Elvish's Nursing Blog

Elvish, BSN, RN (30,296 Views) Guide

Joined Nov 7, '06. Posts: 19,871 (41% Liked) Likes: 20,855

All the Things We Carry

Every so often, a thread pops up around here: "What's in your pockets?" In other words, what do you carry that you know you'll need before your shift is up? Most of us carry alcohol swabs (never enough of those), penlights, probably a syringe or two, some 2x2s, tape, and it's a running joke on my unit that real nurses carry hemostats. And heaven help the soul who arrives at the end of shift and can't find her brain sheet. That's painful in a way only a nurse can understand. Not too long... Read More →

It's your turn now, nurse!

I am an OB nurse; I do mother/baby, newborn nursery, and high-risk antepartum nursing. I'm used to being the one in control. I'm used to doing the teaching, reading the monitor strips, and reassuring the fears of many an anxious mama (pregnant or delivered). That's where I'm 'in the zone'. Give me a 35-weeker feeder/grower, give me an antepartum mama in preterm labor, give me someone who needs that kind of help, and I am good to go. What I am not used to, however, is when the tables are... Read More →

Helping staff cope with perinatal loss

One of the great things about my job is welcoming new life and watching miracles happen almost every day. Nearly every day I fall in love with at least one of the babies and/or new families in my care, and more often than not, it's all of them. However, this job is - as mentioned in the previous entry - like the proverbial little girl with the curl in the middle of her forehead. When it's it's good, it's very good; when it's not...well, we all know how the saying ends. It can be ugly and sad,... Read More →

Grieving a perinatal loss

When I tell people I'm a mother-baby nurse, the usual reaction is, "Oh, what a great job that must be!" Sometimes, that's a true statement. But what most people don't realize (or if they do, they don't mention it) is that when bad things happen, they are very very bad. Families and staff alike need support, though each needs a different kind. This article (part 1) is about supporting families through what is likely one of the most difficult times of their lives. Whether it's a miscarriage... Read More →

What Keeps Me Coming Back

I'm a mother/baby nurse and proud to be one. Compared to lots of units, we mother/baby folks might be considered lucky to have such 'cake' jobs, and some days I'd agree. Other days I leave work exhausted, with sore feet, sore back, dry mouth, empty stomach, and full bladder from running between one crisis and another. We do have our fair share of crises; when they are bad, they are really bad. But this isn't about those crises, nor about the frustrations we encounter as mother/baby nurses. This... Read More →

Postpartum Mood Disorders

The postpartum period - just after giving birth - is, for most a time of happiness and adjustment to new family roles. However, for some women it is a time of overwhelming sadness, anxiety, and inability to cope with the stressors at hand. Postpartum depression, anxiety, and psychosis are mood disorders that affect approximately 10-20% of new moms. Most moms can expect to experience some 'baby blues' symptoms in the first week or two postpartum - crying over anything (and nothing), some... Read More →

Family-centered Maternity Care and Rooming-in

A thread in the Ob/Gyn nursing forum got me thinking about this. Family centered maternity care (FCMC) is a buzzword that's no doubt quite familiar to many in maternal/child nursing circles. In my almost-eight years as a nurse - not long in comparison to many of my colleagues - I have seen several hospitals in my area make the switch from all separate units to some form of FCMC and rooming-in. There are, according to Dr. Celeste Phillips, 10 principles upon which FCMC is based: ... Read More →

Some quick tips for a good latch

For moms who are breastfeeding, a good latch is supremely important. If not, nipple pain will soon ensue - even if the improper latch is held for just a few minutes, those few minutes can have a long-lasting effect. Additionally, if the baby's mouth is not wide open with enough breast tissue in the mouth, he will not get the full amount of milk possible. So, here are a few quick tips for nurses assisting mom with breastfeeding latch. *Make sure Mom is comfortable with her back, neck,... Read More →

When the mother is in prison

The hospital in which I work has a contract with our state wherein all pregnant prisoners deliver at our hospital, regardless of home county. This population has a special set of needs to consider. Prisoners get a very short hospital stay - for a normal vaginal delivery, the woman goes back to the prison the next day, most often in under 24 hours. For a Cesarean delivery, the woman goes back to the prison infirmary on post-op day two. This translates into a) a very short amount of time for... Read More →

Care of mothers with babies in intensive care

I work at a facility with a level IV neonatal intensive care unit (NICU) and it's my estimate that roughly (this is purely a guess) one-third of the mothers in my care have delivered babies that are in the NICU for whatever reason. Some of their physical assessment may be different (not by much) but the emotional aspect of their care is far different, and the range of emotions is about a wide a spectrum as can be. Some women who deliver at my hospital have been there for days, weeks, or... Read More →

Hypoglycemia in the newborn

While in utero, glucose from the maternal bloodstream crosses the placental barrier and into fetal circulation to be used for growth. The fetal pancreas functions much as would an adult pancreas; that is, it facilitates glucose uptake by the cells that need it. However, in a situation in which the mother has diabetes, the risk for neonatal hypoglycemia increases, especially if the mother's blood glucose levels were not well controlled. What happens is that the fetal pancreas accomodates the... Read More →

Long-term antepartum care in the hospital

Care of the antepartum patient that's on your unit for an extended length of time can be a huge challenge, both for staff and for the patient. These are women who, for whatever reason have a pregnancy complication that cannot be managed on an outpatient basis. Diagnoses can range from preterm labor to premature rupture of membranes to placenta previa to high-order multiple pregnancy to hyperemesis gravidarum, and anything else you could imagine. The challenges are numerous. To begin with,... Read More →

Late Preterm Infants (Part 3)

Apologies for the long hiatus! I have not forgotten that we were last on the subject of late pretermers and hyperbilirubinemia; this time it's late pretermers and breathing. Obviously, one can't survive extrauterine without oxygen-carbon dioxide exchange in the lungs, whether by natural respiration or mechanical ventilation. There is never a 100% guarantee that things will go as they should in any situation, but with a late pretermer, it is even less certain. These babies are more... Read More →

Late Preterm Infants (Part 2) - Hyperbilirubinemia

This next entry deals with hyperbilirubinemia and jaundice in the late preterm infant. Just to recap, late preterm as defined by AWHONN is an infant born between 34 and 36 completed weeks' gestation. During the antenatal period, fetal hemoglobin levels are necessarily higher than postnatal. Increased hemoglobin is needed to carry oxygen from the maternal/placental blood into fetal tissue for the massive perfusion and growth needed in the third trimester of pregnancy. Fetal hemoglobin levels... Read More →

Late Preterm Infants (Part 1)

While still considered premature, these infants are often under the care of a well-baby nursery after birth. However, it is a mistake to treat these babies as we would a full-term baby. Below are some special things to take into consideration when caring for a late preterm infant. Thermoregulation Late pretermers cannot always maintain their body temperature at normal for multiple reasons. To begin with, their neurological development is incomplete and the neurological centers that... Read More →