NICU NURSE CHEAT SHEET

Download from above link or you may print for acceptable view.

Remember to look at the whole baby. 

Numbers are just numbers!!

THE HARDWAREWHERE IT SHOULD BE
UAC (high-lying)Insertion depth = BW(kg) X 3 + 9cm;
T6 - T10
UVC (high-lying)Insertion depth = 1/2UAC + 1cm;
at or little above the diaphragm
UVC (low-lying)insert 2-3cm for emergency use
Endotracheal TubeWeight(kg) + 6 = cms at the lip;
T2 - T4;
check for chest rise, equal air entry and lack of gastric air
Pulse oximeterfoot, hand, great toe or thumb (large infant), wrist (micropremie);
light emitter and detector of probe must be facing each other through baby's extremity to be accurate!!
Oral or Nasal Gastric TubeInsertion depth = Distance(cm) xiphoid process to ear lobe to tip of nose;
listen for air pushed in stomach (1-2cc); aspirate (should get back air & any stomach contents)
Skin Temperature ProbeSupine - exposed area of abdomen (best reading over liver area);
Prone - soft tissue of right or left flank;
do NOT place under baby or on bony area (i.e. spine or ribs)
ENDOTRACHEAL TUBE SIZE
    <1kg           2.5mm>
TOTAL FLUID VOLUME
TFV = ml/kg/day 
IV rate = TFV ÷ 24 =ml/hour
CALCULATIONS FOR GTTS
Alert: watch whether using mcg or mg!
Order: mcg/kg/min

dose(mcg) x wt.(kg) = mcg/min
mcg/min x 60(mins/hr) = mcg/hr 
mcg/hr ÷ 1000 = mg/hr
mg/hr ÷ ml/hr (IV rate) x total volume (ml in syringe or bag) 
     = quantity on hand (mg in bag or syringe)

Order: mg/kg/hr

dose(mg) x wt.(kg) = mg/hr
mg/hr ÷ ml/hr (IV rate) x total volume (ml in syringe or bag) 
     = quantity on hand (mg in bag or syringe)

To determine rate based on dose & concentration:

mg/hr ÷ quantity on hand(mg) x total volume(ml)
URINE OUTPUT
Urine total ÷ hours (i.e. 24 for a day, 8 or 12 for a shift)

UOP should be ≥ 1 ml/kg/hour


    1000 mcg = 1 mg;

    1000 mg = 1 gram;

    1000 grams = 1 kg;

    1 kg = 2.2046 pounds;

    1 ounce = 28.35 grams;

    1 pound = 453.6 grams;

    1 teaspoon = 5 mls;
VITAL SIGNSTemperatureHeart RateRespirationsMean Blood Pressure
Normal97.8o to 99.0oF
(36.5o to 37.2oC)
120 - 160/min.; some healthy term infants have a low, resting heart rate (90 - 110/min.)40 - 60/min; variable, may count rates of 30 - 65 in a healthy infantThe Old Adage: 
MBP = gestational age ± 5;
today many providers prefer MBP = GA + 5 or refer to a chart;
increases with GA, weight and age of life
Common Considerations for Below Normal Valueslow fat stores, hypoglycemia, hypoxia, acidosis, sepsis, environmental factors (air temp., drafts, cold surfaces, wetness), skin probe problem, phototherapy (false high reading of skin probe; if shiny probe cover used w/phototx - cover shiny part w/tape)bradycardia (HR <>apnea (0 respirations for >20 secs. or accompanied by bradycardia) vs. normal periodic breathing, central apnea (no resp. effort) vs. obstructive (secretions, positioning, anomalies, equipment-related), with or without retractions (respiratory vs. cardiac/other etiology), prematurity, sepsis, hypoxia, anemia, polycythemia, gastric reflux (raise HOB, position left side or prone, slow gavage feed), cardiac (i.e. PDA, CHD), neurologic (i.e. IVH, seizures), narcotics, pain, adenosine, maternal magnesium therapyhypovolemia (check IV & rate), sepsis, decreased cardiac output, PPHN, tension pneumo (rapid destabilization), UAC or equipment related (dampened waveform? reduced pulse pressure? bubbles in transducer or arterial line?), check tubing and pump if on vasopressors (disconnect before fixing to avoid bolus), pain
Common Considerations for Above Normal Valuesinfection, narcotic withdrawal, environmental factors, skin probe not on or in bad position, phototherapy (turn NTE/ISC down; turn back up when phototx dc'd), excessive activity (large infants), IV prostaglandinsanemia, hypoxia, sepsis, supraventricular tachycardia (HR > 220 & QRS <>respiratory distress, TTN, pneumothorax, anemia, hypoxia, sepsis, cardiac (i.e. PPHN, CHD), hyperthermia/over-heated infant, narcotic withdrawal, painshock, cardiac, renal, bronchopulmonary dysplasia, IVH, PDA, fluid overload (correct total fluid volume?), UAC or equipment related (check level of transducer & zero), vasopressor bolus (recent line change? check tubing and pump), pain
ARTERIAL BLOOD GASESpHPCO2PO2BicarbonateBase*
Normal7.30 - 7.4535 - 4550 - 8019 - 26-4 - +4
Respiratory Acidosislow;
normal if compensated
highnormal unless accompanied by hypoxianormal;
high if compensated
normal;
may be high if compensated
Metabolic Acidosislow;
normal if compensated
normal;
low if compensated
lowlow
Metabolic Alkalosishigh; normal if compensatednormal; high if compensatedhighhigh
CBG CO2 normal values are 35 - 50. CBG PO2 values are falsely low and irrelevant to care.
Acidosis and alkalosis may have mixed etiology - both respiratory and metabolic.
*Base excess or deficit reflects the amount of base that would be needed to return to normal.
APGAR SCORES (1 min, 5 min then Q 5 mins til score ≥7012
Heart rate/pulse
(apical or umbilical)
Absentless than 100more than 100
Respirations 
(rate and effort)
Absent or gaspingSlow, irregular, labored, poor cryNormal, good cry
Grimace 
(reflex irritablilty to stim, i.e. oral or nasal suctioning)
No response to stimMinimal response to stim (grimace only)Grimaces, coughs or sneezes, withdraws
Tone 
(flexion and movement)
Floppy, no tone, no spontaneous movementsSlightly flexed, minimal movementFlexed, active
ColorCyanotic or paleAcrocyanosisPink all over
NRP REVIEW - A quick reference - not a complete study guide!!
1st 30 seconds30 - 60 seconds
Evaluate respirations, heart rate & color
60 - 90 seconds
Baby's StatusInterventionsBaby's StatusInterventionsBaby's StatusInterventions
Term baby w/clear fluid; breathing or crying; w/good toneWarm, clear airway, dry and assess color; "routine care"Pink & breathing w/HR>100ObserveHR>60, apneicPPV*
Premature, apneic or hypertonicWarm; position and clear airway as needed; dry, stimulate and repositionCentral cyanosisGive oxygenHR<60PPV* & compressions
Meconium in fluid; baby vigorous - good resp. effort; HR>100; w/good toneWarm; suction mouth and nose; dry, stimulate and repositionApneic or HR<100PPV*HR<60,>Epinephrine
Meconium in fluid; baby not vigorous - i.e. poor resp. effort; heartrate <100;>Intubate and suction trachea (use meconium aspirator), suction mouth and noseBreathing effectively after PPV & HR>100Post-resuscitation care*Intubation may be considered at several points.

 
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