PIONEER NURSING COLLEGE

VADODARA

SUBJECT: CHILD HEALTH NURSING

TOPIC: OBSERVATION REPORT (NICU)

SUBMITTED BY:
SUBMITTED TO:
RATHOD JIGISHA H
Mrs MAYURIKA PATEL
2nd YEAR M.Sc NURSING
ASSISTANT PROFESSOR
PIONEER NURSING COLLEGE
PIONEER NURSING COLLEGE
ROLL NO:09
VADODARA

SUBMITTED ON:
 INTRODUCTION
My self Rathod Jigisha H the student of 1 st year M.Sc nursing paediatric speciality from
Pioneer nursing college vadodara. We posted in NICU of Jamnabai General
Hospital,Vadodara.

We learn about the general objective, Activity and policy regarding NICU.

The Vision of NICU:

● A premier provider of comprehensive, leading-edge, evidence-based, cost-effective,

and family-centered neonatal medical care to the babies.
● A provider of excellence in service to our referring physicians;
● A supportive, equitable and excellence-based group in which to practice neonatal-
perinatal medicine;
● As contributors to a wider communities through participation in research, education,
and advocacy for our tiny patients.

I am thankful to Shri Govind Guru University for giving some opportunity and giving
practical hours in our syllabus.
Objectives
General objectives:

● After the completion of NICU observation I can identify health needs of each babies
& provide comprehensive health care to each patients according to their health needs.

Specific objectives:
● To learn about various disease which are generally fond in neonates in NICU.
● To improve the skill in management of neonates in emergency condition.
● To know about drugs, equipments and articles which are used in NICU.
● To learn about roles and responsibility of nurse in NICU.
● To identify the staffing pattern and physical set-up of NICU.
● To learn about records and reports which are maintain in NICU.
● To know about stock distribution and registers.
PHYSICAL SET-UP

Staffing pattern
 Paediatrician

Residential doctors

Junior doctors

Head nurse

Staff nurse

Student nurse

Co-workers

● Equipments which are use in NICU

● ARTICLES USED IN NICU
What types of equipment are used in the NICU?
Neonatal Intensive Care Units (NICUs) have complex machines and devices for
the unique needs of tiny babies. The NICU can be overwhelming to a new
parent. Learning about what to expect in the NICU can help ease your concerns.

Some of the equipment often used in the NICU includes:

Heart or cardiorespiratory monitor. This monitor displays a baby's heart and

breathing rates and patterns on a screen. Wires from the monitor are attached to
adhesive patches on the skin of the baby's chest, and abdomen. 

Blood pressure monitor. Blood pressure is measured using a small cuff placed

around the baby's upper arm or leg. Periodically, a blood pressure monitor
pumps up the cuff and measures the level of blood pressure. Some babies need
continuous blood pressure monitoring. This can be done using a catheter (small
tube) in 1 of the baby's arteries.

Temperature. A temperature probe is placed on the baby's skin with an

adhesive patch. A wire connects the temperature probe to the overhead warmer
(or incubator) to help regulate the heat needed to keep the baby warm.

Pulse oximeter. This machine measures the amount of oxygen in the baby's

blood through the skin. A tiny light is taped to the baby's foot or hand. A wire
connects the light to the monitor where it displays the oxygen saturation or
"sat." This refers to the amount of hemoglobin in the baby's red blood cells that
is saturated with oxygen.

X-ray. Portable X-ray machines may be brought to the baby's bedside in the

NICU. X-rays use invisible electromagnetic energy beams to produce images of
internal tissues, bones, and organs on film. X-rays are taken for many reasons
including checking the placement of catheters and other tubes, looking for signs
of lung problems, such as respiratory distress syndrome or pneumothorax, and
checking for signs of bowel problems.

CT scan. A CT scan is a diagnostic imaging procedure that uses a combination

of X-rays and computer technology to produce horizontal, or axial, images
(often called slices) of the body. A CT scan shows detailed images of any part
of the body, including the bones, muscles, fat, and organs. CT scans are more
detailed than general X-rays. CT scans are sometimes done to assess bleeding
inside a baby's head. A CT scan is done in a special room and the baby may
need a sedative medication so that he or she will be motionless for the exam.
MRI. MRI is a procedure that uses a large magnet, radio waves, and a computer
to make detailed images of organs and other tissues in the body. Like a CT scan,
MRI is done in a special area of the hospital. It is often done to examine a
baby's brain stem, spinal cord, and soft tissues. The baby will need a sedative
medicine so that he or she will lie still for the exam.

Endotracheal tube (ET). This tube is placed through the baby's mouth or nose
into the trachea (windpipe). The ET tube is held in place with special tape and
connects to a mechanical ventilator (breathing machine) with flexible tubing.
An X-ray is used to check the tube's placement. When a baby has an ET tube, he
or she is unable to make sounds or cry.

Respirator or mechanical ventilator. This machine helps babies who can't

breathe on their own or who need help taking bigger breaths. High frequency
ventilators give hundreds of very fast puffs of air to help keep a baby's airways
open. Ventilators can also give extra oxygen to the baby.

Continuous positive airway pressure (CPAP). Through small tubes that fit

into the baby's nostrils, called nasal CPAP, this machine pushes a continuous
flow of air to the airways to help keep tiny air passages in the lungs open. CPAP
can give extra oxygen as well. It may also be given through an ET tube.

Extracorporeal membrane oxygenation (ECMO). This is a special treatment

for babies with respiratory disease that does not respond to maximum medical
care. With ECMO, blood from the baby's vein is pumped through an artificial
lung where oxygen is added and carbon dioxide is removed. The blood is then
returned back to the baby. ECMO is only used in specialized NICUs.

COMMON MEDICATION WHICH ARE USED IN

NICU:
● Ampicillin
● gentamicin
● caffeine citrate
● vancomycin
● beractant
● furosemide
● fentanyl
● dopamine
● midazolam
● calfactant

COMMON DIAGNOSIS OF NEONATES IN NICU:

ABO incompatibility. A condition that arises when a mother with type-O blood
has an infant with type-A or type-B blood. Her body makes proteins that cross the
placenta and cause a rapid breakdown of the blood in a fetus or newborn.
Anemia. An insufficient amount of red blood cells, often found in premature
babies.
Apnea. A stoppage in breathing. Premature babies sometimes do not breathe
regularly. A baby may take a long breath, then a short one, and then pause for 5
 to 10 seconds before starting to breathe normally. This is called periodic
breathing.
Asphyxia. The poor exchange of blood gases, with low oxygen and high carbon
dioxide. This can occur before or after birth.
Aspiration. The breathing into the lungs of some substance that shouldn't be
there, such as amniotic fluid, meconium, or formula. This may cause aspiration
pneumonia.
Bradycardia. Slow heart rate.
Breathing problems. A condition often seen in premature babies when their
lungs are not fully developed and the brain systems that regulate their breathing
may still be immature.
Bronchopulmonary dysplasia (BPD). A disorder (now called chronic lung
disease of infancy) that occurs when there have been serious breathing problems
after birth, and the lungs and bronchial tubes have sustained some damage and
scarring.
Cerebral palsy. A condition involving disturbances in motor tone and the
smooth control and coordination of motor movements.
Cerebrospinal fluid (CSF). The fluid around the brain and spinal cord. Taking
a sample of this for testing is called a lumbar puncture, or spinal tap.
Chest physiotherapy (CPT or Chest PT). Tapping, moving, and vibrating the
chest to loosen secretions so they can be cleared out of the lungs, often by
suctioning with a catheter.
Coarctation of the aorta. A narrowing of part of the aorta, the large artery that
connects the heart to the rest of the body, so that blood doesn't flow evenly.
Cyanosis. Bluish discoloration of the lips, gums, or extremities. This may
develop if the oxygen content of an infant's blood is too low because of heart,
lung, or brain problems.
Desaturation. A reduction of the level of oxygen in the blood, often used as a
verb, as in "He's desating." More oxygen or more respiratory support is usually
needed to correct the situation.
Gastrostomy tube/button (G-tube). A tube or opening directly into the
stomach from the abdominal wall. This allows for prolonged feeding of infants
who cannot feed orally. Special formulas may be given continuously by pump
infusion or dripped in periodically at mealtimes.
Heart failure. The inability of the heart to maintain adequate pumping, either
because of a problem with the heart itself or with the lungs or kidneys. A salt
imbalance can cause heart failure as well. Typically, the heart will look enlarged
on an X-ray. One common drug given to stimulate the heart is digitalis, but
many other medicines and treatments are also used in NICU hospitals.
Heart murmur. An extra heart sound caused by rapid or wayward blood flow
through the heart.
Heart valve abnormalities. The narrowing, closing, or blockage of a heart
valve, which prevents blood from flowing smoothly.
Hypoglycemia. Low blood sugar
Hypotension, hypertension. Abnormal blood pressure (too low or too high).

Hypothermia. Low body temperature.

Intrauterine growth retardation (IUGR). A condition in which a baby grows more
slowly than usual in utero and is smaller than normal for his gestational age at birth
(termed SGA, or small for gestational age). There are multiple causes, and testing may
be needed to evaluate the condition.
Intraventricular hemorrhage (IVH). Bleeding into the cavities (ventricles) of the
brain, a condition most common in the smallest premature babies. An ultrasound
examination can show whether a baby has had brain bleeding and how severe it is,
noted by a grade from 1 to 4.
Jaundice (hyperbilirubinemia). An excess of bilirubin, which comes from the
breakdown of red blood cells. Jaundice is common in premature babies and in infants
who have blood-type incompatibilities with their mothers.
Laryngomalacia/tracheomalacia. A softening of the vocal cords (larynx) or the
windpipe (trachea), making them floppy enough to interfere with breathing.
Meconium aspiration. The breathing in of the infant's first bowel movement just prior
to or during delivery.
Necrotizing enterocolitis (NEC). An intestinal problem that occurs when the bowel
becomes damaged due to decreased blood supply or poor oxygenation.
Patent ductusarteriosus (PDA). The most common heart problem in premature babies.
Before birth, much of the fetus's blood bypasses the lungs through a passageway called the
ductusarteriosus.
Periodic breathing. Irregular breathing
Periventricular leukomalacia (PVL). Damage to areas of the brain around the ventricles,
including a possible loss of tissue with cyst formation.
Persistent pulmonary hypertension of the newborn (PPHN). Elevated blood pressure in the
lungs, which prevents babies from breathing properly.
Pneumonia. A lung infection that is common in premature and sick newborns. Doctors may
suspect pneumonia if the baby has difficulty breathing, shows changes in his rate of breathing,
or has an increased number of apnea episodes.
Pneumothorax. Air in the chest cavity.
Polycythemia. A condition in which there are too many red blood cells, which makes the
blood thick, or hyperviscous. The opposite of anemia, polycythemia may require an exchange
transfusion.
Reflux. The return of food up into the esophagus once it is swallowed and in the stomach, also
termed GE reflux. Immaturity of the muscle valve between the esophagus and the stomach
causes this.
Respiratory distress syndrome (RDS). A lung condition that makes it hard for small
preemies to breathe. Babies born before 34 weeks may have breathing difficulty because their
lungs are immature.
Retinopathy of prematurity (ROP). An abnormal growth of blood vessels in the retina,
occurring in babies born before 32 weeks.
Retraction. A pulling-in of the abdominal wall between, above, and/or below the ribs while
breathing. This indicates breathing difficulty or distress.
Rh incompatibility. A condition that occurs when a mother doesn't have the Rh factor
on the surface of her red blood cells but her fetus does (as do most people).
Seizures. Electrical storms in the brain's activities, often with multiple causes.
Sepsis. Infection in the bloodstream by a bacterium or virus.
Septal defect. A hole in the wall (septum) that divides the two upper chambers (atria) or
two lower chambers (ventricles) of the heart.
Tetralogy of Fallot. A combination of four heart defects keeping some blood from
getting to the lungs, so that a baby has episodes of cyanosis and may grow poorly
 Total parenteral nutrition (TPN). A treatment in which the infant's GI tract is
bypassed completely while a balanced nutritional fluid is delivered by an intravenous
line into a deep blood vessel. This is also known ahyperalimentation, or "hyperal."
Transposition of the great arteries. A condition in which the positions of the two
major arteries leaving the heart are reversed, so that each arises from the wrong
pumping chamber. Surgical advances have enabled correction of this defect in the
newborn.

SUMMARY
We are posted in NICU for a 1 week. We observed NICU physical set-up, staffing
pattern, procedures which are performed in the NICU set-up. We gain knowledge
regarding paediatrics disease condition. We are oriented regarding emergency care.
We also taken knowledge regarding how to manage records and reports.

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