carebeth

I work in a Level 4 NICU. Last night, we got a baby transported to us from another nearby hospital. The baby was just about 8 hours old by the time we got him, born at 36 5/7 weeks. The infant was born with multiple anomalies. But our first priority to address was the platelet count of 8000 (normal value for our hospital is 150,000-450,000). This child needed a platelet transfusion, however, the mother is a Jehovah Witness. She refused the transfusion even after talking to our neonatologist who explained the risk for IVH, and subsequently death should no transfusion be administered due this very critically low platelet count. Social workers were involved, as well as another neonatologist. They were in the process of getting a court order, however, due to the child's deteriorating signs, (lethargic, bruises all over, desaturations, emesis), the neonatologist that night overwrote the mother's wishes and got another neo to ok the order to give the platelet transfusion to the infant. I gave the platelet transfusion after getting all the appropriate doctor's orders. and the transfusion completed with out any complications. Our hospital law states that in an emergency, when parents refuse blood transfusion for their child, doctors are able to 'overwrite' the parents religious beliefs with two attending MD (in this case two neonatologist) signature, while awaiting the court order. What are your thoughts? What would you have done? What is your hospitals policy regarding this?

Last night, I cared for a 25 week baby girl. She is 4 days old on the HFOV Jet. She required about 30 % fiO2 (give or take some). On my shift (the night shift) she was sheduled to get her 5th dose of surfactant. Yes that's right, her 5th dose. We did an ABG at midnight and it was great. The doc even went down one on the PIP (from 20 to 19). At 3 am , she received her surfactant (3ml for a .67 kg baby) via the ETT by the RT. One hour later we checked another ABG and she was acidodic and her PCO2 went up to 67 (previous one was in the high 40's). At this time we increased the pip back to 20. Her bloodsugar was 172 (previous ones were both 154) So my head starting to think...what is happening here? One hour later, I noticed she was was getting restless, requiring more O2 (from 30 to 40%). We checked yet another fiO2 and bang...her CO2 was 92 and her pH was 7.02. And on top of this her blood sugar was 235. Right away we brought the PIP to 22 and ordered a stat CXR. I also gave her ativan. The CXR surprisingly looked great, much better then the previous XR and her ETT was in the correct position. This all happened approx 3 hours after receiving her 5th dose of surfactant. The charge nurse and I realized she needed to be suctioned and I suctioned her ETT and all that came out was surfactant. After I was done suctioning, her stat came up to near 100%. We did an ABG and everything was back to normal. Literally. He pH was 7.3, PCO2 was 48. We weaned the pip back to 20. her bood surgar was starting to come down. Wow. Could this 5th dose of surfactant be too much for this tiny baby? I've been trying to do some research on this and I have only found the surfactant to give temp bradycardia/desats and pulm hem. Anyone else have any experience on this? Our policy states that we don't suction babies 4 hours after surfactant administration. Obviously I needed to suction her earlier then this because her tiny lungs weren't able to absorb it. I left the unit in tears. I felt as though the treatment we gave her failed. Although I realized suctioning her was probably the best move I did for her. I feel like calling the unit and finding out how she is doing. Thanks for listening. Any comments are greatly appreciated.

I work in a level III NICU. I work nights and rarely see the neo unless there is an admission. They usually sleep throughout the night (one of my petpeeves...) The team rounds once during the day shift. So other then that, you call the doc/resident if something happens...but beware of calling them in the middle of the night, you might wake them up from there beauty sleep.....grr....

Hi Does anyone plan on attending the neonatal conference in Las Vegas? Here is the link: http://www.contemporaryforums.com/m795/bene.asp I'm trying to get some of my co-workers to go, but I don't think they can make it. Maybe there are some folks on here that would want to go as well and we can plan together. I live & work in the San Francisco bay area. Thanks!

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Hello! I was offered a job with Summit Health, in Northern California. I am moving in 10 days! Upon my arrival, I have to do a drug test. Now, comming from Canada, we don't have those kinds of test as part of employee selections...so I have a few questions. What kind of testing will they do? Blood? Urine? Hair? I don't have anything to hide because I don't do drugs, however, I was exposed to second hand marijuana smoke several times out of my control (concerts...) So if someone could tell what type of test is done, that would be greatly appriciated and would relieve some tension. Thank you.

Hi If you plan on continuing your education afterwards (such as getting your masters or become an educator, clinical nurse specialist ect...) then you will need a BSN in order to advance. Otherwise, it really does not make a difference. But I do think there is a difference is pay whether a nurse does or does not have her BSN...but all in all, we are all RN's once we pass the boards. Good luck.

Hello fellow NICU Nurses! I am a surgical (adult) RN from Toronto Canada. I was offerered a position in the NICU in the Bay area and decided to take it (got my California license, visa screen...paper work all done...) I am moving in a month. (a bit nervous...) I was wondering if you have any advice for an experienced nurse new to the NICU. I have NEVER worked with infants, or in that matter, sick infants...or parents... Any comments would be greatly appreciated! Thanks! Caroline

hello fellow nurses!! i am a 25 year old rn from canada. i have passed my nclex, i have received my visa screen certificate...aka pretty well almost ready to move to california. i have an interview this week with alta bates summit medical center in oakland/berkeley (part of sutter health). does anyone work there? live there? i would greatly appreciate any info/comments/opinions, (good or not so good)....i have never been to that area and just curious about what nurses have to say about this hospital/city. thanks. good day caroline

Congradulations on passing the NCLEX!!!!!!!! it's such a good feeling eh?!!! Well take it easy for now, but give yourself atleast 3 months to study before the exam. Best of luck, Caroline

I've been an RN for 2 years now...I work full time at a downtown Toronto hospital in the recovery room....love it!

First of all..take a deep breath....theres nothing you can do but wait for your nclex result. I am an RN in Toronto and I have written both the CRNE and the NCLEX(i passed the CRNE on the first try, and passed the NCLEX on the second try) My opinion is that the NCLEX is a bit harder then the CRNE...that said..the NCLEX seems to be more medically based, and the CRNE not so much, but still have plenty of med/surg question....If you have studied hard for the NCLEX, then you should be ok for the CRNE...but I would recommend that you pick up a study guide for the Canadian exam, such as the one written by the Canadian Nurses Association...another good one that goes through all the systems with reviews plues question/answer with rational is the Mosby's review of the CRNE (its a big orange book). Unfortunately, the CRNE is still on paper...maybe one day it may change but who know...and yes, it can take up to 12 weeks to get the result and the exam is only offered about 3 or 4 times a year. Again...not much you can do about that but try to forget about and then one day you get an envelop with the result.... I know you probably heard this before...but IF you did not pass the NLCEX...its ok...you can re-write it in 90 days (i think)...take it as a learning experience and keep studying... As I said before...I thought the NCLEX was much harder then the CRNE...but maybe thats because I trained in Canada and not the States... oh...also don't forget that conversion system is different here in Canada...normal blood sugar is 4.0-8.0 mmol/L.... in the states...its 70-110d/L... little things like that... hope that helps. study hard, eat well, get sleep and exercise will all help! Caroline. RN BScN.

I'm a Canadian nurse...I passed the NCLEX on my 2nd try....my best advice is do lots and lots and lots of different questions...just keep practicing with questions....study hard...eat well, sleep well, excersise, think positively and you will pass.