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NICU RN 7 last won the day on August 9 2018

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    Mission Viejo, USA

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  1. 49 57 posts Report post Posted June 10 Resuscitation: · Receive baby in sterile towel (pre-warmed) and place in plastic sheet (NeoWrap or household plastic wrap) on warmer (Giraffe Poptop) with a warming mattress in place and activated. Our focus at delivery is on keeping the baby warm and limiting movement as much as possible, so a sterile thermal hat is also put in place. · We use gel pad leads in micropreemie size for ECG (NeoTech Micro) and temp probe (Accutemp Plus), and velcro/cloth pulse oximeter probes (LNCS NeoPT-3) Gel pads lose adhesion very quickly in humidiity, and probe positions are changed Q12 hours with cares · Lines are placed and respiratory support tubing is secured before lowering top of Giraffe to isolette position. Humidity is added to 80%, and the ambient temperature is put on "skin" to keep skin temp at 36.5. · Once humidity is effective, plastic sheet is removed and infant is placed in supportive cotton wraps (Snuggle). Linens are changed Q24 hours · UVC, UAC insertion using checklist; clean skin with chlorhexidine 2% without and rinse with sterile saline. For 1st72 hrs of life · Humidity in isolette: 80%. · No bath. · No tape except for ETT securement · Routine diaper care with water wipes. · Score skin health with a skin care score Q6 hours No weights, touch only Q6 hours or when necessary · Transition to PICC at 48 hours of life if no signs of infection.; If skin condition poor, keep UVC if in good position, until skin condition permits PICC (max 14 days). We continue daily linen changes until PICC Is DC'd We continue Q6 hour cares until approximately 32 weeks, or until infant is consistently uncomfortable more quickly
  2. I'm working on a practice change for our unit with regard to the human milk spills that are a normal part of pumping for and feeding infants. The obvious solution is to wipe them with paper towels and then sanitize the area, but what do you do when the spot is dried before you see it? Our mothers pump at bedside, and we are often faced with dried spots of milk on the plastic chairs and bedside shelves after mothers have left. Our sanitizers: Sani-Cloth and Oxycide, do not lift the milkfat, and one of them even crystalizes it, making removal extremely difficult.My questions are as follows: 1. What does your infection control say about spilled milk? 2. What solutions do you use to clean dried spilled milk 3. Whose responsibility is it to clean such spots? Environmental services, Nutrition, Nursing, Parents?
  3. We allow siblings over the age of 16 to visit unrestricted, and siblings under that age to visit once (or twice for an extended stay patient) with a Child Life Specialist who can guide them in appropriate hygiene and contextualize the experience.
  4. One thing we do for our culturally modest families is to provide curtains which surround the bedside, and hospital gowns for parents which open in the front. There are also kangaroo shirts a parent can wear which provide full coverage, but allow for the infant to be placed skin to skin within them. Staff are sensitive to the needs of the individual families, and don't insist that any family member provide skin to skin care if they are uncomfortable. We do, however, allow skin to skin care for any infant stable enough to transfer from the bed to the parent and back. This includes infants with lines, and intubated infants who are not on HFOV.
  5. We have two methods. The first is a survey mailed by NICPicker that contains some carefully worded questions designed to evaluate the overall percieved effectiveness of our care. The second is a phone call made by our discharge planner which identifies specific events that were either praiseworthy or troubling to our parents and to make certain that our discharge teaching was understood.
  6. What are your policies regarding feeding of the preterm of newborns specifically pertaining the following questions. When to start feeds (LBW/VLBW/ELBW) ? We start on the second or third day when the infant is somewhat stable respiratory-wise What should be the initial volume of feeds and volume of increment ? Our unit uses a series of feeding guidelines which increase feedings and fortification according to the infant's weight at birth. The lower-weight guidelines start at 10ml/kg/day and increase after 3-5 days. What to feed (EBM/Donor milk/Preterm formula) ? Our infants under 32 weeks get either EBM or Donor milk unless parents refuse, in which case they get preterm formula. When to add HMF ? HMF is added on day 10 of the <750g guideline, day 8 of the 751-1250g guideline, and day 6 of the 1251-2000g guideline. Doubling of fortification occurs two days later, and beneprotien is added within a week. How long do you store the milk after adding HMF ? Where do you store it? Milk is considered safe on our unit for 24 hours after fortification, and is stored in a breastmilk refrigerator How do you define feed intolerance and how do you tackle it ? Feeding intolerance is a residual of >50% of the ordered feed with other gut symptoms such as a loopy belly, or bilious residual. It is first tackled by holding a feeding, and then by some time NPO, and finally by stopping any fortification which has been ordered. Any other information on feeding of the preterm newborn We begin PO feedings after infants have been scoring 1-2 on our feeding readiness scale for 50% of at least 48 hours (meaning that the infant has been waking up prior to feeds and staying awake through the feeding time, rooting). Would be obliged if you could provide references ?
  7. We verify initial placement with x-ray, and then aspirate/auscultate before each use.
  8. We switched to the barcode system a few years ago, and it has been pretty successful. To Cristina24, yes. We have a section in the chart to identify if the milk was scanned or double-checked with another RN, and the results are audited regularly. I think that barcode scanning of milk does reduce the risk of a sentinel event.
  9. Our standard is to use developmental supports and change position every 2-4 hours as needed with cares for all patients, and for infants who are immobilized for extended periods of time, we use a Z-flo mattress to allow frequent changing of support without changing the infant's position. For infants who have developed pressure breakdown, we use Mepitel/Mepilex products.
  10. We use a standardized TPN solution (based on gestational age) for the first 24 hours, and then transition to individually prepared solution. Both are prepared by pharmacy
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