I am very new in all senses of the word and shadowed a obgyn nurse 3 weeks ago and ! and am very confused on the turn of events and am searching for some sense to a delivery I witnessed, if anyone could tell me if this is normal I would appreciate it. It just feels wrong to me somehow, but what do I know- not much .. yet!
induction- given prepidil one dose was just at 0 cm, proceeded to give 2nd prepidil dose. Patient complained of not feeling well, lots of pain. nurse checkd and she was already at 4 cm in just about maybe 4 hours? called md who said keep me updated etc. I think that was about 12 am or so.
in the meantime the patient was supposed to be sleeping on a ambien and scheduled to start the pit at about 7am the next morning.
I followed my nurse to do other patient assesments, she had a break (I think , I was told to look at charts am pretty sure she had her break) etc.
during this time- the husband of the mom in labor looked for a nurse at the station two times he said and found no one, apparently the mom was in serious pain (was 3rd delivery so seasoned mom) , the main nurse came in as I followed her and she said "oh crap" , runs to the mom and checks and says "your at 8cm"
etc.
the delivery happened in what seemed minutes, the dr raced in at 3 am, the fetal heart rate started to decrease and resuc. was used, lady partsl birth happened luckily very quickly...the placenta was starting to detach at this point (I am assuming its because of the onslaught of contractions?)
The child was born with suspected sepsis and sent to nicu (the bag of water didnt even break yet until before pushing). I learned the child was in nicu for a few weeks waiting for lungs to clear up and fuild drain etc.
my question is that is this hyperstimulation? should the nurse I was shadowing watched the patient a bit closer and realized she was going very quickly from just a ripening agent? could the nicu stay have been avoided if labor slowed (or could it have been?)
just trying to understand what happened. I asked questions but everthing happened so quickly and I was back to looking at charts and etc and nurse got off shift etc.
I can only speak for me personally....Unless I am in the bathroom, I always have my eyes on the monitor. I do go in my patients room to chart q 30 min, if my patient is high risk and requires q15 min charting I will chart for 15 and 30 after the hour in one sitting and 45-00 on the second half hour, if that makes sense. Obviously, if my patients call out or I see something on the strip that requires my immediate attention/intervention I am in the room. We do have the capability to chart on the strip at the nurses station, but I don't. For one reason the screen refreshes too quickly on the charting system we use. Second, I like to lay eyes on my patient. I work on a much smaller unit now and typically only have one laboring patient all shift and there is no reason for me NOT to be in there q 30 min. HTH
You certainly can chart while sitting at the desk, but you are being PAID to take CARE of the patient. Charting is only one part of your job. While you are responsible to evaluate the FH and uterine activity, you should also be assessing how well your your patient is dealing with pain and labor and actually providing care while in labor. There is really no reason why you cannot be in the room with your patient routinely. As in this case, the family had to find someone because attention was needed.
While central monitoring is beneficial from a safety standpoint, it should never replace patient care and assessment.
I agree I was in OB before central monitoring and still cannot stay out ofthe room I like central because I cansee all strips and I cover for others bathroom runs ect... but I like to see the real mstrip no matter how good ,cler or big the central screen is Many like document at the desk too much you need toget up and foin at least q20-30 and YES hypertension does put a whole new spin on this
OMG...can you believe we ever did anything WITHOUT central monitoring? You could be in the middle of something and stop and hear a decel from down the hall, that is how in tune you got with the monitors before central monitoring. Newer nurses have a cow when the system goes down briefly....it is a hoot. Soon we will all look back on narrative notes and feel the same way because of EMR.
not to be completely idiotic, but- if you have central monitoring cant you just monitor every 15 minutes remotely vs in person? am truly asking in such lazy/simple terms just to understand the scope of basic care if that makes sense!
When you have central monitoring, you are watching it all the time you are not in your patient's room. BUT you need to be in your patient's room frequently. If you don't have internal monitoring, the only way you can tell how strong the contractions are is to touch your patient and feel their strength with your hand. You have to see how your patient is dealing with the contractions, help her with dealing with the contractions by coaching her with breathing and teaching her SO how to help her. Seeing if she wants pain medicine or an epidural.
Even if she is supposed to be sleeping you have to at least look in the room and make sure she's still breathing. It's not the best thing to find out you patient is in active labor by someone else telling you she is 8cm. It's best to find out for yourself by observing her yourself.
PIH increases the chances of an abruption. But you probably couldn't tell from the monitor just when the abruption started. Often when you in the room touching your patient, you can feel the contractions become unusually hard and the uterus doesn't relax well between contractions. Often there is lady partsl bleeding. More reasons to be in the room interacting with the patient personally. But these signs are not always present.
Obstetrics has lots of law suits; everyone expects a perfect outcome and if it is less than perfect the American way of thinking is that someone must be to blame. This is not the case, but it is the way the general population views life. (See all the lawyer ads on TV). For a case to have any merit, a person has to have a duty to another person. ( A nurse has a duty to give safe, reasonable appropriate care to her patients). That duty must be breached. There must be harm. And that harm has to have been caused by the breech of duty. That last one is mostly what the trial is all about. Did this damage happen because of something that was or was not done or was done incorrectly? Or was it caused by something else and would have happened anyway?
LDRNMOMMY, BSN, RN
327 Posts
I can only speak for me personally....Unless I am in the bathroom, I always have my eyes on the monitor. I do go in my patients room to chart q 30 min, if my patient is high risk and requires q15 min charting I will chart for 15 and 30 after the hour in one sitting and 45-00 on the second half hour, if that makes sense. Obviously, if my patients call out or I see something on the strip that requires my immediate attention/intervention I am in the room. We do have the capability to chart on the strip at the nurses station, but I don't. For one reason the screen refreshes too quickly on the charting system we use. Second, I like to lay eyes on my patient. I work on a much smaller unit now and typically only have one laboring patient all shift and there is no reason for me NOT to be in there q 30 min. HTH