question for OB nurses - page 2
I have been out of nursing school for quite some time, and I forgot what the four numbers stand for when you do para/gravida. Does that make sense? Hopefully you can help.... Read More
Nov 16, '02Hi Everyone. Another question for you experienced OB/GYN nurses. I am thinking about switching over to post partum/couplet care nursing. When I was in, I had a difficult time checking the uterus of women who were on the "fluffy" side. I was lucky if I located anything, it was buried so deep. I hate to dig and make them uncomfortable, but I have to see if they are contracting properly. Then you get the c-section on top of the "fluffiness" and you really don't want to dig. Any tips you would be willing to share? Oh, ever run into bicornate uterus on a patient and do any of you have any suggestions for a better way of assessing them? Thank you.
Nov 16, '02Well, w/the fluffy patients you just have to "dig" sometimes, unfortunately. The best way to find a fundus on a fluffy patient is to place your fingers directly below the belly button and press at an angle toward their pelvis. That usually works for me.
Also, for the pain thing w/post op, I explain WHY I'm doing it, give them two fingers (crossed over one another so she can't break 'em) to squeeze, and feel. Once I feel that little firm ball with even ONE fingertip, I stop.
I've gotten to the point that I barely have to touch now to find a fundus. It's not that hard once you get used to it, and if you teach your patients self fundal massage, it's much easier for them to massage themselves to express clots.
I make it a habit to teach my post op c/s patients self fundal massage in the recovery room while their spinal is still working. I explain to them how often the nurse will be checking it and WHY, and that if they can do it on their own it will be much better than a nurse massaging them.
Oh, btw, unless your pt. is bleeding or has funky vitals pp, don't freakin' massage her if she's firm. Leave her alone after you feel a firm uterus.
Nov 16, '02Agree with what Shay had written - sometimes you've gotta dig. I find it helps to place my othe hand, edgewise across the belly just above the pubic bone to support the uterus, then feel for the fundus. Kind of pushes it up there where you can feel it easier in fluffy pts. I find most women deal with it better when you have to massage if you acknowlege - yes, this hurts like h*ll, but less if you do it yourself.
Nov 17, '02I lay them as flat as they can tolerate, first. I have always started at the umbilicus, moved out and up or down.... and "dug" like stated above. I always explain what I am doing and it may seem like I am diggin a hole to China, but I have to reach the uterus to know its status. Then, I take the patient's hand and guide it there to the fundus, so she can feel what I FEEL. I teach her what a firm fundus should feel like...I teach what a boggy one is like ---"jello-y"
.....this is empowering to women to know their bodies and most are VERY open to such teaching. That and on the (hopefully) rare occasion, she may come across a disturbing finding to point out to us staff. Patients are partners in healthcare.......empowerment is key!