id int64 670 892 | text stringlengths 127 3.25k | label stringclasses 3
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|---|---|---|
670 | NPN addendum
4. Completed 21day course of amp/cefotax. Continues on day
[**6-22**] vanco course. Last BC [**12-14**] ntd.
Continue to monitor for s+s sepsis and administer antibx as
ordered.
5. Temp 97.4ax post CXR/cares this am--warming lights
applied, temp resolved and stable thereafter. Active
w/cares. Req 2 d... | Overall Positive Note |
671 | Nursing NICU Note
Pt required frequent bag and mask venitilation for
desaturations noted to high 70s-low 80s despite 100% FiO2,
combivent puffs and increase in HFOV settings.
Poor perfusion noted; delayed capillary refill and
extremities cool to touch despite stable temp. [** 13**] attempted
arterial sticks for arte... | Overall Negative Note |
672 | Nursing NICU Note
1. resp. O/Pt remains on [** **]- please see flowsheet for
settings. FiO2 62-85% this shift, with a need for increase
in FiO2 to 100% with cares. Brief sat drifts noted to around
84-86%. Please refer to CBG from this shift. A/No changes in
[** **] settings thus far this shift. Pt appears present at
... | Overall Neutral Note |
673 | Nursing progress note
#1 O: [**Known lastname 1140**] maintained on [**Known lastname **] ventilation as documented
without changes made for shift, lungs continue tight and
squeeky with slight increased aeration noted in upper bases
at [**2185**] evaluation, FiO2 63-84 for shift increasing to 100%
for cares, without ... | Overall Positive Note |
674 | NP NOTE
Procedure Note: [** 1876**] removal
Time out observed.
[** 1876**] shut off, suture removed and line pulled back to 1 cm , afte which it was discontinued with out any difficulty, No blood loss, Infant desaturated during procedure, and was hand bag ventilated to increase O2 saturations. Infant has been stress in... | Overall Neutral Note |
675 | NP NOTE
PE: samll critically ill preterm infant on radiant warmer, orally intubated on HFOV. Pale pink, warm, well perfused. Very intolerant to caregiving with desaturations during handling.
AFOF sutures approximated, eyes closed, oral ETT, clear secretion.
Chest with improved excursion with manual ventilation, continu... | Overall Neutral Note |
676 | 0700-[**2115**] ADDENDUM TO NPN
FEN: NPO, TF 130cc/kg/d based on a weight of 800gms per
order. IVFs PND10w, IL and Fentanyl drip infusing via PICC.
Electrolytes sent at 1300 today, see lab for results.
Dsticks 195, 218, 161, 75 in subsequent order (see flowsheet
for exact times that dsticks were obtained). Infant has... | Overall Neutral Note |
677 | Cont. of Nursing Progress Note
#4 cont.- P: Complete abx course, monitor for s/s of
infection closely.
#[**5-21**] O/A: Infant remains on servo warmer, nested with tent
in place with stable temps. Servo setting decreased by .1
for warm temps. Eyes are bilaterally fused. Receving
Fentanyl infusion to maintain comfo... | Overall Neutral Note |
678 | Nursing NICU Note
1. Resp. O/Pt remains on [** **] vent settings: MAP of 16,
Delta P 39. FiO2 primarily 80-90% this shift (RT and [** 13**]
aware), but FiO2 ranging from 60-90%. Desaturations noted as
low as 77% usually requiring adjustment in FiO2. See
flowsheet. See lab results for CBG obtained this shift (RT
and [... | Overall Neutral Note |
679 | Nursing progress note
#1 O: [**Known lastname 1140**] remains on [**Known lastname **] vent with settings as documented,
FiO2 for shift 87-100% with one episode of drifting to 79-80
requiring bagging to resolve for shift, lungs tight and
coarse thru/out with slightly diminished fields noted on
right at 1400 evaluatio... | Overall Positive Note |
680 | 0700-[**2115**] ADDENDUM TO NPN
PARENTING: Mom came in to visit at around 1p.m. today and
[**Year (4 digits) 370**] was in at about 3p.m. Prior to [**Year (4 digits) 370**] coming in, M.D. sat
down with Mom at bedside for a meeting to discuss the twins'
clinical status' and the plan of care for each. When [**Year (4 ... | Overall Negative Note |
681 | NPN Noc
#1 Resp: HFOV MAP 17 AMP 39, Fi02 65-78% o/n. LS tight and
coarse, [** 842**]'d sm cloudy secretions from ETT/mouth. Will
check blood gas this AM. P: Cont to monitor resp status.
#3 FEN: TF=130cc/kg/day, infant cont to be NPO. PND7.5, IL,
and Fent infusing via DL PICC. Primary port to PICC line
with blood bac... | Overall Neutral Note |
682 | NPN addendum
5. Infant nested on sheepskin and water pillow in isolette.
Temp stable 97.9-98.4ax. Req fentanyl prn dose prior to
cares w/fair effect. Active w/cares, settled well after.
Continues on fent drip (500mcg in 50ccD5W) at 5.5mcg/k/min.
Skin appears dry but in fair condition. Rpt HUS done today
given poor... | Overall Neutral Note |
683 | npn 7a-7p
1.) SEPSIS: ABX amp/gent dc'd today after day 7. began
oxcicllin for 3doses today. FOR CT changes. bc-, LP-.
continue to monitor for s/sx of infx.
2.) RESP: Infant remains intubated with settings of 16/5
rate 26. 5 of peep. no changes made today. 02 sats 86-100%.
ls very diminished-course. rr=20's-50's. i... | Overall Neutral Note |
684 | NPN 1900-0700
ID: Infant now day 7 of 7 with abx Amp and Gent. Meds
admin as ordered. Temps sl elevated on servo warmer.
Warmer therefore weaned. BC and LP negative.
RESP: Infant remains intubated on conv vent settings 16/5,
R26. Rate weaned x2 thus far this shift per CBG. Most
recent CBG 0200: 7.31/55/39/29/... | Overall Neutral Note |
685 | npn 7a-7p
1.) POT FOR SEPSIS: DAY [**4-26**] ON AMP/GENT. BC PENDING. CBC
WNL. LP-. CONTINUE TO MONITOR FOR SEPSIS.
2.) RESP: received on vent settings. of 16/5 rate22.
increased to rate of 30 at 2pm after capgas of 7.16, pco2
94, po2 22, c02 35 and base-0. fio2 28-48 %. increase with
cares. ls course amd diminished... | Overall Neutral Note |
686 | NPN
#1 Sepsis: infant remains on amp/gent, plan to repeat CBC
tonight with 24h labs d/t low WBC on initial labwork. stable
temps, active, alert. cont to closely monitor and complete
abx course as ordered.
#2 Resp: remains on NCPAP +6 FiO2, 28-34% with sats 89-97%.
BBS sl coarse/=. no desats or bradys so far this shi... | Overall Neutral Note |
687 | Cont. of Nursing Progress Note
#5- O/A: Mom up this am, updated at bedside by this RN.
Asking approriate questions. Dad up this pm with
grandparents, then mom and other visitors. Again updated at
bedside by this RN. Stated that they would be returning for
next set of cares. Very loving and invested parents who are
ap... | Overall Neutral Note |
688 | npn 7a-7p
1.) SEPSIS: Infant continues on amp/gent for 48hr R/O. BC
pending. continue to monitor for s/sx of infx.
2.) RESP: infant continues in nasal cpap prong 6. fio2
34-36% most of shift. lscl/= with ic/scr. no desats or
bradys thus far this shift. rr=50's-70's. 02 sats 87-96%.
bulb suctioned mouth with cares ... | Overall Neutral Note |
689 | [** 13**] Progress Note
Infant had very unstable night with intermittent re-ecumulation of right pneumothorax and left atelectasis. Required numerous boluses of NS, Sodium Bocarbonate, PRBC as well as hand bagging and ventilator manipulation. HR have ranged from 185-200 with sats 65-85%. Phenobarbital given to help R/O... | Overall Neutral Note |
690 | NPN continued:
Tibial arterial line NS + 1u hep/cc. DS 70, 52. Abdomen
round, firm, taut when palpated, appears mottled. No loops.
Girth stable. Bilious aspirates obtained throughout night-
Infant examined by [** 13**]. Please see flowsheet for details.
Air also aspirated via NGT. NGT left open to vent. BabyGram
obtai... | Overall Negative Note |
691 | Nursing Progress NOte Cont.
CV- Infant started on dopamine and then dobutamine for
unstable CV status, including frequent low HR's and blood
pressures. Doses manipulated multiple times with the goal
of maintaining MAPS >25. Infant completed 8cc of 2nd ordered
aliquot at approximately 1100. Infant pale to dusky as
p... | Overall Negative Note |
692 | NICU NPN 1900-0700
RESP O: Baby remains orally intubated on settings of HFOV
MAP17, DELTA P 36. FIO2 during the night has been 44-67%,
increased to 80-100% with cares. O2 sats 90-97%, with
occasional drifts to the 80's. Lungs are coarse, suctioned
x2 for scant to small amount of secretions from ETT and
mouth. Baby ha... | Overall Neutral Note |
693 | NPN 0700-1900
#1 RESP O:Infant remains orally intubated on [** **] 70-100%
02, desats easily with any stimulus, requiring Fentanyl
boluses and hand bagging with 100%02 during procedures. BBS
equal, tight,coarse and diminished. ABG done today, wnl. A:
Alt in RESP P: Cont to assess for increased resp distress,
monitor... | Overall Neutral Note |
694 | NPN
#1 #2
Infant remains on [** **] with present settings of Delta P=34;
MAP=15; FIO2~81-100% to maintain sats low/mid 90s. (most of
shift was spent in 100%-- at times able to wean down to 80%,
but usually not for long periods). Please see flow sheet
for all ABGs and changes made, but most recent at ~0200-
7.24/59/... | Overall Neutral Note |
695 | Nursing NICU Note
1. Resp. O/PT remains on [** **] settings of: Map-17, Delta
P-37. FiO2 primarily 68-81% this shift. Increase in FiO2
needed with cares, sometimes as high as 100%. Combivent
puffs given once this shift thus far. Please refer to
flowsheet. A/Requires [** **] support to maintain adequate
oxygenation. P... | Overall Neutral Note |
696 | NPN 0700-1500
Received infant on HIFI vent-MAp-9, Delta P-23, FIO2 59%. breath sounds very diminished left worse than right. ABg at 0800-7.3/33. Acute episode of pneumothroax at 0830 resulting in hypotension, bradycardia and desaturation. Hr 76-95- chest compressions done x 5minutes. Received Epi x 1. Chest need... | Overall Negative Note |
697 | NURSING DEATH NOTE
At parents' request, infant was removed from the ventilator at 1610. Infant had received Fentanyl qhr for comfort. Baby was held by both Mom and Dad. [**Name (NI) **] was pronounced dead at 1655. Parents were with their very supportive family at this time.
Post-mortem care was done by myself... | Overall Negative Note |
698 | NPN
1. RESP: Infant was received on HFOV vent settings: MAP 14,
delta P 34, FIO2 61%. Self extubation during cares,
reintubated, in gd position by CXR. Infant was agitated,
unabe to settle despite 3 fentanyl boluses, and increasing
in 02 to 100%, requiring bagging. Infant was given 1 dose of
Pavulon and fentanyl drip... | Overall Negative Note |
699 | NPN cont'd
7. Social: [** **] left as infant became more stablized.
A/P: Cont. to support and update, encourage mom to take
breaks from bedside.
8. [** **]: Remains on neo blue photox with eye shields. will
need to recheck [** 33**].
| Overall Neutral Note |
700 | NPN 7a-7p
#1: [**Known lastname 1140**] conts orally intubated on [**Known lastname **] vent. Settings: MAP
16 and delta P 39. FIO2 70-100% most of the day. BBS very
coarse and tight. This afternoon had sign. desat with apnea
and bradycardia, needing PPV to recover. Slow to recover.
Infant was started on Combivent ... | Overall Negative Note |
701 | NPN 7p-7a
#1: [**Known lastname 1140**] remains on [**Known lastname **] vent. Weaned settings x1 this shift
to current settings: MAP 16 and delta P 37. FIO2- mostly
70-78%, into the 90-100% range after PICC placement and
adjustments, several x-rays, retaping, and care. BBS
coarse/tight. CXR improved [**Name8 (MD... | Overall Neutral Note |
702 | NPN 7a-7p
#1: [**Known lastname 1140**] conts on [**Known lastname **] vent. Weaned this am to current
settings: MAP 16, and delta P 36. FIO2 50-77%. Infant sats
better when prone. BBS coarse/tight/=. CXR this am stable.
Sx'ed for sm amt secretions from ETT and mod-lg amts PO. A:
weaned vent settings P:Cont to... | Overall Neutral Note |
703 | NPN 0700-1900
#1 RESP O: Infant remains orally intubated on [** **], settings
as charted, 02 90-100% most of shift, unable to wean, infant
having frequent desats and needing 100%02 and handbagging
with procedures. 1800 ABG was good this evening, Delta P
decreased but MAP increased to 17 with improvement in
infant's o... | Overall Neutral Note |
704 | Nursing Note
1. O/A Recieved [** **] on HiFi settings of delta P17 Map of
9. Weaned from these vent settings to delta P15, MAP of 8
after good gas. Gas after wean at ~1430 of
7.28/52/50/25/-2. Pls see flowsheet for trends. Received
3rd dose of surf at 11am. BLS course/=, sats >90%. Sats
stable with all cares. No sp... | Overall Neutral Note |
705 | [** 96**] ON-Call
Both [** 26**] in to visit last evening. Father has returned from out of town. He reports having done a lot of internet research regarding Trisomy 18 and feels that [**Known lastname 536**] chest and heart anomalies should be treated surgically. I stated that consultations could be obtained from speci... | Overall Negative Note |
706 | NICU nursing note 7p-7a
1. Resp: Infant remains intubated on IMV settings 21/6 Rt
24. FiO2 21-26%. BSC/=, no retractions. No bradys. Occas
labile O2sats with drifts to high 70's. Sxn'd scant amount
via ETT. Appears comfortable. Cont to monitor.
2. CV: Loud murmur ausc. Brisk cap refills. + peripheral
pulses. ... | Overall Neutral Note |
707 | Nursing Progress Note
#1-O/A- Received infant vented at 21/6x24. Infant remains
vented at those settings. FIO2 21-27% so far this shift.
No resp distress. P- Cont to assess for Resp needs.
#2-O/A- Cont with audible murmur. Known large VSD. HR and
BP wnl. No current CV distress. P- Cont to assess for CV
n... | Overall Negative Note |
708 | Case Management Note
Discharge options are limited for this little infant with Trisomy 18, endotube, vent,NGT feeds, IV Mso4 and Versed. I have called [**Hospital 541**] Hospital for Children ([**Telephone/Fax (1) 542**]) and they are not able to manage an endotracheal tube and would not be able to consider admission... | Overall Negative Note |
709 | [** 96**] On-Call
Please see Dr.[**Name (NI) 407**] note for overall summary and plan.
Physical Exam
General: infant on open warmer, intubated on vent support, under phototherapy
Skin: warm and dry; scattered petechiae; pink
HEENT: orally intubated; anterior fontanel open, level; sutures opposed
Chest: breath sounds e... | Overall Neutral Note |
710 | NPN 0700-1900
1. SIMV 21/6 rate24, 21-26%FiO2. No vent changes made
today. rr30-50's, sats88-94%. LS clr/=, sm airleak
audible. Sxnd for mod-lg cldy from ETT. Of note, sm [**Doctor Last Name **]
of blood noted at one catheter passing, none seen
thereafter. Team aware. Continue to monitor resp status,
plan on g... | Overall Negative Note |
711 | Neonatology - [** 96**] Progress Note
Infant sleeping with exam. Blunted response to stimuli. AFOF. MCA noted. She is pale pink, well perfused, grade III/VI murmur auscultated. She remains on conventional vent, breath sounds clear and equal. Abd softly distended with large visible loops. Stable temp on open warmer. Pl... | Overall Neutral Note |
712 | NURSING PROGRESS NOTES.
#1 O: BABY REMAINS INTUBATED AND VENTILATED. VENT SETTINGS
INCREASED TO MAP 13, DELTA P 24, HZ 15. OXYGEN REQUIREMENT
IN 30 TO 40% RANGE THIS MORNING, BACK AT 60 TO 70% RANGE
THIS AFTERNOON. BREATH SOUNDS COARSE AND DECREASED. ETT
RETAPED TODAY. SUCTIONED FOR MODERATE SECRETIONS FROM ETT,... | Overall Neutral Note |
713 | NPN Days
#1 ID: Temp stable on servowarmer, infant MAE, alert and
active with cares. Day [**5-30**] of Amp and [**Last Name (LF) **], [**First Name3 (LF) 31**] forgo LP
at this time r/t patient instability. Bld cxs NTD. P: Cont
to monitor for sx of sepsis, cont [**First Name3 (LF) 622**] for 14 day course per
team.
#... | Overall Neutral Note |
714 | Family Meeting Note
Family meeting held with both parents, Dr. [**First Name (STitle) **], RNs Tierny and [**Doctor Last Name 3532**], RT [**Doctor Last Name 2791**], myself. Review of pre/perinatal events, current clincal status by systems including IVH. Respiratory and nutritional plans over the next 1-2 weeks and cl... | Overall Neutral Note |
715 | Admission Note
NICU Nursing Admission Note
Infant admitted to NICU after precipitous delivery in triage room of L&D. Please see Attending MD note for maternal history and infant's physical exam.
He was intubated in L&D and brought to NICU.
RESP: Infant intubated with settings of 24/5 X25. FiO2 40-60%. Survanta gi... | Overall Neutral Note |
716 | NPN 0700-1900
RESP: Rec'd [** **] on HFV- Delta P-21, MAP-10, FIO2 ~60%.
0745:[** 20**] had several desats and sats remained in 60-70's
despite 100% FIo2, also noted Hr dropping to 60-70's- all
qsr. Poor perfusion noted w/ BP MAP-16-20(on 20mcqs
Dopamine). Team called to bedside. ABg just prior to
event- 7.25/52/4... | Overall Negative Note |
717 | Nursing Progress Note 0700-1900
SEPSIS O/A: Infant continues on Abx of Ampi & Gent. Day 3 of
7. P: LP to be done this week. Cont to monitor on current
regime.
RESP O/A: Infant received on HFOV: MAP 10, AMP 23, weaned
MAP to 8 & AMP to 21 @ after good ABGs (see laboratory for
results). CXR done @ 0945. ETT re-taped @... | Overall Neutral Note |
718 | continued NPN
6. Parenting: Mom called at MN, briefly updated by this RN
and Dr. [**First Name (STitle) 202**]. Parents then came up to see baby due to his
fragile state. Parents were both updated by Dr. [**First Name (STitle) 202**],
discussed how sick baby was, need for parents to think about
re-direction of care w... | Overall Negative Note |
719 | NPN 1900-0700
SEPSIS: Infant continues on Amp & Gent. Blood culture
remains negative at this time. Will continue to monitor.
RESP: <Please see attending and RT's note for details>
Infant received on HiFi. Had a significant respiratory event
requiring hand bagging with several failed attempts to
return to HiFi. Conve... | Overall Neutral Note |
720 | NPN 1900-0700
1 Infant with Potential Sepsis
2 Alt. Respiratory
3 Alt. Cardiovascular
4 Alt. FEN d/t prematurity
5 Alt. growth and development
6 ALt. Parenting d/t NICU stay
#1: O: Infant continues on Amp and Gent for a rule out. BC
pending. P: Conitinue to give abx as ordered, monitor for
further s/s of sepsis.
#2:... | Overall Neutral Note |
721 | NPNOte
#1.On AMP+ gent given as ordered, gent pre level 1.2 cont
with gent,infant alert,active. A; asymptomatic P; cont
antibiotics as ordered.
#2. Remains orally [** **], on HFOV, currently at Delta
P=24, MAP10, Fio2 52-100%, labile with o2, BBS diminshed,
equal, checked for Pnuemo for having desat episode to 50's
... | Overall Neutral Note |
722 | Nursing Progress Note
#1. O: Infant remains on day [**10-30**] of treatment of presumed
sepsis with ampicillin/gentamicin/ceftazdime. Blood cultures
neg thus far. A: Sepsis. P: Continue to follow.
#2. O: Infant remains on HiFi vent, settings increased
tonight per ABG of 7.24/78. Currently on delta P 18, MAP 12.
FiO2... | Overall Neutral Note |
723 | NPN con't
G&D/Neuro: Temps stable nested on servo warmer. Skin intact
except for small area on left side of neck cracked and has
mod white/yell drng. Cleaned w/ sterile water and open to
air. Infant is lethargic and hypotonic especially in arms.
No reflexes. Has little spontaneous movements, although is
responding mo... | Overall Neutral Note |
724 | NURSING PROGRESS NOTES.
#1 O: BABY REMAINS INTUBATED AND VENTILATED. BABY WAS
INITIALLY ON CONVENTIONAL VENTILATOR, CHANGED TO HI FI AT
NOON. BABY INITIALLY ON MAP OF 11, GRADUALLY INCREASED TO
12 AND THEN WAS ABLE TO WEAN OXYGEN FROM ABOUT 70% TO 35%TO
40%. BREATH SOUNDS COARSE, MILD RETRACTIONS. BICARB GIVEN
ON... | Overall Neutral Note |
725 | NPN 0700-1900
#1 RESP O: Infant remains on HIFI Ventilation, 02
requirement 30% most of day. Weaned on vent today,please see
flowsheet for details. ABG's with good results. No spont
resp effort today, BBS equal with poor aeration. No spont
desats or bradys today. A: Alt in RESP P: cont to assess
closely for changes i... | Overall Neutral Note |
726 | NPN 7p-7a
Resp: Infant remains intubated settings unchanged today.
17/5x18. Fi02 23-27%. Abg this am 7.29/49/65/25/-3. On above
settings. RR 40's. Ls coarse to clr with sxn. Sxn x1 by RT>
Ic/Sc retractions. Cont to wean as [** **].
CV: Infant is mottled slightly jaundice. Conts with soft
murmur. Recieved last dose o... | Overall Neutral Note |
727 | NPN Days 7am-7pm
#1 O: [** 20**] remains orally intubated on vent settings of
32/6 BR 40 and remains in 100% FIO2. Breath sounds are
coarse. Very occasionally with have a few of his own
bresthes but chest movement is usually "in sync" with the
vent. Sxn orally for small amts tan/old blood secretions. A:
no chnages m... | Overall Neutral Note |
728 | NPN Days continued
#5 continued.... Fentanyl given q 3-4 hours for presumed
discomfort r/t edema and immobility. Eyes remain fused.
[** 20**]'s posotioned side>back while on warmer, is on
sheepskin. A: 25+ week [** **] with edema, history of
concerning head u/s. P: Continue to moniter, continue to
give PRN fentanyl... | Overall Negative Note |
729 | NICU NPN 1900-0700
POT FOR SEPSIS O: Baby remains on ampi, [** **], and
ceftazadime, day [**9-29**]. BC neg to date.
RESP O: Baby remains on HFOV MAP12,AMP 16. Art gas at 2200
7.46/48/38/35/+8. NNP aware. No changes made. Fio2 has been
68-100% during the night. O2 sats 87-99%, with drfits to the
80's, and she desats... | Overall Neutral Note |
730 | NICU NPN ADDENDUM
Baby was noted to have some intermittent jerking motions of upper and lower extremities, and what appeared to be some lip-smacking also, around 0430am correlating with desats. NNp aware and examined baby. [**Name (NI) **] continue to monitor. Per lab, coag results on careview have to be re-run. Result... | Overall Neutral Note |
731 | npn 7p-7a
1 alt resp
2 alt cv
3 alt FEN
4 alt sepsis
5 alt dev
6 alt parenting
7 alt bili/skin
admission note and care plan 7p-7a
#1 Infant recieved from L+D intubated with 2.5 ETT. Placed
on convent vent and given first dose of Survanta with good
FiO2 wean effect. CXR done and ETT high, no tension to be
put on t... | Overall Neutral Note |
732 | NPN/0700-1900
#1 RESP: Infant remains orally intubated on settings 17/5
r18. FiO2 21-30%. No spells. LS sl. coarse to clear;
diminished on R side x1. Sxn ETT for small amts clear to
old blood tinged secretions. No spontaneous resp. effort
noted.
#2 CV: No audible murmur heard on exam. Repeat ECHO done
this afte... | Overall Neutral Note |
733 | NICU NPN 1900-0700
POT FOR SEPSIS O: Baby remains on ampi, [** **], and cef, day
[**8-30**].
RESP O: Baby remains critically ill, orally [**Month/Year (2) **] on
HFOV settings at MAP12, AMP 16. Fio2 has been 80-100% during
the night. Amp increased from 14-16. Last abg at 0230 was
7.32/57/61/31/0. She has ic/sc retra... | Overall Neutral Note |
734 | NPN 0700-1900 cont'd
BILI: Under double phototherapy w/ a bili at 1400 of
3.0/0.3/2.7.
DEV: HUS- significantly more bleeding, increased bradys, Bp
instability.? seizure activity. Labile w/ any intervention.
Fentanyl given x 2 ( less agitation noted off HFV).
Eyes remain fused.
Temp=97.8 ,nested on open warmer.
A... | Overall Negative Note |
735 | Neonatal NP-Note
Parents at bedside. Mother currently holding. Myself and bedside RN [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **] with parents current plan of care to include: comfort measures only, no blood work, no blood products. I also discussed the possibility ... | Overall Negative Note |
736 | NICU NPN 1900-0700
POT FOR SEPSIS O: Baby remains on ampi, [** **], and cefotaxime
now day [**7-30**] of antibiotics.
RESP O: Baby remains critically ill, orally [**Month/Year (2) **] on
HFOV current vent settings of MAP11, AMP 14. Both were
weaned during the night. Fio2 has been mainly 43-70%, but
has increased ove... | Overall Neutral Note |
737 | NICU NPN 1900-0700
PARENTING: Mom and dad arrived to the NICU at 0630 this am, and spoke with NNP at the bedside. They are aware that it has been a difficult night for [**Known lastname 3527**], and that she is maxamized on her BP meds.
| Overall Neutral Note |
738 | NPN con't
will be ready on [** 461**]. Parents anxious to get CT scan
results. A: Involved and concerned family P; cont to inform
and support family as needed. Plan for family meeting
tommorow.
#7 BILI O: Infant remains under double phototherapy with eye
shields on . Bili today 5.0. P; cont with present managment.
CH... | Overall Neutral Note |
739 | Neonatology NNP note
PE:
NEURO: Infant nested in open crib, on pavulon and fentanyl, AFOS, sutures sl [**Month (only) 120**].
RESP: infant remain orally [**Month (only) **] on HFOV, breath sounds = sl coarse with hand bagging.
CARDIAC: color pink/jaundice sl mottled on exam, mild generalized edema on exam, no audibl... | Overall Neutral Note |
740 | 1. Resp: O: Infant continues on the vent at settings of 21/6
X 24. FiO2 has been 21-27%-- FiO2 more than RA when infant
is moving around. Ls are clear. RR 20-40s. She was sxned X 1
so far for a small amt of cloudy secretions. She is on no
resp meds. A: Stable on the vent. P: Monitor. Continue as
per plan.
2 & 4: O: I... | Overall Neutral Note |
741 | NPN 1900-0700
1. RESP: Infant received on CPAP 5 with FiO2 >50%. CBG
was 7.17/80 and infant was intubated with 3.0ETT at [**2163**] and
given survanta X2. Initial vent settings were 18/5 X30.
CBG's done throughout this shift (see flowsheet for details)
and vent settings increased to 22/6 X33. CBG on these
settin... | Overall Neutral Note |
742 | Neonatology - NNP Progress Note
Infant is active with good tone. AFOF. She is pale pink, well perfused, soft murmur audible. She remains vented on moderate settings, breath sounds clear and equal. She remains NPO. IV fluids infusing via intact PIV. Abd soft, active bowel sounds. Congenital anomalies of absent sternum,... | Overall Neutral Note |
743 | Nursing Progress Note
Remains on SIMV, no vent changes this shift. FiO2 28-35%.
Breath sounds squeaky this am, noted diminished breath
sounds on left at 1630. Transillumination neg.Sx'ed x1 mod
blood tinged secretions.
#3 TF decreaased to 150cc/kg/day. DS 108x1. voided
10cc/kg/hr.
#4 Baby appeared comfortable and p... | Overall Neutral Note |
744 | Nursing NICU Note.
2. Resp. O/Received pt on [**Last Name (LF) **], [**First Name3 (LF) 1045**] P of 12, MAP. FiO2
primarily 47% today. Occasionally requiring increase in FiO2
noted as high as 67%. Please refer to flowsheet. Pt switched
to conventional vent, SIMV settings of 21/5, rate 26, 100%
FiO2 initially (when h... | Overall Neutral Note |
745 | Nursing Progress Note
#2 Remains on HIFI vent, weaned to 14 on Amplitude. Sx'ed x1
sm cloudy secretions.
#3 TF at 170cc/kg. PN and lipids infusing thru UVC. Ds 87.
voided 3.3cc/kg/hr.
#4 Quiet most ofday. Became somewhat agitated when placed on
back. Appears mor comfortable on abd. Temp stable when probe
positioned... | Overall Neutral Note |
746 | NPN 0700-1900 cont'd
5. [** **]: Mom and Dad and MGM in to visit from 1100-1300.
Updated at bedside on infant's condition and plan of care by
this RN and attending [**Doctor Last Name 46**]. Asking appropriate questions.
Appropriately concerned about HUS results tomorrow. Mom
very quiet and distant today. Dad [**N... | Overall Neutral Note |
747 | NPN 0700-1900
Received infant orally intubated on HFOV settings of [** 1195**] p 13, map 8. FiO2 requirement this shift has been between 21-30%. No murmur appreciated. B/P stable, arterial maps between 35-45. Infant was pink/well perfused (s/p transfusion). DUVC and UAC in place and running fluids. D/S 53. Infan... | Overall Neutral Note |
748 | NPN 0700-1900
1. Hyperbili: Infant remains under double photo with eye
shields in place. Bili drawn - results pending. P: Cont.
to monitor bili level and draw next level in am.
2. Parents: Mom and Dad in throughout day. Udpated at
bedside on infant's condition and plan of care by this RN,
[** 96**], and attending... | Overall Neutral Note |
749 | NPN
ADDENDUM: P= keep strict I&O, monitor lytes closely, keep Ca
Gluconate at bedside, follow DS's, cont per plan
NPN#5 O= remains on warmer on servo under plastic tent..T
97.5 x1 with loose probe..reapplied..temp stable since, ^
fiesty/ active, MAE, tone appropriate for GA, nested in
shhepskin with boundaries in pl... | Overall Neutral Note |
750 | NPN addendum
Parents: Mom and Dad and extended family have been up to visit throughout day. Dad and mom [**Name (NI) 203**] at bedside. Parents have been updated on infant's condition and plan of care by this RN and NNP. Asking appropriate questions. Parents were given sibling #2's memory box. A: Loving, invested... | Overall Negative Note |
751 | 1900-0415 NPN
RESPIRATORY: RECEIVED BABY ON 32/6 X35. FIO2 50-100%. BS COURSE. RESP RATE 30-50 WIHT IC/SC RETRACTIONS. MULTIPLE GASES OVERNIGHT WITH CONTINUED ACIDOSIS DESPITE VENT CHANGES AND BICARB GIVEN.~3AM BABY BEGAN TO DESAT--FIO2 INCREASED TO 100% WITH MANUAL BREATHS GIVEN AND THEN PPV STARTED. NNP/MD CALLED T... | Overall Negative Note |
752 | 1 RESP
2 CV
3 FEN
4 SEPSIS
5 G&D
6 FAMILY
Nursing Admit note:
See attending note for maternal and delivery room history.
Infant arrived to NICU at approx 11:15am - for prematurity
32 weeks and hydrops with ? viral etiology.
RESP: Intubated and surfactant given x2 today. Currently on
settings of 32/6 rate of 35. FIO2... | Overall Neutral Note |
753 | Nursing Progress Note:
2 Alteration in Perfusion
4 Birth Malformations
9 Alt in cardiovascular status
#1 Resp: O: Infant remains on prong CPAP of 4, 28-33% FiO2.
O2 sats stable. Lung sounds cl/=. Moderate IC/SC retractions
noted. Infant suctioned q 3hrs for mod. amount cloudy oral
secretions. Occasional drifting note... | Overall Neutral Note |
754 | Nursing Note 7a-7p
Baby girl [**Known lastname 524**] was rec'd this morning on a HiFlo NC, 4L at 100%. During change of shift she had her first episode of apnea and bradycardia (HR 56/59%) requiring BBO2 for an extended period of time, attending, [**Known lastname 96**], RRT and this RN in to evaluate. Infant weaned b... | Overall Negative Note |
755 | NPN 7p-7a
Nursing addendum -
DEV: Infant recieved swaddled on off warmer. Temp @ 2100 - 100.3ax; unswaddled and blanket loosely placed. Last temp taken as of this writing - 98.9ax. Infant appeared agitated after ETT taken out; received one dose of midazolam with very good effect. Currently, infant is very calm an... | Overall Neutral Note |
756 | Nursing Progress Note
#1-O/A- Received infant on prong CPAP 6cm. Infant
decreased to CPAP of 5cm. FIO2 23-30% so far this shift.
No A's or B's so far this shift. P- Cont to assess for
Resp needs.
#2-O/A- Cont with loud murmur. Lg VSD. HR and BP wnl. No
CV distress. P- Cont to assess for CV/perfusion needs.... | Overall Neutral Note |
757 | 0700-[**2040**] NPN
RESP: Current vent settings 26/7 r48 (received on vent
settings of 20/6 r30). Vent changes made based on blood gas
values, see lab. Sodium Bicarbonate given x2, tx metabolic
acidosis evidenced by blood gas values. Most recent blood
gas at 1530 7.15(pH)/70(pC02)/63(p02)/26(tC02)/-5(BXS). PIP
increa... | Overall Neutral Note |
758 | 0700-[**2040**] ADDENDUM TO NPN
....CONTINUED FROM ABOVE...
PARENTING: ...Dad expressed that he and Mom remain shocked
about the unexpected, early arrival of their twins and they
are very worried about this [**Year (4 digits) **]. Both parents expressed
understanding of what was explained to them in the meeting.
Dad... | Overall Neutral Note |
759 | NPN 7a-1330
Received [**Doctor Last Name 846**] this am being hand bagged s/p right chest needle and chest tube placement for pneumothorax and decompinsating resp status. Several CXR's done and chest tube placement adjusted by [**First Name9 (NamePattern2) 96**] [**Last Name (un) 322**] as needed. Chest tube was connce... | Overall Negative Note |
760 | Neonatology - [** 96**] Progress Note
Infant sleepy with exam. Responds to tactile stimulation with movement of extremities. She is pale pink, well perfused, loud murmur audible. She is comfortable on prong CPAP, breath sounds somewhat diminished to bases. Abd soft, active bowel sounds. Monilial rash in diaper area. m... | Overall Neutral Note |
761 | NICU TRANSFER NOTE
Baby Girl [**Known lastname 644**] [**Known lastname 641**] ready for transfer to TCH for PDA ligation. Transfer Consent signed. [**Known lastname 8**] at bedside. ID bands on.
Resp. Orally intubated with 2.5ETT. 20/5 x35. FIO2 21-25%. LS clear and equal. RR 40-50's. IC/SubC retractions. No bradys.... | Overall Neutral Note |
762 | NPN 7a-7p
Resp: HFOV MAP 13, DP 21, Hertz 15. ABG at 1130 was
7.38/46/48/28/0. No vent changes made. FiO2 24-38%. LS very
course, IC/SC retractions, No CXR done. No bradies. Stable
on current vent settings, con't to monitor closely.
CV: No murmor heard. HR 150s. Pink, well perfused. Keeping
MAPs 28-35. Required 16-... | Overall Neutral Note |
763 | 1900-0700 NPN
#3CV
O:HR 130-160. COLOR PINK. SKIN WARM AND DRY/PEELING.
DOPAMINE 60MG/50CC INFUSING AT 9-11MCG/KG THIS SHIFT TO KEEP
MBP 28-32. SECOND ALLOQUOT PRBC'S GIVEN THIS SHIFT WITHOUT
INCIDENT. NO MURMUR. GOOD PULSES AND BRISK CAP REFILL..
FINAL DOSE HYDROCORTISONE GIVEN
A:STABLE
P:CONTINUE DOPA TO KEEP MBP 2... | Overall Neutral Note |
764 | NPN: continued
9 Parent
8. Skin (Cont) Use of sheepskin and gel pad under head.
Plan: Continue with pressure reduction and auquaphore as
ordered. Monitor potential areas for breakdown closely.
9. Parents: Mother called early in shift and both parents
down to see baby. [**Name (NI) 7**] touched baby, asked [**Name2 (... | Overall Neutral Note |
765 | Nursing Admission Note
Pt was admitted from L&D at 1645. Please see Attending
MD/NNP note for history and physical. See flowsheet for
additional details.
1. RESP: O: Pt was intubated in the OR and brought back
and placed on hifi vent. Survanta given at 1700. Lung
sounds were very coarse. IC/SC retractions. ... | Overall Neutral Note |
766 | NPN 0700-1900 Correction from [**2195**]
[**Name6 (MD) 25**] above MD note, flowsheet, and labs for further
information.
1. O: Received pt orally intubated on vent [**Name6 (MD) **] 23/5
X30. Currently 28/6 X40 FiO2 increased from 40-100% by 1100.
No resp effort from pt. Ls crs. [**Name6 (MD) 187**]'d for lg yellow... | Overall Neutral Note |
767 | NPN DAYS
Alt Resp Status: Remains on vent [** **]: 18/5 rate 18 with
FiO2 25-31%. LS coarse to clear after sx. Sx q2-4hrs for
large amounts white [** 656**]. RR 30's-40's. Baby with mild
IC/SC retractions. No episodes of bradycardia so far today,
does have occasional drifts to the 80's%. Remains on
caffeine. Will che... | Overall Neutral Note |
768 | NICU NSG NOTE
#1. Resp. O/ Conts on Conventional Vent. Rate weaned x2
today for adequete gases as documented on flow sheet.
Current [** **] 16/5 x19. FIO2 21-25%. Last gas on theses
[** **] at 1600 7.31/42/22/-4. RR 30-50's. LS clear. Sx'd
x2 for mod secretions. A/ Weaning vent support. P/ Cont to
monitor resp status... | Overall Neutral Note |
769 | Nursing Progress Note
#1 RESP
Remains intubated on SIMV rate and pressures increased due
to hypercarbia (PCO2 up to 101 with PH 7.05) and resp
acidosis. At present on Rate of 30 with Pressures 20/5.
FIO2 25 up to 50% with cares.Breathing over vent 30-60's.
Slightly coarse BS with good air entry. Suctioned large amt... | Overall Neutral Note |
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