Nurse Practitioner Intervention to improve Postpartum Appointment Keeping in an Outpatient Family Planning Clinic

A nurse practitioner (NP) program to improve postpartum appointment keeping in an outpatient family planning clinic is described and evaluated. The subjects (N = 59) were non-high-risk obstetric patients prescheduled to be seen at 6 weeks postpartum by the NP. Two groups were identified by convenience sampling: Group A (n = 25), the nonintervention group, and Group B (n = 34), the intervention group. Two types of intervention were used: a postpartum telephone call after discharge (n = 11), or a predischarge postpartum visit (n = 23). Results suggest that those in the intervention group were more likely to keep their appointments (p less than .02); only the postpartum visit increased the probability of appointment keeping (p less than .05).     

Understanding Blood Gas Interpretation

Blood gases are the most common and one of the most important laboratory values performed in the neonatal intensive care unit. Because of technological advances including surfactant and high-frequency ventilation, the need for immediate responses to rapidly changing clinical conditions is of utmost importance. An arterial or capillary blood gas is a clinical tool for determining an infant's pulmonary and metabolic status. An infant can easily be overventilated, underventilated, or metabolically unstable, which can affect their long-term outcome. Therefore, nurses need to have a basic understanding of acid-base physiology and accurate interpretation skills to be a competent and skilled neonatal intensive care unit nurse. This article presents a brief review of blood gas interpretation.     

Unit based procedures: impact on the incidence of nosocomial infections in the newborn intensive care unit

Nosocomial infections are one of the major causes of morbidity in the Newborn Intensive Care Unit (NICU). Known risk factors include birth weight, gestational age, severity of illness and its related length of stay, and instrumentation. Infections result in prolonged hospital stays and, consequently, increased hospital costs. As advances in medical technology improve mortality in the tiniest of infants, it is imperative that health care providers identify effective interventions to minimize the risks of nosocomial infections in the NICU. This article examines the effects of common procedures on the incidence of nosocomial infections. Unit-based procedures discussed include visitation, hand washing and nail care, skin and cord care, maintenance of hubs in peripheral and central lines, gowning and isolation procedures, use and misuse of antibiotics, and unit design and staffing. Investigation of these procedures in individual units may reveal areas to improve patient outcomes.     

Neonatal herpes infection: a review

Herpes simplex virus (HSV) is a devastating infection in the neonatal patient. The incidence of maternal HSV infection and consequent neonatal infection has increased significantly over the last several decades due to changing sexual practices. Despite the improvements in outcome with the use of high dose acyclovir, a delay in the diagnosis of HSV has been associated with progression of the disease and increased mortality and morbidity. Even with adequate treatment, permanent sequalae, such as developmental delay, cerebral palsy, blindness, and persistent seizures may occur. Since the onset of symptoms can occur up to four weeks of age, clinicians caring for infants in any setting including the neonatal intensive care unit, the well baby nursery, pediatric floors, emergency rooms, and outpatient clinics must be fully aware of the clinical presentation, evaluation, treatment, and prevention of neonatal HSV infection to facilitate successful diagnosis and treatment of this deadly disease.     

One Practice Week at a Glance

This is the synopsis of the work week of an RN practicing in a level III neonatal intensive care unit. The married mother of three daughters works three shifts per week. Her husband recently started his own business and, despite the hectic hours, is supportive of her educational goals.     

FISH Diagnosis of 22q11.2 Deletion Syndrome

The 22q11.2 deletion syndrome is the most common microdeletion syndrome. Although once thought to be separate disorders, cardiac anomalies, abnormal face, thymic hypoplasia, cleft palate, hypocalcemia, and chromosome 22 deletions (CATCH 22); DiGeorge syndrome; velocardiofacial syndrome; and conotruncal anomaly face syndrome are now known to be part of the same 22q11.2 deletion syndrome. Diagnosis of this syndrome is extremely challenging because of wide variability in phenotypic presentations. When the deletion is suspected, genetic testing is typically ordered. Conventional karyotyping is only capable of detecting a small percentage of chromosome deletions. However, fluorescence in situ hybridization (FISH) is capable of detecting many deletions and microdeletions. This article discusses the pathophysiology and presentation of chromosome 22q11.2 deletion syndrome. The use of FISH as a diagnostic tool is also described, including the FISH process, its use, and its accuracy and reliability in the diagnosis of chromosome 22q11.2 deletion syndrome in the fetus and/or newborn.     

Hearing outcomes in the neonatal intensive care unit graduate

Universal hearing screening is accepted as a standard of care in the United States. Infants in the neonatal intensive care unit are at increased risk of hearing loss. Delay in the diagnosis of hearing loss may delay language and communication skills that result in life-long challenges for these infants and their families. Types of hearing loss, methods of screening, and interventions are reviewed.