What to do to prepare for PP practicum?

RunBabyRN · Oct 7, 2014

I precepted in PP as well. There have been a few threads posted in here with advice, and I've responded to them at length, so do a little digging, and you'll see some good threads.

I used a brain sheet that got printed out there. I found a method that worked well for me using that and a multi-colored pen.

Review NB VS normal values, PP normal lab values for mom (remember that the CBC will be different than a non-pregnant, non-PP woman!), newborn care, feeding, breastfeeding, circ care, perhaps what Coombs + means, ask about the c-section recovery procedures for mom and baby, what the protocols are for assessments, VS, etc upon admission to PP, corificeat safety (though on nights you probably won't have a lot of DCs)... PP is A LOT of teaching and understanding family dynamics. Lots of myth debunking, especially r/t BFing (like the mom I had who was CONVINCED that lanolin is a carcinogen). Also think about considerations r/t fetal demise or having a baby in the NICU or with anomalies, or a birth that didn't go according to plan. Think about signs of potential depression, psych issues, bonding issues.

You're right, there's no "typical" shift. In PP, you have visitors at all hours, very often. Lots of high-running emotions, so those can be good and bad. Again, lots of teaching, assessments, Is & Os, that sort of thing.

I'm a L&D junkie, too, but I really enjoyed PP. Plus, most hospitals are more likely to hire a new grad into PP than into L&D.

allycat77, BSN, RN · Oct 7, 2014

Thank you, I will definitely search for your posts. I have been looking at the competencies for the Mom-Baby unit at the hospital I work at as well. Thanks for the advice!

RunBabyRN · Oct 7, 2014

When you get on the unit, ask if they have a binder with P&P and with protocols. Someone put one together on the unit where I did my preceptorship, and it was great to have the glucose protocol, hemorrhage, etc all in one place.

Oh, also review FLACC scores.

MSNce1 · Oct 11, 2014

I worked mother-baby many years and loved it. Like Silver1 said there are protocols to follow which I believe you will learn quickly. Look at a U tube ahead of time on feeling a fundus though hands on is more effective learning but you will at least have some familiarity. Does you school have the latest OB manikin model 'Victoria'. It is amazing how the simm experience can help you. Remember you will sometimes see a lot of blood and clots- just stay with client and stay calm massaging that top of the uterus (the fundus) till bleeding reduced and the fundus will usually firm up. I would not get someone up to the BR with heavy bleeding rather have someone bring you a cath kit if mom's bladder is pushing her uterus up and way off to the side and the uterus does not firm up and she is unable to void. A full bladder makes the uterus displaced up or off to the side and boggy (soft). You may pull the nurse call chord out of the wall at the bedside it will many times emit an emergency response sound so you will get assistance sooner, or you can call your preceptor from the bedside.

The BUBBLE acronym for assessment is the check Breasts (for nipple inversion or flat and s/s of redness &/or excess warmth of the breast tissue or firmness and while examining the upper front body you can listen to lung sounds; Umbilicus (to note where the top of the uterus is at in relation to the belly button area-above it, to the side or a horizontal finger width below-Bowel sounds, softness and if BM occurred or problems having one; Bladder-should not be but is it soft and spongy and distended? (try waiting to go to the bathroom to urinate and check how your supra-pubic area feels) and ask if any UTI s/s and of course if there is a C-section incision in this area check if intact and with or w/o signs of redness &/or induration; lochia (lady partsl discharge/bleeding if it is bright (Rubra)or dark red, mixed with serous clear fluid (serosa) and are Kotex type pads being soaked through in an hour ( not good) or less, plus are there any clots especially > the size of a plum); and last Episiotomy- check after they have just used their peri wash bottle-is it real red looking, intact or open or very bruised (nursing action through your preceptor to let the doctor know)? There is another addition to this acronym with the letters HE standing for Homans- check for clots in the calves- but latest evidenced based practice says not to do anymore as if there is a clot the nurse would possibly be dislodging it so instead check for hemorrhoids which look like pink to skin colored lima beans, and The 'E' here stands for emotional welfare as (if mom is unable to take care of herself unless post C-section day 0 or 1 this can be more than the baby blues setting in) Silver 1 had mentioned. So nursing care would involve documentation, possible need for teaching like the need to keep incision areas clean and how or use of nipple protrusion aides, and giving pain &/or healing meds such as Motrin or Epifoam for perineum) or Pitocin ( to manage PP bleeding) in IVF. The first time or two OOB your fresh C-section will need your assistance and of course and maybe help with care of the baby. Since lactation consultants are not usually available at night the BF mom may need help getting the baby latched on properly. There will also be a newborn assessment and care you will learn about. This is a lot of what you will do or be supervised doing but not all. You will learn it quicker than you think and many things will become routine so enjoy it over an acute med-surg setting:0