Neonatal assessment - please help!

  1. 0
    I am working as an RN at a small mission hospital in village India, and need suggestions for educating the nursing staff and setting up a small NICU. The hospital has fairly limited resources (in terms of technology, meds, etc), and the patients we serve are very poor and uneducated. Our main patient population is maternal-child, and we deal with many complicated cases of eclampsia, premature births, placenta previa, placental abruption, birth asphyxia, maternal anemia (hemoglobins as low as 1-3 gms at times), neonatal sepsis and tetanus, etc
    I am not a neonatal nurse (I mainly worked Adult Med surg in the US), and would love any suggestions from NICU nurses or helpful websites about neonatal nursing care:
    1. I am looking for good, fairly simple neonatal assessment charting forms that could be modified and used by the nurses here...physical assessment at birth and the following days, intake/output, etc.
    2. What are the common protocols/medical management of premature newborns?...concerning feedings (when to start, method, frequency, etc), positioning, and IV fluids and meds
    3. Respiratory status: tips for assessment, dealing with apnea, etc. Along this line, we are considering getting a neonatal CPap - what are the indications/contraindications for its use, benefits of its use, settings, etc?
    4. Jaundice and phototherapy


    Thanks!

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  2. 10 Comments...

  3. 1
    Wow.... tall order.... I'll think about it and post a little later.
    glimpses likes this.
  4. 0
    glimpses,

    You might do your patients some good by telling us more about yourself and the support available locally. When and where did you receive your nursing education. What sort of medical staff do you have available. What experience or training do you have in respiratory therapy, hemoperfusion, neonatal cardiology?

    Without a neonatologist and some well-equipped respiratory therapists, your ability to establish an effective NICU are slim to none. CPAP is over 30 years old. These days you need oscillator vents, etc. to be effective. Do you have a lab available to give you arterial blood gas analyses? What you are proposing to do is well outside the scope of practice of an RN in the US. What is your liability exposure in India for attempting to practice in a discipline for which you appear to have no training? How is the nursing profession regulated in India? Are you familiar with the nurse practice act or it's equivalent in India? India is a very bureaucratic nation; if you look into it I'm sure you'll find a substantial body of regulations and legislation pertaining to nursing practice there, especially in such specialties as neonatology.

    If you are unfamiliar with such basics as jaundice and phototherapy, you will be in serious trouble dealing with anything beyond those subjects. Almost any pediatric nursing or neonatology text will tell you enough about phototherapy to get by, lacking these, google will quickly tell you what you need to know.

    Be realistic, you can't help your patients by subjecting yourself to the liabilities of practicing beyond your qualifications.

    I wouldn't assume that my scope of practice is unlimited just because I'm practicing outside the USA.

    Here's wishing the best of luck to you and your patients.


    Thanks!
  5. 0
    Thanks for the reminder about scope of practice. I am familiar with the rules/regulations here. However, I am simply trying to find ideas to improve the services the hospital already offers, and to provide some additional edication for the nurses. Sorry if it came across differently in the post. There are two family practice physicians and an array of nurses with various training that work with all the patients, including those in our newborn nursery. I am just looking to see if anyone has any personal tips or resources for improving the quality of care that is already available here for our neonates. We already have the basics (as you said, about phototherapy, etc), but know that nurses working elsewhere sometimes have experiences and suggestions that can be helpful, or may know of more recent research and evidence-based practices that we could implement.
    Thanks.
  6. 1
    Quote from glimpses
    Thanks for the reminder about scope of practice. I am familiar with the rules/regulations here. However, I am simply trying to find ideas to improve the services the hospital already offers, and to provide some additional edication for the nurses. Sorry if it came across differently in the post. There are two family practice physicians and an array of nurses with various training that work with all the patients, including those in our newborn nursery. I am just looking to see if anyone has any personal tips or resources for improving the quality of care that is already available here for our neonates. We already have the basics (as you said, about phototherapy, etc), but know that nurses working elsewhere sometimes have experiences and suggestions that can be helpful, or may know of more recent research and evidence-based practices that we could implement.
    Thanks.
    My apologies then. That puts the matter in a substantially different context. While you may have some difficulty meeting the standard for a NICU, you can certainly strive to bring in improvements and it sounds like these could be quite substantial given the resources that you already have. I'll inventory my own resources and see what I can come with. I'm sure there others here who could be of substantial help with references, etc.

    Best of luck to you!
    glimpses likes this.
  7. 0
    1. I am looking for good, fairly simple neonatal assessment charting forms that could be modified and used by the nurses here...physical assessment at birth and the following days, intake/output, etc.

    - Here we use completely computerized charting. Our downtime forms are cumbersome and outdated.....

    3. Respiratory status: tips for assessment, dealing with apnea, etc. Along this line, we are considering getting a neonatal CPap - what are the indications/contraindications for its use, benefits of its use, settings, etc?

    - We use bubble CPAP. Indications are RDS, periodic apnea, TTN, prematurity, etc. We use a completely old-fashioned, electronics-free version that consists of a CPAP circuit, heater/humidifier, and 1 liter bottle of 0.25% Acetic acid with the expiratory circuit suspended to a depth of 5cm for a peep of 5. Almost all our kids are on a peep of 5. This CPAP setup, combined with permissive hypercapnia and strict pulmonary cares has lowered our BPD rate to <9%. All you need is the above equipment plus an O2/gas source.

    The issues with CPAP are nasal septum damage. This can be avoided with proper nursing care.
  8. 0
    There was an article not too long ago in Indian Pediatrics about using Bubble Cpap. It may not be sophisticated but it's simple and cheap.

    http://www.indianpediatrics.net/apr2008/apr-312-314.htm
  9. 0
    Quote from TiffyRN
    There was an article not too long ago in Indian Pediatrics about using Bubble Cpap. It may not be sophisticated but it's simple and cheap.

    http://www.indianpediatrics.net/apr2008/apr-312-314.htm

    Thanks for the article. Learning to improvise when there are limited resources is always a challenge...it may not be "sophisticated," but many times it works well when there aren't other options available.
  10. 0
    [quote=SteveRN21;3017711]1. I am looking for good, fairly simple neonatal assessment charting forms that could be modified and used by the nurses here...physical assessment at birth and the following days, intake/output, etc.

    - Here we use completely computerized charting. Our downtime forms are cumbersome and outdated.....

    ]


    Does anyone have up-to-date and non-cumbersome assessment forms? Or, what does your computerized charting assessment include?
  11. 0
    Our computer assessment is pretty thorough, and the parameters can be customized to the individual baby. Head-to-toe assessment, careplan, which protocols you are reviewing and implementing for the shift, etc.

    Are you having a US medical team coming soon to teach CPAP? My hospital has a group heading to India any day now. It would be funny if that were you, wouldn't it?


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