Wednesday, June 27, 2012

Evalyn and Eunice

I only had two patients all night. But Eunice needed care on the hour and Evalyn on the half. Both are one month old and each weigh barley 1 pound. They need to be fed hourly via tube, vitals, meds, IV for Evalyn and PO for Eunice. Eunice weighs 1700 grams and technically hasn’t hit her actual birthday yet as she is 4 weeks old but I think she was at least 6 weeks premature so she should still be in the womb. When I came on board with her care two days ago her abdomen was horribly distended so she was changed over to only IV, no tube feedings (she doesn’t have the energy to take formula from a bottle).  Tonight’s shift she doesn’t have IV access anymore and consequently is really dehydrated. But her belly is soft. So we’ve been trying 10 mls of milk every two hours and 10 ml of ORS on the other hour. She seems to be tolerating as long as we go slowly but she still looks really dehydrated. Also she cries every time I put anything in her stomach.  But she isn’t vomiting and her belly is still soft.   
Eunice's initial assessment
In the incubator
Then there is Evalyn. She weighs 1500 grams but is losing weight. She is on 5 ml of formula by tube hourly but has diarrhea several times an hour. So she is getting 15ml/kg/hr of LR. That is one drop every 15 seconds. I’m not sure I’ve ever watched a drip rate that closely before. (No pump or burette for my nurse friends). She doesn’t maintain her own temp and only have one incubator so we use hot water bottles under her blankets but that means we need to take her temp often to make sure she isn’t too warm or that the bottles are getting too cold. And every time we try to change her diaper (which is often) her body temp drops and we have to wrap her back up.
Mdnight meds
Both have to stay under mosquito nets as the bugs are really bad and even the thought of malaria could kill them.  And both are on abx though I don’t understand the rational for the specific meds they are on. I hate giving but I still have to follow their orders. 
So that was my night. Lots of diarrhea, tiny IV checks, NG flushes, hourly vitals and I’m happy to report that they are both still alive and kicking.

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