Acuity

Over the last few months, I've been a little.... (not sure if 'bored' is the correct word, but..)bored with some of the low acuity that I've been assigned. (Acuity- Medical definition- the level of severity of an illness. This is one of the parameters considered in patient classification systems that are designed to serve as guidelines for allocation of nursing staff, to justify staffing decisions, and to aid in long-range projection of staffing and budget. The Medical Dictionary) So I have been requesting high acuity assignments from the charge nurses, so that they are accustomed to me working with more critical patients and will (hopefully) automatically assign me to them. I have been assigned some really great patients as a result of this plan. Recently, I've taken care of an infant with a thorocostomy or chest tube. The chest tube is placed to drain either air or fluid from around an infant's lungs and remove the pressure that is restricting the lungs from achieving full expansion.
The chest tube drains into a collection chamber that is attached to suction or sealed. And the drainage is measured (if there is any).
I have also had a patient on a High Frequency Oscillating Ventilator (HFOV) which is a ventilator (breathing machine) that gives breaths at a greatly increased rate. The usual breathing rate for a conventional ventilator is 40-60 breaths per minute- while the oscillator give 400-600 breaths per minute. This can be useful in several different cases. The HFOV is gentler on the lungs (for the most part) and helps decreased Carbon Dioxide (Co2). The oscillator looks like a very old machine, it's a little crazy how we depend on such old equipment. But it works!

Our conventional ventilators are a little more up-to-date looking though.

Don't You Just Hold Babies All Day Long?

I found this on a tumblr blog named #WhatShouldWeCallNICUNursing

"'Don't you just like, I don't know..... hold babies all day long?'
Yes.

I hold a baby when I hand him to his mother for the first time, three weeks after his birth date.

I hold a baby when teaching a new mother how to breastfeed her child.

I hold a baby when morphine and walking the halls twenty-four hours a day are the only things that will quiet him down while he's withdrawing from the illegal drugs his mother took.

I hold a baby's arm still when my fellow nurse inserts an IV.

I hold a baby's head still while we bag oxygenated air back into his tiny lungs.

I hold a baby when he has no family to hold him.

I hold a baby when he takes his last breaths because his parents didn't make it to the hospital in time.

I hold a baby when I'm placing his lifeless, tiny hands in plaster to make a keepsake for his parents.... because there is no baby too hold anymore.

Yes.

I hold babies all day long."

What I Do Now

In the years since I last posted, I have been rather busy. My last post involved my trip home from the college I attended in a large city, somewhere in the Midwest. Since then, I have attended a couple of other colleges and have obtained my degree. I graduated from University in December of 2013 with a Bachelor of Science with a Major in Nursing and have been working for a year now.

This post will be a departure from my previous posts where I reviewed books. And, I may not return to reviewing books at all in my later posts (if I ever actually write them). I am using these posts as a way to look back from where I started in the beginning of my career and to see how I grow as a nurse.
As I mentioned, I graduated in December of 2013 with my BSN and I was hired by one of the major medical centers in my (not impressively-large) city in the Northwest. I work in the Neonatal Intensive Care Unit, commonly referred to as the NICU ("Nick-you"), which is the ICU for infants. I explained what I did this week to someone and I realized how little people know about such a specific and access-limited area. So, I'll explain what exactly the NICU is and does... Well, as best as I can.

The NICU is where infants who are just born or were born in the last 30 days are admitted for treatment. Infants who are older are no longer in the "neonatal" period (which means "new baby") and would be admitted to pediatrics. The NICU I work in is a Level III, which means that we can treat infants born as low as 22 weeks gestation -before they've hit the 6th month of pregnancy. We are not up to a level IV NICU- which means that we send infant with complicated cardiac issues to other hospitals, where they will receive surgerical correction or other treatments. We also do not perform other specific types of surgery- e.g. complicated eye surgery. We are not ECMO-certified, which is what makes us a Level III, versus a Level IV. ECMO is essentially heart and lung bypass; it is a machine that oxygenates and filters the blood and pumps it to the body, thereby bypassing the heart and lungs.
A Level II NICU cares for Infants born at greater than 32 weeks gestation and without respiratory support greater than oxygen through a nasal cannula. So as a Level III, we can have infants on the ventilator (with breathing tube) or CPAP ("continuous positive airway pressure- pressurized oxygen that assists in keeping the infant's lungs open), and there are many degrees and modes of respiratory support that we provide. I could explain, but then it would become rather technical and since my (one) reader is probably not a respiratory therapist (RT), it wouldn't be very helpful or interesting.

Many people are most interested in our premature infants or "preemies", especially those that are what we call "micro-preemies"- they are born before 26 & 27 weeks gestation and weigh-in under one and a half pounds. They appear very fragile, and they can be both more resilient than they appear and more delicate than you think.

There are a huge list of complications that these patients can experience and I'll probably discuss them as I (hopefully) continue to post. But that is brief overview of the NICU I work in. In the last year of working there, I have grown and improved immeasurably. I love my job! Working with the parents, Neonatologists, Neonatal Nurse Practitioners, RTs, and other RNs to help babies get better is the best job that I can imagine. I'm so glad that I was hired where I was, and that I got the chance as new nurse to work in such a difficult and complicated place!