Medication
What is the standard dosage of prune juice?
5ml per dose
How long can an adlib baby go without feeding?
No longer than 4 hours
How do you verify placement of OG/NG tube?
Listen for air bolus with stethoscope on stomach and aspirate gastric fluid.
How long is a caffeine watch?
Caffeine watch is for 10 days. 5 days to get meds out of the body, and 5 days to monitor for A/B/D.
What does ROP stand for?
Retinopathy of prematurity
A mother asks you how often she should be pumping. What is the correct response?
Ideally every 3-4 hours
How long do you count manual respirations?
60 seconds
What are Gent and Amp?
The are two broad spectrum antibiotics neonates are placed on while they are waiting on the results of the rule out sepsis workup.
If a baby spits up vit D/ iron at home should the parent give a second dose? If you answer no, when should they give it next?
No, you do not want to accidentally overdose the patient. You should plan to give it when the next dose is due.
What is the max amount of time a OG/NG should stay in the nare?
No longer than 7 days
What is a quiet event versus a feeding event? What are the event watch lengths for each?
Quiet event- Is apnea, bradycardia, or desaturation while at rest or asleep and requires a 5 day watch.
Feeding event- Is apnea, bradycardia, or desaturation while feeding and requires a 3 day watch.
What are the tube colors of cbc and bili/p2?
The cbc is lavendar top and p2/bili is a green top
What must be done when your patient turns 24 hours old? (4 Tasks)
1) NBS
2) Bili
3) Congenital heart screen
4) Umbilical clamp removed
When should you be concerned about a change in girth?
When the difference is over 1cm the provider should be notified.
What is synagis? And who qualifies for it?
1)Synagis is a medication given in injection form to neonates who are at risk for RSV
2)DOES NOT prevent RSV, but decreases severity
3)It is given to neonates born at <35 weeks and to children <6 months at the beginning of RSV season
When is gastric residual concerning?
1) >20%
2)Bilious
3)Blood tinged
If your IV is saline locked, how often should you flush it?
No less than every 4 hours, but it's easier to do with care times.
What does RSV stand for and what is it?
Respiratory Syncytial Virus. Very common virus that causes infection in the respiratory tract. Usually cold like symptoms, but babies who were born premature are at greater risk.
What are the DC videos that parents must watch?
1) Safe sleep
2) CPR
3) Car seat
4) Shaken baby
5) Period of purple crying
6)Circ (If applicable)
Your baby is going to circ. What must you do before taking them to the nursery? (5 tasks)
1) Parents need to watch circ video
2)Consent form must be signed by both parents and provider
3)Circ must be on the stat board
4)Patient must be properly banded
5)Pull meds from pyxis
What are all of the normal vitals for a term neonate?
HR: 120-160 bpm
RR: 30-60
Temp: 36.5-37.5
BP: MAP above gest age
O2: 90-100%
What does the term "Antibiotic Hostage" mean?
This term is used for neonates that have grown a bacteria from their blood cultures and require a full IV antibiotic treatment.
Why do we not PO feed a patient with respirations over 70?
A patient breathing over 70 respirations is at risk for aspiration should they attempt to PO feed.
If your patient has an infusion running, how often do you visually check IV and why?
IV should be assessed every hour to prevent infiltration
What does the acronym PEEP stand for?
Positive End Expiratory Pressure
Describe safe sleep practices? (5 Factors)
1) Back to sleep protocol
2) Flat bed
3) Firm bed
4) No co-sleeping
5) No objects in crib
Your baby gets referred on their hearing screen. What should you tell the parents?
This does not mean their baby is deaf, it only means that they will receive a formal hearing screen from audiology as a outpatient.
What is the purpose of bili (phototherapy) lights?
Bili lights are used to treat jaundice by breaking down the bilirubin and making it easier to excrete urine and stool
What is the purpose of erythromycin and Vit K, AKA "eyes and thighs"
"Eyes"-Erythromycin is given to prevent conjunctivitis from bacteria in the birth canal.
"Thighs"- Vit K is given because neonates are born vit K deficit which can cause bleeding
Under what circumstance would you notify your nurse about urine output?
1) <1 ml/kg/hr on UOP
2) Two dry diapers if on diaper counts
At what level of respiratory support should the OG/NG be vented in between cares?
Over 2LPM needs to be vented in between feeds
What does the acronym PIP stand for?
Positive Inspiratory Pressure
Verbalize the process of your bedside setup/check? (5 Parts)
1) Check your working BVM set up to NRP standards
2) Working suction with 8Fr and bulb syringe
3) Monitor is on appropriate settings
4) O2 card on monitor
5) Check patient binder for correct code blue worksheet
A parent asks you what the NBS tests for and how they'll get the results. What do you say?
The NBS tests for developmental genetic and metabolic disorders. Parents will be contacted if anything is detected.
What are 2 physiologic causes of tachycardia?
1) Sepsis
2) Hyperthermia (environment)
3) Pain
4) Caffeine admin
Why do we give caffeine and to which neonate population? (Gest age parameters)
Caffeine is given to premature neonates (<34 weeks) to prevent frequency of apneas due to their immature neurodevelopment.
When is spit up concerning?
1) Projectile
2) Bilious
3) Blood tinged
What are 5 signs of IV infiltration?
1) Redness
2) Swelling
3) Leakage
4) Bleeding
5) Discoloration/ Blanching
Does cpap effect PEEP or PIP?
PEEP
What are 3 signs of Down's Syndrome?
Almond shaped eyes, small/ low set ears, flattened face, short neck, enlarged tongue, palmar crease, hypotonic
What is the point of "cooling" a baby?
Cooling is used to prevent anaerobic metabolism and heal already damaged cells caused by a hypoxic event.
What does a congenital heart disease screen test for and how do you set it up?
The CHDS is used to detect defects that are undetectable before the PDA closes.
To set up you place to O2 sat probes on the baby, one pre-ductal on the right wrist, and one post-ductal on the left foot.
What are the 6 rights to medication administration?
1. right patient
2. right medication
3. right dosage
4. right route
5. right time
6. right documentation
What are trophic feeds and what are they used for?
They are very low volume feeds used to "gut prime". Generally used in high risk feeding patients and to assess feed tolerance.
What volume to be infused do you set your IV pump when you have a continuous infusion?
The hourly rate
What are 4 signs of respiratory distress?
1.grunting
2. nasal flaring
3. cyanosis
4. gasping
5. retractions (substernal, intercostal, substernal/subcostal)
6. apnea
What does NEC stand for and what is it?
NEC aka Necrotizing Enterocolitis is when the intestine is injured/inflamed which can lead to death of the intestinal tissue and possible perf of the bowel wall. Once perfed it can send bacteria into the bloodstream and cause infections.
You think your baby is developing NEC. What the 3 signs to look for?
1) Distended abdomen
2) "Loopy" appearance
3) Tender/rigid abdomen
4) Bilious emesis/residual
5) Bloody stool
What is the reasoning behind the high alarms? (4 Parts)
2) Exposure to oxygen can cause ROP in neonates
3) High alarm is used to remind caregivers to titrate down on oxygen requirements if patient is high alarming
4) Refer to bedside oxygen cards for gest alarm settings