Okay, back to the original question!!!
Let me review my last three nights at work, as they show different sides of the NICU world...
Four grower-feeder babies, which means that they have no IVs and are just learning to eat from a bottle and gain weight before they go home. Two had nasal cannulas with small amounts of oxygen, as they were tiny preemies and had some lung damage. Three of the four babies still had feeding tubes, while the other was taking everything by bottle. The ones with the tubes, they'd alternate taking one feeding by bottle, the next by tube, etc. The babies ate every 3-4 hours. All had several oral medications that I'd mix in with their formula at feeding times. The two with oxygen also had inhalers that the respiratory therapist had to give once a shift. Three were in basinettes or cribs, the last was still in an incubator and was still too small to handle room termperature. So basically, I came on, got report on the babies and made a schedule for the night - when all four babies had to eat, when they had medications, etc. I gave them all sponge baths, weighed them, dressed them, changed their linens, fed them, medicated them, held them, and spoke with their parents when they visited and called. If the parents where on the unit, I tried to do some discharge teaching. If any of the babies had problems, which luckily none of them did, I'd have called the docs for an update and new orders. It was kind of like being on a hamster wheel - I ran around all night caring for these babies, and as soon as the last one was fed, the first one was due to eat again! It wasn't too stressful, as they generally did very well overnight, and they were cute as can be - it was just busy is all.
I had two babies - one former preemie, who was now several months old, and a week-old preemie that was about 2 pounds. The former preemie recently had surgery and was not yet feeding, so I had to monitor his central line and IV fluids. He was on IV antibiotics for an infection, and he had a NG tube in his stomach to suction out any secretions to let his bowel rest after surgery. He was a little cranky, as he had recently been weaned off a narcotic drip and was hungry. I basically monitored him all night, gave him his antibiotics, and comforted him when he was upset. The second baby was pretty "new" still, and didn't yet have a central line. Her peripheral IV came out, so I had to insert a new one. She was getting small amounts of breastmilk by feeding tube every 2 hours, but most of her fluids and nutrition came from her IVs so it was vital to get the IV started ASAP. She was under the bilirubin lights for jaundice, and was not happy about having her eyes covered! She had come off the vent earlier in the day and was on Vapotherm, which is a high pressure, high humidity nasal cannula. She did forget to breathe a few times that night, so the doc increased the amount of pressure the cannula was at. Her only medication was IV caffiene, which was given to stimulate her brain to breathe. If she kept having apneic episodes, the doctors were going to have to put her back on the ventilator. Luckily this didn't happen! I also had the high-risk OB pager, and once was paged to go down to a delivery with the docs and respiratory therapist. It was a 30-week preemie, so after we got him breathing well we brought him to the unit and another nurse admitted him, while her previous patients got absorbed into other nurses' assignments.
I took care of a baby that had come back from surgery about 6 hour prior to my shift. She was on very high ventilator settings and her blood gasses were horrible. Every two hours I had to poke her heel with a lancet to obtain small amounts of blood to do the gasses. Twice the docs wanted me to stick her artery in her wrist to get an arterial blood gas to better monitor her progress. She was on one kind of ventilator, then we changed to another type, then back to the first one. We tried all different ventilator settings, and I had the doctors and respiratory therapists at my bedside on and off all night. I drew 6 or 7 poor blood gasses, and finally at 6:30am I drew a gas that was perfect. She was on 100% oxygen, so no where to go if her oxygen saturations fell. We finally found the correct support for her! She was very pale, so I asked to draw a blood count. It was fine, so no transfusion for her. She was also on a paralyzing IV medication every 1-2 hours. The surgeons wanted her on it so she wouldn't move and disturb the surgical site, but with the way her blood gasses were, we'd probably have started her on it anyways to stop her from fighting against the ventilator and improve her lung compliance. It's scary at first giving this medication, because honestly your patient looks dead when you do. They can't move a muscle, not even they eyes, so they hang open sometimes and you have to put ointment on them to keep them from drying out. I also gave her three kinds of IV antibiotics, IV steroids, and IV diuretics. She was on morphine boluses but by the end of the night we started a fentanyl drip to keep her constantly comfortable. I checked her vital signs once an hour. She didn't have a central line so I had all her IV fluids running through a peripheral IV line, and had another to give her medications through. I monitored her skin so it wouldn't break down while she was immobile. I talked to her parents several times when they called, and explained everything that was going on. It was a very stressful night, as she was doing so poorly, and I rarely left her bedside except to pee and take a 20 minute dinner break. I was just glad that she was doing better when I left, weaning on the oxygen and color improving. On my way out, I asked a nurse practitioner who just came on shift to please ask the docs if she could start a central line on the baby for her IV fluids and meds, and an arterial line to draw blood gasses from.
So there you have it - my work week!