need help with exams
i just started l&d 7 weeks ago after nursing in many other areas over the past 13 years. i am having trouble doing sve's and knowing what i am feeling. after about 50% effacement and/or 3 cm it gets puzzling. there is virtually no rim to use as reference. if anyone has any tips on exams and how to interpret, i would greatly appreciate it. this is a bit embarrassing but it is more so when the doctor asks the progression and i can't be certain. it can also get me and the pt in a tight spot with a precipitous delivery.
thank you ever so much!
veteran nurse in despair
Aug 15, '01
This story will make you realize we all made our mistakes w/ exams...I worked L/D and had a doc that scared the s--t out of me. He would admit his pt. and tell you not to call him until the baby was crowning. He would go off to the bar (I'm serious) and come strolling in just in time to catch. I was new to L/D and had his pt. who felt like she had to push. I checked her and felt all head at plus 2 station 100% effaced, fully dilated. I panicked, called him, and when he got there he wasn't happy. He went in the room, checked her, came out and pointed at me, and said if I ever call him again for a pt. who was a fingertip dilated again, he would kill me. I almost died, thank God he liked me. it seems she was 100% effaced and plus 2, but the cervical opening was so posterier that all I did feel was head. I had to reach WAY back to get into the OS and it was a tight fingertip. The cervix was paper thin all around the head. Thankfully she was a multip and she did go fast, but those exams can fool you, it was a good lesson and I never made that mistake again. Good Luck, after awhile you'll be able to do vag. exams in your sleep! ( and some nights it felt like I was!!)
Aug 15, '01
Don't worry, you'll get it. I always keep the dilatation board in full view so I can look at it to get an idea what I am feeling. I agree that it is very subjective from one nurse to another what they estimate the effacement to be.
Everyone always thinks that vag exams are easy, but sometimes it feels just like a bowl of mush. Add to that a tense pt who won't keep her legs apart and you've got a prescription for the wrong dilatation and effacement.
Hang in there!!!!
Aug 15, '01
I agree with all the posters. It just take practice. One of my most embarassing VE's was on a patient I THOUGHT was a fingertip dilated.........she really was 8cms with a frank breech!!!!!
Hang in there...it will get better!
Sep 5, '01
Kday you're so crazy! One of our attendings tells the story of the intern who came rushing in the call room saying, I've killed the baby, I just put the IUPC in the fontanel!! Well, you can guess that IUPC had a little meconium on it as well. Bet that baby had a vagal response!!
I agree, the only way to learn to check is to do it, do it, do it!!
Sep 5, '01
I've also gotten a doc out of bed for a fully dilated pt who turned out to be only a fingertip.
Luckily I got another RN to check behind me as the pt was unbelieveably calm and painfree, and she felt the same thing. Doc made fun of us for the rest of the shift.
Oct 8, '01
Thank you ever so much for all your advice. I'm doing better but have had some embarrassing moments myself since I posted this thread. One I thought the pt was 10 with a posterior rim---it was the baby's EYEBROW!!!! LOL Doc came in just in time to catch! I'm having a blast! The doc's are even requesting me over nurses that have been there longer than me! I'm also learning to love newborn nursery. Although my NRP cert date was 9/11/01 and interupted by dispairing news. Had a difficult time concentrating after one of the instructor's got called out d/t her parents being in NYC headed for WTC at that very moment. Luckily they are fine. They rode by WTC moments before it occurred and had to return to hotel for the guide who-thank God- was running late! They wound up 5 blocks away when it happened. Anyway, back to the subject-... Thanks for all your help and encouragement. I've come a long way in just 3 months! I have also taken on the depressing task of bereavement nurse, so keep me in your prayers and thoughts!
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