Preceptorship on mother/baby... what do I need to know????

nurse carla espinosa · Jan 30, 2013

you've probably renewed enough! but aside from what you've mentioned also know normal ranges for vital signs for babies.

i'll answer your questions as we do it in the hospital i work at to give you an idea. but keep in mind you will be following the doctor's orders in your hospitals and the units protocols. Mos of these are not things you are expected to KNOW before starting. But here goes...

How many hours after delivery should you get mom out of bed? I know the soon the better...

Vag are OOB and ambulating immediately pretty much. C-Section either 6 hrs post op or 12 hrs depending on the type of anesthesia they had (general vs astromorph)

When does the foley come out? My guess is about 12 hours after delivery?? does it differ lady partsl vs. c section?

Same as above.

After the foley is out pt is due to void 6-8 hours after right? If not, bladder scan and possible straight cath??? *distended bladder= inc risk for pp hem so i know this is important

We give the pts 6 hours to void after d/c foley. If not we straight cath once, if still no void after we place a foley and call MD

How soon can they start drinking or eating ? (hours after delivery)... I know u advance the diet is tolerated but would like to know what to expect...

Vag- immediately after. C/s- we give them clear liquids at 6 hours at progress from there

How soon after the delivery does the baby need to eat? I know you can attempt breast feeding in the delivery room but if they are formula feeding would u get them formula right away? or wait till they wake up... I vaguely rememember something about sleeping phase and alert phase ... lol

Yes breastfeeding can be done right away. We feed them after transition (so about 4-6 hours after)

How many times a day should the baby be feeding? 8 to 12 times a day for bf, and for formula? is it the same?

q 2-3 h for breastfeeding AND on demand (if baby is hungry) and q 3-4 for for formula

Meconium should be passed in the first 24 hours right? urine too?

How many wet diapers per day? 6-8?

24 hours to pass 1 stool and 1 wet diaper, and expect increases from then

GOOD LUCK. you'll be okay.

itsannberg · Jan 30, 2013

studentnurse9806...congratulations on landing your dream preceptorship! What a wonderful opportunity that could result in a permanent position on mother baby! However...you need to relax. It's a preceptorship...not your first day on the job. Seriously.

Your anxiety translates to lack of confidence...which stresses out your patient. No self respecting preceptor is going to drop you off with a mother baby couplet and ask you to assess them and get back to her...remember, it's her license on the line all day every day that she's precepting you.

A preceptorship is designed to integrate didactic and clinical knowledge resulting in applied nursing. This isn't "Are You Smarter Than a Second Year Nursing Student?"...it's critical thinking through the situation you are presented with and applying knowledge you have obviously spent a fair amount of time accumulating. Preceptorships are meant to help you develop the skills to manage your time, prioritize your nursing care and above all else, practice safe nursing care.

We want you to ask questions. Don't even show up on your first day thinking 'I got this' because you 'don't got this'...that's why you are in a preceptorship. We know your maternal child lecture class didn't cover every detail of maternal child care. We expect you to have questions, to be inquisitive and to seek out opportunities to learn; that is the whole point of a preceptorship! Jump in and help other nurses on the floor...get warm blankets or clean linens, clean up the trash in the room, answer call lights.

You asked "what do I need to know?" Know this: you have orders and a care plan...follow them. Read them. Read them again. You have protocols and policies and procedures in place by the hospital...do what they say, do not deviate without a good reason. Wash your hands or use hand gel between each patient. Tell the patient who you are and why you are there. This is not hard. Learn from your mistakes and above all else collaborate with your preceptor and the other nurses on the floor. You never make a clinical decision because you think you might have read it or seen it done a certain way...you make decisions & perform interventions with the input of your preceptor, other nurses, the care provider and your patient. Confidence comes with practice. Somedays you have more confidence than others...that's okay. Remember, when in doubt, ask.

Take a little notebook so you can write down questions as you think of them...and to capture those "nuggets" of wisdom your preceptor shares with you. Yes, write down something she says...and you'll be endearing to her forever. Your preceptor experience should be a rewarding, rich learning experience, but first...chill out. It's not hard...you are privileged to walk along side a new little family for a brief time...enjoy the journey.

ab

SE_BSN_RN, BSN · Mar 9, 2013

studentnurse9806...congratulations on landing your dream preceptorship! What a wonderful opportunity that could result in a permanent position on mother baby! However...you need to relax. It's a preceptorship...not your first day on the job. Seriously.
Your anxiety translates to lack of confidence...which stresses out your patient. No self respecting preceptor is going to drop you off with a mother baby couplet and ask you to assess them and get back to her...remember, it's her license on the line all day every day that she's precepting you.
A preceptorship is designed to integrate didactic and clinical knowledge resulting in applied nursing. This isn't "Are You Smarter Than a Second Year Nursing Student?"...it's critical thinking through the situation you are presented with and applying knowledge you have obviously spent a fair amount of time accumulating. Preceptorships are meant to help you develop the skills to manage your time, prioritize your nursing care and above all else, practice safe nursing care.
We want you to ask questions. Don't even show up on your first day thinking 'I got this' because you 'don't got this'...that's why you are in a preceptorship. We know your maternal child lecture class didn't cover every detail of maternal child care. We expect you to have questions, to be inquisitive and to seek out opportunities to learn; that is the whole point of a preceptorship! Jump in and help other nurses on the floor...get warm blankets or clean linens, clean up the trash in the room, answer call lights.
You asked "what do I need to know?" Know this: you have orders and a care plan...follow them. Read them. Read them again. You have protocols and policies and procedures in place by the hospital...do what they say, do not deviate without a good reason. Wash your hands or use hand gel between each patient. Tell the patient who you are and why you are there. This is not hard. Learn from your mistakes and above all else collaborate with your preceptor and the other nurses on the floor. You never make a clinical decision because you think you might have read it or seen it done a certain way...you make decisions & perform interventions with the input of your preceptor, other nurses, the care provider and your patient. Confidence comes with practice. Somedays you have more confidence than others...that's okay. Remember, when in doubt, ask.
Take a little notebook so you can write down questions as you think of them...and to capture those "nuggets" of wisdom your preceptor shares with you. Yes, write down something she says...and you'll be endearing to her forever. Your preceptor experience should be a rewarding, rich learning experience, but first...chill out. It's not hard...you are privileged to walk along side a new little family for a brief time...enjoy the journey.
ab

Great advice!! Thanks! I am all set to my preceptorship in L&D in May. One thing though.....IV's are my weakness, I've maybe only done 4-5 in my 7 year LPN career. Is it ok for me to ask to do all the IV starts if time permits?

RN_BSN09, RN · Mar 11, 2013

I agree with nurse carla espinosa... you will definitely have Dr. orders for most of these questions, when in doubt, look at the orders and also the hospital policies. You can also ask your preceptor as well. :)

Here's my answers according to what we do at my hospital.

How many hours after delivery should you get mom out of bed? I know the soon the better...

Vag delivery without epidural, right away. Vag delivery with epidural, I'll usually get her up a couple hours after she was last cathed in L&D... some take longer for the epidural to wear off than others... take it slow because occasionally they aren't ready to walk to the bathroom and in the past I've had to use a bed pan (altho rare). Usually the problem is they can walk, but are unable to void, in which case you would eventually cath them if they cannot void. For C/S patients our orders say to get out of bed 6 to 12 hours after delivery. I'll usually walk them to the bathroom for peri care to start with.

When does the foley come out? My guess is about 12 hours after delivery?? does it differ lady partsl vs. c section?

Vag deliveries rarely have a foley over in mother/baby, unless they were unable to void and ended up with a foley that way. The Dr. will usually write the order to discontinue. C/S the orders say to take out foley 12-24 hours post-op. We usually wait closer to 24 hours because if it's taken out too early, they won't be able to void and then it needs to be put back in.

After the foley is out pt is due to void 6-8 hours after right? If not, bladder scan and possible straight cath??? *distended bladder= inc risk for pp hem so i know this is important

Pt is DTV 6 hours after cath removal. I'll have the pt attempt to void every 2 hours. Sometimes they will start to feel distended before the 6 hour mark, and you might need to I&O cath before then. Bladder Scanner is a great tool to measure retained urine if you're not sure, just don't use the bladder scanner on C/S d/t their incision. You can use the peri bottle or a sitz bath to encourage the pt to void... the warm water helps if they have difficulty by the second or third attempt. Our orders say to straight cath x2 if still unable to void and insert foley on 3rd cath if still unable to void.

How soon can they start drinking or eating ? (hours after delivery)... I know u advance the diet is tolerated but would like to know what to expect...

Vag delivery right away. C/S start with ice chips, then clear liquids. There's not really a set "time" but see how the patient handles liquids, whether she has any N/V. Then try crackers, then real food.

How soon after the delivery does the baby need to eat? I know you can attempt breast feeding in the delivery room but if they are formula feeding would u get them formula right away? or wait till they wake up... I vaguely rememember something about sleeping phase and alert phase ... lol

If your unit is baby friendly they will get baby breast feeding immediately after birth, then every 2-3 hrs even if baby is asleep. Usually first 24 hours they are extra sleepy and tend to feed less. Formula babies feed every 3-4 hours... they have a smaller amount per feeding on day one, and slowly increase the amount on day 2 and 3. (probably in your orders).

How many times a day should the baby be feeding? 8 to 12 times a day for bf, and for formula? is it the same?

See above answer. You can technically go about 8 hours without a feeding if baby is unable to latch at the breast... by then you need to check a blood sugar. If ever worried, or baby is jittery, check a blood sugar. Again, see what your orders say. Breast feeding classes are helpful also.

Meconium should be passed in the first 24 hours right? urine too?
How many wet diapers per day? 6-8?

Yes. 1 wet and 1 dirty on day one. 2 wet and 2 dirty on day two. 3 wet and 3 dirty on day three. 4 wet and 4 dirty on day four... until day five, then it's 6 to 8 wets per day. We never really worry unless it's been greater than 24 hours with no void, or for no stool. Then we just let the pedi know, and usually they say to do rectal stimulation, and eventually baby will stool, esp if he's already had a stool.

Hope that is helpful! Congrats and Good luck!