knufflebunny 4,059 Views
Joined Jan 30, '10.
Posts: 101 (15% Liked)
Epidurals can fail for many reasons. Sometimes technique or circumstance causes a poor placement of the catheter. Sometimes patients anatomy can cause problems with how the medication travels in the epidural space. Asymetrical blocks or "patchy" blocks can sometimes result even with best technique. Sometimes a patient's labor is rapid enough the epidural doesn't get time to set up fully.
I think, however, that what you may be refering to as failure of the epidural to "work" is actually not a true epidural failure. The nerves that cause labor pain from contractions are easily blocked by epidural placement for the nerves that travel from T10 to L1 (typically speaking, uterus cervix and perhaps even the upper vagina). The second stage of labor, as the baby drops lower, causes pain to result from a different set of nerve fibers-namely the sacral nerves (posterior pain and perineal pain, lower vagina). local anesthesia has a harder time blocking these nerves in general, and with typical placement of an epidural they offten times aren't completely blocked.
Our anesthesia team and nurses do a good job to provide adequate education for our patients that epidural labor is not pain free labor and as labor progresses and the baby moves down, epidurals block low pain less. This may result in pressure type pain sensations during second stage. We reassure the patients that often times this means they are getting close and that this pain will assist in directing pushing efforts. Anesthesia will still come up and evaluate these cases and give boosts when appropriate. alernative pain management options such as position changes,breathing techniques, heat, ice, counterpressure can sometimes help, too.
Next time you have a patient who's epidural "isn't working", try checking their block with ice or alcohol wips. If their block is up to their umbilicus and they are still having pain, chances are their epidurals ARE working, just not for the nerves being stimulated. The most common pain we have trouble blocking at my facility is suprapubic pain and low back labor. It can be frustrating as the nurse, because lets face it, pain free is best if you ask me! But knowing WHAT is going on for you and your patient can help. This also allows you to let your patient know that their epidural IS helping her some. We have one CRNA that jokes "If you don't beleive me, I can turn it off".
I don't see entitlement as new problem.
To be an adolescent is to be fairly self-centered and yes, entitled.
Eventually we outgrow the self-centeredness of youth, or can no longer get away with it.
Exposure to the real working world gets rid of entitlement for most of us.
What has changed is that people are slower to assume the role of mature, independent adults.
I don't know why people are so afraid of the government "controlling their health" when right now the insurance companies are doing it.
One morning( I work nights), I got a call back from a doc. He was very kurt and obnoxious because i paused before I started reporting on the patient in question and he started to berate me, calling me incompetant, and I said "Doctor, I have 3 charts in front of me, I called 3 docs about patients and YOU were the first one to call back. I want to make sure I am talking to the correct doctor about the correct patient."
Long pause...oh, okay. No apology. However, afterI was done and got orders from him, he thanked me. Very uncharacteristic.
Very interesting thread - -
Question for OP - exactly what is it that makes you believe you are an introvert? I know that may sound simplistic (or stupid) but just because you are not a "touchy feely" person does not make you an introvert. Some of us just have a natural tendency to be more solitary. We aren't 'afraid' of social situations, we just prefer not to engage in them - and this is not a personality defect.
If you discover that you are actually fearful of expressing yourself or being assertive, this could certainly have an effect on your clinical effectiveness. Have no fear, you can overcome these problems - many times they just go away as your confidence increases over time.
As you may have guessed, I prefer a much lower level of 'social density' myself.... I blame my Norweigian heritage - LOL. My preferred clinical setting is ICU - the work is primarily solo, and interacting with others when needed. I would advise you to engage in some self-exploration. There are some really good self-assessment tools you could use. One of the most popular right now is "Strengths Finder 2.0" by Marcus Buckinham - it includes an online self assessment.
just saw your question, so i'm posting an answer to your 2nd question in case you or anyone else surfing for it would like to know. (if you are still wondering about your first question, please post again and i'll answer; otherwise i'm assuming you've already learned more by now.)
i just started here, and i had also applied to a (much more expensive) bsn program. got accepted to both, and i asked a former head nurse, who is also a nursing instructor in another state, how important it would be to get my bns right now instead of transitioning later. (there are a number of rn-bsn transition programs, as well as some absn ones if you already have a bachelor's degree in anything else.) this was her answer:
"the adn is a perfectly great starting point. the foundation for both degrees is the same. the only significant difference is the bsn offers leadership/management and community health. it is really a good idea to work for a while with your adn and finish the bsn concurrently."
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