Neonatal nursing

Here's one nurse's description:

A day in the life of a NICU nurse definitely differs...there's really no way to give you a good feel of what it's like because it can differ from minute to minute depending on the stability of your patients.

Taking care of babies in a NICU is a very scheduled job though - on other nursing units usually night shift doesn't bother them much throughout the night and it's just giving them meds every few hours, but in the NICU we do a full head to toe assessment every 3 to 4 hours depending on what's going on with the patient.

In my unit we admit any gestational age from 22 weeks (if viable and parents want to resuscitate) to sick term kids (the only thing my unit doesn't do is cardiac defects), but we do cooling, PPHN, ECMO, etc.

So my shift goes like this...get report from day shift, scrub up (washing hands is VERY important), start my cares. "Care times" or "touch times" is when we go into each baby's bed and do their assessments, change diapers, feed them, etc. It's very important for premature and sick babies to sleep (aka their way of healing) so we cluster our cares. Either every three hours or every four hours depending on the needs of the patient.

When we do our care times, I start by taking a blood pressure (with the teeniest blood pressure cuff you've ever seen), then I take an axillary temperature. Our goal temp is 36.5 to 37.5 degrees celsius. After temp I always listen to lung sounds, heart sounds, and bowel sounds. Then I feel the baby's head to see how their fontanels and sutures feel - we don't want the fontanels to be bulging (could mean increased ICP) or sunken (could mean dehydration) - we want them to be soft and flat. Sutures can be normal line, overriding, or separated - all of these can be normal at first but should go to normal line relatively quickly. After feeling the head I check pupillary response for PERRLA (especially if it's a baby with neuro issues). Then I go to the belly and make sure that looks and feels good. Premature babies are at a high risk for NEC (necrotizing enterocolitis - where part of the bowel basically dies - it can be fatal for babies). You need to watch the abdomen for loops - which are bowel loops visible from the outside - they feel like little lumps on your baby's belly. You also want to make sure the belly is very soft and the abdominal girth is stable. Measure abdominal girth around the entire abdomen near the umbilicus. Then I'll check residual via the baby's nasogastric or orogastric tube - we don't want more than 30% of the baby's feed to be left in the belly - this means the baby has not digested their food and maybe cannot tolerate the volume. Last (always last) change diaper. Makes sense why you would do this last - INFECTION RISK - but some people don't do that... make sure you monitor closely for any breakdown on the bottom. Take off gloves, wash hands, new gloves, feed the baby.

That's basically a set of cares for a typical baby. Of course each baby is very different - if you have an intubated baby you'll have to do oral care and suction out the mouth and ETT, and ensure the ETT is in the proper place. You'll also want to check your ventilation settings to make sure the baby is getting the proper amount of pressure and support. You also want to wean the FiO2 (oxygen) per protocol. Premature babies less than 36 weeks gestation have oxygen saturation parameters of 85%-93% and babies over 36 weeks have parameters 88%-95% (but those can also change per baby). You do not want your baby to self-extubate on your shift so you need to make sure you monitor the tube positioning VERY closely and make sure it is safely secure on the baby's face.

Feeding the baby can differ too - we never try to PO feed babies who are less that 33 weeks gestation as they physically do not have the suck/swallow/breathe reflex - which means they'll aspirate when they try to suck on a bottle. For these babies we feed them via an NG or OG tube (which is something I mentioned previously). Always check the placement of your NG/OG tube! If the tube is even a few centimeters out - it can be in the trachea rather than the stomach - and you would be pouring food into your baby's lungs!! This happens more often than you would think And this then causes aspiration pneumonia, which can also be fatal.

IV's are another thing you'll have to check if your baby has one. Little baby veins can blow and become infiltrated VERY easily. If your IV has continuous fluids running through them you need to be putting your eyes on that IV every hour. IV's, if infiltrated, can burn babies depending on the fluids going through.

Those are some of the basic things I can think of right now - The NICU is a great place to work! If you have any more questions feel free to ask :) I'd be happy to try to answer/help!!

And here are some FAQs about NICU nursing.