maternal child yay!!

timonrn · Jan 27, 2001

Boy can I relate to you--All of my charge orientations have been uneventful but the very shift I fly by myself--What a nightmare!! Why is this? Anyways, in answer to some of your questions, Always expect your multiparas and teenage moms to hemorrhage; always expect redheads, nurses and doctors (pts, I mean) to pp hemorrhage and/or go into DIC; (ask any OB nurse--its a proven theory!!) and if an OB or LDR nurse delivers, you might as well have the pp hem. box in her room (haha). Always expect GYN's to be hypotensive--remember, gyn surgery is brutal and the uterus is so close to various vasculatures; The cure? feet up, run in a quick bolus; As far as poor uop, our docs watch, if pt is young, they will turn the corner in about 24 hrs; And a lot of GYN and sometimes even OB's develop PE's so watch for s/s--you'll be suprised how often you'll see this; As to the Breast feeding issue--check with your hospital's lactation consultant as to what you should do but ultimately it is the mom's choice to supplement, but should use formula not sugar water. I'll only give sips of sugar h2o to a baby w/ hiccups. The c/s issue-our hospital is a little archaic as we let them be for 12-24 hrs; most moms are raring to go after 4 hrs--esp. the smokers. If they are tingling after their epidural alot of times its because a nerve was hit; usually goes away. Good luck with charge (I, too am a new charge nurse on both OB and GYN/Medical) and I know how things can go from quiet to dissaterous in a matter of seconds. Our unit is 32 bed OB and 20 bed GYN. Bye!

ShannonB25 · Jan 27, 2001

I found your post really interesting, timonrn. Do PE's really occur frequently in the postpartum area? I am probably going to be starting out in postpartum and am curious as to if this is rarely seen or not? Any other advice would be appreciated as well. Thanks!! Shannon

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"The highest reward for man's toil is not what he gets for it, but what he becomes by it."-Johan Ruskin

timonrn · Jan 29, 2001

ShannonB25--OB's are at high risk for PE's--I have never seen a full blown PE on my unit (knock on wood) but we are always cognisant of the possibility. We do see an awful lot of DVTs in the lower extrems, esp. in late pregnancy, but does often show up in post-delivery. We treat DVTs almost once a week on post GYN surgicals, post delivery pts and ante partum pts. who have come back weeks later with s/s. So keep a mindful watch--I in fact sent a pt home with o2 sats of 86% post-surgical (GYN) who the MD blew off as "a pulmonary problem to look at next week"--his progress note exactely--And I think she prob was working on a PE but all the doc would do was order home oxygen and see her in two days!! I still worry about her--I bet we see her back. She was not a smoker and there was no rhyme or reason for her s/s but she was worked up appropriately, so--what to do?

earthangel30 · Jan 30, 2001

Thanks everyone for your responses. Timonrn- how do you all usually staff for your 32 bed ob and your gyn/medical floor? Just curious to see how different places run things. We are a 15 bed unit and at night we'll have one nurse for up toe 5-7 pts on his/her own (depending on the supervisor for the night i suppose), 2 nurses for up to 12 pts and sometimes to a full house. evenings we usually have a third nurse (lpn) which is a great help. As for the redhead/nurse bleeders i can certainly attest to that fact!!! red heads definetely and nurses i'd say yah only cuz i had my first one last week who also happened to be a L&D nurse to boot.

timonrn · Jan 31, 2001

We staff a 32 bed OB unit plus a 20 bed GYN unit (I call it GYN/Medical becuz we get everything female lately--not what this unit was intended for, of course, as we are not equipted for Medical pts beyond the basic stuff) plus our nursery--so most of our staff including the HUC's rotate weekly or as needed to each place. Our GYN unit happens to be one floor up. Anyways staffing ratio is OB--4-5 moms/babies on days, 5-6 on PM's and 6-8 on noc's; GYN is 4 on days, 5 on PM's, 6-8 on nocs; Antes is 3-4 depending on if on MGSO4 protocal or not. Nursery is 12:1 w/ an NA. However I'm sure you can read between the lines that we usually don't have it this good due to Nursing shortage. I am told by travelers and outside pools that our hospital has the worst staffing ratios in the Twin Cities!! I can sure attest to that. Why? becuz our administration is holding onto an archaic version of a staffing grid that we are trying to revise as we speak. We all know that patient acuity is higher than in the "olden days."

bbnurse · Mar 1, 2001

Timonrn,

You might want to get copies of the guidelines for staffing from AWHONN which were developed by the AAP and ACOG for the actual increased acuity and increasingly "sue happy" clientele of the pt. population you serve.

Just a thought...