WHAT DOES A NURSE DO??

I'll tell you!! I work in NICU, so,here goes.

Clock in. Get assignment, report. LOOK at baby. Check emergency stuff @ each pts bed: suction, bag and mask, code sheet, monitors and alarm settings. Check IVs: look at sites, check pumps, rates, look at bags, check ingredients in hyperals w/ orders; if pt is on drip(s), check those, including the math. Review Kardex for meds, labs, etc. If there are labs pending, check computer for results. If pt has a field trip that day (surgery, CAT scan, MRI, nuclear med, whatever), start planning for that. If on Breast milk, check frig for supply, thaw some out +/or fortify prn.

Field ??'s from Doc's, participate in rounds to formulate a plan of care du jour, alert social workers of any problems w/families, +tox screens, work w/ d/c planners.

Most babies get q3h feedings/assessments. This involves vital signs, tpr, bp, sat, transcutaneous monitor readings, record resp support settings (ventilator, nasal simv/cpap, nasal cannula, tent); suction, prn. IV sites are checked qh, esp if peripheral, amt infused. Assessment: observ: position, color, precordium, retractions, grunting, flaring, tachypnea, periodic breathing; ausc-lungs, heart, abd; feel [gently]: skin, refill, liver, abdomen, fontanelles and sutures. assess also for tone and movement, pain, state, i.e., awake, alert, sleeping (in which case, try not to bother the baby too much), crying, restless, irritable. Care will usually be diaper change, hygiene appropriate for individual baby, and finally, feeding: nipple, gavage, g-tube, assist w/breast feeding.

On a sicker baby, I might need to get a blood gas, adjust vent settings, (w/ the respiratory care practitioner) adjust drips, assist w/ x-rays; liason w/consulting docs. Monitor baby if getting head/heart ultrasound, eeg, all done on the unit, I have to keep an eye on the baby to be sure he's tolerating it. Make sure everyone touching baby is healthy and washes their hands, including the surgeons [not as easy as it may seem].

Families: for babies, families are crucial! Mom needs to visit, be updated about medical condition, hold baby is possible, nurse him. She needs to learn about his care--it will probably be different from a well-baby. Discharge teaching starts early, some babies are with us for months, and may have special needs when d/c'd.

Call lights: in NICU, crying babies and monitor/pump alarms are our version of call lights. Crying babies need to held, comforted, changed, etc. Alarms are checked. Premies have apnea, their resp centers aren't developed; thay need to be stimulated to breathe; apnea can also be an early sign of sepsis. Septic work-ups may be indicated; feeding problems: their guts are immature, too, and can cause major problems unless watched closely.

Document: all of the above! I know I haven't written everything, but I may have told you more than you want to know anyway!