If you have seasoned medical students or are lucky enough to have another MD in the nursery with you (another intern or a family medicine resident), arrive at 7am at the latest. The first thing you should do when you hit the nursery is scrub, surgical style, at one of the sinks. Stay on the good side of the nurses. Trust us. Next, print two copies of the census (hit task print print) from PowerChart. One is for you, one is for the attending. Take a big, black marker and cross off any babies who aren’t staff (see next page). Always double-check if staff is covering for a PMD. Note on your census which babies need to be admitted, which ones you think should be discharged and which ones are interim. An anticipated discharge list (with T/D bili levels) will be hanging up on a clipboard to your right as you walk in. Compare the anticipated discharges with patients you think should be discharged home (day 2 NSVD, day 3 CS). Anyone missing from the anticipated list could still be discharged. Check with the floor nurses or moms themselves. Organize yourself using your census as a to-do list. Examine all of the babies, discharges with priority. Tip: If the census is manageable, see all the babies in the nursery first. Then, take your binder and ophthalmoscope onto the floor and see the babies in their mothers’ rooms. If the census is crazy, ask the nurses very nicely if you could please have, at least, the discharges brought to you. The night newborn resident should have done all of the admissions overnight, but you should still examine all of the new babies in the morning if you have time to do so. Before or after your exam, note on your flow sheet the date, DOL, weight, change from birth weight, feeds, voids, stools and physical exam. Newborn Exam General Appearance: alert, active, NAD Skin Look at color – pink, cyanotic, acrocyanotic Feel for temperature – is baby cold, or warm Look for any rashes
If you have seasoned medical students or are lucky enough to have another MD in the nursery with you (another intern or a family medicine resident), arrive at 7am at the latest. The first thing you should do when you hit the nursery is scrub, surgical style, at one of the sinks. Stay on the good side of the nurses. Trust us. Next, print two copies of the census (hit task print print) from PowerChart. One is for you, one is for the attending. Take a big, black marker and cross off any babies who aren’t staff (see next page). Always double-check if staff is covering for a PMD. Note on your census which babies need to be admitted, which ones you think should be discharged and which ones are interim. An anticipated discharge list (with T/D bili levels) will be hanging up on a clipboard to your right as you walk in. Compare the anticipated discharges with patients you think should be discharged home (day 2 NSVD, day 3 CS). Anyone missing from the anticipated list could still be discharged. Check with the floor nurses or moms themselves. Organize yourself using your census as a to-do list. Examine all of the babies, discharges with priority. Tip: If the census is manageable, see all the babies in the nursery first. Then, take your binder and ophthalmoscope onto the floor and see the babies in their mothers’ rooms. If the census is crazy, ask the nurses very nicely if you could please have, at least, the discharges brought to you. The night newborn resident should have done all of the admissions overnight, but you should still examine all of the new babies in the morning if you have time to do so. Before or after your exam, note on your flow sheet the date, DOL, weight, change from birth weight, feeds, voids, stools and physical exam. Newborn Exam General Appearance: alert, active, NAD Skin Look at color – pink, cyanotic, acrocyanotic Feel for temperature – is baby cold, or warm Look for any rashes
Guide2010.docx