RNin2007

How intermittent are the feedings given via gavage? We sometimes send kids home on gavage feedings (after parents are taught how to do so). We also had parents not long ago that were very adamant on not having a G tube and the baby went home on NG feedings (he would probably eventually need one because he had severe HIE, and no suck/gag reflex). But it wasn't something that we could force upon the parents at that point.

Oh wow, so sorry - that is truly a bad week.

Wow you surely know a lot about this child...but as you know we can't give out medical advice. I will just share a few "off topic" things about my own child who has PVL. He also scores above the standards on state testing. He is quite intelligent. He has ADD (not ADHD) which is treated by medication. He also only last year learned to ride a two wheel bike (he was very fearful up until this point of learning how to, despite my attempts to bribe him with $50 to ride LOL!). I think he has a sensory processing disorder due to his prematurity and MANY problems (8 surgeries before the age of two, need I say more). He isn't OCD, but he does chew his nails and would play video games 24/7 if I let him. I would say he also fixates on certain subjects, such as science. He is an overflowing river of knowledge when it comes to the most random of facts. His ADD is managed by a neurologist, and we see a pediatric psychiatrist every two years for testing, and he has an MRI every two years in addition d/t hydrocephalus (no shunt, he had an ETV at the age of 2). He also has a hard time making friends and he does talk nonstop. He just turned 12 last month and he was a 2 lb. 2 oz. 29 weeker. He is a handful but an amazing kid. Again...no medical advice but thought I would just share with you - more on a mom level here I guess.

Lots of agreement with PPs, as a mom of 3, and mom to two micro-prems, NICU is definitely not a place to work because *you love babies* (as was said), however it sounds like you have thought it over well and are on a great path! I love my job and can't imagine do anything different for many of the reasons you describe. :) GL and keep us posted.

Quick add....my 11 year old was a former 29 weeker and had/has PVL and hydrocephalus. He had his shunt removed at 2, and is completely normal. He scores above average on state testing in school and has NO medical issues from being a preemie.

That is so sad

That is why I questioned it. I've only been a nurse for a year and a half and wasn't sure. Sorry for not knowing this.

I heard that the state of CA paid for her IVF? Did they not even screen this mother to see if she was a good candidate? What is the screening criteria? It does not even seem ethical to transfer 8 embryos. She'll probably sue Kaiser for malpractice and live happily ever after.

Yeah, our local news said they would be in the hospital for about 2 weeks. The smallest was 1 lb. 8 oz. and they were born at 30 weeks. Um .... we'll see about that!

I am a mom to two preemies (26 weeker and 29 weeker) and they were my inspiration for wanting to be a nurse. I love my job, and really can understand what parents are going through. You have to have good boundaries (don't expect every parent to experience what you did in the same way). Honestly I very rarely share my personal experience with parents. I don't want them to *compare* or expect that their preemie will have a simlar course as mine did. For instance my 680 gram 26 weeker did great, came home a month before her due date...my 29 weeker was a trainwreck and had 8 surgeries, 5 for hydrocephalus and was in the NICU for 4 months (that could really scare a parent). I'm lucky that both of my kids are doing fine today - you would never know what they went through. I think the most important thing is to keep good boundaries.

I've been in the NICU for a year now (this month) and I feel the same way you do. My orientation was very slow...we are a small unit as it is, and I had NO admissions on orientation, and only one level 3 patient. I feel exactly the same way you do and i'm glad i'm not alone. We are finally starting to get busy and i'm trying to take as many of the micros as I can. I am starting to feel slightly better, but still not very confident. I also go home and my brain is spinning...wondering if I forgot something or didn't do something right. I feel slow at some skills that I haven't gotten to do much (e.g. assisting with line placement). I think it will get better as time goes on and everyone learns at a different pace. I don't feel like i'm unsafe or anything like that and i'm never afraid to ask questions, but wish I had more confidence.

Definitely get bored if I have a stable vent patient and nothing is going on with them. :grn:

Wow, you had two vented patients that night? When we have a vented patient it's a 1 on 1 assignment (however we are a small 26 bed unit). That sounds like it was a rough night, I can only imagine. I am really starting to enjoy level 3, and learned a lot taking care of this baby. I try to ask for as many patients like this that come in since lately they are few and far between.

We use bubble cpap and monitor it also by checking frequently. I've not been around long enough to follow kids toaster heads lol but I have my own 29 week preemie who spent a fair number of days on CPAP and has a very slightly noticable toaster head at 11 years old...but not that bad really. There's my 0.02 for what it's worth... ETA: his nose is perfectly fine! spent 3ish weeks on CPAP

I'm learning right here reading these replies...this is so helpful to me. Appreciate all of you who are chiming in on this, because my level 3 orientation and number of vented patients i've had has been very limited. The tubing was propped on another sandbag and I always take a look at my patient when sats drop to make sure whatever support they are on (CPAP, NC, etc.) is correctly positioned...but its a bit more of a mystery with an ETT and a baby this small. There was no clot in the tube, which is what I expected since we were suctioning thick secretions all night long. I did watch the tube for kinks and tried to be sure that the tube was in optimal positioning while he was prone. The only other micro i've cared for (while I was on orientation) was so sick that she didn't move really...which also leads me to really concur with what Steve said about the baby possibly needing something for pain ...sedation. I'm really learning still, and it really did make me feel bad to have to reintubate my patient two days in a row, especially when he had a blood tinged residual which im sure was from the trauma of being re-intubated . Again thanks for your reply.

Yeah, I was told by dayshift RN in report "he does much better prone" as far as saturations and comfort level. He didn't seem to be overly active but maybe he did need some sedation. Thanks Steve.

I was wondering if anyone else could share a similar story. I'm about to enter my second year of nursing in a smallish level 3 NICU (26 bed, no surgeries or ECMO). We haven't had a lot of vented patients since i've come off orientation in June but I had the opportunity the last 3 days to take care of a micropreemie (800 gm 25 weeker). i really enjoyed the experience and learned a lot. Two of the three nights I had him, he self-extubated. I'm still trying to understand this. He was positioned prone on a pony both times, ETT tape secure, head was sandbagged to prevent too much movement, etc...sats started dropping, not having any spontaneous breaths on the vent (low tidal volumes)...so I suctioned, called for RT, we put on CO2 detector, no change...listened for BS bilaterally...pretty much was clear he was extubated. Now when you looked at the CXR you can see the ET tube and it's position near the carina (one xray it was a little high and our reintubation was T3), and it's definitely apparent in a tiny baby like this there is not a lot of room between intubated and extubated. I somehow feel responsible for this happening...I was not at the bedside when it happened (I mean I wasn't in there doing cares or anything) but is there anything I could have done to prevent it? Someone told me we have a day charge nurse that considers it "an incident report" when this happens so now i'm questioning myself (*note this was just info told to me by someone else, no incident report was written). Anyone have any advice for me on this?

Cancel you? ...yep and we get squares for that...MTO FLoat you?....if they need us we can float to peds, OB (post-partum) Let you be over by 1 nurse? .....occasionally And for those that have to float...where do they put you? ......(answered above) :) All that being said, our census is scary low right now! We are only using 5 nurses. I am going to call our travel nursing agency here on monday and see if i can get some per diem work in adultland

We kangaroo stable kids with lines and on the vent - not HFOV or while on nitric but that is because the baby is usually not stable enough to tolerate it. My own two kids were 26 and 29 weekers and are now 14 and 11...I did kangaroo care when they were born, even on the vent - it was strongly encouraged.

I am a former NICU mom. I keep very good boundaries with my own experiences and my job. It helps me to relate and understand, and because my professional boundaries are well defined, I think it is very beneficial thing. I very much understand what parents are going through and remember the "little things" that maybe not all nurses can relate to. I have told VERY few parents that i've had children in the NICU (yeah two of my babies were micros)...there have only been less than a handful of times that it was appropriate to disclose that information. And when sharing it certainly wasn't "about me"...I kept the conversation where it needed to be.

This last weekend I had a term IDM baby...won't be with us long, he got his RDS and sugars straightened out, he just needs to learn how to eat. His parents are really nice and they have a 3 yr old girl as well. They brought her in and I could tell they were nervous about having a bundle of energy in the NICU - she was very cute, full of questions and wanted to touch "her little sunshine" as she called her brother lol. I got her crayons and a color book and her own chair so she could color for her brother. Then a bit later got her stickers, and gave her the last newborn diaper in her brothers drawer for her dolls (he's already wearing size 1s). She turns to me and says "excuse me, excuse me...I like you!" About melted my heart lol. Her mom said she has never said that to anyone before. Moments like that make me love my job even more. :)

Thank you everyone for your replies (both here and PM). The first person who PM'd me gave me great advice so I think i'm all good now.

I have something that happened at my work i'm stressed about. I really would like to ask an experienced nurse who wouldn't mind a few words of advice for a newer nurse in PM (little nervous to do it here public due to the specifics because i'm not sure if anyone I work with reads this board). I would really appreciate it....let me know if I can PM you. Thank you...

We don't give seperate packs to siblings but we have coloring books available (they can color/tear pages out) and books, toys, magnadoodles, etc. that they can play with while on the unit. I think I would keep it simple (crayons/books and stickers seem enough) since attention spans seem limited in the stimulating NICU environment.

We had a transport kid, 36 3/7 weeker admitted for RDS, and r/o sepsis. I was 2 days into my 5 day stretch and when I went to pull my meds off our MAK (computer medication program) I did not see his antibiotics listed so I thought they were D/C'd. They did not show on his profile at all. The same thing happened to another nurse the same night (both of us KNOW we looked up our meds and they did not appear in the computer). I kick myself because I should have looked in the orders to see if it had been written as D/C'd. So I never gave the kid (who was 3 days old at this point) his Amp or Gent. I found out the next night when I showed up and the charge nurse asked me if I forgot to give my meds....I explained to her what happened. The doc D/C'd the antibiotics the day I came back to work anyway, but I still can't help feeling bad about it. The other nurse I was working with who had the same issue, made a call to the people that run our MAK system to ask if anyone else was having the same problems but they said no. I can't help but kick myself for this. I know it's not a huge deal but I still feel crappy about the whole situation.