of probe must be facing each other through baby's extremity to be accurate!! Oral or Nasal Gastric Tube Insertion depth = Distance(cm) xiphoid process to ear lobe to tip of nose; listen for air pushed in stomach (1-2cc); aspirate (should get back air & any stomach contents) Skin Temperature Probe Supine - exposed area of abdomen (best reading over liver area); Prone - soft tissue of right or left flank; do NOT place under baby or on bony area (i.e. spine or ribs) ENDOTRACHEAL TUBE SIZE <1kg 2.5mm> TOTAL FLUID VOLUME TFV = ml/kg/day IV rate = TFV ÷ 24 =ml/hour CALCULATIONS FOR GTTS Alert: watch whether using mcg or mg! Order: mcg/kg/min dose(mcg) x wt.(kg) = mcg/min mcg/min x 60(mins/hr) = mcg/hr mcg/hr ÷ 1000 = mg/hr mg/hr ÷ ml/hr (IV rate) x total volume (ml in syringe or bag) = quantity on hand (mg in bag or syringe) Order: mg/kg/hr dose(mg) x wt.(kg) = mg/hr mg/hr ÷ ml/hr (IV rate) x total volume (ml in syringe or bag) = quantity on hand (mg in bag or syringe) To determine rate based on dose & concentration: mg/hr ÷ quantity on hand(mg) x total volume(ml) URINE OUTPUT Urine total ÷ hours (i.e. 24 for a day, 8 or 12 for a shift) UOP should be ≥ 1 ml/kg/hour 1000 mcg = 1 mg; 1000 mg = 1 gram; 1000 grams = 1 kg; 1 kg = 2.2046 pounds; 1 ounce = 28.35 grams; 1 pound = 453.6 grams; 1 teaspoon = 5 mls; VITAL SIGNS Temperature Heart Rate Respirations Mean Blood Pressure Normal 97.8o to 99.0oF (36.5o to 37.2oC) 120 - 160/min.; some healthy term infants have a low, resting heart rate (90 - 110/min.) 40 - 60/min; variable, may count rates of 30 - 65 in a healthy infant The Old Adage: MBP = gestational age ± 5; today many providers prefer MBP = GA + 5 or refer to a chart; increases with GA, weight and age of life Common Considerations for Below Normal Values low fat stores, hypoglycemia, hypoxia, acidosis, sepsis, environmental factors (air temp., drafts, cold surfaces, wetness), skin probe problem, phototherapy (false high reading of skin probe; if shiny probe cover used w/phototx - cover shiny part w/tape) bradycardia (HR <> apnea (0 respirations for >20 secs. or accompanied by bradycardia) vs. normal periodic breathing, central apnea (no resp. effort) vs. obstructive (secretions, positioning, anomalies, equipment-related), with or without retractions (respiratory vs. cardiac/other etiology), prematurity, sepsis, hypoxia, anemia, polycythemia, gastric reflux (raise HOB, position left side or prone, slow gavage feed), cardiac (i.e. PDA, CHD), neurologic (i.e. IVH, seizures), narcotics, pain, adenosine, maternal magnesium therapy hypovolemia (check IV & rate), sepsis, decreased cardiac output, PPHN, tension pneumo (rapid destabilization), UAC or equipment related (dampened waveform? reduced pulse pressure? bubbles in transducer or arterial line?), check tubing and pump if on vasopressors (disconnect before fixing to avoid bolus), pain Common Considerations for Above Normal Values infection, narcotic withdrawal, environmental factors, skin probe not on or in bad position, phototherapy (turn NTE/ISC down; turn back up when phototx dc'd), excessive activity (large infants), IV prostaglandins anemia, hypoxia, sepsis, supraventricular tachycardia (HR > 220 & QRS <> respiratory distress, TTN, pneumothorax, anemia, hypoxia, sepsis, cardiac (i.e. PPHN, CHD), hyperthermia/over-heated infant, narcotic withdrawal, pain shock, cardiac, renal, bronchopulmonary dysplasia, IVH, PDA, fluid overload (correct total fluid volume?), UAC or equipment related (check level of transducer & zero), vasopressor bolus (recent line change? check tubing and pump), pain ARTERIAL BLOOD GASES pH PCO2 PO2 Bicarbonate Base* Normal 7.30 - 7.45 35 - 45 50 - 80 19 - 26 -4 - +4 Respiratory Acidosis low; normal if compensated high normal unless accompanied by hypoxia normal; high if compensated normal; may be high if compensated Metabolic Acidosis low; normal if compensated normal; low if compensated low low Metabolic Alkalosis high; normal if compensated normal; high if compensated high high CBG CO2 normal values are 35 - 50. CBG PO2 values are falsely low and irrelevant to care. Acidosis and alkalosis may have mixed etiology - both respiratory and metabolic. *Base excess or deficit reflects the amount of base that would be needed to return to normal. APGAR SCORES (1 min, 5 min then Q 5 mins til score ≥7 0 1 2 Heart rate/pulse (apical or umbilical) Absent less than 100 more than 100 Respirations (rate and effort) Absent or gasping Slow, irregular, labored, poor cry Normal, good cry Grimace (reflex irritablilty to stim, i.e. oral or nasal suctioning) No response to stim Minimal response to stim (grimace only) Grimaces, coughs or sneezes, withdraws Tone (flexion and movement) Floppy, no tone, no spontaneous movements Slightly flexed, minimal movement Flexed, active Color Cyanotic or pale Acrocyanosis Pink all over NRP REVIEW - A quick reference - not a complete study guide!! 1st 30 seconds 30 - 60 seconds Evaluate respirations, heart rate & color 60 - 90 seconds Baby's Status Interventions Baby's Status Interventions Baby's Status Interventions Term baby w/clear fluid; breathing or crying; w/good tone Warm, clear airway, dry and assess color; "routine care" Pink & breathing w/HR>100 Observe HR>60, apneic PPV* Premature, apneic or hypertonic Warm; position and clear airway as needed; dry, stimulate and reposition Central cyanosis Give oxygen HR<60 PPV* & compressions Meconium in fluid; baby vigorous - good resp. effort; HR>100; w/good tone Warm; suction mouth and nose; dry, stimulate and reposition Apneic or HR<100 PPV* HR<60,> Epinephrine Meconium in fluid; baby not vigorous - i.e. poor resp. effort; heartrate <100;> Intubate and suction trachea (use meconium aspirator), suction mouth and nose Breathing effectively after PPV & HR>100 Post-resuscitation care *Intubation may be considered at several points.
The NICU is a scary, terrifying, yet exciting world. As a neonatal nurse, here are the things I wish I knew before entering this world.
So your friend's new baby is in the NICU. She's distraught. What could you possibly say? Here's what to say - and NOT say - to moms of NICU babies.
Neonatal Resuscitation Program (NRP) for the Non-Neonatologist MR. SOPA: - Mask Adjust - Reposition Airway - Suction - Open mouth - Pressure increase - Alternate: LMA/ETT (NG first) Compressions: - Thumbs on sternum - 1/3 chest diameter Post-Resus Targets (STABLE): - Sugar (4-6) - Temp (36.5-37.5) - Airway - Breathing - Labs (C02 45-55) - Emotional support Dr. Sarah Foohey @SarahFoohey #NRP #Neonatal #Resuscitation #Program #management #peds #pediatrics
10 lies about NICU nursing and the real truth about what it takes/what it's like to be a neonatal nurse working in the NICU.
I thought of the idea to photograph NICU graduates to let their story be known. The sessions are styled in a way that shows their journey of being in the NICU, all the challenges they have overcome, and how now, in the present day, they are thriving and healthy. I decided to name these unique photoshoots “The NICU Warrior Session.”
ContentsIntroductionJaundice in the first day of lifeJaundice in days 2- 14Jaundice after 14 daysSigns and symptomsInvestigations of the Jaundiced NeonateInterpretation of bilirubinManagementUseful ResourcesFlashcardReferencesRelated Articles Introduction Neonatal Jaundice is very common, with 60% of babies becoming jaundiced within the first week of life. It is however, often very worrying for parents, and for clinicians, the challenge is […]
Read through these NICU Quotes if you are feeling stressed, anxious, or need a little hope. They'll help you get through this tough times.
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