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Sweeper933

NICU
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Sweeper933 specializes in NICU.

Sweeper933's Latest Activity

  1. Sweeper933

    OG /NG Tube Placement

    Auscultation / aspiration upon insertion, and before each feed/med. X-Ray only if it's an NJ/ND. We also chart with each VS what cm the tube is at at the nares / lips.
  2. Sweeper933

    Measuring urine output

    We will use a 5fr feeding tube as a catheter on our babies. Works pretty well. But we have to make sure to use the old style ones - the ones that connect to both feeding tubes and IV syringes, not our new orange feeding syringe only ones. This way, we just connect the end of the feeding tube up to the rest of a normal foley set-up.
  3. Sweeper933

    Measuring urine output

    How do you deal with skin integrity and all of that stuff on kids with long term IVs...??? I can't imagine having to put a bag on a kid for more than a few times in a row, let along days / weeks!!!
  4. Sweeper933

    NICU RNC

    http://www.amazon.com/Certification-Review-Neonatal-Intensive-Nursing/dp/1416036679/ref=sr_1_1?ie=UTF8&s=books&qid=1252801839&sr=1-1 That's the book we all used on my unit. Although, a bunch of us have been taking a review class that has been offered in the area. It was 3 days, 8 hours each. The instructor was awesome - had powerpoint presentations for each of the topics, and had it all narrowed down to what was important to know for the test. Most of us ended up using that book as more of a reference as we were studying off of the notes from the class, as the book has a lot of information that simply isn't needed for the test. Good luck - just remember that you can't learn everything in the NICU right away! You need at least 2 years of clinical experience in the NICU to even take the test (if I remember correctly...)
  5. Sweeper933

    busy or slow

    Evidently the fun on my unit is continuing. I just got a call from one of the managers to see if I could come in to work tonight at 11pm. Evidently in the last 18 or so hours, they've gotten 35 wk twins, 27wk triplets, a kid with skeletal anomolies / hypoplastic lungs... and a giant omphalocele. Yikes...
  6. Sweeper933

    busy or slow

    This whole week we've gotten nothing but sick term kids. Which is always a nice surprise addition to the census. At least with the preterms, you have somewhat of a warning as to their admission. And all of these term kids have been really sick. A few bad mec aspirates, an unknown cardiac / other anomolies, and an unknown diaphragmatic hernia (that was fun....)
  7. Sweeper933

    busy or slow

    We (finally) slowed back down to normal after being crazy/busy all year. Our census is back to normal, but our acuity is still really high. A few really sick kids and a few really time-intensive chronics do wonders for staffing...
  8. Sweeper933

    Measuring urine output

    We weigh the diapers if they are on IV fluids, on oxygen, under phototherapy, or on diuretics. Otherwise we just do diaper checks.
  9. Sweeper933

    Family Support Person

    We have several social workers that just deal with our Moms / families. If Mom is inpatient on antepartum, then they get hooked up with them at that point as well.
  10. Sweeper933

    full assessments vs. monitor vitals

    Even when it's an "off" time (non feeding or vitals) we still chart a lot of stuff each hour - bed temps, hr, resp rate, O2, IV status.... And for the first hour of our shift, we always chart their position, color, and their behavior (awake, sleeping...). That way if we come in at 7, but they aren't vitaled until 10, we still have proof that we've looked at them when we walk in the door
  11. Sweeper933

    Stoma trouble

    The wafer is the donut shaped piece of duoderm that gets cut out to go between the skin and the bag. It gives the bag something better than just skin to stick on to. It also helps protect the skin surrounding the ostomy. As far as the paste goes - I have no idea what you would have available over in the UK... The stoma nurse should know what it is if you do have something you can use.
  12. Sweeper933

    Stoma trouble

    Have you tried using stoma paste? It's used to fill in the gaps between the wafer and the bag. Works well when you have a tight area to work in and it's hard to get a good seal between the wafer and the bag all the way around. In my unit, when the stoma's start prolapsing as bad as you have described, we to take them to surgery quicker than we otherwise would have, so they can be reanistamosed.
  13. Sweeper933

    I Passed the RNC!!!!!!!

    I know there's a ton of the "I passed the RNC" threads going on... but I'm super excited and just wanted to start a new one!!! Yay for me!!!!! :balloons: I did study a lot - but by the end of it, this is how I felt... Totally worth taking it though :wink2:
  14. Sweeper933

    NICU- how much math?

    All this math talk makes me really glad that we have our own NICU nutritionist with us during rounds every day! They are the ones who keep watchful eyes on all of the kcal/kg/day according to the growth charts and total fluid needs / restrictions and all of that. Of course we all use math when double checking med doses. Thankfully we have standard concentrations for doPa/doButa/fent drips, so the calculations are much easier for us to double check. For example, our fent comes in either 10mcg/ml or 20mcg/ml - depending on how slow it ends up running...
  15. Sweeper933

    "Never trust a 35 weeker"

    And it continues... 35 4/7 twin girls, born right at 2000 when I walk in the door. I get twin B - who is a champ. Sugars a fine, temps are great, eating 15-20cc q3h PO, planning on sending her up to newborn after rounds in the morning. Twin A was the one with the slight temp issues and needed D10 for some sugar issues. I come back the next night and see that twin B was no longer in my assignment, I figured she had indeed gone up to newborn. I asked the resident who was standing right there when she went upstairs. He then told me that she had spontaneously perfed and was in the OR that very minute. I think my jaw actually hit the floor! Seriously!!! At 09 she was still fine. Girth was still 29, and ate her 20ml no problem. At 12, her belly was huge - girth up to 34... X-ray showed a huge amount of free air. Never had any temp issues or A/Bs or any of that other stuff. She had perfed in her sigmoid colon - only took out a few cm of bowel, and no ostomy or any of that non-sense. Since when do 35 4/7 wk babies spontaneously perf at 14 hours of life???
  16. Sweeper933

    full assessments vs. monitor vitals

    Well we never make q4 vitals due at 7-11-3... because then it would always be due during shift change - no matter if it were a 8 or 12 (or 4) hour shift. Because of this - vitals are never more than 3 hours after you walk in the door (start shift at 7, first set of vitals are at 10). Obviously, if it appears that something is clinically changing with the baby, we don't wait until that 4 hour mark - assessing immediately. On the "off hours", we are still doing hands off assessments on all of our babies - no matter what their vital sign schedule is. This includes taking numbers from the monitor (and actually counting respirations if they're on O2), assessing IV sites, fluid totals, oxygen settings, and a few other random things that are a case by case situation (iNO, chest tube site assessments...)