Weight on the board is 1615, a gain from 1580. I still don’t trust these weights.

He is on 27% oxygen. Nurse today is again one that has not had him yet, but she is familiar with him. She is the one that made his awesome one month poster.

She tells us he had the cranial ultrasound this morning.  He handled it really well.  He has been dealing with cares well, and he finally had a big poop this morning again,  it seems he has been working one out every morning lately!  Good boy. 

He is pretty deeply asleep and looking comfy, still having some small temperature fluctuations.

We do morning cares, temp is 37.5 nurse turns his incubator down .1. Diaper just pee, he stays calm through cares. Then respiraroty therapists swaps him from nasal cannula to nasal mask. He gets a little angry about the swap at first but doesn’t mind a short bit later.

Then I head out and send in one of RT’s grand pops. Oxygen percent down to 25%. Grandpa talks to him and RT opens his eyes to see who is talking. They cover his isolette back up to let him sleep. His leak is really big out of his mouth (not abnormal for RT’s open mouth) so the nurse repositions  and reswaddles him. Grandpa is thrilled to see his little grandson unswaddled and wiggly. Mom explains the ventilator systems and all his sensors. They sit and enjoy being in his presence.

Then lunch time.  Back up to the NUCU.

1400 cares.  One of his grandmas goes into NICU with mom 36.8 for temp. Just pee. Occupational therapist stops by, she observers “his stressful life is causing him to hold tension in his shoulders” to relax him we will give him shoulder massages,  and hip turns to help loosen him up. The respiratory therapist puts the little comfier neopuff mask on RT for this. He enjoyed her touch and all the stretches she made him do. Can already see the changes in his body,  he is reacting well!  The respiratory therapist pulls off the neopuff mask occassionaly through cares and allows grandma to see his cute smiles and open eyes. Occupational therapist will be back Wednesday.

Skin to skin with with mom, grandma will get to hang out with him for 3 hours to watch mom and baby cuddle. Transition is smooth,  he settles down on mom immediately.  He high sats at 100 spo2, nurse turns him down to 23%, then 21%. He continues to high sat for a while.  The nurse turns off his high alarm so that it isnt too loud. She can’t turn down his oxygen lower than room air. His spo2 come down to 95, 96 good boy. Holding steady. Then suddenly from 95, to 76 spo2. what’s going on? Nurse gives him a moment to come back up but comes over. 68, for a little bring it back up buddy, 66, 64, 60. Nurse turns up his oxygen.  59 spo2. 60% oxygen,  tries stimulating his back.  He comes up to 68, then back to 64, more simulation,  mom keeps telling he has to breathe. They close his mouth,  he slowly works his way back up. Then he high sats. Nurse is able to quickly wean his oxygen back down to 25%, well I guess his lungs are ok,  he came back down.  Wonder what causes these desats. Especially quick ones like that.

1550  RTs heart rate dips to,  86 bpm from 166. Spo2 from 95 to 60’s. What’s going on buddy, you have to breathe.  Nurse is already there because his mouth is open and his leak alarms continue to sound.  She gives him two stimulating rubs, he comes back up quick. Nurse thinks he was bearing down,  mom agrees. Then he got really wiggly,  whole body squirming,  agitated. Mad about air blowing out of his mouth,  buries his face on mom’s chest to try and stop the air,  didn’t work as well as on a mattress pad. Mom checks his diaper,   Turns out he is agitated because he made a big poop, almost blowing out the top of his diaper!

They decide to change diaper on mom’s lap. Pillowv on mom’s lap,  sit up amd pivot him to his back on the pillow,  nurse changes his big dirty diaper cleans him up and then back to skin to skin.

He is comfy but his mouth is wide open ventilator alarming.  Mom checks with her finger his mask to make sure it’s alarming because his mouth is open,  not because mask slipped off somehow.  It hasn’t,  RT sees his opportunity grabs her finger,  and pulls it directly into her mouth.   Good boy.

During skin time,  nurse swapped out isolette to the one for older babies. Fresh linens.

1700 skin time is over, into the fresh incubator he goes. Smooth transition.

Cares,  just pee, temp is 36.3 a bit cold.  Swapped back to nasal cannula,  gma helps contain him.  She gets to give RT a milk swab too! Obviously  he loves it.

Dinner time, with the grandparents.

Back up to NICU new nurse tonight,  but she is familiar with him.

There is a gift for us! Name omitted for privacy, thank you nurse and mom!  You are amazing! A super cute blanket for little RT. Almost made me cry with happiness! It means so much to us that your all there for us!

2000 time for cares,  temp 36.6.  diaper just pee.

Respiratory therapist is the one with fast hands. She doesnt turn up his oxygen this time,  so that was awesome!  While doing his neopuff break she breaths for him with her finger on the hole of the mask to make sure he takes enough breaths. Lately he hasn’t needed help like that.

Maybe anxious because of last time when she turned him and he desat, maybe he can sense it.  He isn’t happy with her.

Her finger breathing seems slightly excessive with the amount of effort she does it, I want to joke with her we aren’t playing whack a mole on his face but I know it probably looks harder than it actually is… right? I don’t think it would go over well. I know he really is in good hands.

He deals with it all fairly well just a little upset heart rate into the low 200’s

When she is done I give RT some milk dipped binky.  He loves it.  I only do 3 this time then we swaddle him up and turn him on his right side.

Sleep tight RT, no more quick desats like earlier please!

I forgot to mention this on the 15th but…

National Neonatal Nurses Day is celebrated every year on September 15. 

Thank you to all the nurses that make it possible to have a baby like RT!

Maybe in 15+ years after I retire from the coast guard I’ll join the ranks of nurses or respiraroty therapists that do this amazing job.