New OB Nurses, Grads and Students, Please Feel Free to post your questions here:

crb613, BSN, RN · Apr 1, 2005

Mugwump had a great idea offering services to new grads as a mentor (thank you for that!)
So, I thought having a "sticky" for new grads, OB nurses, students, and others with questions who want to post these can do so here. We also seem to see many of the same questions over and over, so perhaps this would help serve as an ongoing discussion of common issues/questions we all seem to have on our minds. This could serve not just for those asking directly, but others who may be "lurking" and looking for information or considering a career in OB, newborn, GYN nursing, or midwifery, doula services, childbirth education, lactation consulting, or other related work.
So if any mod thinks this is a good idea, mind stickying this?
Let's give this a go and see how it works out. We have many potential "mentors" here among us who, I am sure, would LOVE to help a new nurse/midwife/doula or student on his or her way to a rewarding career. I know I would love to help out!

I do have a question about my L&D patient. I have to do a careplan with a patho. She does not have anything wrong with her/just came in to deliver. Any ideas as to what to do??? Thanks CRB

SmilingBluEyes · Apr 1, 2005

IF this is a healthy, normal spontaneous lady partsl delivery, you really don't have a pathologic condition to address. The majority of childbearing women are healthy. Now, if you have complications, or complicated prenatal conditions/histories, you can have all sorts of possiblities:

Pre-eclampsia/PIH and associated careplanning

Gestational Diabetes Issues

Risk for hemorrhage

Risk for infection

Risk for impaired bonding with newborn(psychologic area)

Risk for postpartum depression

Risk for dehydration (or water intoxication/over hydration due to pitocin use)

Know mom's history and possible existing pathologies and go from there---that is another approach.

I realize these are MEDICAL diagnoses, but you can look these problems up in any care plan book (or your OB text) and find the proper NANDA nomenclature and nursing interventions for each one.

Hope I started you on your way....

crb613, BSN, RN · Apr 2, 2005

IF this is a healthy, normal spontaneous lady partsl delivery, you really don't have a pathologic condition to address. The majority of childbearing women are healthy. Now, if you have complications, or complicated prenatal conditions/histories, you can have all sorts of possiblities:
Pre-eclampsia/PIH and associated careplanning
Gestational Diabetes Issues
Risk for hemorrhage
Risk for infection
Risk for impaired bonding with newborn(psychologic area)
Risk for postpartum depression
Risk for dehydration (or water intoxication/over hydration due to pitocin use)
Know mom's history and possible existing pathologies and go from there---that is another approach.
I realize these are MEDICAL diagnoses, but you can look these problems up in any care plan book (or your OB text) and find the proper NANDA nomenclature and nursing interventions for each one.
Hope I started you on your way....

Thanks so much. She was/is healthy so I am kinda scratching my head, I agree If you don't have a problem I don't see how you can do a patho. It would make more sense to me to have a pregnancy related patho assigned to each student in a case like this. That's just me. She did have to have the placenta manually removed so I guess I could do one on hemorrage risk/infection, although there was no problems. Thanks again you have helped/supported me alot & I do appreciate it.CRB

SmilingBluEyes · Apr 2, 2005

Yes do risk for hemorrhage/infection on that one. Also, do remember, almost EVERY postpartum mom is at GREAT risk for dehydration, despite much IV fluid. It often "third spaces", especially with the use of pitocin, which acts like Antidiuretic Hormone (ADH), causing water retention. The Paradox here, is they need to INCREASE GREATLY their water intake to encourage diuresis. So each and everytime I round on my patients, they get a liter pitcher of fresh ice water (unless they are people who prefer hot beverages, then they get warm water or herbal teas) to encourage PO hydration.

GOOD LUCK on your assignment. You are right; manual removal of the placenta means greatly increased risk of infection/hemorrhage and don't forget PAIN!!!!! Often, you can use warm blankets on the tummy as well as analgesics for such discomfort. Hope this helps.

mugwump · Apr 2, 2005

Thanks so much. She was/is healthy so I am kinda scratching my head, I agree If you don't have a problem I don't see how you can do a patho. It would make more sense to me to have a pregnancy related patho assigned to each student in a case like this. That's just me. She did have to have the placenta manually removed so I guess I could do one on hemorrage risk/infection, although there was no problems. Thanks again you have helped/supported me alot & I do appreciate it.CRB

One great tool I use is Tabers. In the back it has diagnoses one of which is labor, and pregancy and the nursing diagnoses that go with it. Also keep in mind that just because it was a normal healthy delivery doesn't mean it didn't have the opportunity to go bad. Also Post Partum Depression might not "hit" for a while so you can always do interventions now with teaching to make the mom and family aware that it is a potential problem

crb613, BSN, RN · Apr 2, 2005

One great tool I use is Tabers. In the back it has diagnoses one of which is labor, and pregancy and the nursing diagnoses that go with it. Also keep in mind that just because it was a normal healthy delivery doesn't mean it didn't have the opportunity to go bad. Also Post Partum Depression might not "hit" for a while so you can always do interventions now with teaching to make the mom and family aware that it is a potential problem

Thanks to both of you another problem solved. I forgot about my Tabers!! :banghead:This thread was such a great idea! CRB

JMinCO · Apr 3, 2005

Hi all. Thanks for this thread. I've been in L&D for a yr now and still working on building my skills, of course. I was wondering if any of the more exper nurses have tips on managing two actives at the same time. We try to avoid this on our unit but occasionally you have no choice and it happens. We have computer charting, GE's QS. I'm not sure if this is better than paper or not, since it's all I've used but it's not like I have a choice anyway. Any tips as far as charting, pt care, active management with pit, etc? Thanks.

SmilingBluEyes · Apr 4, 2005

It's an extreme challenge we try to avoid on our unit as well. Usually when busy, we manage ONE labor patient and say, a healthy couplet. If you must do two, you have to have a "flow" and keep up on your charting religiously. You will also need to rely on coworkers to help you out when one keeps you especially busy for a while.

Personally, I don't think you can satisfactorily manage and render truly quality care for two patients in labor (really being there for them) unless they have epidurals or LOTS of QUALITY support from loved ones or a doula. Especially in active labor, patients need and depend on us to be there for them! Try next time exchanging assignments w/someone who has a less acute patient or couplet. That is my best advice, if you want to be happy with the care you gave on your shift. JMO.

Welcome to the boards and I hope this helped you some. I am sure there are others w/more advice.....HUGS.

SmilingBluEyes · Apr 6, 2005

any mods interested in stickying this one yet???

KELLYGIRL · Apr 7, 2005

Hello there! I have been working in long term care for 5 years. But what I really have wanted to do for more than 13 yrs is L&D/Neonatal (this is the reason I became a nurse). I have applied for an L&D RN position recently. Currently, the unit does not have a director and I feel worried about that. I'm afraid also that with low staff, I may not be oriented as well as I should be. I really want to work for this particular hospital and definitely want to work in L&D/Nursery. Would it be foolish to put forth my efforts for employment there at this time? Or should I look to other facilities?

I have other questions.........TIA!!!

BETSRN · Apr 7, 2005

Hello there! I have been working in long term care for 5 years. But what I really have wanted to do for more than 13 yrs is L&D/Neonatal (this is the reason I became a nurse). I have applied for an L&D RN position recently. Currently, the unit does not have a director and I feel worried about that. I'm afraid also that with low staff, I may not be oriented as well as I should be. I really want to work for this particular hospital and definitely want to work in L&D/Nursery. Would it be foolish to put forth my efforts for employment there at this time? Or should I look to other facilities?
I have other questions.........TIA!!!

First of all L&D and nursery are two distinctly DIFFERENT specialties and depending on where you work, the training will differ.

My advice to you would be to steer clear of this place with no director for now. Your gut feeling about a poor orientation would probably become a reality. L&D is a highly litigious specialty. Don't risk your license.

Go elsewhere and do Mother/baby first. That gives you a great base on which to build L&D skills at a later time.

My best to you!

Nurse032006 · Apr 7, 2005

Hey all!!!! I am in my Women's Health/Labor & Delivery Rotation and I have an assignment to come up with a 2 page teaching plan on Breast Health/BSE/Mammogram....any suggestions?????

Thanks,

Sherry :confused: