Unhappy 22 Weeker

nekhismom · Mar 3, 2004

OMG, JNette!! YOu had it ROUGH!! YIKES!

nekhismom · Mar 3, 2004

You know what I hate? When I chart pain scores of 5 and other nurses put 0. Or a NAS of 9 and other nurses chart 3! How is that possible when you told me in report that the kid cried all night, vomited and has tremors???
And the doc'll tell me, "Oh, that's just his temperment." !

Exactly!!! It's like, because I'm a new RN, I don't know how to look for pain. Hello??? I'm a MOM, and an RN. That makes me qualified to know that babies don't cry endlessly for hours and hours without SOMETHING being wrong. Even if it's just too much light, or a wrinkle in the sheet, or the way they are laying, it's something.

We have one chronic kid that nobody likes to be assigned to. She stays up all night, and most of the day, too. Cries a lot. Has lots of vomiting after meals. She usually can't take all of her PO feeds. I held her one slow night and fed her, and kept her up and played with her for about 1 hour after her feed. Guess what? She smiled, played, and was calm. She did not vomit. And she did not fuss half as much for the rest of the night as she usually did. She just needed a little attention. Well, and she's so big now that she needs to go to the PICU, but that's another thread.

nurseiam · Mar 4, 2004

There are alot of nurses that think the PICU is automatically a better place for a big chronic kido. Just a thought......

Unless a baby is vented they usually will be on a med surg floor. So instead of 1-2 other patients the baby will be in the mix with up to three or four per nurse. This is a good option if there is a family very involved and the hospital has family centered care.

Is there a long term care facility or medical foster care that the baby can go to? Is it worth sending the baby from people it knows before it can transition to home??

In our unit we had a baby that had very little viable bowel and they couldn't do anything eles. The family had several other children so visited very little plus tested + for cocaine @birth. So then they tried for a transplant. Two weeks before the team was going to evaluate her they wanted to send her to the connecting childrens hospital. I spoke with the doctor and all her primary nurses and told them the reality of the childrens hospital(not that it is bad, just not right for this patient). This baby knew her nurses very well and it would have been horrible to take away all the people she loved. She would have been on the floor during RSV season. They almost sent her one morning, she was packed and ready. Then one of her primarys came and saved the day. The doctors all agreed that she could stay until after the initial evaluation. So she was with us for a few more weeks until they wisked her away for her transplant. Sadley she died from influenza a week after she was there. The best thing I ever did was be her advocate. She was surrounded by people that she knew and loved for as long as possible.

Sorry to ramble......

Hellllllo Nurse, BSN, RN · Mar 4, 2004

OMG, the things you all see and deal with. My deepest respect and admiration to all NICU nurses.

carriec · Mar 4, 2004

Sometimes I don't know how I do it myself

nekhismom · Mar 4, 2004

nurseiam,

I'm not extremely familiar with our PICU, and I don't necessarily think that all babies that big should go to PICU. THe thing is, she is big. She needs tummy time and play time and she needs to be OFF her back sometimes. Her AGA is old enough that she should be working on sitting up now. We just can't do that with her with our staffing. And she stays up all night and a good chunk of the day, too. I think the PICU would be better for her simply because our PICU does allow for play time and they have better staffing ratios. Also, they don't bother their pts. at night, they let them sleep. They keep all the kids on a monitor, and check on them, but don't wake them. Our NICU wakes the kids q3h, even if they just got to sleep 5 mins. before! THey must have their vital taken, and then be fed and placed back in the crib. It's just not a good fit for her right now. I think she would be better off in the PICU where she could sleep at night because once she falls asleep, if no one touches her, she will stay asleep. Just my .02 cents!

prmenrs, RN · Mar 4, 2004

When we had kids like that, OT/PT came and played w/them. Also, we could get help from the child life program on the peds floor.

Rosepink · Mar 4, 2004

Thank you for your input. This baby had 4 very good primary nurses that knew him very well and 2 fill in nurse that knew him very well. BUT after over 200 days they all just burned out, so that is why I was asigned to him. His parents are in jail and no other family visits. True he needs to be rocked and held. The Neo on that night got into a loud shouting match in a small office with the charge nurse because he wanted her to take my other babies (2) away so I could sit and hold this baby. There was not enough staff for that(inlies another problem). That poor baby has a misreable life because he has no lungs. None of the voulunteers will get near him to hold him because they are afraid of him. His Co2 are still so high no long term care facility will accept him. I am just praying he will some how get some peace and rest

There are alot of nurses that think the PICU is automatically a better place for a big chronic kido. Just a thought......
Unless a baby is vented they usually will be on a med surg floor. So instead of 1-2 other patients the baby will be in the mix with up to three or four per nurse. This is a good option if there is a family very involved and the hospital has family centered care.
Is there a long term care facility or medical foster care that the baby can go to? Is it worth sending the baby from people it knows before it can transition to home??
In our unit we had a baby that had very little viable bowel and they couldn't do anything eles. The family had several other children so visited very little plus tested + for cocaine @birth. So then they tried for a transplant. Two weeks before the team was going to evaluate her they wanted to send her to the connecting childrens hospital. I spoke with the doctor and all her primary nurses and told them the reality of the childrens hospital(not that it is bad, just not right for this patient). This baby knew her nurses very well and it would have been horrible to take away all the people she loved. She would have been on the floor during RSV season. They almost sent her one morning, she was packed and ready. Then one of her primarys came and saved the day. The doctors all agreed that she could stay until after the initial evaluation. So she was with us for a few more weeks until they wisked her away for her transplant. Sadley she died from influenza a week after she was there. The best thing I ever did was be her advocate. She was surrounded by people that she knew and loved for as long as possible.
Sorry to ramble......

carriec · Mar 4, 2004

Some of the girls in our nicu has donated things like an exosaucer, and a bouncy seat with toys, also we buy neat mobiles and those water aquarium things...

I know that all units are different....Some babies have their own rooms..ours is all open, so we can watch our older babies as they play and sit up in their things....Also, baby swings with music....

Do the parents come and spend time with the baby?

Gompers, BSN, RN · Mar 4, 2004

I think it depends on your hospital, whether Peds or NICU would be best. By me, a trached kid might be best in PICU because they only have 1-2 kids per nurse. But non-trached kids will go to the peds floor, and then will have to share their nurse with 5-6 other kiddos. In that case, it's better to stay in NICU where they'll have a better ratio to their advantage, as most of our chronics are only paired up, never tripled if possible.

We have a whole bunch of swings, strollers, bouncy seats, high chairs, exercise mats, mobiles, mirrors, toys, etc. that we give to the older kids while they're still on the unit. OT/PT works really hard to bring them up to speed developmentally. The primary nurse often makes a schedule for the baby and posts it on the crib. During the day, we try to have them sitting up and playing as much as possible, with a couple scheduled naps. At night, we usually put them down around 9 or 10pm, and don't bother them until 5 or 6am. We'll maybe sneak in for diaper changes, especially if the baby has a sore bottom, but that's about it as long as they're stable. Most of these kids are on tube feeds, often continuous overnight. We turn out the lights around them or cover their crib with a dark blanket and make a tent. We try to put them in corners, as we have a big open unit. Most of them end up sleeping really well once we get them onto this schedule, and the parents or nursing home really appreciates this when they are discharged. The BPD trach kids, especially, do really well if you give them a nice warm bath before bed. We soak off all the sweat and that BPD smell, and put them down on a nice, cool, dry bed. They are OUT for the night! As far as vitals, most of the chronics are once per shift anyways. We can always write down the monitor vitals if necessary.

carriec · Mar 5, 2004

Gosh, that sounds a lot like our unit, except for the 1-2 babies is more like 3 babies....grower feeders 4....

We used to have a lot of 1 on 1 nursing care for our sick babies, but it seems like we're always short staffed, and that makes it very hard on everyone...lots of people in my unit are starting to get burnt out....WORK brings on a whole new meaning!!!Maybe I need to move!!!!

nekhismom · Mar 9, 2004

Gompers, your unit sounds like a dream!

I work nights, so we don't have OT at night. And there are NO play things on the unit unless the parent supplies them. We have a couple of swings and bouncy seats. No saucers, mirrors. We do have the plastic aquarium things that our unit supplies, but not many. We have 3-4 babies each and we usually don't have time to play with kids. Day shift certainly doesn't. We wake all of our kids up q3h, I think we have a couple who are on q4h schedules, but everyone gets vitals, a fresh diaper and food q3-4 hours. No deviations! We can't have boppy pillows or other soft things in the cribs, either, for safety issues. So the kids don't really get much play time. Our PICU has these things available, and the staffing to do it, so that is why I think our PICU is a better fit for the baby i described before.