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Mira 2,312 Views

Joined: Apr 22, '03; Posts: 84 (0% Liked)

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    Originally posted by Jolie
    Dawngloves,

    It's an attempt to prevent an asymptommatic hypoglycemic infant from bottoming out during a bath. Most units check blood sugars only on babies that fit their protocol or are symptommatic. But it is possible to have a hypoglycemic baby that neither fits the protocol nor is symptommatic. If such a baby is fed prior to bathing, chances are that he will tolerate the bath without dropping his sugar too badly.
    Sorry I can't seem to get the point,maybe I'm thinking about the theory of having your meal and going in a rollercoaster ride, or maybe I'm thinking about bathing the baby right after feeding.Is'nt it they have glucose reserve from maternal influence and unless they have a metabolic problem and they had cold stress they should maintain their glucose level within normal range?

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    This is interesting. In comparison to the practices in United Kingdom, bathing in the first few hours is not common. They can have their bath whenever convenient or necessary (i.e. going home and it's the first born child,baby got dried lochia,parents wishes). Admission to the NICU because of cold stress is usually caused by forgetting to keep the baby warm all the time, and in our setting nothing to do with bathing.(NICU nurse)

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    Yes Dawngloves maybe right,maybe it was only you that's giving a nice bath for that baby.I feel shameful when my baby stinks(babies w MRSA or pseudomonas are exceptions).To prevent stinky babies,I bath them thoroughly(clean folds,and orifices)and rinse with plain water,I don't use zinc oxide on their bum because it doesn`t smell nice,I always keep them dry and dress them appropriately,I don`t use lotion because I suspect the sweat does not interact well with it,I use minimal oil on extremities instead.We change their trachy dressings and tie everyday.I change their nappies when I smell poh(Though some milk formulas make their stool very smelly).With stomas I have never encountered smelly ones except when it is infected,leakage prevention might minimise stinkiness.

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    Thank you so much Kristi for responding

    I was thinking abou it and thankful that you reminded me about its potential to be used in a court room. Safer to talk about events with a friend or vent my sentiments in this forum

    At times,I write about the trauma inflected by others on my patients because I have noticed that some people just don`t admit their faults especially if it happened before my shift, I find it difficult to trace who the culprit is (i.e.burn from tcPO2 monitor)so just to be on the safe side I write it down in details(apart from the usual nursing notes). I write things to remind me about the events and reflect on what were my contributions to the trauma or if I intervened appropriately.I take a mental note on how to prevent future trauma. I think it is ok to keep a diary/journal so long you write things in a sensible way.

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    Hi everyone,
    I just like to know if any of you is keeping a diary and writing down every event while at work. Does it help you improve your practice?Here in UK,some hospitals require their most senior staff to do reflective practice,the higher your position the more you need to write something.Thank you in advance for the replies.

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    brilliant,I managed to read it well the second time because I was looking at the paragraph as a whole the first time I saw it

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    Hi,I qualified `94.done endosocpy,theatre,and now NICU.I`m in London,married,my babies are all in NICU.

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    There is a referral unit for parents to learn how to look after their kids on ventilatory support and send home once they are competent,but they have a long waiting list and the community should be funded for nurses who can support these families(foster as well). homes needs to be adjusted to suit the care of these babies,and there is a waiting list for appropriate council houses.We are encouraging parents to change trachy tube/dressings,and we teach them how to do resus via trachys.Funding/benefits depends on each Borough,some are rich and some are not.Hospital is not a healthy place for them,I remember the first time I took one out for a walk,he was so shocked and in awe(even if it was w slow intro,like going in another room,showing him what is outside the window-took days),I can see how excited he was eventually to the point that he went slightly dusky.A father spoke with me the other night while I was waiting for the transport,his baby was transferred in the Pediatric ward,he showed me his son`s picture,the father was smiling while talking to me but his eyes looks so sad,he was telling me that his baby is ok with the oxygen and collapses once you try weaning w/c happened 3days ago,baby is 14mos but his immune system still cannot cope w infections,he is very worried that the winter mos. are coming and don`t know if his baby can cope w winter bugs,he doesn`t sound hopeful but he can`t do anything because he is not married to his partner,they are not together therefore he has no parental rights unless agreed by his partner.The other day an ex-preemie visited our unit she was a 24weeker(classmate of one of our long term patient) she is going one year next week,she was walking around,she was unstopable,she doesn`t have traces of the rough times she had while she was in our unit.There are many success stories about NICU graduates,a hypoxic baby who had been diagnosed to have severe bleed turned out to have a wrong diagnosis and live to tell the story,an ex preemie won a settlement for extravasation injury 20 years ago,she turned out to be brilliant and is planning to pursue a career in ?Law.Once an individual comes out from the womb and breath for life,he has the right to live including the right to dignity and protection from the society,and as a nurse it is our responsibility to celebrate the uniqueness of this individual,protect and promote their interests and dignity,irrespective of age,race,ability,sexuality,economic status,etc.I have not been in the NICU for that long to be an expert in this setting,but I have always a gut feeling how the baby will cope the roller coaster ride,I love observing their movements/facial expressions because it is my way of communicating with them.The topic I have started is contreversial,it is about ethics.I expect further reaction,and I am not complaining about these babies, in management term(?w/o a heart)"blocking beds for those who really needs it,and draining the budget", I am just pondering about the quality of life they a leading into and the lengthening of the grieving process for the family.Not because I raised this topic means I agree with withholding or withdrawal of treatment(depending on the situation though)My view is to celebrate the specialness of life without pain or suffering,and to keep an individual alive when the chances are bleak with artificial ventilation,nutrition and hydration is to clear the conscience/guilt our society has inculcated to us.

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    MomNRN:I feel sad for your loss but I`m happy that you found the light at the end of the tunnel.

    Kristi:I look at the NICU life as a roller coaster ride for parents and babies.Everyday we deal with the emotional/social side of the parents.We exactly do what you`ve been doing and I can say that all the babies (and families) I looked after got the excellent care I can offer(something anyone can be proud of).We have five long term babies(7-14mos.old),we keep them even if we are not a pediatric ward while waiting for the funding from the community or a referral unit for babies w trachys or a proper PICU or pediatric ward.We do a psychosocial meeting every week and we discuss how the parents can participate with the cares(and intellectual stimulation),3 out of 5 give their full participation,the other 2 stays in the unit for 30mins(most of them are unemployed or on government benefits). they make promises and they don`t keep it(well documented).1 of the mother got so many warnings for her verbal abuses,not appropriate but we can`t transfer her baby out(because of funding) and we can`t discharge the baby home because he needs ventilatory support and suctioning,all we can do is to limit visiting time w/c she`s been doing anyway,foster carer is not an option as well(funding again).I am an optimistic person,but something(apart from the previous posts) just triggered me to be morbid lately and I am looking into the outcome of NICU graduates and any guidelines/protocols that hospital follows when the baby got a very poor prognosis.

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    There are many issues that the Health and Safety groups are concerned about sp. w regards to SIDS,like giving wrong signal to parents.W co-bedding we usually explain that we are doing it because the nurse is always on guard for any danger that might happen,that we work in shifts etc.We make sure that we are not feeding the wrong baby and we remove the other if one needs medication,each got an apnoea alarm attached.For a reason,most of the doctors I knew of encourages co-bedding.

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    Co-bedding with whom?w Mum?Health and safety reasons does not allow it.w twins?so long as the bed is not too small for them or the other twin got no infectious disease,bonding thru co-bedding is allowed her in the UK,they`ve been together for several months in the womb and with the developmental care point of view,Is it not nice to re-create their natural habitat up to the point they are not comfortable with each other anymore?Most of our developmental care knowledge came from the USA,and some of us follows it religiously

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    Yes,small vomits/spit.When the feed is delayed by 15minutes,when the baby is still wearing the same clothes he had the previous day,when the baby did not have his solids,when the baby is sleeping(the baby got bored as the nurse was not paying attention/playing w him-?hence the nurse is negligent for not giving intellectual stimulation),when the nurse does not answer the SaO2 alarm at once while the baby is kicking it despite explanation to the parents from the start that the alarm is sensitive to movements and we just need to look at the baby for any changes.The list of complaints is endless,that sometimes we are feeling lucky that we are not in a country where litigations are common practice,but sometimes we are thinking perhaps it`s better because we will know who is at fault,but perhaps it might end up with name blaming.Parents are being tormented with the condition of their child as well,they want to be in control,we take that into consideration,but sometimes we get tired and look back thinking what is the point of all the effort when the quality of life is non-existent anyway,but who are we to define what a quality life is?

    Sorry if I`m venting.I still adore the babies and I feel very happy when I can see in their movements/eyes that they are going to survive.Miracles happens everyday but I just wish that those who will not have the opportunity to survive and taste life to the fullest just perish in a natural and more dignified way.

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    We still use feeding tubes for big babies unable to wee,sterile plastic glove for very prem,we have U-bag(not good if sterile spcimen is required) and prem Urinicol(too sticky for prem skin).I hope appropriate catheters from NY will be shifted to London soon

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    I was looking after a baby w tracheostomy tube,she is going to be one year old next month,there is another one with gastrostomy 7mos.old,and another one with trachy 14mos.We just transferred 2 1y/os to paediatric ward they can`t take anymore babies from us because of their limited staffing/funding.All of them had very rough periods.2 families are blaming the hospital for the condition of their babies where in fact these 2 families are the ones insistant to keep them alive despite the very slim chances for better prognosis(23wks w IVH,etc.).Their discharge planning are dependant on the community funding,take ages to sort out(ethical dilemma).It is a joy to look after the babies because of the smile on their faces,but most of the parents are driving us mad with their demand, to the point we lost valuable staff because they felt they are being treated like they just go to work to bathe,change nappies and feed babies.1/2 of the parents would come in the afternoon and demand in a loud voice to see the manager because their baby got a posset and no one seem to have noticed.Maybe the real blame should be toward us,how we manage these babies,how we communicate w parents and how we present ourselves to them.I don`t know how these babies are coping with the constant trauma they have been receiving just to be alive.

    Would you mind sharing your guidelines/protocol in dealing with babies with poor prognosis and withdrawal/withholding of treatment?How do you feel about it?Thank you.

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    That is a good point donnuchi because I have been attending breastfeeding study days but I have never heard how long can we hang breastmilk for continuous feeding.In my unit it is based on pure assumption that the length of time you can hang it on is the same time you can keep it at room temperature(max4hours-UK Association for Milk Banking,Apr.01)w or w/o fortifier.`Could be nice to have evidence-based practice.Try:www.lalecheleague.org
    www.breastfeeding.org
    www.breastfeedingonline.com
    www.peach.ease.lsoft.com/archives/lactnet.html
    www.ukamb.org
    www.babyfriendly.org.uk


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