[SmilingBluEyes]

YES YES YES externships and volunteering ARE valuable work experiences you certainly *must* include on your resume. I am so excited for you. What a great opportunity ! Congratulations to you (oh and hello again, been a while hasn't it).

[BETSRN]

Originally Posted by LauraLou

I work as a nurse tech on a postpartum floor. We have a lot of pts from other countries. Many of them have different ideas about postpartum care, such as not bathing, not getting out of bed, not caring for their infant except to feed.

Do I respect their beliefs and let them to stay in bed, etc. or do I try to make them conform to the plan of care? We are taught to respect cultural diversity but what if that diversity puts pts at risk for DVT or infection?

Some nurses force the pts to ambulate, bathe and demonstrate infant care, while others allow the pts to do whatever they want. I am not sure which approach is correct.

Thanks for your help!

You must respect cultural diversity. However, if you think a practice is unsafe, you are certainly free to speak with the woman and her family and see what kind of compromise you can reach that will benefit her health and not undermine her cultural beliefs. This is your chance for teaching (as well as learning).
This is where your critical thinking skills come in to play and you "think outside the box." There are too many nurses out there who are stuck on policies and cannot (or don't want to) think outside that box.

[BETSRN]

Originally Posted by haileasmom

I work in an OB dept and ours is a closed unit and we don't have floaters or registry from outside. This is due to the amount of orientation involved. You have to really know what to watch for as far as dfundal firmness etc.. The risk for hemmorhage is to great to allow floating. Just keep watching for the openings. Our hospital has a internship program and sometimes we hire new grads that went through an internship. Hope this helps!

There should be no problem with nurses floating to PP. Fundal checks, post-op section assessments and those related skills can be taught to any experienced med-surg nurse. On occasion, someone from Med-Surg floats to help us in times of high census. They do no labor or related activities but they certainly can help with PP's and well nursery.

[SmilingBluEyes]

Originally Posted by BETSRN

You must respect cultural diversity. However, if you think a practice is unsafe, you are certainly free to speak with the woman and her family and see what kind of compromise you can reach that will benefit her health and not undermine her cultural beliefs. This is your chance for teaching (as well as learning).
This is where your critical thinking skills come in to play and you "think outside the box." There are too many nurses out there who are stuck on policies and cannot (or don't want to) think outside that box.

very true.

[crb613]

Originally Posted by SmilingBluEyes

Mugwump had a great idea offering services to new grads as a mentor (thank you for that!)

So, I thought having a "sticky" for new grads, OB nurses, students, and others with questions who want to post these can do so here. We also seem to see many of the same questions over and over, so perhaps this would help serve as an ongoing discussion of common issues/questions we all seem to have on our minds. This could serve not just for those asking directly, but others who may be "lurking" and looking for information or considering a career in OB, newborn, GYN nursing, or midwifery, doula services, childbirth education, lactation consulting, or other related work.

So if any mod thinks this is a good idea, mind stickying this?


Let's give this a go and see how it works out. We have many potential "mentors" here among us who, I am sure, would LOVE to help a new nurse/midwife/doula or student on his or her way to a rewarding career. I know I would love to help out!

I do have a question about my L&D patient. I have to do a careplan with a patho. She does not have anything wrong with her/just came in to deliver. Any ideas as to what to do??? Thanks CRB

[SmilingBluEyes]

IF this is a healthy, normal spontaneous vaginal delivery, you really don't have a pathologic condition to address. The majority of childbearing women are healthy. Now, if you have complications, or complicated prenatal conditions/histories, you can have all sorts of possiblities:

Pre-eclampsia/PIH and associated careplanning
Gestational Diabetes Issues
Risk for hemorrhage
Risk for infection
Risk for impaired bonding with newborn(psychologic area)
Risk for postpartum depression
Risk for dehydration (or water intoxication/over hydration due to pitocin use)

Know mom's history and possible existing pathologies and go from there---that is another approach.

I realize these are MEDICAL diagnoses, but you can look these problems up in any care plan book (or your OB text) and find the proper NANDA nomenclature and nursing interventions for each one.

Hope I started you on your way....

[crb613]

Originally Posted by SmilingBluEyes

IF this is a healthy, normal spontaneous vaginal delivery, you really don't have a pathologic condition to address. The majority of childbearing women are healthy. Now, if you have complications, or complicated prenatal conditions/histories, you can have all sorts of possiblities:

Pre-eclampsia/PIH and associated careplanning
Gestational Diabetes Issues
Risk for hemorrhage
Risk for infection
Risk for impaired bonding with newborn(psychologic area)
Risk for postpartum depression
Risk for dehydration (or water intoxication/over hydration due to pitocin use)

Know mom's history and possible existing pathologies and go from there---that is another approach.

I realize these are MEDICAL diagnoses, but you can look these problems up in any care plan book (or your OB text) and find the proper NANDA nomenclature and nursing interventions for each one.

Hope I started you on your way....

Thanks so much. She was/is healthy so I am kinda scratching my head, I agree If you don't have a problem I don't see how you can do a patho. It would make more sense to me to have a pregnancy related patho assigned to each student in a case like this. That's just me. She did have to have the placenta manually removed so I guess I could do one on hemorrage risk/infection, although there was no problems. Thanks again you have helped/supported me alot & I do appreciate it.CRB

[SmilingBluEyes]

Yes do risk for hemorrhage/infection on that one. Also, do remember, almost EVERY postpartum mom is at GREAT risk for dehydration, despite much IV fluid. It often "third spaces", especially with the use of pitocin, which acts like Antidiuretic Hormone (ADH), causing water retention. The Paradox here, is they need to INCREASE GREATLY their water intake to encourage diuresis. So each and everytime I round on my patients, they get a liter pitcher of fresh ice water (unless they are people who prefer hot beverages, then they get warm water or herbal teas) to encourage PO hydration.

GOOD LUCK on your assignment. You are right; manual removal of the placenta means greatly increased risk of infection/hemorrhage and don't forget PAIN!!!!! Often, you can use warm blankets on the tummy as well as analgesics for such discomfort. Hope this helps.

[mugwump]

Originally Posted by crb613

Thanks so much. She was/is healthy so I am kinda scratching my head, I agree If you don't have a problem I don't see how you can do a patho. It would make more sense to me to have a pregnancy related patho assigned to each student in a case like this. That's just me. She did have to have the placenta manually removed so I guess I could do one on hemorrage risk/infection, although there was no problems. Thanks again you have helped/supported me alot & I do appreciate it.CRB

One great tool I use is Tabers. In the back it has diagnoses one of which is labor, and pregancy and the nursing diagnoses that go with it. Also keep in mind that just because it was a normal healthy delivery doesn't mean it didn't have the opportunity to go bad. Also Post Partum Depression might not "hit" for a while so you can always do interventions now with teaching to make the mom and family aware that it is a potential problem

[crb613]

Originally Posted by mugwump

One great tool I use is Tabers. In the back it has diagnoses one of which is labor, and pregancy and the nursing diagnoses that go with it. Also keep in mind that just because it was a normal healthy delivery doesn't mean it didn't have the opportunity to go bad. Also Post Partum Depression might not "hit" for a while so you can always do interventions now with teaching to make the mom and family aware that it is a potential problem

Thanks to both of you another problem solved. I forgot about my Tabers!! This thread was such a great idea! CRB