pregnancy,labor ,delivery and postpartum with cardiac patient

  1. I just been notified that I have been request to work monday to do C/S on 22 yr old primagravida with cardiac condition recent MI and HX CHF,pt also has family history of congenital cardiac problems. I got the feeling this can get real interesting to say the least. to me this is a much higher risk case than we usually see here. I was told that is why they called me in for it. being I have the most critical care ,ICU and high risk OB experience here.

    needless to say I am a little concerned about this one. what are your thoughts and reccomendations on this scenario.
    Last edit by mark_LD_RN on Jan 5, '03
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  2. 22 Comments

  3. by   KELLYGIRL
    YIKES!!! SOUNDS LIKE THEY CHOSE THE RIGHT GUY!!! HOPEFULLY EVERYTHING WILL GO JUST FINE.....I'LL KEEP MY FINGERS CROSSED FOR YOU AND THE PATIENT....AND THAT BABY!
    GOOD LUCK!!

    KELLYGIRL
  4. by   mark_LD_RN
    thanks KELLY
  5. by   mother/babyRN
    The patient trusts you and wants you to be with her. What a great affirmation of your skills and rapport with patients. If something untoward happens, you and I am sure, due to the high risk status of the patient, many others, will be there to intervene. If nothing bad occurs, then this patient will have only wonderful memories of both her experience and the specific nurse she chose to share in it.....
  6. by   SmilingBluEyes
    sounds as if they found their man. you ARE going to do it, right? was there any doubt? (grin)
  7. by   mark_LD_RN
    of course i am going to do it. you know me I don't know how to say no. i hope it goes well. will let you know how it goes.
  8. by   hoolahan
    Maybe you should suggest non should go to ICU post-op? Not ideal, but what happens after you go home? Is there another OB nurse w critical care expereince to take over?

    I would do everything you always do but also do frequent heart/lung sounds assessments, unless you already do that in OB, I don't remember anyone doing it to me in PP, and that is the extent of my experience w OB/GYN...my own! Maybe nom shoud stay on a cardiac monitor aqnd pulse ox if not to ICU PP. Be sure to teach her what to call you for, SOB, palps, edema, etc.... I don't know how long the fluid shifts go on PP, or when cardiac output is expected to return to normal or the circ blood volumes decreases. I would say mom warrants further monitoring until that period passes.

    Please post Mark, this is an interesting case, and they are already off to a great start w such a conscientious, intelligent, and caring nurse!!!
  9. by   mark_LD_RN
    hoolahan-- we discussed sending her to ICU after. but so far this is the plan i suggested and we decided to go with, she will have general anesthesia to avoid excess fluids r/t epidural. i arranged for remote telemetry monitoring from ICU. I plan on staying in house until she is discharged.which so far is planned for 3-4 days depending on circumstances. I will work my shift and then just take call and sleep in call room. also ICU is aware of the case and agreed to offer anyhelp we may need. I just get the feeling this is going to turn into more than we are thinking it is. I hope not but will have to wait and see. I want mom and baby to do well, and i want her to have a good experience. since this will be her one and only baby.
  10. by   Cheerio
    I'll be thinking of you today, Mark. I hope all goes well.
  11. by   mark_LD_RN
    hi everyone just aq little update for you. everyone is doing ok at the moment, mom tolerated section well, but in recovery her bp dropped , decreased cardiac output she is on dobutamine and neosynephrine at the moment, we are currently weaning her down of the meds. baby is ok has irregular hrt rate which cardiologist thinks will resolve it self. well I am going to get some sleep ICU nurse is here for a while to take over. will let you know some more tommorrow, kinda tired at the moment
  12. by   mark_LD_RN
    pt is doing well, she is off cardiac meds,is now heplocked and actually got out of bed and walked a little this evening. looks like they are going to be fine. I am still staying around until they leave just can not seem to rest well while away. there i go again with the being to attached thing. oh well i will work on that some more later
  13. by   illeniccup
    Mark--I am new here, not even a nurse (yet!), but just wanted to say what a great nurse you must be! Even having had four babies of my own, I never experienced a male L & D nurse--I have always wondered how it would work out (just for the "empathy" aspect--the nurses I had were key in my experience)--now I guess I have my answer! Glad everything went well for you and mother and baby! :angel2:
  14. by   hoolahan
    Really Mark, they should nominate you nurse of the year for this!!!

    Glad they are doing better. Sorry I didn't see the update posts sooner.

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