Latest Comments by SoldierNurse22

Latest Comments by SoldierNurse22

SoldierNurse22, BSN, RN, EMT-B 48,471 Views

Joined Mar 29, '10. Posts: 2,217 (67% Liked) Likes: 6,994

Sorted By Last Comment (Past 5 Years)
  • 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.

  • 4

    As far as I'm aware, aspiration is no longer required/recommended due to an increase in pain and potential for tissue damage (AEB your patients), except in the case of specific medications (penicillin being one of them).

    So really, unless you're giving tons of IM PCN, the issue is that you're aspirating at all.

    Injection technique

    Aspiration prior to injection and slowly injecting medication are practices that have not been evaluated scientifically. Aspiration was originally recommended for safety reasons and injecting medication slowly was thought to decrease pain from sudden distension of muscle tissue. Although aspiration is advocated by some experts, and most nurses are taught to aspirate before injection, there is no evidence that this procedure is necessary. The ACIP’s General Recommendations on Immunization document states that aspiration is not required before administering a vaccine. There are no reports of any person being injured because of failure to aspirate. In addition, the veins and arteries within reach of a needle in the anatomic areas recommended for vaccination are too small to allow an intravenous push of vaccine without blowing out the vessel. A 2007 study from Canada compared infants’ pain response using slow injection, aspiration, and slow withdrawal with another group using rapid injection, no aspiration, and rapid withdrawal. Based on behavioral and visual pain scales, the group that received the vaccine rapidly without aspiration experienced less pain. No adverse events were reported with either injection technique.
    Pinkbook | Vaccine Administration | Epidemiology of Vaccine Preventable Diseases | CDC

    Also:
    http://www.stti.iupui.edu/pp07/vanco...0l.-f%2010.pdf
    Question: What is the current practice for giving an IM injection across the lifespan? Should the nurse aspirate the syringe?... | Academy of Medical-Surgical Nurses

  • 0

    What makes a variable decel a variable decel is how quickly the FHR drops and subsequently recovers. Variable decels are rapid drops in FHR (more than 15bpm in 15 seconds) that recover within 2 minutes of when they begin.

    On the other hand, early and late decels are both slower declines and returns in FHR and are defined as either early or late based on where they occur with respect to a contraction.

    Electronic Fetal Heart Monitoring
    Fetal Heart Monitoring: How to Make an L&D Nurse Run – Cervix With A Smile

  • 0

    You're correct. Usually, a prolapsed cord won't cause a variable decel, but a prolonged decel (one that never returns to baseline and in the case of prolapse, usually continues to decline). The only time in which I can ever recall seeing variable decels with a prolapse was (as I mentioned in my first post) when the head was not the presenting part. Baby's feet were on the cord.

    Variable decels may or may not be related to a contraction. They can happen at any time, but often, if you have decels happening with contractions, baby may have a cord wrapped somewhere or perhaps mom's position in bed, sitting up or walking is putting the cord in a position to get pinched with contractions.

  • 0

    I'll be upfront with you--I haven't written a careplan since nursing school.

    However, I can tell you that the GBS + status, 48-hour labor (I'm guessing the patient's water was also broken for an extended amount of time during said labor?), and history of chorio all are under the "r/t" section of your diagnosis.

    A few questions:

    1. In this scenario, is your mom already postpartum? Or is she currently laboring?

    2. Does your scenario tell you how long the pt's water was broken in the course of that 48 hours? Especially if it's a new mom, labors can be long. While the labor length is a concerning factor for chorio, it's more about how long mom's membranes have been ruptured, how many times she's been checked, and whether or not her GBS has been treated.

    3. Does mom have a history of chorio in this pregnancy or a previous one? I'm assuming it's this pregnancy since it was mentioned at all in your scenario.

    4. Your AEB portion should contain physical symptoms displayed by the infant, lab values, culture results, and vital signs. Does baby have a fever? Is baby tachycardic? Are baby's counts elevated or cultures positive? Is baby irritable, having difficulty feeding, or are baby's blood sugars off? All of those are potential signs of infection.

    Also, mom may have displayed signs of chorio during labor as well, which you could argue also belong under the AEB section, especially if baby is asymptomatic (which can happen). If mom had a fever during labor, tachycardia, purulent or foul-smelling amniotic fluid, a tender abdomen, etc, those also indicate an infection which presents a risk to baby.

    Good luck!

  • 0

    Yes, a contraction can cause variable decels. So can a wrapped cord (neck, body, or a variation thereof) or baby squeezing his or her cord.

    Typically, a prolapsed cord does not cause variable decels. It causes a decline in the FHR d/t an interruption of fetal perfusion, and if untreated, results in death.

    I can see an early prolapse potentially causing variables if baby's head isn't fully engaged in the maternal pelvis OR if baby's head isn't the presenting part. A contraction would push baby's head (or butt or feet) against the maternal pelvis and the pressure would somewhat relent when the contraction was over, but I wouldn't expect the FHR to return to baseline as in such a position, the pressure on the cord would never fully release. I would also think that such decels would be a very early and extremely short-lived phase of a rapid decline in FHR.

  • 9

    I know c/s patients at my hospital head over to PP with NS and pit running. However, I know most of our PP nurses take the NS down when the patient has shown that they are tolerating PO fluids/solids (usually about an hour or so after). We do maintain IV access for a certain number of hours after delivery, but it is saline locked and removed as fast as safely possible, as per our protocol.

    Pitocin, both intrapartum and postpartum, can cause water retention that can lead to swelling and breast engorgement and may interfere with mom's function and breastfeeding in the postpartum stage. Personally, I'd have no problem stopping the NS and maintaining a saline lock as long as mom is tolerating PO.


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