How often would you have monitored this pt?

  1. Hey y'all, just started a job at a hospital new to me after working 7+ yrs in ob at another. All places are different, I am sure, but just wanted some input. Here they seem to do minimal fetal monitoring, which I can see for early labor/low risk pts. Recently I had a 39wk on MgSo4 and labetolol for preeclampsia, having irreg contractions, dilated to 2cm. Baby's LTV+, occ mild var decel, few accels. The nurse orienting me said I could leave her off the monitor, just get fhts with vs- which were ordered q2hr but I was getting qhr.

    Second case a GI, term 38yr old came in with srom, early labor, mec in fluid, PIH, breech and low platelet count (so low she received two bags of platelets this am before she could go to surgery). She intermittantly monitored her, wasn't my pt, didn't see the strip.

    She said the pts did not need to be continually monitored b/c they were not "high risk".

    What do you think? I guess I should've asked her what warrants continuous fetal monitoring here.
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  2. 22 Comments

  3. by   parker in arkie
    IF you are going to do continuous EFM, will someone sit and watch the strip throughout the entire labor? If not, why tie the mother up with the monitor? In my labors, the only thing the monitor did was stress me and hurt and distract me during contractions.


    NOT A NURSE....please don't take offense.....just asking.
  4. by   SmilingBluEyes
    These to me, are clearly cases where closer monitoring was DEFINATELY WARRANTED....both quite HIGH risk situations.

    Parkie, as a patient, I can certainly understand where you are coming from. Being stuck on a fetal heart monitor is VERY uncomfortable and confining. It can make anyone crazy. However, You need to understand these two moms were HIGH risk moms... A woman ON MAGNESIUM SULFATE, blood pressure being labile, few indications of fetal wellbeing (accelerations) /platelet problems (TWO BAGS OF PLATELETS???!!!)-----DEFINATELY CAN IMPACT THE FETUS IN NEGATIVE ways that MUST BE WATCHED CLOSELY. These WERE NOT LOW RISK SITUATIONS at all.

    Moz did you consult your MAG PROTOCOLS???? I am sure they call for close monitoring when a woman is in labor and on MGSO4....Anyhow, For more info about defining risk and monitoring and nursing responsilbities, one need only consult with AWHONN standards, since these are the standards we are held to as OB nurses in a hospital (high acuity) setting.

    Also, you can always check with care provider orders. THEY usually are QUITE clear on what type of monitoring they expect. Did you check the orders or with them? Maybe I am an alarmist, but I would have continuous monitoring in BOTH the above situations. I am just NEVER blase when it comes to OB, period.
  5. by   parker in arkie
    oh i do understand that these were high risk...my question is who "monitors the monitors" ? and these are the exception.
  6. by   mother/babyRN
    Definitely high risk, and just because a certain hospital or doctor doesn't follow adequate designated guidelines doesn't excuse them, the nurses or the facility. If on the monitor, I would document every half hour. What wasn't documented wasn't done, after all...As a PIH toxemia complete previa who nearly lost a baby and my life due to the fact that "we really don't have to watch things aggressively", I would do what my gut and current guidelines state..The real difficulty here as I see it, is the fact that the staff considers the patients you described, as low risk...Where the heck were they educated...I would like to caution people to avoid whoever taught them this ridiculous idea...
  7. by   mother/babyRN
    Parker, when a patient is monitored, we DO watch the strip the entire time someone is in labor, and are required to document variability and vs q 1/2 hour, low OR high risk. We have the luxury of central monitoring, but no free person to "sit" there....If a high risk pt is not in labor but is there admitted or a labor check, she will and should definitely be on the monitor, at least every half hour minimally....
  8. by   parker in arkie
    mother/babyRN

    thanks for clearing up a misconception. :-)
  9. by   SmilingBluEyes
    WE MONITOR THE MONITORS, PARKER! AS nurses/doctors, we are HELD to that STANDARD...if a patient is on continuous monitoring, WE MONITOR THEM CONSTANTLY. I would think this would be clear. Those AWHONN standards I mentioned, are there for a reason. They GOVERN what we do with different risk situations and quite specifically. Failing that standard, we are WIDE open to accusations of malpractice. It is UNIVERSAL USA-WIDE and there are no loopholes for us to jump through. (not that we would wish to)..... But, I see--- Apparently, your experiences are otherwise???
    Last edit by SmilingBluEyes on Dec 27, '02
  10. by   HazeK
    Originally posted by moz
    ... MgSo4 and labetolol for preeclampsia... few accels.
    .........38yr old...mec in fluid, PIH, breech and low platelet count (so low she received two bags of platelets this am before she could go to surgery). ...
    both patients would qualify as high risk here in Las Vegas....
    requiring CONTINUOUS fetal monitoring!


    "She said the pts did not need to be continually monitored b/c they were not "high risk".

    Wow! IF Mag, labetolol, PIH, mec, breech, low platelets aren't high risk, I'd love to know what "SHE" this would qualify as high risk? Her own daughter??

    Haze
  11. by   RNMom1969
    At our hospital, both situations would be considered high risk, warranting continuous EFM. Even if Dr had ordered intermittent, I would consult your standards first. I believe ours states that a pt recieving mag must be on continuous......will have to check to be sure.
    As far as who is monitoring the monitors? Well, WE are.....but also, the ANM has the screens in front of her at all times as well, guess that's our "safety net". SOMEONE is always watching! Kinda creepy if you think about it! lol
    Joyce
  12. by   moz
    Hey, thanks...my gut did say to monitor her continuously, so I did. I will read the mag policy next time I work and see what it says about monitoring, the dr didn't specifically order it, just vs/reflexes q2hr. I feel better now, I didn't think I was overreacting...where I came from we would have continually monitored in those cases.
  13. by   SmilingBluEyes
    listen to gut reactions...sometimes they save your a$$ in nursing, believe me.
  14. by   shay
    The others said it well. If they were mine, I'd have either hooked them up to the monitors or if the doc demanded the monitor be removed, I'd have him write it as an order AND document EXACTLY what he said as his "order" in my nurse's notes. Holy crap. Those patients were high risk in anyone's book. I'd get outta that hospital. You're going to end up in court.

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