Please provide admission orders for a 3‑week‑old infant under PCAP‑B protocol.

Admission Orders for a 3-Week-Old Infant (PCAP-B Protocol)

For a 3-week-old infant requiring NICU admission under PCAP-B protocol, initiate continuous cardiorespiratory monitoring, establish vascular access, provide respiratory support as indicated, and implement strict metabolic monitoring with blood glucose maintenance between 90-180 mg/dL. 1

Monitoring Orders

• Continuous cardiorespiratory monitoring: Heart rate, respiratory rate, oxygen saturation (SpO₂), and blood pressure 1
• Vital signs: Every 1-2 hours initially, then every 4 hours once stable 2
• Temperature monitoring: Use axillary digital thermometer with emollient; avoid adhesive probes 2
• Oxygen saturation monitoring: Maintain SpO₂ >90%; use soft cotton or silicone dressing between monitor and skin to prevent trauma 2, 1
• Fluid balance: Strict intake/output monitoring; document any bilious or repetitive vomiting or abdominal distention 2

Respiratory Support Orders

• Oxygen therapy: Titrate to maintain SpO₂ >90% 1
• CPAP: Initiate if oxygen requirements exceed 30-40% FiO₂ or if signs of respiratory distress persist 3, 4
• Prepare for intubation if: Apnea requiring positive pressure ventilation, inability to maintain adequate oxygenation despite CPAP, severe respiratory distress with impending failure, or hemodynamic instability 5
• Surfactant administration: Consider if preterm with oxygen requirements >30-40% FiO₂ on CPAP (administer within 2 hours if indicated) 3

Vascular Access and Laboratory Orders

• Intravenous access: Establish peripheral IV or consider intraosseous access if difficult; use experienced practitioner to minimize attempts 2
• Secure IV: Use low-adherent tape with preventative padding under tourniquets 2
• Blood glucose: Check immediately on admission, then every 2-4 hours until stable; maintain 90-180 mg/dL 1, 3
• Complete blood count with differential: Only if clinically indicated (suspected sepsis, anemia) 2
• Blood culture: If sepsis suspected based on clinical presentation 2
• Electrolytes: Baseline sodium, potassium, chloride, bicarbonate 1
• Genetic testing: Cluster with newborn screening if not previously obtained 2

Nutritional Orders

• NPO initially if respiratory distress present or requiring significant respiratory support 1
• Feeding tube placement: Lubricate well with water-based lubricant; secure with low-adhesive tape 2
• Feeding protocol: Once stable, initiate careful feeding advancement with continuous monitoring for necrotizing enterocolitis signs (abdominal distention, bilious emesis) 1
• IV fluids: D10W at maintenance rate (adjust based on weight and clinical status) until enteral feeds established 1

Infection Control and Preventative Care

• Safe handling practices: Post notices around cot alerting staff to trauma risk; use emollient or padding between gloved hands and infant 2
• Lifting technique: Use side-roll technique holding under neck and diaper area; never lift under arms 2
• Skin care: Apply petroleum-based lubricant around anus to prevent fissures; use nonmedicated hydrating eyedrops if corneal irritation 2
• Urine collection: Avoid adhesive bags; attempt clean-catch collection or dipstick testing 2

Medication Orders

• Avoid routine blood pressure cuffs: Only if medically necessary; use padding or clothing between cuff and skin 2
• Pain management: Assess regularly; provide appropriate analgesia if procedures required 2
• Antibiotics: NOT routinely indicated unless clinical signs of sepsis (fever, lethargy, poor feeding, respiratory distress with suspected bacterial etiology) 2, 6
  • If sepsis suspected: Ampicillin 50 mg/kg IV every 12 hours PLUS gentamicin 4-5 mg/kg IV every 24 hours (adjust for renal function) 2

Consultation Orders

• Neonatology: Primary service 2
• Pediatric cardiology: If murmur detected or signs of congestive heart failure 1
• Genetics: If dysmorphic features or suspected genetic syndrome 2
• Ophthalmology: If oxygen-dependent or premature with risk for retinopathy of prematurity 1
• Dietetics: For feeding plan optimization 2

Special Considerations for 3-Week-Old Infant

At 3 weeks of age, this infant is beyond the immediate neonatal period but still at risk for late-presenting complications. Use pediatric (infant) resuscitation protocols with 15:2 compression-ventilation ratio for 2-rescuer CPR, NOT the 3:1 ratio used in the delivery room for newly born infants. 2 This distinction is critical as arrest etiology at this age is more likely cardiac rather than purely asphyxial.

Discharge Planning (Initiate Early)

• Assess family capability: Ensure parents can provide necessary care with appropriate support services 1
• Parent education: Begin teaching on feeding, monitoring, and recognition of deterioration 2, 1
• Follow-up arrangements: Establish primary care with physician experienced in NICU graduates 1