neonatal intensive care unit - northumbria … · 2010-02-01 · neonatal intensive care unit ......
TRANSCRIPT
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NEONATAL INTENSIVE CARE UNIT
STUDENT NURSE/MIDWIFE
Profile of Learning Opportunities
CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST
STUDENT……………………………… MENTOR ………………………………
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WELCOME TO NICU
Welcome to our unit, we want you to enjoy your placement here
with us and that you benefit from your allocation here.
The staff on the unit aim to assist you in achieving your learning
outcomes/elements.
To help you fulfil this aim you would have been allocated a
trained mentor who has had the appropriate training to
undertake the assessment of students like yourselves, you will
also be allocated an associate mentor to help you also. Your
mentor will undertake the programme with you and will
regularly review your progress. This gives you the opportunity
to reflect on your learning and discuss your future
development. These reviews are for your benefit so please
express any concerns regarding your placement.
Part of this pack provides you with a list of topics which are to
be discussed with your mentor; this list is an informative guide
which will help you gain an insight into the field of Neonatology.
May we remind you that it is your responsibility to fill in your
documentation during your placement here with us.
You are advised to follow your mentor‟s shifts, which should be
clearly marked in the ward off duty book. We would like you to
work a variety of shifts during your placement, which may
include night shift rotation.
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ORIENTATION TO UNIT
Please photocopy this sheet once fully signed and give a copy
to your mentor.
Checklist
Student Mentor
Give student booklet Initial interview/learning needs
assessment Role of mentor
Student responsibilities
Layout of the unit Unit telephone number
Awareness of/introduction to team members
Emergency equipment/procedures Bleep system Disposal of;
Sharps Bodily fluids
Blood products Drugs, glass
Location of hospital policies Sickness policy
Complaints procedure Child protection file
Education link resource file Referral procedures
Ward routine
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UNIT PHILOSOPHY
We aim to provide a friendly relaxed atmosphere.
Encourage parental independence.
Listening to the needs of parents and families.
Communicating with parents, relatives and colleagues.
Ongoing assessment of family needs.
Maintaining high standards of care and best practice.
Educating parents and staff.
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WHAT IS NEONATOLOGY?
Neonatology is a fast growing speciality with many advances in
technology, techniques and treatments.
“The branch of medicine dealing with
disorders of the new born infant.”
(Baillieres Nursing Dictionary 2005)
“The art and science of caring medically
for the newborn.”
(Online Medical Dictionary 1998)
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WARD PROFILE
The unit comprises of 25 cots, 7 of which are allocated to
intensive care, with the remainder being for high dependency
and special care. We have two cubicles for admissions from the
community, within the neonatal period (10 Days) or for babies
who need isolation. We also have two mothers‟ and baby rooms
for parents to use overnight prior to discharge, to increase
their confidence in caring for their new baby. They are also
used for mothers when establishing breast feeding for more
privacy and for those mothers who are expressing milk.
We have babies admitted from the Sunderland area whose
mothers have booked at our delivery suite and also babies from
the northeast region who need intensive care. We have
intrauterine and extra uterine transfers. We have close links
with other neonatal units within the northeast region. We
regularly have babies from Cumbria, Hartlepool, Hexham,
Wansbeck and all the hospitals in the middle.
We are part of the Child Health Directorate as well as having
close links to the Obstetric and Gynaecology directorate. We
work closely with all midwives, paediatric wards and
community children‟s nurses.
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Who do we admit?
Babies of 34 weeks gestation and below as babies of less than
32 weeks gestation will show some evidence of Respiratory
Distress Syndrome (RDS). Babies of 33 & 34 weeks gestation
are likely to require assistance with feeding.
Some, not all, babies of 35 & 36 weeks gestation will require
admission for establishment of feeding.
Babies who weigh less than 1900grams at birth.
Babies who are unwell from the post natal wards/delivery suite,
this includes Transient Tachyapnoea of the Newborn (TTN),
grunting respirations, abnormal movements, some congenital
cardiac anomalies, intestinal obstructions, macrosomic babies
of diabetic mothers and babies who the midwives feel are not
handling well.
Babies from the community are often admitted for
phototherapy, poor feeding, apnoeic episodes and infections.
Babies do not need to be admitted from the post natal wards for
phototherapy alone as this can be delivered on the wards.
We have clinics on the unit held by our Consultants and our
Registrar.
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NAMED NURSE
We work in a named nurse system on the unit. Each baby is
allocated a named nurse on admission. She is responsible for
the assessment, planning, implementing and evaluating for the
baby. It may not be possible for the nurse to care for the baby
every shift due to skill mix and other patient dependency. She
will oversee all care from admission to discharge. She may also
be required to attend MDT meetings, Child Protection meetings
and be involved in any other discharge planning.
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STUDENT RESPONSIBILITIES
It is very important for your learning that you document your
progress in your portfolio.
Section two of the Education Resource File describes all your
responsibilities that have been set out by the university.
Please make yourself aware of the sickness policy.
Although you are a university student you MUST adhere to
Trust practice, procedures and policies. These can be found at
the nurses station in LDA
HOURS OF DUTY
You are expected to follow your mentor‟s shifts; this may
include night shift rotation. This is not appropriate for 1st year
students but is expected in 2nd and 3rd years.
You must work a minimum of 40% of your placement with your
mentor according to NMC guidelines but on the unit we strive to
achieve 100%.
You must negotiate your duty with your mentor and mark it
clearly in the off duty book.
Each student and mentor will be colour coded.
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HOURS OF DUTY
EARLY 7:15 - 14:45
LATE 12:45 - 20:15
LONG DAY 07:15 - 20:15
NIGHT SHIFT 20:00 - 07:30
EMERGENCY SITUATIONS
Fire Alarm
Every Thursday morning the fire alarms will be tested and an
intermittent tone will be heard.
If this tone is heard at any other time it indicates that an alarm
has been activated. At this time all doors and windows are to be
closed and remain so until stand down. No one is to leave the
unit area.
If hearing a continuous tone the alarm has been activated
within our area and needs investigation. All windows and doors
are to be shut and no one is to leave the unit until stand down. If
evacuation is necessary then directions will be given from the
fire officer/nurse in charge.
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MEDICAL EMERGENCY
Shout for help
Nurses will initiate resuscitation until medical staff attends.
A Doctor/ANNP is always present on the unit. All babies have
blow off valves, oxygen and suction at their cot space.
Resuscitation trolleys are located within the high
dependency area and outside the laboratory.
Crash bleep is NOT used unless it is for a visitor. If required,
switchboard is telephoned (2222) and A NEONATAL
EMERGENCY is stated, giving the area to switch staff.
EMERGENCY NUMBERS
CARDIAC ARREST 2222
FIRE 333
SECURITY 777
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MEDICAL STAFF/CONSULTANTS
Dr S Richmond
Dr M Abu-Harb
Dr L Gillespie
Dr R Geethanath
We have a paediatric registrar based within neonates for a 6
month period working within paediatric rotations.
We have 5 SHO‟s at any one time.
To work alongside the SHO‟s we have 5 ANNP‟s who work on
the doctor‟s rota, as well as working on the nurse‟s rota.
BUSINESS MANAGER
Joanna Clark
MATRON
Pauline Palmer
UNIT MANAGER/ANNP
Pam Jack
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USEFUL TELEPHONE NUMBERS
NICU 5699153 ext 42159
CCN‟s ext 41236
CAT 5108933
Dietician 5699013 bleep 51602
Education and Training ext 49633
IT help line ext 42705
Library ext 42430
Paediatric A & E ext 42135
Paediatric Wards
F63 ext 49763
F64 ext 49764
F65 ext 49765
Paediatric Liaison
Teresa Laidler ext 42419
Matron
Pauline Palmer bleep 52370
PDN
Kim Coxall bleep 55015
Child Protection Nurse
Marie Craig ext 45227
School Nurse Manager
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Sandy Tait ext 42487
Speech and Language ext 39935
PPF
Sonia Malt Ext 47210
Bleep 52273
Mobile 07769682053
Email [email protected]
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Recommended Structured Learning Experience for Pre-
Registration Students - Interprofessional Learning
Child Branch Students are allowed up to 2 weeks within
structured Learning Zones Areas (within an 8 week placement).
Rather than leave these learning zone visits to ad hoc
"opportunistic" plan these within the 8 week placement.
Students will still have the responsibility to ensure these visits
take place - via negotiation with mentor. E.g. Students can
choose to follow a patient x-ray within that week of the
programme (patient journey). Opportunistic learning will still
take place, but the pre-planning ensures that minimum learning
zones are visited (to achieve the competencies).
Must work at least 50% of their shift with a trained mentor.
Testimony of Witness statement must be provided by the
member of staff who supervises the student within the learning
zone area- as evidence that learning objectives have been
achieved
This proposed timetable can be amended to incorporate
Mentor's holidays - so that the students utilise the learning zone
areas during this time to ensure the 50% protocol is adhered to.
Flexible to students needs - recommended only. Provides
structure for the student nurse.
Planning and organisation for the student placement - proactive
approach / forward thinking (increased support and direction
for the student - student feels valued as part of the team.
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There are two structured learning plans within this pack, one is
blank for you and your mentor to discuss and plan together.
The other is one that is one that has already been planned.
These are designed to help you plan how you are to achieve
your learning outcomes/elements.
LEARNING ZONES
TRANSFERS
CLINICS
CDU
ANNP
PHYSIO
XRAY
EEG
ECG
PHARMACY
HEALTH
VISIITORS
S/W
MIDWIFE
CCN
WARDS
EDUCATION
LINKS
RESOURCES
JOURNALS
LIBRARY
RESOURCE
ROOM
NICU
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PROFILE OF LEARNING OPPORTUNITIES
The NICU is an ideal place to develop clinical skills. You will
have the opportunity to manage care, improve your
organisational and management skills, communication skills
and have the opportunity to increase your understanding of the
physiology of the newborn.
KEY ELEMENTS INTERPERSONAL SKILLS
LEARNING OPPORTUNITY RESOURCE/RELEVANT
PERSONEL/DEPARTMENT
Communicating with families
Via telephone On unit
Confidentiality
Nursing staff Doctors
Interprofessional communication
Nurses Doctors ancillary staff MDT meetings Handovers ward rounds referrals
Nursing staff Doctor MSW Social worker Liaison health visitor Midwives Stoma nurses Physiotherapy Pharmacy x-ray EBME Electronics Porters Matron
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Business manager CCN Domestic Chaplaincy EEG ECG
Use of telephone answering calls making calls ring back facility bleep system
Nursing staff Switchboard
Use of computer hiss internet intranet email access
Nursing staff Doctors Library
CLINICAL SKILLS
LEARNING OPPORTUNITY RESOURCE/RELEVENT PERSONEL/DEPARTMENT
Physiological observations temperature heart rate respirations blood pressure pulse oximetry blood glucose blood gases blood results electrolyte balance oedema
Nursing staff Doctors Biochemistry Microbiology Haematology
Patient care Nursing staff
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mouth care skin care elimination hygiene pressure area care positioning nutrition
Doctors Physiotherapy Dietician
Drug administration oral rectal iv im sub-cut infusions calculations
Nursing staff Doctors Pharmacist Pharmacopoeia
Infection control source spread prevention treatment hand washing aseptic technique
Nursing staff Doctors Infection control team Link nurse – Donna Coppard Infection control file
Moving and handling correct procedures stance risk assessment
Nursing staff Manual handling advisor Link nurse – Sheila Middleton Manual handling file
Procedures cannulation venepuncture UAC UVC long lines lumbar puncture intubation catheterisation chest drain blood product
Nursing staff ANNP Doctors Blood transfusion department Blood product guidelines Unit guidelines Trust policy EEG department ECG department Dr Mellon Radiology
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administration exchange transfusion
Investigations EEG ECG USS ECHO ph study CT scan MRI Biopsies
Surgical Doctors
ANATOMY AND PATHOPHYSIOLOGICAL PROCESSES
LEARNING OPPORTUNITIES RESOURCE/RELEVANT PERSONEL/DEPARTMENT
Respiratory system RDS TTN PPH pulmonary haemorrhage pneumothorax diaphragmatic hernia tracheo-oesophageal
fistula
Nursing staff Doctors ANNP Literature X-ray
Nervous System Cerebral bleeds neonatal convulsions intrauterine/neonatal
hypoxia congenital malformations congenital/neonatal
acquired infections
Nursing staff ANNP Doctors Specialist nurses x-ray literature EEG
Liver and Bilary systems Nursing staff
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Haemorrhagic disease of the newborn
Jaundice Rhesus incompatibility ABO
Incompatibility obstructive disorders
Doctors ANNP Haematology Literature
Cardio vascular system Congenital cardiac
anomalies Cardiac arrhythmias
Nursing staff Doctors ANNP x-ray ECG technicians Dr Abu-Harb Literature Clinics
Gastro-intestinal tract Feed intolerance NEC obstructive disorders stoma care Hernias
Nursing staff Doctors ANNP x-ray Specialist nurses Stoma link nurse – Literature
Blood Transfusions Clotting disorders
Nursing staff Doctors Haematology Literature Policy‟s
HEALTH DEVELOPMENT
LEARNING OPPORTUNITY RESOURCE/RELEVANT PERSONEL/DEPARTMENT
Healthy life style in relation to;
Parent craft
Nursing staff ANNP CCN
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SIDS Alcohol abuse drug abuse Breast feeding Diet healthy eating
patterns pain assessment and
management child protection
Health visitors Social workers Midwife Community addiction team Dietician Chaplaincy Consultants Literature Internet Intranet Child protection nurse
Child development Nursery nurses Nursing staff CDC ANNP Doctors
MANAGEMENT OF CARE
RESOURCES/RELEVANT PERSONEL/DEPARTMENT
Nursing process Assessment
who what why where how
Planning care plans discharge planning referrals risk assessment tools
Implementation/evaluation
Nursing staff Nurse in charge ANNP Doctors Literature Health Visitor Liaison Chaplaincy Unit manager Internet Intranet
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ward rounds documentation best practice policy procedures standards protocols communication prioritising care
Nursing model Philosophy of care Nursing documentation Dealing with difficult situations Time management Religious needs/beliefs
ORGANISATIONAL AND MANAGERIAL
LEARNING OPPRTUNITIES RESOURCE/RELEVANT PERSONEL/DEPARTMENT
Organisational and managerial skills
delegation leadership prioritising care time management off duty managing patient
workload quality standards of care implementing change
Nursing staff Doctors ANNP Unit sisters Unit Manager Library Resource room Literature Internet Intranet
Risk management policy and procedure moving and handling
Registered nurse ANNP Policy‟s
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infection control equipment safety
checks
Health and safety officer Electronics Support worker Infection control team Infection link nurse – Donna Coppard Moving and handling advisor Moving and handling link
Communication with staff doctors parents/carers members of MDT other departments
Nursing staff ANNP Doctor
Emergency situations Medical
Emergency Fire Untoward incident Security Fast bleep system Missing infant
Registered nurses Fire officer Security officer Switchboard Doctors ANNP
Staff development clinical supervision reflective practice appraisal
Nursing staff ANNP Unit manager Sisters Policy Clinical supervision link nurse
Resource management budget control drug ordering non-stock items stock control stationery establishment skill mix
Unit manager Nursing staff Support worker Pharmacy Stores Secretaries ANNP
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DRUG AND FLUID CALCULATIONS There are guidelines on the unit regarding fluids which should be referred to. The guidelines state that fluids for infants on the unit are, Day one 100mls/kg Day two 120mls/kg Day three 150mls/kg IV FLUIDS Weight x mls/kg = mls/hr Hours Work out how many mls/hr these baby‟s require, Baby a weighs 1 kg and is one day old, how many mls in 24 hours does she require and how many mls/hr? Baby B weighs 500gms and is two days old, how many mls in 24 hours does she require and how many mls/hr? Baby C weighs 3.9kg and is 3 three days old, how many mls in 24 hours does she require and how many mls/hr? Baby‟s also have a mixture of IV fluids and enteral feeds. Work out how many mls/hr of IV fluids they require to ensure full fluid requirement.
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Baby D weighs 750gms and is three days old. He is having 1.5mls/hr of enteral feed. What is his total fluid requirement and how many mls/hr of IV fluid does he require? Baby E weighs 1.9kg and is three days old. He is having 3.0mls/hr of enteral feed. What is his total fluid requirement and how many mls/hr of IV fluid does he require? Baby F weighs 900gms and is two days old. He is having 0.75mls/hr of enteral feed. What is his total fluid requirement and how many mls/hr of IV fluid does he require? FEEDS Mls/kg can vary in enterally fed infants. There are guidelines relating to the fluid requirement of infants of 34-36 weeks gestation and their plot on centile charts. Infants can therefore have varying mls/kg according to there gestation and age. 30mls/kg 100mls/kg 40mls/kg 120mls/kg 50mls/kg 150mls/kg 60mls/kg 165mls/kg 80mls/kg 180mls/kg 90mls/kg 200mls/kg
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Weight x mls/kg = feed amount Number of feeds Work out the feed requirement for these infants. Baby G weighs 3.9kg and requires 165mls/kg and is 4 hourly fed. How much does she require for each feed? Baby H weighs 1.875kg and requires 150mls/kg and is 3 hourly fed. How much does she require for each feed? Baby I weighs 1.400kg and requires 150mls/kg and is 3 hourly fed. How much does she require for each feed? Baby J is 34weeks gestation and weighs 2.1kg, requires 60mls/kg and is 3 hourly fed. How much does she require for each feed?
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DRUGS Each drug is prescribed according to the baby‟s weight. The dosages can be found in the neonatal pharmacopoeia. The drug administration policy for the trust must also be adhered to. Work out the following drug calculations using the calculation below. 1000mcg = 1mg 1000mg = 1g What you want x what it‟s in What you got Baby weighing 1.2kgs is prescribed 6mgs of oral caffeine. The caffeine solution is 50mgs/5mls. How many mls of the solution is to be administered? Baby weighing 2.2kgsis prescribed 66mgs of IV penicillin. IV penicillin solution is 100mgs/ml. How many mls of the solution is to be administered? Baby weighing 2.2kg is prescribed 132mgs of IV penicillin. IV penicillin solution is 100mgs/ml. How much of the solution is to be administered?
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Baby weighing 0.6kg is prescribed 3mg of IV Gentamicin. IV Gentamicin solution is 20mg/2mls. How many mls of the solution is to be administered/ Baby weighing 2.6kg is prescribed 130mgof IV Flucloxacillin. IV Flucloxacillin solution is 100mg/ml. How much of the solution is to be administered? Baby J is prescribed 1mmol of 30% sodium chloride. The solution is 50mmols/10mls. How much of the solution is to be administered? Baby k is prescribed IM Konakion (vitamin k). She is prescribed 500mcgs. The solution is 2mg/0.2ml, how much of the solution is to be administered? Baby L is on opiate withdrawal treatment and is requiring 200mcgs of oral morphine solution. The solution is 10mg/5mls. How much of the solution is to be administered? Baby M is administered 1.5mls of IV penicillin. The solution is 100mgs/ml. How many mgs of Penicillin has been prescribed?
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Baby N is administered 0.9mls of IV Flucloxacillin. The solution is 100mgs/ml. How many mgs of Flucloxacillin has been prescribed? Baby O is given 0.85mls of oral caffeine. The solution is 50mg/5ml. How many mgs of oral caffeine is he prescribed?
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Neonatal Intensive Care Unit practice placement evaluation
Please hand to you mentor when completed, thankyou. Please circle, rating 5 as the highest and 1 as the lowest.
How would you rate the opportunity 1 2 3 4 5 to work with your mentor? (We aim for 40% contact time)
Have you completed your required 1 2 3 4 5 learning outcomes?
How would you rate the quality of the 1 2 3 4 5 mentor support in achieving your required outcomes?
How do you rate the NICU as a learning 1 2 3 4 5 environment?
How do you rate the opportunity 1 2 3 4 5 to access the identified learning zones?
How could we improve our learning environment? Please feel free to make any additional comments you wish.
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GLOSSARY OF TERMINOLOGY WITHIN NICU
OBSTETRIC ANS - ANTENATAL STEROIDS APH - ANTE-PARTUM HAEMORRHAGE EUT - EXTRA-UTERINE TRANSFERS HELLP - HAEMOLYSIS, ELEVATED LIVER ENZYMES AND LOW PLATELETS IUT - INTRA-UTERINE TRANSFER LSCS - LOWER SEGEMENT CAESAREAN SECTION PIH - PREGNANCY INDUCED HYPERTENSION PROM - PRE LABOUR RUPTURE OF MEMBRANES SROM - SPONTANEOUS RUPTURE OF MEMBRANES SVD/NVD - VAGINAL DELIVERY HOSPITALS DUH - DURHAM UNIVERSITY HOSPITAL JCUH - JAMES COOK UNIVERSITY HOSPITAL QEH - QUEEN ELIZABETH HOSPITAL RVI - ROYAL VICTORIA INFIRMARY NUTRITIONAL A/F - ARTIFICIAL FEED B/F - BREAST FEEDING CONT - CONTINUOUS EBM - EXPRESSED BREAST MILK LBW - LOW BIRTH WEIGHT PEPTI/JR - PEPTI JUNIOR TPN - TOTALPARENTAL NUTRITION
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RESPIRATORY/CARDIVASCULAR ASD - ATRIAL SEPTAL DEFECT BP - BLOOD PRESSURE BPD - BRONCHO-PULMONARY DYSPLASIA BPM - BEATS PER MINUTE BPM - BREATHS PER MINUTE CMV - CYCLED MANDATORY VENTIALTION CPAP - CONTINUOUS POSITIVE AIRWAY PRESSURE CRT - CAPILLARY REFILL TIME CXR - CHEST X-RAY ETT - ENDOTRACHEAL TUBE FFP - FRESH FROZEN PLASMA FIO2 - INSPIRED OXYGEN HFOV - HIGH FREQUENCY OSCILLATION VENTILATION HR - HEART RATE IVH - INTRAVENTRICULAR HAEMORRHAGE IVT - INTRAVENOUS THERAPY O2 - OXYGEN PDA - PATENT DUCTUS ARTERIOSIS PPHN- PERSISTENT PULMONARY
HYPERTENSION OF THE NEWBORN PTV - PATIENT TRIGGER VENTILATION PX - PNEUMOTHORAX RDS - RESPIRATORY DISTRESS SYNDROME RR - RESPIRATORY RATE UAC - UMBILICAL ARTERIAL CATHETER UVC - UMBILICAL VENOUS CATHETER VSD - VENTRICULAR SEPTAL DEFECT INVESTIGATIONS ABG - ARTERIAL BLOOD GAS BC - BLOOD CULTURE
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BG - BLOOD GLUCOSE C&S - CULTURE AND SENSITIVTY CBG - CAPILLARY BLOOD GAS CRP - C-REACTIVE PROTEIN CSF - CEREBRAL SPINAL FLUID FBC - FULL BLOOD COUNT FENa - FRACTIONAL EXCRETION OF SODIUM HB - HAEMOGLOBIN K - POTASSIUM LFT - LIVER FUNCTION TEST Na - SODIUM SBR - SERUM BILIRUBIN U&E - UREA AND ELECTROLYTES USS - ULTRASOUND SCAN WCC - WHITE CELL COUNT BLOOD GASES PO2 - PARTIAL PRESSURE OF OXYGEN PCO2 - PARTIAL PRESSURE OF CARBON
DIOXIDE Ph - POTENTIAL HYDROGEN BE - BASE EXCESS GENERAL BD - TWICE DAILY BNO - BOWELS NOT OPEN BO - BOWELS OPEN BW - BIRTH WEIGHT CW - CURRENT WEIGHT C - CENTIGRADE D/W - „DISCUSSED WITH‟ HDA - HIGH DEPENDENCY AGENCY /C - „WITH‟
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LDA - LOW DEPENDENCY AREA NAD - NO ABNORMALITIES DETECTED NPU - NOT PASSED URINE PU - PASSED URINE P&W - PINK AND WARM OD - ONCE DAILY QDS - FOUR TIMES A DAY TDS - THREE TIMES A DAY TEMP - TEMPERATURE WR - WARD ROUND STAFF ANNP - ADVANCED NEONATAL PRACTITIONER CONS - CONSULTANT EN - ENROLLED NURSE GP - GENERAL PRACTITIONER HV - HEALTH VISITOR MSW - MEDICAL SOCIAL WORKER NN - NURSERY NURSE SHO - SENIOR HOUSE OFFICER SN - STAFF NURSE SR - SISTER SSN - SENIOR STAFF NURSE SPR - SPECIALIST REGISTRAR SW - SOCIAL WORKER