Newer NICU RN - question avout basics! Weights, baths, etc...
0Apr 9, '13 by nicurabbottHi everyone! I'm a newer NICU RN and will be switching to night shift soon. On nights we do all of our weights and baths. I'm so nervous about these two things! *sigh*
Do you do weights with or without diapers? Are the does it matter how much linen I have in the isolette if I'm using that scale?
As far as bathing goes...make it short and sweet?
Any tips and tricks for both would be appreciated
0Apr 9, '13 by uRNmywayWell, I've never worked NICU, but in mother-baby we weigh babies completely naked. I would think, especially in NICU where you are likely to have premies and low birth weight kiddos, even the weight of a fresh diaper would be bad to add. Usually what you would do to weight is have like a cloth or chuck on the scale, no baby. Then you tare the scale, or 'zero' it. Then put the baby on. That weight is the weight of only baby minus everything else on the scale.
As far as bathing, since no one else has answered with NICU experience, I would think short and sweet would be ideal. These little ones lose their body weight much quicker than we expect, and any temp drop could give some pretty nasty hypoglycemic episodes.
0Apr 9, '13 by champagnesupeRNovaIt's all going to be according to your unit's policy. At our hospital, we put a new diaper on the scale and 'zero' it, then take the diaper off and weigh the baby while he/she is wearing a diaper. If you're using the bed scale of an isolette, it will take into account the weight of the linens and everything else when you lift the baby and hold.
For baths, ask a fellow nurse - there might by protocols depending on weight/gestational age/ability to thermoregulate.
2Apr 9, '13 by CalabriaYour isolettes should give you instructions on the digital screen when you select the "weigh" option (i.e., lift baby, replace baby), if you can weigh in the isolette. When you lift the baby up, the bed zeroes. So, it doesn't matter how much you have on the bed, as long as whatever's on it when you lift the baby up isn't moved when you put the baby back. Regardless, I like to remove everything but the linens when I weigh my patients. Including the diaper.
When I do baths on my babies in open cribs, I'll weigh them (without a diaper), do a quick bath while they're on the scale, and then swaddle them and put them back in a crib with fresh linens. I don't do baths every night because it's not evidence-based, but I will change linens every evening.
Observe a few of the nurses on your unit and see what they do. And look to see if your hospital has a specific protocol in place.
1Apr 17, '13 by goshenc1Agreed with the previous comments about checking with your unit/hospital protocols. In my NICU we weigh the babies every night and bathe them M, W, F, nights. Regardless which night I'm working I cluster my baths/cares/weights. I tend to do them during assessment times so I'm interrupting the baby's sleeping as little as possible. For my weights I tend to weigh the babies when they're naked. If they're a little boy- I put a piece of gauze over their diaper area while I'm weighing them- no fountains of youth over here! Hehe I've seen it happen and have had it happen to me.
For the baths, I do short-sweet-thorough. You want to make sure you clean and dry all areas of the baby. Really pay attention to drying under their necks and in any folds they may have. If they're not dried off well it can lead to skin breakdown or funky growths (especially when in a covered isolette, perfect for bacteria as it is dark, warm, and humid). Oh, and turn the radiant warmer on/up (even if they're open bed) so they don't get too chilled during the bath.
If the parents happen to be visiting, you can always include them in bathing the baby. They tend to jump at the opportunity, same goes for changing the diaper and taking their temperature. I've had a lot of parents tell me they feel they're not in control when their baby is in the NICU, and those things are small but meaningful things that can help them bond with their baby.
1Apr 21, '13 by twinkletoes53[QUOTE=Calabria;7271106]Your isolettes should give you instructions on the digital screen when you select the "weigh" option (i.e., lift baby, replace baby), if you can weigh in the isolette. When you lift the baby up, the bed zeroes. So, it doesn't matter how much you have on the bed, as long as whatever's on it when you lift the baby up isn't moved when you put the baby back. Regardless, I like to remove everything but the linens when I weigh my patients. Including the diaper.
When using a bedside scale, weigh a dry diaper on the scale, zero it, then place the baby wearing the same size diaper on the scale. Our NICU had a protocol based on infant weights; see if your NICU has one. We did baths M-W-F, before midnight, so infants would not be disturbed in the middle of the night.
Intubated patients were weighed on day shift, b/c there were more staff around. Non-intubated and surgery patients were weighed on night shift (because surgery fellows rounded @ 0530, and needed current weights)
Also, we had 3 portable warming lights that we could use for our smaller infants. We placed one over the scale to prewarm it. We checked a temp. before a bath, if <36.3 C, bath was deferred until temp. more stable.
When I arrived at work, one of the first things I did was to take the blankets & towels I was going to use and place them in the Isolette or warmer to prewarm them. I actually did that with most of my babies, especially if they could be held. When their family arrived, I would tell them "He/she is all ready to hold; I have his blankets all warmed up for you."
One thing our NICU implemented before I left, which I loved, was called 'swaddle bathing'. Basically, we wrapped our baby in a towel or blanket, and submerged him into a tub while still swaddled. The babies loved it, as they did not become cold due to exposure to the cooler air. We unwrapped one part of the body @ a time, washed it, then rewrapped it. It sounds time-consuming, but it's not! Babies stayed warmer, and a bonus for parents, b/c they were calm, they would usually open their eyes while in the tub.