LRC_RN

Hello all, I am new to the NICU and I just recently took my NRP and I feel as though I have an ok grasp of what to do when a baby is experiencing 100% apnea but I find myself getting confused when it comes to situations such as this: I had a patient the other day who gets "very tired" when bottle feeding and has trouble pacing so she did very well for the first bit and the pacing helped her saturations return to 100% when they would go down to high 80's, low 90's. At one point, however, her saturations kept going lower and lower until eventually they reached the 20's. By this point and her heart rate started slowing down. For some reason I decided to put her prone and "stimulate" her by gently rubbing her back- although looking back, don't know if this mattered because she wasn't experiencing apnea. I guess it was my instinct to just stimulate her to breathe more? I have no idea why I did that. And then after a few seconds of seeing no improvement, I provided blow-by oxygen and she eventually came back up and had no problems for the rest of the shift. What would have been the proper thing to do in this situation? I kept thinking back to NRP as I saw her heart rate drop to below 100... first I thought "PPV" but then realized, she wasnt experiencing apnea and wasnt gasping. Then I thought "CPAP" because of her low 02, but I'm thinking that would be something more in the "long run"... if she kept up the low 02 for a long time and didn't come up with blow-by oxygen. I still feel SO confused!!! Was using blow-by oxygen ok in this situation?

Thank you immensely for your replies :)

Hello all, I would greatly appreciate an explanation as to what causes Apneas/Bradys/Desats during gavage feeds? Thanks!!

Thank you so much for this post. It means a lot to me as a new grad!!!:redbeathe

Hello everyone, I am a new grad, I just had my first 2 shifts on a pediatric floor. I love it but I feel like such an idiot that I can't handle it. I have a preceptor for another 10 shifts but then that's it, then I'm on my own. This idea makes me physically ill. There are SO many things to remember and know that I do NOT feel under any circumstances that I will be able to adequately care for a patient on my own. There are SO many protocols (some things have them, some things don't), SO many times when you need an order for something/ other times when you don't need an order, SO many things that you're supposed to notify the doctor of, SO many things that you don't have to. I feel like I am going to die on my first shift alone. I know I will be ok if I really think about it, but I just am SO scared that I'm going to administer a drug and then all of a sudden get in trouble because there was a protocol for it that I didn't follow, etc. I need advice please!!!

I was told the same thing once in the past and they told me that even though I never had a job in the same type of ward that I should really try to prove that I could transfer my skills from med-surg, etc. from the past to the job I'm trying to get. (i.e. think about skills from your past jobs/placements that could be transferred to the job at the birthing centre - i.e. therapeutic communication skills, organization skills, teamwork skills, time management skills, etc. GOOD LUCK! :)

Hello :) Even though I'm just a new grad RN, I've noticed throughout my schooling how many different ways nurses (and other members of the health care team) do things! As for the meds or assessments first, I always do my assessments first. Not only is my license on the line, but so is the health and well-being of my patient- I could go in for a 7am shift and maybe a lot has changed since a) the last nurse went to check on the patient, 2) the nurse checked the patient's vitals, etc. Secondly, I won't give a med unless I'm sure that my patient needs it (i.e. I won't give a antihypertensive if my pts blood pressure is all of a sudden very very low and unlike their usual pattern) so I always assess vitals first. I have worked on wards where resources are slim and there was only one bp machine, thermometer, etc to go around (for a good 30 patients) so it was hard to do assessments first thing in the morning unless you were the lucky first person to get your hands on the machines. In that case, I would just give the meds that I was sure I could give (i.e. a medication that just needs someone's respiratory and/or heart rate measured, etc) and then leave the other medications for later if I needed to use the bp, thermometer, etc. first Hope that answers your question :)