Neonatal Unit
Student Welcome Pack
Name…………………………………………..
Mentor…………………………………………
Associate
mentor………………………………………….
Date……………………………………………
TJ 02/13
1
Introduction to the booklet
Welcome to the neonatal unit. We hope that you find this
programme useful and informative.
A team of mentors have been allocated to you during your time on
the neonatal unit; you will be allocated a mentor and will also have
the opportunity to work alongside other members of the team. If
you have any queries during your time on the unit you also have
the opportunity to speak with the education team:
Tracey Jones Practice Development Sister
Kelly Harvey Clinical Facilitator/ Sister
This pack has been designed to enable you to become familiar
with the structure of the neonatal unit and also to offer
opportunities for learning. The educational pages enclosed are for
additional formative learning and should be utilised alongside your
summative assessments.
TJ 02/13
2
About the unit
The neonatal unit is part of the women and children division within
the district general hospital of South Manchester. The unit consists
of two intensive care cots, two high dependency cots and fifteen
special care cots. There are three nurseries through which the
babies usually progress prior to discharge. The babies admitted to
this unit might come from delivery suite or other trusts within the
greater Manchester area.
Staff orientation:
Consultants:
Dr Faisal Al-Zidgali
Dr Ahmed Elazabi
Dr Gopi Vemuri
Karen Mainwaring
Neonatal Manager
Margaret O’Brien
Neonatal Sister responsible for off duty
Tracey Jones
Practice Development Sister
Kelly Harvey
Neonatal Sister
Advanced Nurse Practitioners:
Angela Smith
Debbie Bean
Lesley Downton
Bernie Green
Dorothy Ridgeway
TJ 02/13
3
General Information
Shifts times:
Early – 0700-1500hrs
Late – 1230-2030hrs
Night – 2015-0715hrs
Long shift 0700 – 2030hrs
Ward Telephone Numbers:
0161 291 2932
Please contact the ward as soon as possible if you are not fit for
duty. It is your responsibility to inform your university tutor and to
inform the unit of your expected return date.
Student Resources:
There are a number of relevant books available as a resource on
the neonatal unit. There is an education seminar room where
teaching will take place on a weekly basis.
You will be asked to complete a student evaluation form prior to
completing your placement; this is a valuable resource and will
assist in improving the student experience on the neonatal unit.
The wearing of jewellery is prohibited on the NNU, and students
are requested to leave valuable items at home. Some lockers are
available in the staff changing room but cannot be guaranteed.
Therefore it is in your interest to bring as little money as is
necessary, as there is little facility for its safekeeping.
TJ 02/13
4
Whilst you are a student on the neonatal unit you will be eligible for
a swipe card which may be obtained through hospital security. A
form must be completed and signed by the manager. Students are
also eligible for a car park pass at a cost again available through
hospital security.
Opportunity for spoke placements are listed below, please discuss
your choices with Tracey or Kelly:
Child protection: Kath Cooper c/o Tracey.jones@uhsm.nhs.uk
Bereavement: contact Chris Navin : Chris.navin@uhsm.nhs.uk
Infant Feeding: Tara.kennedy@uhsm.nhs.uk
Delivery suite (child health students only) c/o
Tracey.jones@uhsm.nhs.uk
Neonatal parent group: Susan.stockton@uhsm.nhs.uk
Pharmacist: Hazel.shoesmith@uhsm.nhs.uk
Infant hearing screening: c/o Tracey.Jones@uhsm.nhs.uk
TJ 02/13
5
Day one check list
Fire policy of the unit
Alarm points
Type of extinguishers
and hose points
Standard drill for
standby alert
Emergency drill for
evacuation
Locker room facilities
for uniform
Rest room facilities
Tour of unit and
directorate
Location of policies,
protocols and unit
guidelines
Kitchen (health and
safety regulations)
Procedure for reporting
sickness and absence
Location of equipment
Visiting regulations
specific to unit
Hand washing
TJ 02/13
6
Normal Vital Signs in Infants
Below is a list of common vital signs measured on the NNU and the normal
parameters expected:
1. Pulse/apex beat.
120-160 beats per minute.
2. Respiration’s.
40-60 respirations per minute.
3. Temperature.
36.6 – 37c. Axilla temperature.
4. Oxygen saturation
In air 95-100% and in oxygen,
gestation >35/40
95-100%
32-35/40 90-95%. <32/40 87-92%.
5. Perfusion.
2 – 3 seconds capillary refill.
6. Mean BP
This is equivalent to gestational age
in weeks
7. Colour.
Skin colour will alter according to
infant’s condition,
pale/pink/red/plethoric/cyanosed.
Student:
TJ 02/13
Mentor:
7
Suggested Areas To Be Explored
1. Baseline observations, temperature control.
2. Nutritional requirements, breast feeding. Blood sugar monitoring and
management.
3. Oxygen therapy and resuscitation.
4. Fluid and electrolytes.
5. Drug therapy and calculations.
6. Psychosocial aspects of neonatal care.
7. Jaundice.
8. Use of equipment.
9. Skin care and prematurity.
10. Developmental care.
Notes:
Student:
TJ 02/13
Mentor:
8
Baseline Observations and Temperature Control
Define bradycardia and tachycardia.
Discuss upper and lower limits of heart rate in relation to gestation.
Attach a baby correctly to a cardiac monitor, apnoea alarm and
saturation monitor.
Understand rationale for alarm limits.
Recognise tachypnoea, apnoea, shallow breathing.
Observe and document temperature.
Discuss heat loss and production in the term and preterm infant.
Modify the environment appropriately to maintain temperature within
normal limits.
Understand how to minimise thermal stress.
Discuss humidity and familiarise with unit policy.
Notes:
TJ 02/13
9
Nutritional Requirements and Breast Feeding
Correctly calculate daily fluid appropriate to age and weight.
Demonstrate ability to document feeds and weight.
Discuss the different feeding methods available.
Demonstrate ability to cup feed and understand the necessity.
Gain an understanding of the importance of breast milk in relation to all
babies, especially premature infants.
Develop an understanding of the principle behind the baby friendly
initiative.
Explore the literature in relation to the importance of donated milk.
Observe and demonstrate the procedure of passing a nasogastric tube.
Care for an infant requiring intravenous fluids. Set up IV fluids.
Discuss the introduction of milk feeds in relation to;
Abdominal distension
Abnormal stools
Respiratory compromise
Absent bowel sounds
See saw regime
Develop an understanding of the need for low birth
weight formula.
TJ 02/13
10
Notes:
TJ 02/13
11
Blood Glucose Monitoring

Identify the reasons for hypoglycaemia/hyperglycaemia

Recognise symptoms associated with the conditions.

Define the upper and lower limits of normal

Demonstrate method of measuring blood sugar.

Discuss appropriate treatment for hypoglycaemia/hyperglycaemia

Recognise infants at risk of hypoglycaemia

Discuss temperature control in relation to hypoglycaemia.

Examine the Hypoglycaemia Policy
Notes
TJ 02/13
12
Oxygen Therapy and Resuscitation
1. Understand the rationale for oxygen therapy.
2. Show an understanding of the importance of monitoring and maintaining
the prescribed oxygen therapy.
3. Care for a baby receiving oxygen via ambient and nasal prongs.
4. Recognise the need for humidification.
5. Understand the causes of respiratory failure in the neonate.
6. Become familiar with all equipment used in a resuscitation scenario,
neopuff, funnel oxgen, suction equipment etc.
7. Recognise and respond appropriately to cyanosis/desaturation,
bradycardia and apnoea.
Notes:
TJ 02/13
13
Fluid and Electrolytes
1. Understand the need for intravenous fluids.
2. Select appropriate fluid according to condition and blood results.
3. Gain a basic understanding of normal levels (see sheet at back of
booklet).
4. Observe/assist with cannulation.
5. Develop an understanding of total parental nutrition (TPN).
6. Observe Neonatal Practitioners obtaining blood samples by various
routes.
7. Become familiar with all IV pumps and Syringe Drivers
8. Understand rationale for restricting fluids.
9. Plan care for an infant receiving (nil by mouth) IV fluids.
Notes:
TJ 02/13
14
Drug Therapy and Calculations
Be aware of various routes used for administration of drugs.
Understand rationale for the choice of route.
Demonstrate ability to calculate drugs and check prescribed amounts.
Understand rationale for vitamins and supplements.
Demonstrate knowledge of the hospital drug policy, and relate it to the
NNU.
Discuss drugs in general use on the NNU
Antibiotics
Respiratory stimulants
Diuretics
Surfactant
Drugs for resuscitation
Demonstrate knowledge and competence to administer drugs.
Become familiar with storage and ordering of drugs.
Notes:
TJ 02/13
15
Psychosocial Aspects of Neonatal Care
Discuss and identify the appropriate support available for families whilst
on the NNU and following discharge.
Gain an understanding of the impact of the neonatal unit on the parentinfant interaction.
Explore the evidence on abnormal interaction and behaviour.
Become familiar with kangaroo care and its advantages.
Develop an understanding of the parent support group.
Develop an awareness of available support facilities for families.
Discuss the grieving process.
Notes:
TJ 02/13
16
Jaundice
Understand the mechanism of physiological jaundice.
Discuss the treatment of jaundice and associated complications.
Become familiar with documentation related to SBR levels.
Become familiar with phototherapy lamps and the billiblanket/billisoft.
Consider the need for additional fluids and eye protection in relation to
phototherapy.
Consider the type of delivery and history in relation to jaundice.
Discuss breastfeeding and jaundice.
Notes:
TJ 02/13
17
Equipment
Become familiar with equipment in use on the NNU.
Safely use incubators in relation to temperature and humidity.
Gain an understanding of the importance of cleaning equipment in
between use.
Be aware of health and safety on the NNU.
Observe the blood gas machine.
Observe a space in the ITU nursery prepared for an admission.
Notes:
TJ 02/13
18
Skin Care and Prematurity
1. Develop an understanding of the immaturity of the skin of a premature
baby and a baby born at term.
2. Understand the reasons for protecting premature skin.
3. Highlight ways in which this can be achieved.
4. Recognise the individual hygiene needs of infants during high dependency
and special care nursing.
5. Develop an understanding of the need for humidity.
6. Become aware of the unit policy for skin care and wound care.
7. Become familiar with strapping techniques used for IV access and the
damage caused by poor strapping.
Notes:
TJ 02/13
19
Developmental Care
Gain an understanding of the importance of positive handling.
Explore the area of positive touch and massage.
Discuss kangaroo care and it’s relation to developmental care.
Become familiar with the developmental care group.
Observe the babies positioning and the use of boundaries.
Examine the literature on noise levels and lighting.
Notes:
TJ 02/13
20
Normal blood levels
Calcium (Ca)
1.9 –2.95mmol/L
Creatinine
28 – 62mmol/L
Glucose
2.0 – 6.0mmol/L
Magnesium (Mg)
0.7 – 1.1mmol/L
Sodium (Na)
130 – 145mmol/L
Phosphate (PO4)
1.30 2.75 mmol/L
Potassium (K)
3.5 – 6.5 mmol/L
Urea
2.5 – 6.5 mmol/L
Alkaline phosphate
70 – 260 IU/L
Albumin
35 – 50 g/L
Haemoglobin
12 – 14g/dl
WCC
5-15X10 /L
CRP
<5
TJ 02/13
21
Normal Blood Gases
PH
7.35 – 7.45
PaO2
6-10 kpa
PaCO2
4.5 – 6.5 KPA
Bicarbonate
18 – 25 umol/L
Notes:
TJ 02/13
22
Conclusion
The objectives within this workbook are formative. They are to assist you and
your mentors obtain a positive experience from your placement within the
NNU.
The reference list at the end may be of use if you wish to further explore some
of the subjects covered.
We hope you enjoy your time on the NNU, if you encounter any problems
please see the education team or any member of the team.
READING LIST
Boxwell G (2000) Neonatal Intensive Care Nursing Routledge Press. London
Brown, S. et al (2000) Accurate measurement of body temperature in the
neonate: A comparative study. Journal of Neonatal Nursing. 6(5): 165-168.
Hamilton et al (2008) Developmental Care: the carer’s perspective. Infant 4
(6); 190-195.
Pinelli. J. (2000) Effects of family coping and resources on family adjustment
and parental stress in the acute phase of the NICU experience. Journal of
Neonatal Nursing. 19(6): 27-37.
Sweet et al 2007 European consensus guidelines on the management of
neonatal respiratory distress syndrome. Journal of Perinatal Medicine 35;
175-186.
TJ 02/13
23