Quote from ShannonC
Hey fellow nurses! This is my first post here. I'm excited to be part of this community.
I'm wanting feedback about a case I had tonight. My patient was a primip, came in with SROM, and her VE was 5cms. Another nurse had admitted her, and I received her as a patient at 0315, just as she was getting her IV. I collected the chart and set out to take care of her. I saw no prenatals, so I got them out of the drawer, at which time I saw she was GBS +. I called the dr. to get orders for ampicillin. It was about 0335. About 5 minutes later, she called me and told me she wanted her epidural. I called anesthesia and then went to go get my ampicillin. Not 3 mins later, she called me again to say she had an urge to push. I hadn't had time to mix my ampicillin yet. I checked and she was complete, and +2 station. We cancelled the epidural and told the doctor to come in. I pushed with her for 1/2 hour and the doctor arrived. Since I knew delivery was immenent (she was pushing wonderfully) I didn't give the ampicillin. When the doctor arrived, at 0420, I told him this, and he was upset and told me to give it anyway. So, whatever... I did. She delivered at 0435.
I find this so wasteful. The research shows (so I thought) that you need AT LEAST 2 hours before delivery for the ampicillin to benefit the baby, and more likely, 4 hours.
Is this what you guys know to be true, too? What are you thoughts? What would you have done?
Thanks in advance for your thoughts!
I know this is not an answer, but you have me wondering why you don't have standing orders
for all GBS positive patients first off. We never have to call for orders for GBS + cases, and these charts are flagged in our prenatal file with a bright fushia colored sheet saying " THIS PATIENT TESTED GBS POSITIVE" and the standing order for GBS protocol follows, as a physician order, signed by the doctor.
In the case where GBS status is unknown or the patient is "no-doc" the protocol is automatically put in place and patient treated. Having this protocol in place, you waste much less time. If I am busy starting IV and getting consents, I ask another nurse to mix and label(and if she has time, give) the ampicillin for me. This saves even more time. It would have helped in the case you present here. Now back to your question......
Yes, you are right; it probably did not
have a very beneficial effect in the time table you present here. It takes a good hour or more for the medicine to circulate mom, and cross the placenta for it to completely
benefit the fetus. But in any case, our doctors would have us do the same; pushing the AMP even at the 11th hour
, in hopes some beneficial tx would be achieved. In the case where less then 2 doses are given ( 4 hour apart), we MUST keep the baby for no less than 48-72 hours for observation. ANY symptomology (temp changes, poor sugars out of range, etc.) and we proceed to r/o sepsis protocol without a moment's hesitation. ( blood counts are monitored, baby goes on antibiotics and is under close observation). Hopefully you are observing this baby for signs/symptoms of GBS infection anyway......
I hope this helps. You must not hesitate to treat as soon as you are aware a patient is GBS positive,
even in the later stages of labor. You can't go wrong doing that. Yes, at the late hour, it may not have been too beneficial, but not to treat at all looks MUCH worse, particularly in a court case. If you have no comprehensive standing protocol for GBS prophylaxis, (including alternate tx for moms allergic to -cillins), then please ask the manager to work on that ASAP; you need it.