How often would you have monitored this pt?

shay · Dec 28, 2002

The others said it well. If they were mine, I'd have either hooked them up to the monitors or if the doc demanded the monitor be removed, I'd have him write it as an order AND document EXACTLY what he said as his "order" in my nurse's notes. Holy crap. Those patients were high risk in anyone's book. I'd get outta that hospital. You're going to end up in court.

RMH · Dec 29, 2002

I would have kept both patients on FHM unless specifically told not to by the provider. It is important to know what the hospitals policies are, but what ever they are you can always do more! Even on continuous FHM in my facility you just have to document q 15 so you don't have to be 1:1. I would have done what I was comfortable doing. Not what I was told in that circumstance.

Good Luck. Maybe things will get better. Remember, patient care is most important.:)

**canoehead, BSN, RN** · Dec 29, 2002

They were both high risk, and I would have both of them on continuous monitering in labor, but the first lady was 2cm- if she was not in labor I would agree with checking FHR with vitals and an NST qshift. If the NST was non reactive then I would leave her on the moniter.

labornurse · Dec 29, 2002

In my facility, both of these pts would be 1 on 1 and be continuosly monitored and if the pt was getting platelets the ob would probably be in house, if not on the floor. Depending on the situation I would even take vs q 15 min. If this isn't high risk, I don't know what is.

mark_LD_RN · Dec 29, 2002

i can hardly believe anyone would not monitor these pt continuously. they need to be. I may consider letting them off a few minutes at a time to go to the rest room or something but no way would i just do intermittent monitoring.

Parker in ARKY we watch the monitors just about continuously, and they also record what is going on so you can go back and look for trends or decels you may have missed, they also have alarms that will sound with decels ,low hrt rates etc. we dont just put pt on monitors and leave them just because we don't feel like removing them,sometimes we have reasons:)

SmilingBluEyes · Dec 29, 2002

as usual, well-said and articulated so politely mark. You are wonderful!

OBNurseShelley · Dec 29, 2002

All i can say is: GIVE ME A BREAK!

L&DTami · Dec 30, 2002

Oh yes, these pts ARE high risk and in my hospital would require continuous monitoring and if you are on mag you have a foley- NO brp! -contiuous monitoring with hourly or even more frequent bps,prn.-and hourly I & O etc.....

As for Who watches the monitor- EVERYONE!!!!! Including the in house on call OB doc. The system is on a screen in thier call room.If we have pts like that on the floor, 9 times out of 10 the resident can be found in front of the monitor system too.

ShandyLynnRN, BSN, RN · Dec 30, 2002

Moz, for SURE they are high risk and need to be monitored continuously! You are a great nurse, and have a great nurse's gut, and I think following it was a great call! We have mag patients on 1:1 with continuous EFM, hourly vitals, outputs, and reflexes. My feeling is that if mag is warranted, that continuous monitoring is also warranted.

mother/babyRN, RN · Dec 30, 2002

You know, if I have a pt on o2 via rebreather and the strip rebounds to decent variability and she wants the mask off, I will document when (o2 off for 2 minutes for ex) AND the exact time I put it back on....I always try to listen to my gut AND place myself in the position of the pt. That is, if I am concerned in any way, shape or form about a pt, either low OR high risk, I am monitoring them, period...If the doc ( and we have a few) inSIST the monitor come off, I politely let them know that if they choose to discontinue the monitor on a high risk pt while they are in my care, they will have to personally remove the equipment, explain why to the pt AND I let them know I will document as such...I then let them know that I have to do what is right both for the pt and myself as a nurse..Anyone who has a problem with that has a definite control issue and I have to question their sincere interest and advocacy of the pt. Sure, sometimes I may over do it, but I can sleep at night knowing I did the best I could....

mother/babyRN, RN · Dec 30, 2002

Hey, Sorry to keep boring you guys with my posts, but I just got home from work so this situation is fresh in my mind. Received a 30 weeker the other night via ambulance with contractions and bleeding. Didn't belong to us of course, and we immediately got the iv going, etc.....Then we had a significant decel, so O2 was started ( the above pt). Pt was scared to death (me too but no way was I going to let HER see that)...Stroked her forehead and told her we were going to take good care of her and her baby...Seems she had a circlage at 23 weeks...Bleeding had stopped by the time she arrived and I called the doc, who did a portable us which showed ruptured membranes and one of the circlage stitches had started to tear..She was having UC's every one or two. Kid was vertex and low.....After Mag and terbutaline and betamethasone, the contractions eased off enough for us to transfer her to a big city facility (Boston) some ways away.. So I call for the ambulance and it seems to take forever. THEN I have to finesse the ER and Lab to get both the ambulance AND her type and screen ready. Pt is beside herself with fear....So are her mom and husband....She and I bond ( she is the same age as my oldest), and, having been sick while pregnant, I think she just happened to be one of " those" patients you somehow really bond with...Supervisor wants to know why I request an ACLS ambulance, as that is expensive! (hello!). THEN wants to know why I ( or any nurse in general) has to go with her....Pt is starting to contract again and having back pain and pressure....I sometimes think people not acquainted with what actually goes on in labor and delivery, have no clue...Thankfully, she made it to the hospital.......But, as eveyone has pointed out here, when in doubt, do what YOU feel is best.....