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Practical Newborn Critical Care Nursing
Dipak K Guha, Rashmi Guha, RD Srivastava
SECTION 1: NEONATAL NURSING
1:
Neonatal Nursing—The Challenge
2:
Role of Nurses in Newborn Care
DELIVERY ROOM (DR) ASSIGNMENT AND NURSING RESPONSIBILITIES
Assignment
Attending Deliveries
SOME HIGH RISK SITUATIONS AND ANTICIPATED RESUSCITATION SITUATIONS
NURSING STANDARDS FOR NEWBORN CARE
DAILY NURSERY ROUTINES FOR NURSES
Observation
Temperature
Heart rate (all NCCN-I/NICU cases and NCCN-II/NSCU when ordered)
Respiratory rate (all NCCN-I/NICU cases and NCCN-II/NSCU when ordered)
Blood Pressure
Color
Activity
Incubator Temperature
General Nursing Care
Eyes
Mouth
Umbilical Cord
Buttocks
Bath
Underpads
Nappies
Position
Weight
Identification
Other
Parenteral Fluid
Reflotest or Dextrostrips
Equipment
Suction
Suction Bottle
Suction Tubing
Suction Regulator
Ventilator Tubing
Humidifier
Oxygen Analyzers
Flowmeters
Bag and Masks
ECG Monitors
Incubators
Thermometers
Invasive BP
BP Domes and Line
BP Cuffs
Phototherapy
TcpCO2 and TcpO2
Sheepskins
Infusion Pump
Stocking Up
Suctioning
Birth Weight less than 1000 gm
Birth Weight—1000–1500 gm
Birth Weight more than 1500 gm
Tracheal Lavages
Indications
Precautions
Oxygen Therapy Guidelines
Infusions
Deciding Whether to Use an Incubator or Radiant Heater
Vital Signs for Specific Situations
Blood pressure Pre- and post- administration of
Reflotest or Dextrostrips
At Risk Register
Standby at Deliveries for High Risk Pregnancies
NEWBORN DEVELOPMENTAL NURSING CARE GUIDELINES
Definition
National Association of Neonatal Nurses (NANN) of USA Recommendations
Interventions that Facilitate Adaptation of the Infant
SECTION 2: NEONATAL NURSING PROTOCOL
3:
Administrative and General Nursing Policy Protocols
4:
NICU Patient Care Nursing Protocols
UAC'S/UVC'S
Peripheral Arterial Lines (A-Line)
PCVC/CVL
Peripheral Lines
IV Fluid Changes
Heparin Locks/Flush
Blood Product Administration
Albumin 5%
Intake/Output
Continuous Feedings
Miscellaneous
Purpose
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Protocol
Pertinent Information
Policy
Expected Outcome
Protocol
Protocol
Purpose
Indications
Points of Emphasis
Equipment
Procedure
SUMMARY OF POLICY
Personnel
Handwashing
Standard Precautions are taken in the Care of all Patients
Nursery Attire
Visitors
Infant Care
Care of Infants and Equipment in Isolation Nursery
Cleaning Nursery Unit and Equipment
Environmental Cleaning
Isolettes and Bassinets
Purpose
Other Equipment
Outbreak Control
Pertinent Information
Policy
Expected Outcomes
Protocol
Nursing Interventions
Asepsis Basics
Sterile Gloves
Masks and Sterile Drapes
Other Basics
Handwashing
Handwashing Norm (Fig. 4.1)
Preparation of Drugs and Parenteral Fluids
Use of Laminar Flow
Housekeeping
Neonatal Skin Condition Score (NSCS)
Dryness
Erythema
Breakdown/Excoriation
Directions for Use
Purpose
Definition
Patient Outcome Goals
Guidelines
Purpose
Special Considerations
Flow Rate and Oxygen Saturation
Humidification
Method of O2 Delivery
Methods of Use of Oxygen Headbox or Hood
Procedures
Nursing Principles
Purpose
Pertinent Information
Policy
Expected Outcome
Protocol
Labor and Delivery Room (LDR)
Family-Centered Care
NICU/Pediatrics
Transport of Infants with Unstable Temperature Control
Pertinent Information
Policy
Expected Outcome
Protocol
Procedure
Cleaning Incubator
Daily Cleaning
Trouble Shooting an Incubator
Factors Affecting Microenvironmental Temperature
Measures for Warming Infant
Purpose
When to Use Servo-Control
How to use Servo-Control
Precautions
Purpose
Procedures
Infants Greater than 1000 Grams
Pertinent Information
Policy
Expected Outcome
Procedure
Maintenance Phase
Weaning Phase
Transition to an Open Crib Phase
Purpose
Pertinent Information
Policy
Expected Outcome
Procedure
Purpose
Pertinent Information
Policy
Expected Outcome
Procedure
Purpose
Pertinent Information
Expected Outcome
Policy
Equipment
Procedure
Purpose
Pertinent Information
Policy
Expected Outcome
Enteral Feeding Tube Insertion
Equipment
Procedure
Purpose
Pertinent Information
Policy
Expected Outcome
Protocol
TPN
Full Enteral Feeds
Other Lab Monitoring
Total Fluid Intake (Low Fluid Protocol)
Initial Choice of IV Fluid
IV Fluid Adjustments and Choice of IV Fluid on Subsequent Days
Hypokalemia
Hypocalcemia
Hyponatremia
Hypoglycemia and Hyperglycemia
Miscellaneous IV Considerations
Pertinent Information
Policy
Expected Outcome
Protocol
Thermoregulation
Cardiorespiratory
Fluids, Lytes, and Nutrition
Skin Integrity
Nursing Considerations
Purpose
Pertinent Information
Policy
Contraindications
Expected Outcome
Procedure
Protocol
Policy
Procedure
Patient Education
Pertinent Information
Policy
Expected Outcome
Protocol
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Protocol
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Pertinent Information
Policy
Expected Outcome
Procedure
Protocol
Purpose
Policy
Equipment
Procedure
Pertinent Information
Policy
Expected Outcome
Protocol
Definition
Purpose
Policy
Expected Outcome
Notification
Documentation
Supplies/Medications
Neonatal MSET Team
Roles are filled according to the number of personnel present and are defined below.
Procedure Person
Airway Person
Monitoring Person
Equipment Person
Medication Person
Documentation Person
Runner
Charge RN
Emergency Equipment
Purpose
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Protocol
Purpose
Objective
Indications
Complications
Assessment of Outcome
Procedure
Pertinent Information
Policy
Complications
Expected Outcome
Equipment
Procedure
Protocol
Bonnet
Hat size
Some Do's and Don'ts of fitting the bonnet of NCPAP
Do
Don't
Ribbed Exhalation Tube
Prongs of NCPAP
CARE OF THE INTUBATED INFANT REQUIRING SUCTION
Equipment Required
Procedure
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Purpose
Pertinent Information
Policy
Potential Complications
Expected Outcome
Equipment
Protocol
Purpose
Pertinent Information
Policy
Expected Outcome
Protocol
Admission
General Care
Cardiac Catheterization
Pre-Postcardiac Surgery
Purpose
Policy
Expected Outcome
Equipment
Procedure
Purpose
Pertinent Information
Policy
Expected Outcome
Equipment
Procedure
Protocol
Purpose
Pertinent Information
Policy
Expected Outcome
Procedure
Purpose
Pertinent Information
Policy
Expected Outcome
Protocol
Pertinent Information
Policy
Expected Outcome
Protocol
Assessment of Sedation
Assessment of Pain/Agitation
Pavulon/Paralysis
Scoring Criteria
Crying /Irritability
Behavior/State
Facial Expression
Extremities/Tone
Vital Signs: HR, BP, RR, and O2 Saturations
How do I use the Sedation Part of the N-PASS?
How Sedated do We Want out Babies?
What do I do with a High Pain/Agitation Score?
How can We tell the Difference between Pain and Agitation?
What Babies are Difficult to Assess?
What do We do with these Babies that are Difficult to Assess?
What if the Doctor or Nurse Practitioner doesn't treat the Pain like I, the Bedside Nurse, thinks they should?
Purpose
Pertinent Information
Policy
Expected Outcome
Procedure
Protocol
Blood Pressure
Special Orders
Useful Formulas
Prescribing on the Neonatal Unit
DRUG ADMINISTRATION
Intramuscular Injections
Administration of IV Drugs
Precautions
When Amino Acid Solution is in Progress and IV Drugs are Ordered (Fig. 4.20).
Purpose
Special Considerations
Equipment
Setting up Medication/Flush Line
Giving Medication through Medication/Flush Line
Special Considerations
Policy
Purpose
Procedures
Purpose
Policy
Purpose
Procedures
General Information
Standard Dosing
Purpose
Procedures
Policy
Purpose
Purpose
HYALURONIDASE (WYDASE)
PHENTOLAMINE (REGITINE)
Purpose
Purpose
Materials Needed
Purpose
Special Considerations
Equipment
Special Considerations
Equipment
INTERMITTENT INTRAVENOUS DEVICE MAINTENANCE
Purpose
Equipment
CENTRAL VENOUS ACCESS IN NEONATES AND YOUNG CHILDREN
When to Call the Surgeon
Where to do the Access Procedure
NICU
What Preparation is Needed Preoperatively
NICU Set up Procedures
Choosing the best Type of Central Venous Access
Postoperative Orders
Troubleshooting
Catheter Removal (Elective)
SECTION 3: APPENDICES
BLOOD PRESSURE NORMS BY GESTATIONAL AGE IN THE FIRST 24 HOURS
Respiratory
Ventilatory Efficiency Index
Fluid/Electrolytes/Nutrition
To Determine Kcal from Glucose
Insulin drip
To Diurese a Patient
To Correct a Metabolic Acidosis
To Mix Dopamine or Dobutamine (same way for either)
Fractional Excretion of Sodium (> 3% suggests ATN)
Serum Osmolarity
Anion Gap (normally 12 +/• 2)
Cardiovascular
Blood Transfusion
Purpose
Equipment/Personnel
Procedure
NICU Fellow/Resident
Charge Nurse
Unit Clerk
Transport Team
NICU Resident or Fellow
Transport Nurse
Transport Nurse, Unit Clerk or Charge Nurse
Purpose
Equipment
Personnel
Procedure
NICU Fellow or Resident
Charge Nurse
Purpose
Equipment
Personnel
Procedure
NICU Neonatalogist, Fellow or Resident
Charge Nurse
Personnel: Staff Nurse or Staff Member Accompanying Infant
Purpose
Equipment
Personnel
Procedure
NICU Fellow or Resident
Charge Nurse or Unit Clerk
Transport Team
Ground Transport
Air Transport (Unlikely but feasible)
Helicopter Transport
GUIDELINES FOR TRANSPORTING BABIES
Before Leaving
When You Get There
In Transit
At Base Hospital
Staffing
Admissions, Transports, Deliveries, C-Sections
General Duties
Night Shift
Protective Isolation
Strict Isolation
Respiratory Isolation
Blood and Secretion Precautions
Secretion Precautions
Enteric Precautions
INDEX
TOC
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