SoldierNurse22, BSN, RN, EMT-B 52,543 Views
Joined Mar 29, '10.
Posts: 2,234 (67% Liked)
SVEs can take time to really master. There are several blogs out there that can add the personal experience/tips/tricks of current L&D nurses to your preexisting experience/textbook info. If you haven't already, take some time to cruise L&D nursing blogs for advice in addition to getting feedback from your preceptors. Here's one of my favorites to get you started.
The Mystery That Is The Cervix – Cervix With A Smile
My apologies, OP--onset time for methergine IM is 2-5 minutes, as stated by a PP. So if you were going to see symptoms of a hypertensive crisis, it would be much faster than what I indicated in my original post.
May I ask how big your facility/unit is?
It's really not that unbelievable. Hospitals hire based on their needs, and if they need an experienced L&D nurse, they will often wait it out until they find one instead of trying to leverage time and resources they don't have to train a new one. I agree with Rose Queen--start looking in other places for a job in L&D.
That really depends on the patient's underlying disease process(es) and the extent of the bleed.
Generally speaking, if you're giving methergine to a patient who is experiencing a hemorrhage and has contraindicating factors for the drug) such as preeclampsia, gestational hypertension, etc.,), a hypertensive crisis is going to be the least of your worries. Typically severe hypotension is more the concern in a hemorrhage.
However, to answer your question more directly, a drug given IM is generally going to start acting 10-20 minutes after administration, so that would be the earliest you'd see symptoms of hypertension. The half life is 3.39 hours, so if you are dealing with a hypertensive crisis, I would imagine the severity of the HTN would begin to fade at that point. If you've got a patient hemorrhaging, BP should be cycling at very close intervals (every 1 minute in my hospital), so you should be able to catch it pretty quickly.
Either BAMC or Madigan would be good choices. Unless things have changed in the past few years, the ICU course is offered at BAMC (I know it was previously done at Madigan, though I'm not sure if this is still the case). You might consider looking into where the ICU course is located and see if you can get stationed at that base to further decrease logistics for you and your family.
Both hospitals are medcens, so they are going to be fairly similar in terms of experience available to you. Consider weather if you have a preference of hot and dry vs. foggy and wet or if you/your family has specific interests that pertain to either location (closer to a summertime beach in TX, lots of great hiking and scenery in WA).
Best of luck!
And suddenly, HR's Halloween costume contest as a morale-improving measure took an unseemly turn...
Nurse: "Maybe this goes without saying, but I think it's best for everyone if the angel helps Mr. Jones sign his surgical consents."
What quazar said. Putting the thick side up makes no sense. You want pressure on that lip to make it skidaddle so you can get to the baby-havin' part! The only time I might consider putting the thick side "up" is if I felt increased swelling in the lip with it down.
I was at WR-Bethesda a few years back. At least at that time, PACU was the place to be. It was a very well-run unit with decent hours. One of the nurses I trained ended up transferring to PACU and stayed there quite willingly until she was PCS'd.
I work in a pretty big facility (~2500 births per year) and it was only around when I was hired that we had an OB in-house 24/7 for the first time. Prior to that, trauma surgeons in the ER were on standby for anything emergent that walked through triage or went super south super fast on the unit. We did (and do) have in-house anesthesia.
Agree with all of the above. I would strongly emphasize continuing education, even on your own time. Take the time to review strips and read textbooks if you've got the availability. Keep up on new research and always, always, always honestly educate and advocate for your patient, even when that means disagreeing with the doc.
Your employer should be investing the time and money to get you certified in EFM, NRP, STABLE, etc. I wouldn't invest any money in anything at this point as that should be taken care of and you will end up paying out of pocket for what your employer should be paying for.
Personally, I'm a fan of L&D blogs. Even in some of the blogs that are purely anecdotal and not intended to "teach", you can learn a lot.
Tales from Labor & Delivery
Adventures of a Labor Nurse – The Highs and Lows of Labor and Delivery
Cervix With A Smile – Walk the floor with an L&D Nurse!
You and I might work in the same place. I am struggling with the same thoughts about what I enjoy vs. what's safe and prudent in terms of my license.
Honestly, I think most of the healthcare field struggles with that dynamic. Though some places are certainly better than others.
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