[MIRockstarRN]

Sunday night i was the contact nurse - nursing sup. calls with pt assignment of pt coming from ED that's 18yo 1 month postpartum, new onset seizures, HTN. Please keep in mind that I work on a tele surgical stepdown... openhearts, thors, general surgeries, bariatric surgery, and many cardiac gtts. When we got the fax report from ED it said pt was 1 week postpartum. I called nursing supervisor to ask if it was appropriate for pt to be on our floor as it sounded like more of an OB type issue not a tele issue. She called ED and said pt was fine to come to us, as "All seizure pt's are pt on tele". I told her we didn't know anything checking those OB things they check, she said all you have to do is check BP and call code if pt seizes again (pt was seizing and posturing when EMT's arrived at her house). So pt arrives, me and another nurse are looking over the pt's orders to help out our third nurse and see pt is on Mg+ gtt, and apparintly this new pt needs basically a whole assessment every hour according to orders. We called over to OB to ask them to come over and check the gtt as that is NOT something we do. OB doc came over also. When OB doc arrived, I told him that if this pt needed to be assessed hourily then she wasn't appropriate for our floor. OB doc tells me that if pt was on L&D and on MG+ she would have 1:1 nursing care!!!! I told him that we don't even do q2 hour blood sugars nor do we have staffing so pt needed to go somewhere else or we could get on OB nurse to care for pt and we could watch her tele. He said pt didn't even need to be on tele! OB doc called birthing center to see what could be done, then nursing sup calls and tells me she is working on moving pt. OB doc says pt can't go back to L&D because she had already delivered and was no longer pregnant, so the problem was trying to find an appropriate bed for her. Nursing sup calls with bed on peds with OB nurse to care for her then tells me that I was out of my scope by trying to get pt moved! I told her that all i did was ask a question of the Doc and found out pt was 1:1 care, she knew it wasn't appropriate for us! Needless to say, all admits after the spat with supervisor were CRAP (not the first time we have had issues with her).
My question for you guys is this: where would this type of pt have ended up in your hospital???

[carebearRN08]

Sounds like she should be on a high-risk OB unit, or worse case, if she is a 1:1, then she should be in ICU. I work tele and this just sounds like bad news to me. I would have wanted to do the same thing in your shoes!

[aeauooo]

Originally Posted by MIRockstarRN

"All seizure pt's are pt on tele"... call code if pt seizes again

WHY?!

a. Telemetry isn't going to tell you if your patient is seizing.

b. If a patient seizes, you give them a benzodiazapine to stop it. Why call a code?

c. I know squat about post-partum, but isn't Mg for eclampsia?

d. If she's post-partum, why not load her with phenytoin or fosphenytoin?

What do I know? I'm just an old neuro nurse!

[Aprilhere]

What was she on mag for? Also..what does 1 week post partum have to do with anything..I'm confused. Noone stays in the hospital 1 week after giving birth..not even c-sections so how would it be an OB admit?

[ernurse93]

I work in the ED at my hospital, so I have actually encountered this. Our policy states any patient from 20 weeks gestation to 4 weeks postpartum presenting with symptoms of pre-eclampsia or eclampsia should be evaluated in L&D unless they are critical (hypertensive crisis, altered LOC, or actively seizing). If they must come through the ER we transfer them to a hospital with neurology coverage. I have found that most of these patients usually are sent to the OB centers at the receiving facility.

I think you did the right thing. I am by no means an OB nurse (I admire OB nurse ), but I actually was on a Mg++ drip for eclampsia, and it made me feel horrible. I wasn't even allowed to get out of bed. I had to have neuro checks every hour. The patient would need 1:1 care for sure. You are a great nurse for standing up for what you believed was safe for your patient.

[MIRockstarRN]

the pt had been d/c from having the baby and was back home. apperentily you can have ecplamsia after you have given birth, not just while prgnant, which was the case with this pt...why she was on Mg+ gtt. OB doc said you cannot be admitted back once you have given birth... so this is the dilemea. our hospital doesn't have high risk OB unit.

[queenjean]

She would have been place in our ICU; they take critical postpartum pts who need cardiac monitoring. You are right, Mag pts are 1:1 on the OB floor in my facility, though I'm not sure about in the ICU, I'll bet they aren't 1:1 there.

Less crictical post partum would have probably ended up on our medical floor. I've taken care of pts who were a couple weeks post partum for nonOB issues, or for issues that were complicated by being pregnant and giving birth (HTN, for example). On the medical floor I've also taken care of a pt with mastitis that was so bad she had horrible cellulitis and was on IV abx for several days.

[cassioo]

probably 1/2 of eclamptic patients are so up to 6 weeks post partum. She probably did need to be on Mag with 1:1 in L&D Our OB's would have had her on L&D from the get go. If not on L&D then ICU or transfer them someplace that can take care of it. Magnesium, hydrolizine, phenobarb

[rph3664]

Was the regular ICU full? My hospital used the cardiac unit as overflow a few months ago when our regular ICU filled up. This has never happened in the 4 years that we've had a CVU.

[dansamy]

She was on a mag drip for pre-eclampsia/eclampsia. (It became eclampsia when she began seizing.) In our hospital, an ICU, post-partum with an L&D nurse or on peds with an L&D nurse. And yeah, I was on mag recovery after my children were born due to severe pre-e. I had 1:1 care.