CallaRN

OK...So i'm finding out this funny thing that when you get a kid with a certain dx, you're gonna get a few more with the same dx... We have gone from no Trisomy 21 to 6 kids with Trisomy 21. Then now we've been getting a lot of placental abruptions and terrible deliveries=asphyxiated kids = seizures = potential CP kids...such sad cases...=G tubes and fundos!!!! Seems that every kid I've had has a date with the OR for a G tube... To top off everything... We put 9 kids on ECMO in a matter of 1 week!!!!! And we've gone months without even the threat of any kid going on... It seems weird how these things happen???? Or is it just me getting off my three 12s????? Just thought it would be interesting if these things happen in your units too.... It comes in threes?????

Nothing really bothers me... When something somewhat disgusting comes about I always put in my head "What if this was my child, or what if this was my grandmother???" I would want the healthcare providers to be strong in their skills and be able to look beyond the body fluids to the person within...

OK...here's my question this week.... What's your policy on drawing ABGs from UACs.... Have any of you heard that using alcohol before drawing up could cause a change in values? So are you supposed to draw back a few ccs then get your abg sample, then put the removed blood back, and then alcohol and cap off? I'm sorry to ask you guys this! IT's just that I ask a million questions at work... and I feel like I should know the answer to this one! Thanks!!!

I'm going to try not to go into great detail, but i was hoping someone could give me some advice.... The other day I was thrown with a random nurse b/c my preceptor was involved with a CRASH ECMO case. So I am paired with this nurse who's been in the NI for 3 years. I personally have been on the unit for about 6 weeks, still working with my primary preceptor, and asking tons of questions. However, I do all of the care, she is there to support me and help if I need her. I always have great experiences, and learn so much each day! Anyways, this nurse I was with on Wednesday was the type of nurse that I never want to be like, and I feel that I gave compromised care to my patients because of it!!!! I was so upset at the end of the day! Here's a summary of the day. We have a ex-28 weeker 3 weeks post NEC, bowel resection and she had been on the ventilator for 2 and a half weeks (just getting off 2 days prior to the day I had her). They d/c'd her morphine and Ativan (which they were using ATC) and all she had for me was a lousy 45 mg Tylenol PRN order. This little one was in PAIN! Crying, Tachypneic, quivering chin, uneasy, restless, arching, moaning, and inconsolable UNLESS BEING HELD!!!! here's the thing... she loved to be held and even looked at peace when in someone's arms... So another nurse who had her a few days prior thought she was withdrawing from the pain meds etc. Anyways, here's the point to my story... I asked the nurse i was with that day if I should go talk to the NNP about some type of pain management and she blatantly says "no she's fine"... so then I go to put my gown on to pick her up and the nurse was like "you need to chart. dont pick her up" (mind you this is a SCREAMING child)and so I said "OK, I'm going to find a volunteer then" and she says "NO, this girl is going to be spoiled if everyone keeps picking her up!!" ANd all I could think was that this poor girl has gone through sooooo much and had just been extubated... meaning she hasnt been held in 3 weeks!!! I was getting fumed at this point, but being a new orientee I didnt say anything... thankfully, a volunteer came by and I secretively asked her to help me! CAN YOU BELIEVE THIS NURSE!! So I'm doing my charting, and we have to do a pain score with each assessment... and I gave her a +3 which i thought was way low for what I was assessing and this NURSE says that is way too high of a score!!! I broke out our pain scale and I said NO!! if anything she's way higher than a three! She shrugged and said "well I wouldnt have given her a 3!!" Anyways, I'm getting totally frustrated... Besides we have an admission coming in as well. ANd that was a whole other story.... BUt this nurse was just totally lazy and didnt want to do anything!!! Orders from a surgeon were written on the new admit. and she blatantly did not fax them because she didnt want to do them right then! And in a ICU ORDERS MEAN STAT! most of the time unless written otherwise.... I was just beside myself, until I vented to another nurse who of course picked up on it that things werent going so good. I told her that the nurse I was with wouldnt let me hold the child and continuously let the child cry and she said it was pure ridiculous.!! Withdrawal, Pain, irregardless of what it was, the child was happy being held. What do you guys think? what do you think I should have done? and how can I, as a 22 y/o new grad, stand up to people like this!? I know its important to be able to confront the person but what would I say? Our team leaders and CNS are incredible and I shared this with them, and they're deciding on what to do... It's not only that I dont want to be paired with this nurse again, it's also that I think she should be reviewed for quality of patient care. IMO, I would never put down a screaming child, I would get pain meds ordered, or have a cuddler there all day!!!! (Granted we had a KUB done, and it lookeds great) THe patient should always come first... and in this case, i dont think she did that day... I cant stop thinking about this shift, and about what I should have done differently. And another quick question... in your units, do you find that they d/c pain meds a little too quickly? I'm a firm believer in pain control and sometimes I just don't get it!!!

Well, coming from a new grad myself, I'm not sure if I'll answer this right, but I will try. And I'm sure some of the more experienced nurses will reply as well. In your post you only mentioned the "flow", however, when a baby is on NC, there is usually a flow and it's also very important to note the percentage of oxygen being delivered; can be anywhere between room air (.21) and 100 percent. You will have some sort of respiratory management plan that will state exactly the parameters that the baby should be in. Such as "keep sats between 85-95%" IMO, if your baby that slowly began to desat, I might give him a little more O's, depending at where the MD wanted him, and knowing that too much O2 can be harmful. So to me it seems like a juggling act. Increasing the Os would thus (hopefully) increase the Sats, whereas increasing the "flow" is not delivering any higher amount of oxygen. So as far as your baby on 25cc...was it RA? or some higher percentage of o2? And YES if you had AN ORDER to d/c the NC in efforts to wean the child from the NC, then you would take it off and "see" how the baby handles it. Sometimes you'll have some chronic lungers who need that small amount of flow to keep their Sats up... IMO (which is very new) I think what the other nurse did was wrong, expecially if she didnt know the child, didn't know the orders, and did it and walked away from the bedside. That's my two cents..someone else hopefully will reply! Ya know, I just reread your post before replying and I really didnt answer you're question. And you probably know everything that I said in my post, but I'm just gonna throw it out there anywhere! So if it was RA and 25cc, I would make sure the MD wanted to wean her off, and take the prongs completely out. B/C the baby can exhale around the prongs, but it would be difficult to impossible to inhale around the prongs I would think.