Nancy was Henry's nurse today. My dad visited Henry in the morning. He said that he was doing great. His sats went down at one point. Nancy suctioned out his nose, and they rebounded to the high 90s. The cannula tends to dry out the nose, so it is easy for the passageways to get blocked (hence the oxygen can't get through as well and the sats go down).
When I came in the afternoon, Henry was sleeping soundly. Nancy asked me if I wanted to hold him but I decided to hold off, since he was looking so peaceful. Today is a Lasix day. Nancy had changed his diaper about 2 hours after his Lasix dose, and he had a 38 gram diaper. She detected the precursors of diaper rash, so she put in an order for Desitin. Desitin is sold over the counter, but in the hospital, it is treated as a medicine, so the nurses have to get prescriptions for it. It took a long time for Henry to stir. When he finally did, Nancy and I did his cares. While we were changing his diaper, she turned him on his side so I could get a good look at his backside. He still doesn't have fat on him. Got a good look at his skeletal structure, especially the pelvic bones and spine. He's one skinny baby.
Once we dealt with the diaper, which I think was 13 grams, Nancy aspirated his stomach. He had about an hour's worth of milk left in his stomach, which was partially digested. The color looked good. He also had almost a full tube (approximately 9 mls) of air, which Nancy got out. When they aspirate his stomach, they connect a tube that looks like your ordinary vaccination tube. But rather than pressing liquid into the system, they begin with an empty tube and pull liquids out. Once they analyze the liquids and get the air out of the tube, they push the liquids back into his stomach. On a continuous feeding schedule, having an hour's worth (or even up to two hour's worth) of milk in the stomach is fine.
The only other new thing today was that they have started adding calories to his breast milk. Breast milk, on average, contains 20 calories per ounce. They are adding 2 calories per ounce to that. Hopefully, that will help him gain weight.
I'll be interested to see how much he weighs tonight. We usually see decreases on his Lasix days. But the 38 gram diaper is far smaller than Saturday when he had his all time record breaking diaper of 69 grams. It may be the case that he doesn't have a whole lot more of excess fluid to lose. Nancy said that she didn't think he looked bloated. I don't think he looks swollen either. As I understand it, he's on the Lasix because they don't want his lungs to be filled with fluid, and his kidneys needed encouragement to get rid of the fluid. Yesterday (non-Lasix day), his urine output was 2.4 ml per hour. That's where it should be. So the question is: Is that average representative of what he'd do if he was taken off the Lasix? The general rule is that, at a minimum, he should be peeing at least 1 ml per hour. But 2 would be better. I'll be happy when he's off the Lasix because it strips calcium, sodium, and potassium from his system. Once he's off Lasix, he may not need the additional supplements.
In other news, he had an isolette change last night. It's nice when it is changed, because by the two-week mark, it gets kind of grungy.
Karin, one of the associate administrative nurses, stopped by to see how Henry and I were doing. She's originally from Sweden. By looking at her, it shows. She has beautiful natural blonde hair and blue eyes. Karin spent some time with us yesterday, when his day nurse went on a lunch break. I was a little down yesterday, and she was great. We spent most of the time talking about research. She heard that I taugh research methods and statistics. She's going back to school to get her bacherlor's degree in nursing. She became a nurse 20 years ago when only a general bachelor's degree was needed. She's currently taking a methods course. She analyzed data from a handwashing study that compared nurses who used antibacterial soap to those who used alcohol lotion (or what the staff often call "goop"). Basically, the finding was that nurses who use the soap eventually develop special bacteria that are resistent to the soap. Those who use the goop do not develop bacterial-resistant flora on their hands. The bacterial-resistant flora that are found on the soap using nurses are unique to the NICU in which the nurses work. So UMC nurses would have different flora on their hands from those who work in a different NICU across town. In any event, the conversation was a marriage of my general interest in research methods and my current obsession with handwashing, so I was enthralled.
That's all for now. When I left, Henry was sleeping, and my mom was staying with him.
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