does hypoxia hurt

BittyBabyGrower, MSN, RN · Aug 1, 2004

I have to give the parents credit for making that decision. Extensive PVL is pretty bad. It isn't our decision to make. They most likely spared that poor child, and themselves. I doubt that the Mso4 "killed" the baby. If the baby lasted for days in spite of that, I would have had to wonder. That happened to me once...I had a Trisomy 18 that we took off the vent, gave mso4 to and lived, and we gave the mso4 many times thru out the day. The baby went home with hospice and lived for a year.

And when we merged with our stepdown, those girls got an orientation to criticals, admits, etc, just like anyother nurse coming in.

gypsyatheart · Aug 1, 2004

I can not even imagine working in NICU without orientation! That is not only unsafe for your patients, but you are jeopardizing your license! As you can see, there are many things to learn in NICU. The scenario you describe is a prime example of why you need more orientation and training.

I realize you are a new nurse, you have to realize that no one is gonna speak up for you, but you. You need to approach the Nurse Manager and demand more training in this area! You owe it to yourself, and to the little ones you are caring for.

If you don't get it, I would suggest finding a job elsewhere, even another NICU, that offers proper orientation.

Good luck to you.

fergus51 · Aug 1, 2004

Not having an orientation is unacceptable. I don't see how you can practice safely without one. If I was a parent and heard that I would freak.

leslie :-D · Aug 1, 2004

hypoxia can lead to ischemia, which is extremly painful.

if your cells are not perfusing with adequate oxgyen, it starts an ischemic event (cell death) which IS painful whether it's babies or adults.

likeminz · Aug 2, 2004

Thanks for your feedback both on hypoxia and on orientation. I am frustrated by lack of good orientation, however this is the only opportunity to work in Neonates in our town. My experience in SCBU stands me in good stead... I am much better prepared than nurses who are employed directly into NICU who also only get 2-3 days orientation. I have some previous experience in nursing, and an ability to keep asking questions until I have an answer. I refuse to do anything I dont know how to do without proper supervision. The part that can trip you up is that you don't know what you don't know. I am religious about only checking drugs with senior staff... only suctioning with senior staff. We run so short staffed that we are constantly having to use ICU nurses and casual staff, the honest truth is that the parents are thrilled to have nurses that actually work in NICU care for their babies.

In terms of not knowing about the hypoxia and pain issue... I guess that is really about me liking to explore stuff. I too respect the parents decision to turn their baby off. I think that being mature, knowing your limitations and asking lots of questions play a huge part in keeping yourself (and your patients) safe.

:rolleyes:

kitty29 · Aug 5, 2004

HI..
I'm new to this forum, and fairly new to NICU nursing, having recently moved to NICU from SCN. Our unit doesnt believe in orientation (like none) so I find it hard to figure stuff out. However the point of this letter is about a situation that occurred at our unit, where a baby's parents opted to discontinue treatment. The doctor charted morphine to maintain the baby's comfort. I queried this as I didnt feel that the baby would be uncomfortable (he had been on CPAP). I felt that the morphine contributed to his speedy demise. Other staff said that hypoxia was very painful and that they required morph. i thought hypoxia was relatively painless.
opinions?...

I don't believe hypoxia "hurts" as much as could cause agitation in the infant, this of course would be upsetting to the family. I think that as a baby dies and becomes more acidotic they can become "air hungrey". Generally the doses of morphine have been half doses. After a certain point I believe there is no pain as the pt enters a comma state.

My feelings are: even if death is hassened, it is better for baby, parents & family if the death is as comfortable and peaceful as we can make it.

nurseiam · Aug 5, 2004

( Parents decided to withdraw treatment. I felt that the baby would have survived without the morphine. That worries me. )

The longer you work in the NICU you might change your mind. As you take care of very chronic kids or see them return for reunions or updates you may find that these were the bravest parents you met!

I agree with the "air hungry". But I also think back to my grandma, they gave her morphine whenever she moaned....she died very peacefully. Just like she wanted too!

melissah · Aug 11, 2004

Hello, I'm new to this forum as well and a fairly new grad. I can not believe that you are not being offered an orientation to a unit like the NICU. Our policy is 12 weeks for new hires w/o NICU exp. and almost the same for new hires with exp. depending on their skill set and comfort level. Orientation is one on one with another nurse, full time. It also includes class time with NRP cert (of course). In some cases orientation has been extended a few weeks for RNs who feel unprepared. As far as the morphine I agree with the previous postings. Just one of the reasons listed would be enough to warrent morphine use. Many dying infants are experiencing pain, air hunger and anxiety to name a few. Hypoxia can also lead to lactic acid build up which is extremely painful (think cramp in your leg when running). Good luck in the NICU. Hope you enjoy it as much as I have so far!