my first couple days in the NICU

Thursday was the first day of my preceptorship in the NICU at Kaiser Santa Clara. I met my preceptor and I reaaaally like her. We had two patients both grower/feeder type babies, they were soooo TINY I was in love :) She walked me through assessments and helped me with a couple feedings both gavage (tube feedings) and bottle. One of my patients was a twin born at 27 weeks and is now 32 weeks. She was having desats all day but otherwise was totally healthy and normal for her age. My other baby was a term IUGR baby whos gender was unidentifiable in utero. The baby was born with microcephaly, micro-penis (actual term), CNS hyperactivity therefore making him extremely hypertonic. So interesting. The baby was so hypertonic, his neck and back were arched at all times, he was unable to lie flat and when he was not bundled up tightly would shake constantly, looked like a really drawn out Moro reflex. The doctors did a work-up of chromosomal and endocrine studies and found that the baby was in fact a male and that the cause for many of his problems were most likelydue to his complete lack of growth hormone. His microcephaly was so severe that he was unable to produce GH. The day went very quickly and my nurse was so great about answering questions and explaining different things to me about the unit and also different patient conditions. After my nurse and I went to lunch that day she and I walked through the L&D unit so she could say Hi to some of the staff she knows. When we walked infront of the nurses station I saw my favorite nurse in the world, Stacey, and immediately she said "Mary, omg are you working here??" I couldn't believe she remembered me I was so excited! I told her how L&D was my first choice but a couple other students got it and I was really bummed. She told me she's been thinking about me and when the manager asked if she wanted to precept a student she was hoping it would be me. I wanted to CRRRRYYYYY. I was so sad. She told the charge or assistant manager or whoever was sitting there how I was her best favorite student she's had and asked if I was slow in the NICU if I would be allowed to work with her for a day (I know I'm probably not allowed but it made me feel so good that she asked!!)
Friday I showed up on the unit and my nurse was scheduled to be team leader (charge nurse). I told my nurse and the assistant nurse manager that I wasn't supposed to work with my nurse the days she is scheduled as charge. They both agreed that I should definitely stay and watch a code that was going on, on the unit. The code was for a term baby born on 9/16 and at birth suffered a stroke. The baby was stable but was immediatly taken to the NICU for observation. The next morning the baby began having seizures throughout the day and developed a cerebral hemmorhage. In the middle of the night/early in the morning the baby suffered a heart attack and developed pulmonary hypertention. The baby was intubated and put on INO (nitric oxide). When I got there the baby was so critical she was assigned to 3 nurses. The doctor had not left the bedside the entire night. The baby was on epinephrine, dopamine, dobutamine and a bunch of other drips and IV fluids. About an hour the doctor was concerned about a possible pneumo-thorax and decided to insert a chest tube (which was really interesting but sad to watch.) Throughout the morning the baby's sats were in the 30s-60s. They then decided the baby needed a Broviac in addition to the IVs and umbilical line she had in place. The pediatric surgeon came to the unit to place the Broviac and told me to pull up a stool and explained to me everything she was doing and the anatomical landmarks she looks for when inserting a central line. While doing the Broviac procedure she noticed that the baby's lymph nodes were enlarged and she and the neonatalogist agreed she should remove one and send it to pathology to determine if they reason for her declining health was due to an infection they had not yet detected. The baby was also oozing pretty badly even though she was having platelets transfused and the doctors were also determining if she may possibly had DIC.
I learned, saw and experienced SOOOO much in just my first couple days. Even though I didn't get L&D I think this will be an amazing learning experience and a way to boost my confidence working with critically ill patients.