Originally posted by LINUS
Assessments just drive me crazy. I finally can count apical pulses on the baby, but counting their respirations is hard, especially when you have mom/dad/family/etc. trying to talk to you at the same time. I don't have any kids myself, so this is all new to me. I still don't know what I'm actually looking at when I check their incisions (perineal incisions). I know what a hemorrhoid looks like, but stitches? I know they have them, but I don't really see them. I feel like a fish out of water here.... Any helpful hints from anyone on doing assessments? The people here don't listen to lungs or bowel sounds ever! How do other hospitals check their patients?
LINUS, continue to do your med/surg ax as you've always done them if that makes you feel more comfortable. Just add a couple extra, like perineal ax- REEDA : redness, edema, ecchymosis, drainage, approximation. You won't actually see the stitches, you are ax for healing. Breast exams-soft, filling, engorged, any nipple problems- cracked, bleeding, inverted, flat, etc. I do listen to lung sounds on everyone and bowel sounds on CS pts, but if I have a vag delivery who's been eating since delivery, I usually skip BS. Also check homan's sign, bleeding, and fundus and I think you're set.
For resp ax on babes, I either listen with a stethoscope or place my hand on baby's chest and count. If you are really having trouble with your ax, just explain to the family that you are trying to count resp and you need to listen for just a minute. I'm sure they won't mind.
And rndiva, just as you acclimated to other areas, you will soon feel comfy in PP. And like someone else said, your cardiac experience is helpful. We had a CS pt the other day, with pressures in the 80's/30's, then 50's/20's. She had classic shock symptoms. We volume loaded (thank God for albumin) and they took her back to OR, where they removed 2000 cc of blood that had been oozing (doc's term) from the uterine incision. Thank God she didn't code. With that much blood in her abdomen, I don't know if we would have got her back.