Where would you have placed this pt? - page 2
Maybe this should be on the OB-Gyn Board, but I will post it here since there is such a wide variety of nurses on this board. We had a pt come in the other day to our hospital. She had... Read More
Aug 9, '02Occupation: RN - College Health Specialty: Geriatrics/Oncology/Psych/College Health ; Joined: Jun '02; Posts: 6,584; Likes: 70I wouldn't know a boggy uterus if it jumped up and slapped me. OB for sure, IMO.
Aug 9, '02Occupation: Forensic/Psychiatric LVN Joined: May '02; Posts: 1,164; Likes: 80I would think OB is the best place for her, but the facility I used to work at would have given her to us on Med/Surg too...due to her being "Potentiallly" infectious. We used to get Hyperemisis all the time. As well as babies that were just discharged from nursery the day before coming in with Hyperbilirubinemia. I loved working with them...called them our "Blue Light Specials" because of the bili lights that they were under.
Aug 9, '02Joined: Sep '01; Posts: 16,606; Likes: 680Originally posted by Stargazer
Crossing my legs in sympathy...
When I gave birth to my second child, another lady gave birth shortly before me that weighed in at a HEFTY 14 POUNDS That baby had his eyes WIDE OPEN looking every bit like a three month old in the hospital baby bed. :chuckle
Aug 9, '02Occupation: RN Joined: Nov '01; Posts: 1,418; Likes: 25Since the baby was not in the hospital, and since Mom had experienced uterine rupture (can't begin to imagine what might have caused that!)OUTSIDE the hospital, she was a "contaminated," potentially septic individual. Therefore, she should have gone to the med surg floor as any other trauma would have after she left the ICU. It was not ICU that would have been the potential contaminant: anything and everything she came in contact with during and after the home delivery would have been the culprit(s). I would hope, had I been a fres OB patient, that they would have put her somewhere else, not with me and the other fresh OB's!
Aug 9, '02Occupation: RN Joined: Nov '01; Posts: 1,418; Likes: 25BTW-you OB specialists correct me, if I'm wrong, but it is my understanding that a ruptured uterus is removed, as there is no longer any way to get it to maintain tone, even with suturing, and the risk of hemorrhage is way too great. She might have been sent to the GYN end of the floor, post hyst. At least she would've been in the neighborhood, so to speak!
Aug 9, '02Joined: Mar '02; Posts: 1,888; Likes: 117I agree with Cathy W. Isn't there a GYN floor? That is, one where post-op hysterectomy patients go? These are SURGICAL patients, who now need med-surg assessment skills. Shock, hemorrhage, ileus, pneumonia and thrombophlebitis are but a few of the complications this patient, who is now a SURGICAL patient, could develop.
Originally, when you said she was post-partum, I would have said an OB floor, regardless of where she delivered--but it SOUNDS like she had to have an emergency hysterectomy due to the uterine rupture. Is that correct? In that case, she belongs on a post-op GYN surgical floor, or, lacking that, med-surg. Post-partum in my opinion, is not the best place for a patient who nearly died from a ruptured uterus. I think post-partum should be for mostly uncomplicated deliveries.
My thinking, however, could be old-fashioned; (I worked OB-GYN in the '70s; at that time, even a patient whose pubic hair had not been shaved was considered an "unsterile delivery," and the baby was isolated from the others in the newborn nursery.) Times have REALLY changed!! I am anxious to hear other thoughts.Last edit by stevierae on Aug 9, '02
Aug 12, '02Occupation: Registered Nurse Joined: Jun '02; Posts: 180; Likes: 7Originally posted by stevierae
I agree with Cathy W. Isn't there a GYN floor? That is, one where post-op hysterectomy patients go?
Aug 12, '02Occupation: rn supervisor Joined: Jul '02; Posts: 472; Likes: 10we had a similar case, but mom wasn't even "unsterile", she needed emergent hysterectomy due to boggy uterus, stayed in the ICU for days... there the OB nurses brought the baby and did an excellent job at educating mom. Baby was isolated (mom in dirty ICU) but mom went to ICU step down... after uterus is out,,, she's medical
mind you I'm an ICU nurse with only this ONE experience
Aug 12, '02Occupation: correctional nurse Specialty: ER, ICU, Corrections ; Joined: Jul '00; Posts: 1,187; Likes: 131Well I haven't worked acute nursing for a while but I think that it sounds like she would need to go to med/surg...she sounds like there was no uterus to worry about and the nurses on med/surg would know how to deal with her surgery.
Aug 12, '02Joined: Oct '00; Posts: 8,729; Likes: 8,412What about the infant and new parent teaching that OB nurses do constantly? And the baby would surely be further away and less accessible to mom, along with the lack of opportunity to room in on M/S.
In my opinion (brace yourself) the threat of infection is way overrated on OB. So long as she has not been diagnosed with infection she is less of a threat to other babies and moms than the visitors that come out of the woodwork when an infant is born, and slobber all over the kid.
Aug 12, '02Occupation: onc/heme rn Joined: Oct '01; Posts: 523; Likes: 37my hospital doesn't just have a gyne floor. post op hysterectomy patient either go to med-surg or obgyn. it all depends on the doc.
Aug 12, '02Occupation: RN, CMSRN employed in a 600 bed Acute Care/Trauma Facility and CNA Instructor for a local Community College Joined: Mar '02; Posts: 459; Likes: 62From a Med-Surg Nurse perspective... the patient would do well on a Med-Surg Unit... private room... and Nursing to get in touch with the Post-Partum Unit to arrange for teaching.
We don't have a specific "gyne" Unit either... it's Med-Surg, Post Partum or some other place too unthinkable to mention
I'd take the patient in a heartbeat....
Aug 14, '02Occupation: RN Joined: Aug '01; Posts: 2,276; Likes: 42Catching up....been on vacation for a few days.
We do not have an gyn floor. M/S, OB, ICU, and ER pretty much covers the acute care at our small facility. Our floor normally gets all the hysterectomies, and other gyn surgeries. I don't have a problem taking care of hysterectomies and other gyn surgeries, just the fresh PP case. The pt refused to let the surgeon take out her uterus . I guess he stitched it the best he could under the circumstances. If this pt gets pregnant again I don't want to be anywhere near the place when delivery time comes. I am sure it won't be pretty.
Thanks for all the replies on here. I really appreciate everyone's responses. :kiss