Some of you may remember my post from back in november. Well i made the plunge after being a med/surg/tele/icu nurse for approx. 9 years. I'm currently working post partum and just about loving most of the nights that I'm working. After just a very short orientation, I was thrust into my night/CHARGE position. But a few hemorrhages and PIH's later I'm still alive and so are my patients!!! Of course all my days/nights on orientation we had very slow days and not very much going on but it has been absolutely CRAZY ever since. sometimes getting 4-5 new moms during a 12 hour shift and along with those of course a few bleeders etc etc. Our unit is a 15 bed unit with gyn surgeries as well. Anyone else out there get a lot of problems wtih their gyn surgeries post op? I've taken care of a few now (remember i started working in november) that have low bp/s (70-90's systolic)and low uop that the docs just give iv boluses (ns/LR) or "just watch". which makes me nervous of course as a previous ICU nurse. And a few that have developed MI's and Pulmonary edema post op. Seems to me they would correct some of these womens low h/h's preoperatively? What sorts of advice do y'all give your new moms with babies that seem unsatisfied with just colostrum and are keeping mom awake all night? The nursery nurses here have been telling me to cup the baby wtih sugar water - but as of my first breastfeeding class last night they are looking to get more strict with their policy re: sugar water. Also- how soon do y'all get your moms out of bed after sections? I'm a bit more liery of getting them up at night after having a 250lb+ woman almost go out on me in the bathroom. Also I've been trying to find literature regarding epidurals- particularly having a few moms with numbness/tingling several hours post epidural. Should i be concerned or is it related to the amount of epidural they used during labor/delivery?
thanks again for any/all information y'all can offer
Jan 27, '01
Boy can I relate to you--All of my charge orientations have been uneventful but the very shift I fly by myself--What a nightmare!! Why is this? Anyways, in answer to some of your questions, Always expect your multiparas and teenage moms to hemorrhage; always expect redheads, nurses and doctors (pts, I mean) to pp hemorrhage and/or go into DIC; (ask any OB nurse--its a proven theory!!) and if an OB or LDR nurse delivers, you might as well have the pp hem. box in her room (haha). Always expect GYN's to be hypotensive--remember, gyn surgery is brutal and the uterus is so close to various vasculatures; The cure? feet up, run in a quick bolus; As far as poor uop, our docs watch, if pt is young, they will turn the corner in about 24 hrs; And a lot of GYN and sometimes even OB's develop PE's so watch for s/s--you'll be suprised how often you'll see this; As to the Breast feeding issue--check with your hospital's lactation consultant as to what you should do but ultimately it is the mom's choice to supplement, but should use formula not sugar water. I'll only give sips of sugar h2o to a baby w/ hiccups. The c/s issue-our hospital is a little archaic as we let them be for 12-24 hrs; most moms are raring to go after 4 hrs--esp. the smokers. If they are tingling after their epidural alot of times its because a nerve was hit; usually goes away. Good luck with charge (I, too am a new charge nurse on both OB and GYN/Medical) and I know how things can go from quiet to dissaterous in a matter of seconds. Our unit is 32 bed OB and 20 bed GYN. Bye!
Jan 27, '01
I found your post really interesting, timonrn. Do PE's really occur frequently in the postpartum area? I am probably going to be starting out in postpartum and am curious as to if this is rarely seen or not? Any other advice would be appreciated as well. Thanks!! Shannon
"The highest reward for man's toil is not what he gets for it, but what he becomes by it."-Johan Ruskin
Jan 29, '01
ShannonB25--OB's are at high risk for PE's--I have never seen a full blown PE on my unit (knock on wood) but we are always cognisant of the possibility. We do see an awful lot of DVTs in the lower extrems, esp. in late pregnancy, but does often show up in post-delivery. We treat DVTs almost once a week on post GYN surgicals, post delivery pts and ante partum pts. who have come back weeks later with s/s. So keep a mindful watch--I in fact sent a pt home with o2 sats of 86% post-surgical (GYN) who the MD blew off as "a pulmonary problem to look at next week"--his progress note exactely--And I think she prob was working on a PE but all the doc would do was order home oxygen and see her in two days!! I still worry about her--I bet we see her back. She was not a smoker and there was no rhyme or reason for her s/s but she was worked up appropriately, so--what to do?
Jan 30, '01
Thanks everyone for your responses. Timonrn- how do you all usually staff for your 32 bed ob and your gyn/medical floor? Just curious to see how different places run things. We are a 15 bed unit and at night we'll have one nurse for up toe 5-7 pts on his/her own (depending on the supervisor for the night i suppose), 2 nurses for up to 12 pts and sometimes to a full house. evenings we usually have a third nurse (lpn) which is a great help. As for the redhead/nurse bleeders i can certainly attest to that fact!!! red heads definetely and nurses i'd say yah only cuz i had my first one last week who also happened to be a L&D nurse to boot.
Jan 31, '01
We staff a 32 bed OB unit plus a 20 bed GYN unit (I call it GYN/Medical becuz we get everything female lately--not what this unit was intended for, of course, as we are not equipted for Medical pts beyond the basic stuff) plus our nursery--so most of our staff including the HUC's rotate weekly or as needed to each place. Our GYN unit happens to be one floor up. Anyways staffing ratio is OB--4-5 moms/babies on days, 5-6 on PM's and 6-8 on noc's; GYN is 4 on days, 5 on PM's, 6-8 on nocs; Antes is 3-4 depending on if on MGSO4 protocal or not. Nursery is 12:1 w/ an NA. However I'm sure you can read between the lines that we usually don't have it this good due to Nursing shortage. I am told by travelers and outside pools that our hospital has the worst staffing ratios in the Twin Cities!! I can sure attest to that. Why? becuz our administration is holding onto an archaic version of a staffing grid that we are trying to revise as we speak. We all know that patient acuity is higher than in the "olden days."
Mar 1, '01
You might want to get copies of the guidelines for staffing from AWHONN which were developed by the AAP and ACOG for the actual increased acuity and increasingly "sue happy" clientele of the pt. population you serve.
Just a thought...
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