In the pitocin thread, a suggestion was made about starting a thread about dangerous first year lessons learned. Personally, I shudder at the fact that there is no way I can know everything before I am on my own on the floor. I hate that some patients will be at my mercy as an inexperienced new nurse, and I am seeking all information possible in the interest of my patients' safety. So this is a very loud, desperate plea for all of you experienced OB nurses out there to contribute and share about scary situations that taught you valuable lessons.
Here are my two valuable lesson learned thus far:
1) NEVER TAKE SHORT-CUTS. Chances are, you will miss something, and it will be something big.
2) Suck it up and drink some coffee when you are tired and feeling lazy. These are the days that some crazy stuff happens, and your pts are depending on you.
To anyone and everyone: please contribute, no matter how small or insignificant you may think your words are!!!!!
We always just say someone is "magged out". And yes, SBE I know that lab work or any diagnostic testing of any kind is not a replacement for pt assessment.
When I started on a very busy med/surg unit, my preceptor taught me a very valuable lesson that I use to this day. She told me when you feel the most rushed and busy, like you can't slow down for a second, that is when it should be a warning signal in your head to double and triple check everything.
Twenty five years later, I had the most horrific labor day, ran out of beds, putting patients in every nook and cranny and I am in charge with two patients. I was going to give one patient pain meds and the warning bell started ringing in my head because I felt soooooo rushed. I was just covering for another nurse and didn't know the patient so I slowed myself down and triple checked that medication and made sure I checked her allergies. Sure enough she was allergic to the med that was ordered and it was missed previously.
Tx the pt not the machines. (Did my 1st yr in cardiac)
-Check your pt before you call a code if you see Vtach on the monitor screen, they might just be brushing their teeth :)
[happens all the time]
-Someone in flash pulmonary edema, barely moving air, can have an O2 sat of 97%
[this really happened to me, lucky for me and the pt I went with my assessment skills]
-You can see a heart rhythm on a screen and still not have a pulse
[went to a code once in SICU, when I got there the nurse said it was ok we could all leave b/c she had done CPR and got a rhythm back (the poor man was still gray and not moving/breathing-this was obvious to the code team); she was treating the monitor and we were looking at the pt]
I've been in High risk L&D for 2weeks on orientation so lots more to go but thank you all for sharing, I've learned some very important things.
Tx the pt not the machines. (Did my 1st yr in cardiac)
-Check your pt before you call a code if you see Vtach on the monitor screen, they might just be brushing their teeth :)
[happens all the time]
-Someone in flash pulmonary edema, barely moving air, can have an O2 sat of 97%
[this really happened to me, lucky for me and the pt I went with my assessment skills]
-You can see a heart rhythm on a screen and still not have a pulse
[went to a code once in SICU, when I got there the nurse said it was ok we could all leave b/c she had done CPR and got a rhythm back (the poor man was still gray and not moving/breathing-this was obvious to the code team); she was treating the monitor and we were looking at the pt]
I've been in High risk L&D for 2weeks on orientation so lots more to go but thank you all for sharing, I've learned some very important things.
I completely agree. the other night i had a pt who had a neuro change, getting lethargic, unable to speak, uneven pupils, drooping l side of face. so i thought, oh god she's stroking out and took her to ct and got a stat neuro consult. called in family[daughters were also nurses] and when the md came to assess her he thought she was having a brainstem infarct. her sats were 98% on room air and her breathing looked fine. didn't think to check abg's until she started fishmouthing and was looking like she was about to code. when i got the abg's the co2 was 98[!] and her sats were still 96%. called md and got her on a vent before she coded and went home. dayshift said she made a total recovery, neuro signs disapearing. but yeah, good point. doesn't matter if sats are 99 or what, always assess the pt.
When I started on a very busy med/surg unit, my preceptor taught me a very valuable lesson that I use to this day. She told me when you feel the most rushed and busy, like you can't slow down for a second, that is when it should be a warning signal in your head to double and triple check everything.
Twenty five years later, I had the most horrific labor day, ran out of beds, putting patients in every nook and cranny and I am in charge with two patients. I was going to give one patient pain meds and the warning bell started ringing in my head because I felt soooooo rushed. I was just covering for another nurse and didn't know the patient so I slowed myself down and triple checked that medication and made sure I checked her allergies. Sure enough she was allergic to the med that was ordered and it was missed previously.
i am just about to qulify (a Brit student) and reading your stories is a little baffling! however this one really helped and i will try to remember it for my own sanity!
keep it up ladies (and gents) i love this site and especially enjoy all the daft stories on other forums!
My 1st year out of school I had an order for 25mg phenergan IV push on a pt with a central line well I diluted it in 10cc of saline ........did it real slow........then just slammed a 5cc saline flush. The pt immediatly fell back, eyes rolled back & I was sure I had killed her. Thank Gawd I had experienced nurses working with me that night, we trendelenburged her, called md started a liter of fluid, she was fine before shift was over........never ever slam a flush!!! lesson learned the hard way.
I want to thank everyone for posting and I hope to read many more posts. I have already used some of the advice posted here just this past week during clinicals (precepting next).
I have done L&D for about 2 1/2 years. I just attended my second adv fetal monitoring class. I can see the machine/person thing evolving the longer I do this. I used to get so caught up in reading the strips at these classes, but this time I found it frustrating because the strip just caused me to have a bunch of assessment questions before I could make a decision as to what was going on. It was a good reminder to assess the patient again and again--things change rapidly.
NurseforPreggers
195 Posts
We always just say someone is "magged out". And yes, SBE I know that lab work or any diagnostic testing of any kind is not a replacement for pt assessment.