nicu standing orders kfafh
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King Fahad Armed
Forces Hospital
Neonatal Intensive CareUnit Standing Orders
NUR07.041
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Policy:Standing orders for
medication or investigations are
carried out by the NICU nurses
to expedite treatment and
enhance recovery.
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Procedures:
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Blood sample collection area
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Vaccines
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Hepatitis B vaccine
0.5ml intramuscularly
given prior to discharge, except for infants less than 1.7
kg
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Bacillus CalmetteGurin (BCG) Vaccines
0.05 ml intradermally
prior to discharge, except for infants less than 1.7 kg
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Respiratory Syncytial Virus (RSV) vaccine
15 mg/kg intramuscularly
All babies born at 32 weeks gestational age and below
All babies with Cardiac Conditions, Chronic lung
disease
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Eye Drops for Dilatation:
Given prior to eye
examination by
opthalmologist:
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Midriacyl 1%
- Apply one drop ineach eye for 3 doses
with 10 minutes
interval between each
dose. To be started
one hour before the
examination once the
opthalmologist called
to confirm his/her
arrival time in the unit.
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Phenylephrine Hydrochloride 2.5%
1 drop to each eye 10 minutes
for 2 doses to start 1 hour
before the examination once theopthalmologist to confirm
his/her arrival time.
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Both drops are used alternatley for
a total of 5 doses collectively
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Vitamin K:
1 mg intramuscularly for
all newborn babies (if not
given in labor ward or
operating room)
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Intralipids:
If the order is 20% and the pharmacy issue 10%, then
double the rate of infusion
If the order is 10% and the pharmacy issue 20% , then
half of the hourly rate of infusion.
Intralipid infusion is not included on the total fluid intake
per day. It is givan as extra.
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Metabolic Screening:
Blood test for
tandem metabolic
screen is done for all
babies 48-72 hoursof age and the baby
is on full feeds.
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Serum Potassium Level:
Serum potassium level to be repaeted venously if
cappillary level is 6.0 mmol and above. If repeated
venous level is still 6.0 mmol and above, then the
physician must repeat potassim level arterially.
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C02 for Electrolyte Result:
If the result from electrolyte is 18 mmol or less,
then blood gas must be done.
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Serum Bilirubin level:
If the baby is having
coombs positive, Rh, orABO incompatibility and
G6pd deficient, monitor
serum bilirubin level
after 12 hours of age.
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If serum bilirubin
level is whithin
photo therapyzone, start
phototherapy light
according to the
result.
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Babies with Diabetic mothers:
Gestational diabetic mothers taking insulin, their babies
must be admitted in NICU and monitor their blood glucose
levels.
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Do initial dextrostics.
Then hourly x3, (if dextrostics is 2 mmol/L 6.8 mmol/L)
Then every 3 hours x3 (if dextrostics is 2 mmol/L
6.8
mmol/L)
Then every 6 hours x3 (if dextrostics is 2 mmol/L6.8
mmol/L)
Every 12 hours
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All dextrostics should be done before feeds.
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Rule out Bacteremia:
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GBS positive mothers,
Spontanous Rupture of
Membranes > 18 hours, with
single dose or no maternal
antibiotics received
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Complete Blood Count , C-Reactive Protein daily for 3
days
SBR done 24 hours of age. If the baby is havingcoombs positive, Rh, or ABO incompatibility and G6pd
deficient, monitor serum bilirubin level after 12 hours of
age.
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If baby is meconium stained, no need
to extract blood for CRP.
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MRSA Screening
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Babies requiring MRSA screen:
(swab for nose, axilla, groin)
Every 2 weeks for all babies delivered in
KFAFH Operating room and labor ward.
All Babies transferred from outside hospital Babies delivered at home. (includes cord
swab)
All babies who stayed in Well Baby Nursery
for >12 hours then admitted to NICU.
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Test for clearance:
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Swabs of the nose,axilla, groin and othersites previouslypositive should betaken 3 days apart.Three negative seriesof screening tests arerequired before the
patient is consideredto be clear.
Babies should not bereceiving antibiotictherapy throughoutthe screeningprocess.
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Antibiotic BACTROBAN OINTMENT(mupirocin)
Ointment, 2% is given for 5 consecutive days, then a
swab from the previous positive site should be
taken.
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Thank You for Listening
E t th h l i