Latest Comments by SoldierNurse22

Latest Comments by SoldierNurse22

SoldierNurse22, BSN, RN, EMT-B 50,161 Views

Joined Mar 29, '10. Posts: 2,223 (67% Liked) Likes: 7,001

Sorted By Last Comment (Past 5 Years)
  • 0

    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.

  • 0

    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.

  • 0

    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!

  • 0

    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.

  • 0
  • 0

    Cervix With A Smile – Walk the floor with an L&D Nurse!
    Adventures of a Labor Nurse – The Highs and Lows of Labor and Delivery
    Tales from Labor & Delivery

    Those are my three favorite L&D nurse blogs. Some of them are written somewhat intermittently and one isn't active anymore, but overall, the info is good.
    Is your hospital giving you a decent orientation to your new cross-trained roles? L&D, PP & nursery is a LOT to take in all at once!

  • 2
    LibraSunCNM and quazar like this.

    Nope, nothing I've ever seen, even in cases of severe maternal disease prompting a medically-indicated IOL (if anything, our docs are more aggressive about cervical ripening in those populations so as to increase the likelihood of vaginal birth. I mean, why not do it right from the start--the OR isn't going anywhere!). Our multips have to have a Bishop of 6 just to get an elective IOL, primips have to have a Bishop of 8. Even then, our docs usually use cervical ripening if mom is less that 3cm/50%.

  • 1
    quazar likes this.

    Holy contaminated field, batman.

    I'm good with "gentle" c/s practice in a non-emergent setting, but this...looks like you're asking for an infection.

    The natural caesarean: a woman-centred technique
    Interesting article, but with very little evidence behind it as this is clearly a new practice. Please note that the above article does not address an increased risk of infection at all.

  • 0

    Quote from BB2bbs2016
    But L&D nurses, I believe, don't have to have ACLS and they would be responsible for mom first.
    Enlighten me...why would you think ACLS would be optional for L&D nurses? (I mean, if you're confused, follow me around for a shift, and maybe you'll understand why ACLS training is important on my unit!)

    As a point of clarification, L&D nurses are actually responsible for both mom and baby simultaneously, not one before the other. Therefore, we have one nurse present for mom and one present for baby at delivery, that way there are two of us should something happen where both patients require our attention (been there before, too).

    With regards to ACLS for NICU nurses, I can only see it if the nurses on that unit are cross-trained and expected to float to L&D, postpartum, a med-surg unit, etc.

  • 2
    quazar and RN_10 like this.

    It's certainly an art mixed with a science. Cervical exams take lots of practice. When I was a new L&D nurse, my preceptor would often check the patient, then have me check her. Within a few months, I was pretty confident.

    The Mystery That Is The Cervix – Cervix With A Smile

  • 0

    I prepared for all of those courses by working on the unit with actual patients under the guidance of a preceptor. I watched her interpret FHR, slowly started to do it myself with her help, and took the courses after several months in order to become independent in FHR interpretation.

    Really, I have no useful advice for you. The only way to help nurses become comfortable and familiar with interpreting FHR is to actually do it in a real-life setting. No amount of practice in a non-clinical setting was helpful to me. Perhaps some of the other L&D nurses here can be of assistance!

  • 4

    I can't believe we're still having this ridiculous discussion.

    OP, aspirating for the majority of meds given the IM route is not only no longer taught,but it is completely unfounded from a scientific perspective--it is NOT evidence-based practice. So whatever you think you're protecting your patients from by aspirating with every IM drug, STOP. It's in your head. (note the CDC, which indicates that vaccines given IM, should you hit a vessel, wouldn't actually be given inadvertently via IV as the vessels in the muscle would blow before you could inject an IM injection IV).

    Quote from Boog'sCRRN246
    Sorry, but if I was that patient, that would be that last IM injection you ever gave me.
    I was with Boog from the start. I just didn't realize how much until now.

  • 0

    Quote from nfeese
    See, that's what I would think also. Like a complete blockage of flow... in which case increasing moms BP and O2 isn't going to matter. Maybe once a nurse pushes on the presenting part to relieve compression, the O2 and bolus would help... idk
    Once you realize you have a prolapse, you would push baby's presenting part off the cord immediately. THEN you have someone else start the bolus and O2, in which case yes, increased SPO2 and blood volume will better perfuse and oxygenate the placenta, and by default, baby, via the relieved cord.

    Yes, it absolutely helps. That's why it's done!

  • 0

    Quote from mkk99
    2) I think you are confusing "prolapsed cord" with "cord occlusion."
    I generally agree with your post, but technically speaking, a prolapsed cord is occluded, often in a permanent sense, especially if baby's head is engaged in the maternal pelvis and the cord is between kiddo's head and mom.

  • 2
    BittyBabyGrower and nfeese like this.

    Quote from nfeese
    So, if it mirrors a CTX in respect to timing but appearance is rapid onset and recovery ud still call it a variable rather than an early?
    Correct.

    Also ATI suggests 8-10 L of O2 to mom for a prolapsed cord... um I hardly see the necessity. If moms o2 sat are fine, which I'd imagine they are, giving her excess O2 isn't going to help the baby or increase her sat level. It also suggests bolus fluids, and while this will raise moms BP, I'm not making a connection of how this will help the fetus. The kinked cord is still gonna be kinked and baby is still only gonna have some much flow toward the placenta to be oxygenated by mom. I mean u could raise moms bp 200 over 150 and if babys cord is kinked and only sending minimal rbc and flow to the placenta ur in the same mess?????? Please help I'm gonna scream
    I think you're missing one of the major interventions in a prolapse scenario: hold baby's presenting part off the cord! That means if you're the first one to discover the prolapse, you're going to have your hand in mom's vagina holding baby off that cord until some helpful surgeon lifts baby's presenting part off your cramping, sore fingers by way of C-section.

    So yes, bolus fluids and increasing O2 for mom makes nothing but sense in this scenario as you've likely got a very compromised soon-to-be-born fetus who will need the increase in mom's O2 sats and BP if he or she is going to live long enough to survive a prolapse.


close