medication

noradrenaline:
need to order everyday!!
shield from light!!
D5 56.4ml + noradrenaline 3.6 mg(3.6ml), total 60ml
2ml/hr


Heparin saline: 
1 unit of heparin in 1ml NS


Amphotercin B:
shield from light
350ml D5
flush with D5
inject pethidine before giving ampho B
2-6hr

Meropenem
500mg/ vial, dissolve 500mg in 10ml WFI( further dilute with D5 or NS, seems not follow in D6)
infuse over 30mins.

2gram >> 40ml WFI

Vancomycin
100ml
no specific rate


Dopamine:
200mg/5ml = 40mg/ml
if need 233.16 mg in 60ml NS
then = 5.83ml dopamine in 54.17ml NS

Doputamine:
250mg/20ml
if need 233.16 mg in 60ml NS,
then= 18.65ml dobutamine in 41.34ml NS

A line

set with dr:
micropore, set one " airplane", half tagaderm, splint

set a line with heprin saline
A line set
need to press the valve when full up the line
stick a line sticker x4, heprin sticker, drip set sticker
put a  pink blanket below it and stick it firmly( dont use micropore: not sticky enough)

Calibration:
close patient's side, then open to air and sensor.
press mon: Aline>> set zero
close sensor side, then open patient's side

Blood culture trolley

S25 dressing set
sterile glove
70% alcohol + betadine
culture bottle x 3 or more
5 ml syringe  x3 or more
500 ml NS
needle

week 7

urine x SG: use a syringe take some urine, then see it in that microscope , normal in 1.010, the higher the value, the more conc in the urine.
urine x osmolity : save in plain white bottle, send to lab.
urine x multistix need to enter into CIS flowsheet
ABG result need to enter into CIS flowsheet, chart at the time which the blood is taken.

GCSF: for white blood cell production( seems need to flush with D5)



TSH for new born: if can't test in cord blood, need to check on D5.
withdrawn sydrome:  convulsion if serious>> die
BB have 80ml/kg blood
mottling>> ?sepsis
cyanosis> ?tramatic cyanosis which can't reverse by O2 giving, need to observe lips to rule out tramatic cyanosis
acrocyanosis: peripheral cyanosis
jittery: can stop if u touch him, twitching: can't stop
lethargic=tired
Diaphram hernia: dont use mouth bagging.

Platelet conc transfusion.

blood transfusion set
plastic bag
NS + 3 way
2 NS in 5 ml syringe+ alcohol swab
can use syringe pump/ infusion pump
*remember to check how many ml in one pack!!

chart血紙，enter serial no of each platelet conc into CIS flowsheet, documentation( start time and end time), add MAR, if verbal order then document verbal order.

take temp before, 15 mins, and after

escort CT:

escort CT:
sedation consent
NPO<< IVF!!!
bring napkin,wet paper, NNS
call 3067 for lift
grey bag+ kardex

admit PICU

Before arrival: 
ask patient's age and KG>> print PICU reference list
get: ventilator, ETT(x6), suction tubing, larygoscope, lighter, steroscope, ambu bag, SpO2 monitor stand by mode,
E-trolly blasket for intubation, water for injection(500ml bottle), IV pump set x2, sringe pump

arrival:
1.first assessment( temp, spO2, GCS, U/O(weight), BP, cardiac mon, drip site, any abnormality)
2. hang over( with IC and 2nd), ask related question
3. call Dr (first if pt very serious)
4. follow treatment( blood taking, A/B, NPA(don't do NPA if pt resp not ok, wait till he stablize)...

After arrival:
enter kardex within one hr(admited fromXXX, escort by nurse...)
flowsheet
APT
assessment form

enter bed assignment, PICU book and milk file, assign Dr and milk formula in CMS.

week 6

patient come back for assessment:
before 10:30: admit one day before
after 10:30: admit on that day.


delay appt:
admission form\
consent              kept in file outside
request form     /
write in delay appt book


NNJ best not breast feed>> to increase time of PT, and also rehydrate the baby

withdrawn sydrome:
chart+ oral morphin>> if high marks, need to increase morphin.<<acidic stool<< check anus.


Hirschsprung's disease:
 is a congenital disorder of the colon in which certain nerve cells, known as ganglion cells, are absent, causing chronic constipation.

Laryngomalacia (literally, "soft larynx") is an unusual condition, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction. It can also be seen in older patients, especially those with neuromuscular conditions resulting in weakness of the muscles of the throat. However, the infantile form is much more common.

Transfer

Transfer NICU:

Transfer memo
2D barcode<< without baby tag, and clip on vital sign broad.
immunization card
inform family
inform D7, book and also call before departure.
portable incubator, +/- oximeter, IV fluid....
ambu bag
call lift(3067)
bring milk and drug(if don't know wether D7 have or not)
write kardex: parent informed, D7 informed, immunization record attached, 2D barcode attached.


Transfer PWH

call PWH to confirm which ward to go
transfer memo( special for PWH)
Consent
milk and drug
ambu bag
fax needed information( MAR...)
call ambulance
write kardex
write memo to take bag instument brought to PWH
enter CMS discharge( home with XXX to XXX hospital)
enter escort book
*Taxi recept+ write a form to clam money
only ventilator case will escort by dr.

week 3

>1.7 kg use blue ryles

ROP cause by prematurity use high conc of o2
the medication of eye consult may cause NEC (necronzing enterocolitis)

LBW= >=2.5kg
SGA(small gestation age) LGA, AGA(approprite)

home breast milk can keep 5 days
keep below 4oC

Discharge

Check mother's name, and write it down, check baby 2D barcode
any napkin borrowed?
immunization record
Discharge checklist
check sex
pink form is for paid at acoount department/A&E, or when it send the recipe to home
one for 留底and claim insurance
MCH FU

Home leave

back from HL:
feeding at home ok?
U/O and BO ok?
last feeding is what time and how much?

Kardex: back from HL at___, mother accompished, Temp___, Last feed at____, feeding at hme and U/O and BO ____, birthmark over buttock and other abnormality noticed and shown to mother.

I/O: back from HL @_______

HL:
HL document, mother sign,
cut baby tag, make one bracelet for HL back use
HL card put on bed
back at next day 9:00

week 1

CRP=
EBK=Expressed breast milk


CCDS( comprehensive child development scheme):
Activated for mother 16-18unmarried
psy mother
drug abuse mother

Cafferin for breath holding baby, withold if AR>180

call dr: "0" operater : call pead dr XXX

NNS:non nutritive sucking for R/T baby

Clafen +4ml WFI, /222

Kardex

General Condition Stable, Active, Jaundish/Pinkish looking.
Temp noraml, Vital signs stable, SpO2:_-_ in room air/_L O2 via NC.
No desat, respiratary distress, insucking, grunting, hyperventilated chest, subcoastal retraction.
Oral feeding sat, fairly sat, fair. completed by T/F, Asp:_ml/trace. no vomiting,reguiatation. milk tolerated well.
U/O and Bo normal.
buttock intact, no redness.
Peripheral IV access on Lt hand,patent, site normal, no redness and swelling.
no visitation.

day1+2

admission from obs/postnatal:
warm in incubator
check baby's body
do gastric lavage(GL)+ Ear surface swab(ESS) *before bathing
first feeding should be done by nurse
bath only when body temp >37c
any PU and PM(meconium)
PU normal in 24hr
PM normal in 48hr
first milk formula should be prescribed by doctor
>2kg can inject BCG and Hb vaccine
weight with bracelet(0.02kg)
can cut cord clamp after 48hr

Discharge
only if over 2kg



Vaccine
check temp after 1hr after Hb vaccine
left clear, right not clear


temp normal range: 36.7-37.2
normal delivery: 39 weeks , 4 kg
normal AR:120-160
normal RR : 40-60


Spo2 Q4H change site, draw a start after site changed






doctor must prescribe milk formula for baby who have IV line
if no, MAT

Enf A+ is rtfm (ready to feed milk)

stool of reducing substance>> check the wellness of digestive system

IIPA=???

normal newborn will regain birth weight within one month

EBF= Exclusive breast feed

C/R=capillary refill

AFNT=anterior fontanelle non tend(normal)
anterior fontanelle diamond shape
posterior fontanelle triangle shape

cepholohemaoma>> induce by vaccum delivery

check heart mumur >> if have, need to do Echo

BAEP= ear examination, do it if SB high as it will affect brain function