SHREE SARSWATI KANYA KELAVANI MANDAL SANCHALIT

SHREE R.G.PATEL COLLEGE OF NURSING, KADI

SUBJECT:- Obstetric & Gynecological Nursing

TOPIC:- Visit Report ( NICU )

SUBMITTED TO:-

SUBMITTED BY:-

Ms. Bhavika G. Sonagara

Roll No.- 12
F.Y. M.Sc. Nursing
Shree R.G. Patel College of Nursing
Nanikadi, Kadi.

Date of Submission:-
INTRODUCTION:

I am the students of F.Y. M.Sc Nursing was placed in sola Civil Hospital. I posted in
N.I.C.U.

Newbom babies who need intensive medical attention are often admitted into a special area of
the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced
technology and trained healthcare professionals to provide specialized care for the tiniest
patients. NICUs may also have intermediate or continuing care areas for babies who are not as
sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU
and babies must be transferred to another hospital.

Ten to 15 percent of all newborn babies require care in a NICU, and giving birth to a sick or
premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and
equipment in the NICU can be overwhelming. This information is provided to help you
understand some of the problems of sick and premature babies. You will also find out about
some of the procedures that may be needed for the care of your baby.
OBJECTIVES OF NICU:

• To improve the condition of the critically ill neonates keeping in mind the survival of neonate
to reduce the neonatal morbidity and mortality.

• To provide continuing in-service training to medicine and nursing personnel in the care of the
new born.

• To maintain the function of the pulmonary, cardio-vascular, renal and nervous system. To
monitor the heart rate, body temperature, blood pressure, central venous pressure and blood
by non-invasive techniques.

• To measure the oxygen concentration of the blood is by oxygen analyzers.

• To check/observe alarms systems signals, to find out the changes beyond certain fixed limits
set on the monitors.

• To administer precise amounts of fluids and minute quantities of drugs through I.V. infusion
pumps.
PHYSICAL SETUP:
LEVEL OF NICU:

 There are three different levels of neonatal nursery where a neonatal nurse might work:

Level:-consists of caring for healthy newborns. Healthy babies typically shure a room with their
mother, and both patients are usually discharged from the hospital quickly.

LevellI> (Aseptic) provides intermediate or special care for premature or il newborns. At this
level, infants may need special therapy provided by nursing staff, or may simply need more
time before being discharged.

Level III: - (Septic) the Neonatal intensive-care unit (NICU) treats newborns who cannot be
treated in the other levels and are in need of high technology to survive.

FLOOR PLAN:

The NICU have adequate space area available. The wall should be made of concrete and
covered by tiles, and window made up of glass, it helps to heat and sound insulation. In the
entrange wash basin are available, having round the clock water supply should be avalable.

door should be provided with automatic door closures. There should be one septic
room where effected neonate with neonatal sepsis should be nursed.

There should one breast feeding room/ KMC room for promoting practice of KMC and
exclusive breast feeding and given proper health education to mother about KMC and
importance of exclusive breast feeding.
VENTILATION AND LIGHTING:

There should be effective air ventilation; there are exhaust fan for good ventilation, and
maintained positive pressure in NICU room.

NICU room is well illuminated and painted with white color so it permits prompt early
detection of jaundice and cyanosis.

Environment temperature and humidity:-

Temperature of room maintained around 28+2 degree centigrade indoor to minimize effects of
thermal stress on babies. This is achieved by air conditioning having temperature control knobs
in the level 1.2. Portable radiant warmer, infrared bulb can be used to provide additional source
of heat to an individual infant. Humidity is maintained around 50% in NICU by using room
thermometer and hygrometer.
STAFFING PATTERN:

Head of the department

CDS unit

KMM II unit

KMM unit

In-charge sister

Senior sister

Junior sister

Student sister

Servant
EQUIPMENT:

In neonatal care unit various equipment are used either for monitoring the physiological status
of neonatal for example like pulse oxymetre, radiant warmer, phototherapy machine.

 Radiant warmer Simple trolley

 Pulse oximeter

 Syringe pump

 Humidifier

 Ventilator machine

 SPT * DSPT

 Multipara monitor Neo puff

 NIBP

 Nebulizer CPAP

 Suction machine
1) Radiant Warmer

A radiant warmer is a device used to maintain the body temperature of the newborn and thus
play an essential role in influencing oxygen consumption, apnea and acid base balance.

• The infrared that is preferable because it directly warms the subject without affecting the
temperature of intervening environment.

Open care system is equipped; with an overhead radiant warmer and skin, thermistor with
servo control is becoming increasingly popular and preferred over an isolates incubator
because of easy access to infant and less chances of nosocomial infection.

Hood-Hood contains the radiant heat panel. The radiant heat panel will automatically turn on
and off to maintain the infants temperature as desired by temperature control and thermistor
attached to the infant. E Panels there are four panels, two sides' panels, head and foot panel.

Bassinet procedure table-the bassinet may be placed in varying levels of fowlers or

trendelenburg position by squeezing the handle under the tabletop.
2) Phototherapy Unit
Principle

Photo isomerisation and photo-oxidation changes indirect bilirubin into water-soluble

substance.

Operational Instruction

• Adjust the angel and height of the lamp housing to the desired position. It is recommended
that the light be kept at 18 inches or 45 cm away from the infant to minimize any heating effect
of the lamp. Intensity of light is 425-475mm.

• Turn on the power switch located on extension arm. Rotate the aperture control for
maximum field size.

• Rotate the intensity asdetermined by radiometer.

Storage area- linen and equipment necessary for the individual care of infant may be stored
here.

Control panel:-

• Off-on switch-turn power on or off.

• Power light-amber light illuminated when power is on.

• Set temperature- Set the temperature between 36°C-36.5°C radiant energy is maintained at a
level that will maintain the desired skin temperature.

•Skin sensor probe-it is fixed to the abdominal skin midway between umbilicus
andxiphisternum. The skin sensor feeds the information regarding temperature of the baby to
thermostat, which automatically regulates the output of the heat to maintain desired skin
temperature.

• Heater output-provides information regarding the amount of the heat generated by

theincubator/warmer to keep the infant normeothermie.

• visible audible alarm speaker-red light flashes /Emits audible alarm when temperature
measured by thermistor is 1°C set temperature L.e.36.0"-36.5"
NURSES RESPONSIBILITIES:-

 Remove clothing to maintain proper skin exposure.

 Turn frequently to expose all skin area.

 Monitor temperature and level of hydration.

 Close infant's eye lids and cover with the light opaque eye shield secured/held in
placeby tape or bandage. It should be changed every eight hours and give eye care.

 Cover genitalia.

 Observe common side effects of phototherapy-loose greenish stools, transient skin rash,
bronze discoloration of the skin, hyper pigmentation, dehydration as phototherapy
increase insensible water loss.

 Local hyperthermia under the electrode can cause redness of the skin. Overheating of
surface should be avoided, The nurse should be alert to the development of blisters and
should record and report her findings. Change the site 2-3 hourly.
3) Pulse Oximeter

• The arterial blood oxygen saturation can be determined transcutaneously by measuring the
absorption of two selected wave lengths of lights of light The light generated in the sensor
passes through the blood and tissue and is converted in to electronic signals by a
photodetectector located in the sensor.

• Pulse oximetery provides a simple, convenient and non-invasive method for continuous
monitoring of hemoglobin saturated with oxygen and heart rate. It has virtually replaced the
transcutaneous monitors. The arterial blood oxygen saturation (Sa0:) can be determined
transcutaneously by measuring the absorption of two selected wave lengths of light. The light
generated in the sensor (probe) passes through the blood and tissues and is converted into
electronic sign.
4) Weighing Machine:

• Accuse weight record of babies is a sensitive index of their well being and availability of a
sturdy and reliable weighing machine fulfills a fundamental need. A sensitive beam-type
weighing scale with a precision of 10g is useful equipment in the nursery.

• It must be calibrated frequently against standard one kilogram weight. The chances of cross
infection should be minimized by using a sterile paper or a towel over the pan before weighing
each infant. Electronic weighing machine (accuracy either +5 g or 1 g) with a digital read-out
though expensive is desirable for sake of convenience and accuracy.

• Electronic weighing scale with an accuracy of 1.0 g sensitive electronic weighing scale is more
useful and desirable than acquiring the status symbol of a ventilator.
5) Oxygen head box:

A square shaped box made of transparent plastic or perspex which can enclose the head of the
infant is useful for administration of higher concentration of oxygen. 'The box should be made
of unbreakable material, moulded as a single piece without any joints. It can be used whether
the baby is nursed in an open cot or incubator. It should systolic, diastolic and mean blood
pressure. There is a provision for alarm or warning signal when blood pressure falls or rises
beyond certain preset limits.

6) Multi-channel vital sign monitor:

The multiple channel complex monitors are asulable to display and record all the vital signs on
an oscilloscope. They are very useful but extremely expensive. They are equipped to record
temperature at different sites, heart rate, and respiratory rate with apnea alarm, invasive and
non-invasive blood pressure and pulse oximetery. ECG, pulse waves and respiratoram are
displayed on the oscilloscope. There is a need to have a computer based monitor to analyse all
the information provided by complex vital sign monitors).
7) Infusion Pump:

• In view of the fact that relatively small quantities of fluids need to be infused and minor errors
in rate of administration may prove lethal to low birth weight babies, constant infusion pumps

• With accurate control are essential to meet these requirements. In centers where parenteral
marition is used for the care of sick babies, the use of infusion pumps has become obligatory.
The infusion pump is a sophisticated electronic micro-pump which displaces fluid and a
microprocessor or pressure transducer controls the rate of fluid delivery. The rate of infusion is
either depicted as drops/minute (1-99 drops/minute) or in terms of volume (1.0-999 ml/hour)
through a disposable, cassette or plastic syringe. The syringe-based infusion pumps are ideal for
administration of drugs or intra lipid. The latest infusion pumps have inbuilt alarms to signal
occlusion of flow, air in the system, system failure, low battery charge etc. The infusion site
must be watched diligently for any extravasations because infusion will not stop due to the
effect of pumping force.
8) Syringe Pump:

• To provide little amount of fluid syringe pump is used. A syringe driver or syringe pump is a
small infusion pump (some include infuse and withdraw capability), used to gradually
administer small amounts of fluid (with or without medication) to a patient or for use in
chemical and biomedical research.

• The most popular use of syringe drivers is in palliative care, to continuously administer
analgesics (painkillers), antiemetic (medication to suppress nausea and vomiting) and other
drugs. This prevents periods during which medication levels in the blood are too high or too
low, and avoids the use of multiple tablets (especially in people who have difficulty swallowing).
As the medication is administered subcutaneously, the area for administration is practically
limitless, although edema may interfere with the action of some drugs.

• Syringe drivers are also useful for delivering IV medications over several minutes. In the case
of a medication which should be slowly pushed in over the course of severalminutes, this device
saves staff time and reduces errors Syringe pumps are also useful in microfluidic applications,
such as microreactor design and testing, and also in chemistry for slow incorporatic of a fixed
volume of fluid into a solution. In enzyme kinetics syringe driver can be used to observe rapid
kinetics as part of a stopped flow apparatus.

• Test strips: A consumable element containing chemicals that react with glucose in the drop of
blood is used for each measurement. For some models this element is a plastic test strip with a
small spot impregnated with glucose oxidase and other components. Each strip is used once
and then discarded. Instead of strips, some models use dises that may be used for several
readings.

• Coding: Since test strips may vary from batch to batch, some models require the user to
manually enter in a code found on the vial of test strips or on a chip that comes with the test
strip. By entering the coding or chip into the glucose meter, the meter will be calibrated to that
batch of test strips. However, if this process is carried out incorrectly. the meter reading can be
up to 4 mmol/L (72 mg/dl) inaccurate. The implications of an incorrectly coded meter can be
serious for patients actively managing their diabetes. This may place patients at increased risk
of hypoglycemia. Alternatively, some test strips contain the code information in the strip;
others have a microchip in the vial of strips that can be inserted into the meter. These last two
methods reduce the possibility of user error. Volume of blood sample: The size of the drop of
blood needed by different models varies from 0.3 to 1 pl. (Older models required larger blood
samples, usually defined as a "hanging drop" from the fingertip.) Smaller volume requirements
reduce the frequency of unproductive pricks.

• Alternative site testing: Smaller drop volumes have enabled "alternate site testing" - pricking
the forearms or other less sensitive areas instead of the fingertips. Although less
uncomfortable, readings obtained from forearm blood lag behind fingertip blood in reflecting
rapidly changing glucose levels in the rest of the body.

• Testing times: The times it takes to read a test strip may range from 3 to 60 seconds for
different models.
9) Glucometer

• A glucose meter (or glucometer) is a medical device for determining the approximate
concentration of glucose in the blood. It is a key element of home blood glucose monitoring
(HBGM) by people with diabetes mellites or hypoglycemia. A small drop of blood, obtained by
pricking the skin with a lancet, is placed on a disposable test strip that the meter reads and uses
to calculate the blood glucose level. The meter then displays the level in mg/d or mmol/1.

• Since approximately 1980, a primary goal of the management of type 1 diabetes and type 2
diabetes mellitus has been achieving closer-to-normal levels of glucose in the blood for as much
of the time as possible, guided by HBGM several times a day. The benefits include a reduction in
the occurrence rate and severity of long-term complications from hyperglycemia as well as a
reduction in the short-term, potentially life-threatening complications of hypoglycemia.

• There are several key characteristics of glucose meters which may differ from model to
model:

• Size: The average size is now approximately the size of the palm of the hand, though some are
smaller or larger. They are battery-powered.
 Neonatal Laryngoscope

• The pencil handle laryngoscope with infant straight blade, its light source and batteries should
be in working condition.

Tracheal tube of different size

• Gamma irradiated disposable endotracheal tubes with internal diameter of 2.5mm, 3.0mm,
3.5mm and 4.0mm mounted with adapters should be available.
10) Resuscitation Equipment

The following equipment needed for the resuscitation of asphyxiated baby at birth.

Ambu bag and mask

Ambu bag and mask is extremely usefully and handy to resuscitate an apneic baby. Self inflating
bag of 250-500 ml capacity is ideal for resuscitation of a newborn baby. It should be provided
with a pop off valve or with a facility to attach a pressure gague. The self inflatable bags are
easy to use but provide only 40 to 50% oxygen, the attachment of a corrugated tube provides
reservoir for oxygen and can deliver up to 90% oxygen to the infant.

One way valve allows delivery of oxygen at the outlet when bag is squeezed but closes as soon
as the bag is released so that the exaled air cannot re enter the bag. A peep valve can be
attached to the valve assembly to deliver required PEEP. Proper size mask is required for the
infant for resuscitation.
11) Catheters, Syringes and Needles:
 Suction Machine

Suction machine and stile suction catheters The suction should be in working condition.
Mechanical suction facility with different sized suction catheters 6Fr, 8Fr, 10Fr and 12Fr and
meconium aspiration device should b available.

Oral mucus suction traps

• Press type rubber bulb or oral suction De Lee macus trap must be available to meet the
exigencies of electrical failure. Oxygen cylinder should be checked for its contents.
• Nasogastric polyethylene feeding tubes (Fr 5,6 and 8) suction catheters (Fr10 to 12), umbilical
vein catheters, small vein infusion sets (G 23), medicaths (neoflon) and exchange transfusion
sets. They are prepackedste rile by a process of gamma- irradiation, not be re used after boiling.
Adequate syringe and needles are available in NICU.

• It is desirable to use tuberculin or insulin syringes for injections to ensure ease and accuracy
of administration, only single use of liberal supplies of disposables is crucial for reduction of
nosocomial infection.

NICU ROUTINE:

• In NICU the recording, medications, charting, rounds continue round the clock.

• In the morning the student sister along with one staff nurse given sponge bath to all baby and
change the cover sheet of warmer.

• Over is taken from the night duty staff by the in-charge sister and morning duty staff.

• Inventory of the word articles is done by morning and evening staff.

•The rounds of doctor are routinely done in the morning according to unit of
pediatricdepartment.

• All the new orders as well as old orders are being carried and charted in the paper.Collection
of blood sample, CSF. Investigations are being carried out in the morning by doctor.

• Medications are administered to neonate by using syringe pump or by using micro drip
around 10 o'clock in morning, in evening.
Urinary catheter

Naso-gastric tube
POSITIVE FACTOR:

•Doctors, staff nurses are present all times in NICU.

• Nurses having good interpersonal relationship.

• The nurses and doctors are very much caring and loving. They give all care, look after every
minute need of the newborn baby. All the work is carried out honestly and sincerity by the
nurses.

• Their main goal is to improve the condition of the neonate. In NICU all advance technology
equipment present.

• Early morning all equipment, medicine and neonate condition checked by in charge nurse.

•Location of doctor and nurse station are good so easily they observe neonate condition.

• NICU connected with intercom facilities.

• All NICU staff wear cap and mask maintain good aseptic technique and done hand washing
before entering into level 1 and 2 department.

• There are changing daily sheet of neonate warmers.

• The slippers for ICU are sufficient for the nurses and doctors 09.
NEGATIVE FACTOR:

• The space allotted for NICU is not sufficient it is little bit congested.

• Improper management of biomedical waste, in each warmer there is no any separate buckets
for biomedical waste. There is no 2:1 ratio for giving neonate care so neonate not receive good
nursing care.

• Many staff are wearing ornament so does not maintain good aseptic technique.

•Sometimes the sleepers are not available when client need them urgently.

• All mother touch their baby without hand washing, and all mother along with relatives enters
directly into level 3, it is very congested room.

• There are sharp warmer buzzle sounds that interrupt neonate sleep.

NEED FOR CHANGE:

• Sufficient space is requiring between two warmers In addition, more emphasis should be
given on the cleanliness of the equipments, floors and articles.

• Some equipment are not in adequate amount so it necessary to purchase enough equipment.

• It is necessary to change nippy of neonate after soiling. It is necessary to stop the warmer
sharp sound frequently for comfort of neonate.

• Continuous monitoring of neonate at nighttime. Need to change in hand washing tap because
it not ideal.
 SHREE R.G.PATEL COLLEGE OF NURSING, KADI
EVALUATION TOOL FOR ORIENTATIN VIST REPORT

Name of the Student: Roll No.:

Year of Study: Date of Submission:

Topic:

Total Marks: Marks obtained:

Sr. Evaluation Criteria 5 4 3 2 1

No.
1 Introduction and overview

2 Objective defined

3 Organizational chart drawn

4 Physical set up drawn

5 Policy described

6 Staffing patterns described

7 Role and responsibilities described

8 Resources and References used

9 Overall appearance and cleanliness

10 Punctuality in Submission

[*Scoring: 5= Very good, 4= Good, 3= Below Average, 1= Poor]

Signature of Student: ___________________ Signature of Evaluator:________________

Remarks:______________________________________________________________________