Love_2_Learn

Thanks for your reply and thoughts! I'm thinking of microscopic amounts of undiluted powder though. The filter needle filters out particles that are 5 microns in size; actually quite microscopic. It seems like the filter would only take out the teensy microscopic bits if there were any, similar to how it removes the teensy microscopic bits of glass shards from ampules. I'd absolutely hate to think I was filtering out too much of the medication and causing the patient not to receive the full dose!!! I guess I'm over thinking this. I only got started thinking about it when seeing a nurse draw up her reconstituted (diluted powder with sterile water) ampicillin and her saying, "I always filter medications that are powder that I've mixed up." Again, I think too much I suppose. Thanks again for your thoughts! They are good ones! I wonder if I should ask a pharmacist?.....

I know very well that the filter needles are always to be used when drawing up any medication from a glass ampule. Fully understand about microscopic glass shards and how they can cause problems. Now I am wondering if I should be using one to draw up a reconstituted powder medication before administering it. Example: We place sterile water in (flat rubber topped) vials of powdered ampicillin and then draw up the liquid ampicillin after it has become clear and fully mixed. Once it's mixed do I need to use a filter needle to draw it up into a syringe and then remove the filter needle before connecting it to the IV medication tubing to give to the patient? I guess my main question is: Could there be microscopic blobs of unmixed powdered ampicillin which needs to be filtered before administering? I'd love to know the correct answer and would be ridiculously happy if someone has a reference I could use to share with my coworkers if this is true. I want to do what is best for my patients and realize that new evidence occurs daily and changes can be good. Thanks in advance for any information or thoughts you have on this subject!

Working part time at a hospital will get your foot in the door and if you are a good employee (dependable, friendly, hard worker) you will probably get extra points when they decide to hire the recent new grads. Lots of student nurses work as secretaries on the nursing units. This is a good way to learn the routine of the unit, common lab and other orders, how to work the computers, etc. Later once you are in your actual nursing classes they might have positions specifically for nursing students, similar to nursing assistants the first year and then with some expanded duties the second year. If you are fully certain OB is the area you want to be in, try to aim for that area (labor & delivery, antenatal floor, postpartum, well baby nursery, mother-baby unit, special care nursery, NICU, etc). If you end up on med-surg that is not a minus because you will realize that all kinds of women have babies and many of them have conditions which are treated in a med-surg area (asthma flare ups, heart conditions, strokes, sickle-cell, kidney stones, gallbladder problems, etc.) so you can learn a lot and be prepared for when later as an OB nurse a mother comes in pregnant and in distress for something unrelated to her pregnancy. I always knew I wanted to work with babies and I asked my OB instructor if it was truly necessary for me to work 2 years of med-surg first (I had worked med-surg for on year as a student nurse every Friday & Saturday night for the last year of my nursing education) and she said that if I knew for certain in my heart that I wanted to work with the little ones that she would rather see me go straight to the nursery rather than force myself to do a 2 year med-surg stint and end up leaving the profession because I was unhappy. I started in a well baby nursery, then did mother-baby (learned postpartum moms & some stable undelivered moms). I appreciate her advice and am happy with my decision. My only drawback is that I realize that today (20 years later) I know very little about adults. I still subscribe to two general nursing journals along with all my neonatal ones but I would feel lost on a med-surg floor or any floor except postpartum at this time in my career. Keep that in mind as you make your decisions. Any experience is good experience and sometimes life puts you in places you don't think you want to be but in hindsight you are ever so glad you were put there because of the learning experience it gave you. Enjoy your education, study hard, remember the basics are incredibly important as everything else builds on them (A&P, Micro, etc) and remember that nursing school is intense but you will make it through just like so many of the rest of us did. Good luck in your schooling and career! One last thought, go ahead and join AWHONN the main nursing organization for OB nurses. You will probably get the student's rate to join and will get journals and loads of other information access concerning OB nursing. It would be good side reading to get your feet wet, but don't neglect your nursing studies. http://www.awhonn.org

We nurses are the last line of defense our patients have. Look up medication information, question doctor's orders, question the pharmacist, do whatever you need to in order to be your patients advocate. And like others have said, little Miss Priss who is so overly-confident, blows off pharmacology, and takes false pride in doing everything like lightening will just as quickly find herself in a heap of trouble! Keep your integrity, smile, and always strive to do your best. I'm proud of you!

Wonderful article! Thanks for sharing! I hope subee gets a chance to read it especially since anesthesia specialists recognized the problem first.

I don't know if its true, but I've heard that at the end of life people do not feel hungry like we do when we are healthy. It was explained to me in reference to my pets (no offense meant!) in how when they are at the end of their life they "go off their food". I've had lots of pets over the years and always noticed that at the end, in old age, they would suddenly turn very gray in their face quickly and then stop eating to the point of refusing food, and then within a couple of days they would leave our Earth. It seems kind of natural that our bodies would not be feeling the need for food when our body realizes that the calories needed to sustain life are not going to be needed. It's late, I'm kind of tired & having random thoughts. Guess I'll go to bed. :zzzzz

I'm honestly not familiar with the kangaroo pumps; don't think I've ever seen one but I've never worked in a pediatrics unit. Anyway, just wanted to say that when we put our breast milk on pumps we always make sure the syringe is in a horizontal position so the fats will enter the tubing in a more constant fashion. If the syringe is placed with the plunger on top and the tubing down below, ALL the fat can be seen collecting just under the plunger. When placed horizontally the fats can be seen all along the syringe. It really doesn't take but about an hour to see the separation occur. This is also why we make sure we put exactly the 4-hour amount of feeding in the syringe so we don't waste any of the precious fats.

I agree with NICU_babyRN's suggestion. You might also want to consider consulting with the dietitian for your unit since they probably would have some good evidence-based information and articles to share. I believe the American Dietetic Association has lots of guidelines and I'm sure they have some which would apply in this situation; your dietitian might have that information at their fingertips. Good luck, take a deep breath, and as I can see you already know...continue to speak and act as the professional you obviously are when coming up against difficult situations.

I really learned a lot from the book, Newborn Intensive Care: What Every Parent Needs to Know Edited by Jeanette Zaichkin. The newest edition was published in October 2009. It's about $30 on Amazon. You may recognize Jeanette Zaichkin's name as she is one of the leaders in NICU nursing. Her name is big for her contributions to the Neonatal Resuscitation Program books. Anyway, it's written in such a way that helps me explain things to parents in words THEY can understand. It's way too easy to use medical jargon without realizing it and this book has helped me a lot through the years. As far as admissions go, I agree with you getting report on the patient now that you have gotten better at performing the routine admission procedures. Where I have worked, the admitting nurse takes report and all the other nurses gather around to help. When you are the one to receive report it puts you in the driver seat to think critically about what is wrong with the baby and the expected plan of care the doctor or nurse practitioner will implement. Of course you will dive in and work on the baby too, but knowing where the baby's "been" helps you know where you will be "going" with the baby over the next few minutes and hours. It will all come together with time, and don't be discouraged if it takes at least 2 years to begin... yes begin.... to feel a bit comfortable. Never stop learning, seeking, and caring with all the empathy your heart can hold for your patients, families and coworkers. Wishing you the best nursing career possible!

Every 2 weeks. We don't use humidity. We have little sheets of paper which also have the NTE based on birth weight which is taped to the isolette and gives appropriate NTE for age as they grow...it's on this paper that we write the date to change the isolette. We also include it on our computer-charting kardex.

We use the Medela waterless breast milk warmers. They also can turn frozen milk into thawed milk or warm milk depending on what you want. It holds bottles and syringes of all sizes. We really like them a lot.

I've not worked on a med-surg floor for almost 20 years but remember how hectic it was. I have nothing to offer to help you but simply want to say how much I admire all of you and will be sure to send extra prayers and good wishes your way. It takes my breath away to see how busy you all can be!!!!!

Sounds like you have everything going in your favor. Honestly I can't think of a thing to share with you other than to be yourself. I'd hire you in a New York second. Keep your compassion and energy. Say your prayers and as you mentioned, God will place you where you need to be; I have a feeling it will be the NICU. Get a good night's sleep, have a healthy breakfast, and take a few deep, slow breaths before your interview. Be sure to look the interviewer in the eye, smile politely and be the kind of personality you would like to hire. I have confidence in you!

Just for clarification, if one of our babies has an og or ng tube in place and are allowed to bottle feed, we do check for residual before the feeding. This would be the case when the doctor orders something like, "Enfamil Premature 20 calorie with iron, 33 ml po/og q3h". If the baby does not have a tube at all and is bottle feeding we would not place a tube to check for residual before bottle feeding. We only check residual if there is a tube in place.

I can't imagine you being fired for crying. As you mention you tend to be strong during emergencies like resuscitations this is true for pretty much all of us. In the heat of the moment we are all strong, level-headed, thinking hard and acting fast. It's often after the incident that we tend to break down a bit and we often do it among ourselves. It's ok to shed a little tear with a family but you must remember they need you to be strong too. When babies pass away they are usually in the arms of their Mother and Father; the parents are usually crying and often the Mother lets out a cry that will bring you to your knees. Generally we pull the curtains around them to let them have their privacy and we walk away and wipe our tears and hug each other. After the family has felt they are ready to leave the unit, this is when we often will truly cry together. A really hard thing to do is assist parents who want to give post-mortem care to their baby like bathing the little one and dressing them, bundling them, etc. Now, that is hard but again, you somehow suck it up because you know they need this for their grieving and they are allowing you into one of their most intimate moments of their lives and will appreciate you for helping them. Sometimes the hospital minister will have a prayer with us nurses and I remember once when we had a bunch of deaths occur in a short time our nurse manager brought in a psychologist to help us with our grief. So, it's ok to cry and be emotional in the right place and somehow you will be able to manage this like the rest of us crybabies do. I'm one of the worst crybabies I know and I've managed to remain professional although I have cried a tear or two with a family (the kind of tear that comes when you look at the parent in the eye, your eye fills with water and you gently wipe it away as you give them a hug). Your compassion will make you a great nurse for working with Mothers and Babies!