Student Nurse Seeking Advice for NICU Clinical

HisKids37 · Sep 9, 2016

NICU is a specialty field, and your preceptor knows that you know basically nothing about it. Your preceptor will hopefully have been chosen as someone who likes to introduce new people to all they need to know to be successful. The most important thing you can do is go in with a positive attitude, a servant's heart, a willingness to learn and ask questions, and probably a little notebook, in which you can write things down so you don't have to ask over and over. Have fun!

rnkaytee · Sep 9, 2016

I think if this is something you're really passionate about you should get a Merenstein & Gardner book - you can usually find older, used ones on Amazon (I just checked Amazon and the used 6th edition is $2). I would just spend time reviewing the basics - temperature management, basic feeding techniques (gavage), and common respiratory issues (which is what the majority of NICU is). Don't worry - no one expects you to know much, that's what you're there for!

SNRR610 · Sep 13, 2016

Thank you! Great advice...I think I'm just over-thinking it :)

SNRR610 · Sep 13, 2016

NICU is a specialty field, and your preceptor knows that you know basically nothing about it. Your preceptor will hopefully have been chosen as someone who likes to introduce new people to all they need to know to be successful. The most important thing you can do is go in with a positive attitude, a servant's heart, a willingness to learn and ask questions, and probably a little notebook, in which you can write things down so you don't have to ask over and over. Have fun!

Thanks! Great advice...I think I'm just over-thinking it all. :)

SNRR610 · Sep 13, 2016

I think if this is something you're really passionate about you should get a Merenstein & Gardner book - you can usually find older, used ones on Amazon (I just checked Amazon and the used 6th edition is $2). I would just spend time reviewing the basics - temperature management, basic feeding techniques (gavage), and common respiratory issues (which is what the majority of NICU is). Don't worry - no one expects you to know much, that's what you're there for!

I'm going to look into that..it sounds like a wonderful resource. Thank you!:)

adventure_rn, MSN, NP · Sep 14, 2016

I agree with all of the above. I love the Merenstien and Gardner, although it's probably a little too detailed for your purposes (though it's great if you do go into NICU and are studying for your specialty certification).

Here are a few of the main pointers for neo care:

*The term 'brady' will become a central concept in your NICU vocabulary, along with A/B/D (apnea/bradycardia/desat) events. A 'brady' is when a baby drops his/her heart rate down to the 70s or below (norm is 120s-160s). It is often caused by a respiratory issue (i.e. apnea, desat, aspiration) but not always. Desats can cause bradys, but bradys can also cause desats. When a baby has a brady, you first wait to see if they can bring themselves out of it. If not, your next step is to stimulate them (by tapping or rubbing). If that doesn't do the trick, you may have to give O2, give CPAP, or even bag them and give breaths.

*Unlike in adults, cardiac collapse is almost always preceded by respiratory collapse. What that means is that if your kid is crashing, you generally fix the baby by fixing the respiratory issue. We don't defibrillate babies; rather, if you can fix their breathing (by bagging them or intubating them), their clinical picture will improve.

*There are three types of respiratory support that you'll generally see, from least invasive to most invasive: nasal cannula, CPAP, and intubation/ventilation (with various settings). It isn't like adults, where there are 18 different types of masks to memorize.

*Babies receive blended oxygen, i.e. oxygen on a 'blender.' The oxygen in the atmosphere is only 21% O2. The oxygen in an oxygen tank is 100% O2. We try not to give babies 100% O2 since it can cause oxygen toxicity and blindness (ROP). Therefore, when a baby is on respiratory support, we use the blender to adjust the O2 anywhere from 21-100% oxygen (though we don't generally go above 45%). If you've got a kid on 21% oxygen, you're not really giving them extra 'oxygen' per se; rather, you're giving them extra air pressure into their lungs (kind of like sticking your head out of a car window).

*You'll see a bunch of umbilical lines, which are literally just central IV and aterial lines that are threaded through the cord stump and into the inferior vena cava or aorta, respectively. They're called UVCs (umbilical venous catheters) and UACs (umbilical arterial catheters). They have to be placed within the first few hours of life (otherwise the cord dries up and they can't be threaded), and they can stay in for about a week.

*Common NICU diagnoses resulting from prematurity: PDAs (patent ductus arteriosis), BPD (bronchopulmonary dysplasia), ROP (retinopathy of prematurity), NEC (necrotizing enterocolitis), feeding difficulties

*Common NICU diagnoses not resulting from prematurity (though some can be more common in preemies): infection/sepsis, PPHN (persistent pulmonary hypertension), HIE (hypoxic ischemic encephalopathy), birth trauma, meconium aspiration, congenital heart conditions, GI tract anomolies (i.e. gastroschisis, tracheo-esophageal fistulas), neuro anomolies (i.e. hydrocephalus, spina bifida), neonatal abstainance syndrome (NAS, i.e. neonatal drug withdrawal).

*A few unique NICU meds: caffiene (IV or PO), Indocin for PDAs, prostoglandin drips for PDAs

*It helps to know the normal vitals for neos, since they're totally different from adults. In nursing school, they drill the adult vitals into your brain. I'd have the neo norms jotted down somewhere easily accessible. You can buy peds vitals badge cards on Etsy and Amazon for like 2 bucks.

Your preceptor isn't going to expect you to know any of this stuff (since 90% of NICU has nothing to do with adult nursing), but hopefully this can give you a brief intro before you jump right in.

As for resources, I'd recommend that you start by reading books/websites for parents, since they break it down into pretty basic, easy-to-understand info. Your unit may have a book called 'Preemies' (Linden, et. al) which is kind of like a textbook for parents; if they have it, they may be able to let your borrow it. It's only $17 on Amazon (I have it on my coffee table, lol). Another great resource is the Neonatal Resuscitation Protocol (NRP) handbook, which is basically BLS for babies. It breaks down the resuscitation process, including the explanation behind the process, in a pretty straightforward manner. The unit or hospital library should definitely have NRP manuals, since NICU nurses are NRP (if not PALS) certified.

Best of luck.

SNRR610 · Sep 20, 2016

I agree with all of the above. I love the Merenstien and Gardner, although it's probably a little too detailed for your purposes (though it's great if you do go into NICU and are studying for your specialty certification).
Here are a few of the main pointers for neo care:
*The term 'brady' will become a central concept in your NICU vocabulary, along with A/B/D (apnea/bradycardia/desat) events. A 'brady' is when a baby drops his/her heart rate down to the 70s or below (norm is 120s-160s). It is often caused by a respiratory issue (i.e. apnea, desat, aspiration) but not always. Desats can cause bradys, but bradys can also cause desats. When a baby has a brady, you first wait to see if they can bring themselves out of it. If not, your next step is to stimulate them (by tapping or rubbing). If that doesn't do the trick, you may have to give O2, give CPAP, or even bag them and give breaths.
*Unlike in adults, cardiac collapse is almost always preceded by respiratory collapse. What that means is that if your kid is crashing, you generally fix the baby by fixing the respiratory issue. We don't defibrillate babies; rather, if you can fix their breathing (by bagging them or intubating them), their clinical picture will improve.
*There are three types of respiratory support that you'll generally see, from least invasive to most invasive: nasal cannula, CPAP, and intubation/ventilation (with various settings). It isn't like adults, where there are 18 different types of masks to memorize.
*Babies receive blended oxygen, i.e. oxygen on a 'blender.' The oxygen in the atmosphere is only 21% O2. The oxygen in an oxygen tank is 100% O2. We try not to give babies 100% O2 since it can cause oxygen toxicity and blindness (ROP). Therefore, when a baby is on respiratory support, we use the blender to adjust the O2 anywhere from 21-100% oxygen (though we don't generally go above 45%). If you've got a kid on 21% oxygen, you're not really giving them extra 'oxygen' per se; rather, you're giving them extra air pressure into their lungs (kind of like sticking your head out of a car window).
*You'll see a bunch of umbilical lines, which are literally just central IV and aterial lines that are threaded through the cord stump and into the inferior vena cava or aorta, respectively. They're called UVCs (umbilical venous catheters) and UACs (umbilical arterial catheters). They have to be placed within the first few hours of life (otherwise the cord dries up and they can't be threaded), and they can stay in for about a week.
*Common NICU diagnoses resulting from prematurity: PDAs (patent ductus arteriosis), BPD (bronchopulmonary dysplasia), ROP (retinopathy of prematurity), NEC (necrotizing enterocolitis), feeding difficulties
*Common NICU diagnoses not resulting from prematurity (though some can be more common in preemies): infection/sepsis, PPHN (persistent pulmonary hypertension), HIE (hypoxic ischemic encephalopathy), birth trauma, meconium aspiration, congenital heart conditions, GI tract anomolies (i.e. gastroschisis, tracheo-esophageal fistulas), neuro anomolies (i.e. hydrocephalus, spina bifida), neonatal abstainance syndrome (NAS, i.e. neonatal drug withdrawal).
*A few unique NICU meds: caffiene (IV or PO), Indocin for PDAs, prostoglandin drips for PDAs
*It helps to know the normal vitals for neos, since they're totally different from adults. In nursing school, they drill the adult vitals into your brain. I'd have the neo norms jotted down somewhere easily accessible. You can buy peds vitals badge cards on Etsy and Amazon for like 2 bucks.
Your preceptor isn't going to expect you to know any of this stuff (since 90% of NICU has nothing to do with adult nursing), but hopefully this can give you a brief intro before you jump right in.
As for resources, I'd recommend that you start by reading books/websites for parents, since they break it down into pretty basic, easy-to-understand info. Your unit may have a book called 'Preemies' (Linden, et. al) which is kind of like a textbook for parents; if they have it, they may be able to let your borrow it. It's only $17 on Amazon (I have it on my coffee table, lol). Another great resource is the Neonatal Resuscitation Protocol (NRP) handbook, which is basically BLS for babies. It breaks down the resuscitation process, including the explanation behind the process, in a pretty straightforward manner. The unit or hospital library should definitely have NRP manuals, since NICU nurses are NRP (if not PALS) certified.
Best of luck.

Thank you very much! You gave some really helpful points and things to look over before I start. And I will definitely check out some of those resources you mentioned.

Thanks again! :)

ehankins · Oct 5, 2016

@adventure_rn, BSN, RN Even though I'm not the OP, I just wanted to thank you for your reply! You gave so much information that is invaluable to those of us wanting to go into the NICU and it honestly helps more than you know.

Good luck, OP! I hope your experience goes well â˜º