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Unformatted text preview: SCANNED TO PHARMACY STAT MEDICATION ROUTINE NURSERY CARE: On Admission/During Hospitalization A. Call exchange/M.D. upon admission of infant. Chart who/when notified. H. Obtain Total serum Bilirubin, if jaundice in first 24 hours of life. B. If cord pH <7.10, obtain ABG within 30 minutes after delivery. I. Obtain B/P when: H.R. > 165, Temp <35.5°C (96°F), Blood glucose C. Obtain T(ax) PR, then T(ax) every 30 minutes until stable for 2 hours, <40, or if cord pH<7.10, or ABG pH<7.15 or respiratory distress then vital signs per unit protocol/standards. (grunting, tachypnea or labored respirations) D. Monitor temperature per Protocol for Newborn: Thermoregulation. J. If infant does not stabilize by 4 hours of age or infant deteriorates, Notify M.D., if (R) > 38°C (100.5°F) or (R) < 36.3°C (97.4°F). transfer to NICU/Special Care Nursery. E. Initiate Protocols: K. If infant demonstrates acute respiratory distress: 1. Newborn: Care of AND if applicable, Newborn: Near Term Infant 1) Clear airway. Suction oropharynx ONLY if necessary 2. Newborn: Glucose Intolerance: Actual or Potential. 2) Initiate 100% oxygen 3. Jaundice Screening and Management 3) Obtain arterial blood gas 4. Pain Management 4) Initiate Pulse oximetry 5. Newborn Hearing Screening 5) Request assistance of ALS Nurse 6. Newborn Screening (State) 6) Initiate Neonatal resuscitation per protocol F. On Rh negative or 0 + mother obtain group/type on infant’s cord blood. 7) Transfer to NICU/Special Care Nursery, as necessary If infant Rh positive or A/B obtain Coombs on cord blood. 8) Notify M.D. G. Obtain CBC with manual differential and Blood culture if: L. Trim nails PRN. 1. Membranes ruptured for ≥ 18 hours or if maternal temperature M. Pacifier 1) Per Breastfeeding Protocol for breastfed infants. ≥ 101°F (38.3°C) within 24 hours prior to or after delivery 2) PRN for bottle feeding infants per maternal preference. - OR N. Lactation consult per criteria 2. GBBS (+) status mother received no antibiotics > 4 hours prior to a O. No discharge without documented void or stool. vaginal delivery or C-section delivery which included labor or rupture of membranes Medications Hepatitis B: Give an immunization record card to parents, documenting all immunizations infant has received. a. For all infants, within 12 hours of delivery Obtain consent for Hepatitis B vaccine Give infant Hepatitis B Vaccine 0.5 mL IM of Recombivax (5 mcg) or Engerix B (10 mcg). b. If mother screened positive for Hepatitis B (HBSA): surface antigen: Within 12 hours of delivery Give infant HBIG (hepatitis B immune globulin) 0.5 mL IM - and Notify Infection Control Office for assistance in follow up with M.D/Health Department d. Phytonadione (Vitamin K) 1 mg IM for infants 1600 gms and over, 0.5 mg IM under 1600 gms e. Eye Prophylaxis within one hour of birth. Erythromycin Ophthalmic Ointment 0.5%, apply 1/2 inch along conjunctiva pocket inside lower lid each eye Laboratory a. CBC with manual differential within 4 hours of admission to newborn nursery. b. Neonatal Toxicology Screen with simple consent for maternal history of substance abuse with this pregnancy Other a. Saline nose drops for stuffy nose. b. A&D ointment PRN for diaper rash. c. If mother not screened for Hepatitis B surface antigen: Double check records for screening data -andNotify Infection Control Office for assistance in the follow up with M.D./Health Department Feedings a. Breastfeeding as per standards: Feeding on demand or offer breast at least every 3-4 hours Other: ____________________________________________ b. If not breastfeeding, initiate bottle feeding: Feeding on demand or offer bottle at least every 5 hours. Formula as listed: 20 cal/oz. of the following Mother’s preference, or Enfamil with iron Similac with iron Other: ________________________________________ M.D. Signature _________________________________ Physician #________________ Office Ext/Phone _____________ Private Line: ________ Date__________ Time__________ OTHER ADMISSION ORDERS: ____________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ M.D. Signature __________________________________ Physician # _______________________ Date: ______________ Time: _____________ Authorization for therapeutic substitution is given unless checked here Patient Identification Sutter Medical Center, Sacramento A Sutter Health Affiliate Newborn Nursery Doctor’s Treatment/Order Sheet 00040 (11/17/08) White-NURSING/SCAN TO PHARMACY ORDERS ...
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This note was uploaded on 12/26/2009 for the course PHYS 341 taught by Professor Mavromatis during the Spring '09 term at American University of Beirut.

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