Chrissy24RN

I am starting FNP program in May as well. Good luck to all of you and see you in the discussion threads!!!

Defenitely time for US at that point. I had a mom come in recently @ 21 weeks and thought she was SROM. I tried to apply US and nothing so I used doppler and I got a HR of 120 but immediately I palpated maternal radial pulse (habit) and it was hers! She was so nervous that she got herself all worked up. I had a feeling too since I would expect a 21 weeker to be in 150's or so. She told me she had an anterior placenta. Once the doc US'd we saw the fetal heartbeat right away in 150's! The RN's who trained me told me they did have a pt with IUFD who was tachy and looked like the fetal tracing was normal. Ever since I heard that I ALWAYS manually palpate a maternal pulse and document when I apply a monitor. For example: EFM applied. FHR audible @ 135 bpm. Maternal radial pulse palpated @ 80 bpm.

This is intersting! We ususally push Labetalol if needed in L&D and reading on here it can cause Ventricular Arrhythmia. Has anyone ever come across a situation like that or a reason tele was warranted. Just curious. Thanks!

I guess I could help a little since Im and L&D RN and usually after a birth we think UTERUS, UTERUS, UTERUS. Is it firm, midline, and what is the lochia (bleeding) like. You said she is G3P3, well with the 3rd baby we are worried about if her uterus is going to contract properly like a G1P1 would. Did she have epidural? If not when did she urinate last? A full bladder will push a uterus to the right/left and possible cause increased bleeding because it cannot contract properly. If epidural, does she have a foley still? If not, same situation. Pain meds are needed usually d/t increased cramping after delivery. Breastfeeding is good since it promotes: noursihment for infant, bonding emotionally, and the uterus will contract! (Which decreases bleeding). We check B/P's Q 15 min after for hypovolemia from blood loss after delivery so I guess you can get a ND off that. Bonding is big for a G3P3 since they have 2 other children at home. Side note: How long before delivery did she get nubain? That does cross placenta into fetus so it can be depressed by the meds. So we are thinking bleeding elimination mobility (epidural...or if not, she just had a baby..its not easy to just get up and run around) emotional bonding with infant I am not doing your homework for you just giving suggestions. Dont listen to others posts and next time go to obstetric nurses forum on here and we will help you. I just graduated last year and I know how it is. Good luck! :)

I am a Labor & Delivery nurse and we have to start all our own IV's and Foleys. I have been doing this for 1 year and foleys are soooo easy but IV's can be tough. Foleys on the female: you need to pull back on the labia minorum which is wayyyy in there. Many mistakes are made by pulling back on the majorum (outer labia) and not finding anything. Usually if you are in the right spot when you wash with the betadine it will pool for an instant and the area looks like a small star. If you insert the foley halfway and you dont get return then you are probably in the lady parts. Fine, inflate the bulb and leave it there. Do not remove it. This way when you try again you know that you need to go a little north. IV's: well i have to say that our healthy female pregnant pt's usually have nice veins. The best thing you can do is see if you can shadow or do some IV's in day surgery (where they do it on everyone) or IV team. Otherwise I think and important thing is choosin a angiocath size for what you have. We try to use 18 gage on our pt's since we may have to give fluids fast or blood, but sometimes we need to use 20 gage. AC area is not the best spot. Hand veins are ok but they usually hurt the most. We like to find veins on the lateral aspect of the wrist/arm. Usually there are some juicy ones there. Otherwise you can see some on the anterior forearm that are usually good with a smaller gage angiocath. It seriously takes practice and I am not an expert by any means. I have had to do 2 attempts on pt's and sometimes I get it right away. Sometimes I have to have someone else do it. Good Luck! :)

This is very interesting! I know for sure that when I put on an EFM or ISE I palpate the maternal radial pulse and chart that (AWHONN guidelines) everytime...even during decels. Moms with IUFD's may have a HR elevated to mimick a FHR d/t infection. OMG...that amost felt like I was back in nursing school when I just wrote d/t infection!!!! Anyway, that would be interesting to know if that was in fact not maternal and fetal PEA if possible. :)

I agree that no 24/7 anesthesia coverage is a problem. Also the fact that you are floating! I work at a 10 bed LD unit with 28 or so PP rooms and we have the coverage and we never float to other units. We have implemented a rapid response team which really is people from ER who come when we call. It is usually patients who have problems with respiration. The ER team comes which is some ICU and ER RN's, an ER doc, and on call anesthesia. They pretty much handle everything and if the pt is stable OB wise they are transferred to a different unit and one of us LD RN's can go with to monitor baby. We also just started an OB Alert for hemorrhages. If we call one of those over the paging system an ER team comes with ER RN's (they are awesome at hanging blood!), ER doc in case we code or need an assist with emergency hysterectomy, lab staff to draw labs, Blood bank person will bring O- blood, OB call doc is paged automatically, and anesthesia is paged too. We also made little hemorrhage kits that we keep in the Pyxis refridgerator with meds: Methergine, Hemabate, Cytotec, and Pit. They are in a little tupperware kit that we just grab for hemorrhages or even just high risk pt's just in case. Since starting this we have had really great outcomes and it really works to have a team/system in place in case things happen. Unfortuanately, sometimes something terrible will have to happen before it is recognized as a problem. I know that is why JACHO has started this. There seems to be more and more complications before/after pregnancy lately. Sorry that was so long but its good to share what we are all doing to make things better and easier not just for us but for the safety of our patients. :)

This is a funny post! I especially like the Purdue Chicken post! Seriously though, I am and LD RN and there has been more and more shaving/waxing and I think it is a trend but after talking with pt's...also good reason. Scheduled C/S...you are getting shaved...at least around the incision which is very low. Wouldn't you rather do it yourself? I shave my pt's all the time before C/S and they do tend to have some small bleeding (even though we use clippers....razors are not allowed anymore) which is now an open portal of possible infection on the mothers lower abdomen/upper groin area. Even if it does not bleed at all, you are still opening tiny little areas of the skin. Better to shave a few days before and let it heal up! I think this should go for lady partsl delivery too because you never know if you may end up with C/S too. Anyway, just thought I would share!

Those links were interesting Daytonite! I still dont know what to do for a ND though. He is doing great post op! Good for him....not so good for me. His acute MI was not symptomatic except for a 'pause' on EKG so they drew a cardiac panel and the levels were through the roof. He has a t-tube that is draining well! Nothing about mets. Is there something I can say like a risk for infection r/t t-tube? Can that cause an infection in the liver? Anything about absorbtion since the bile is draining into tube and not intestine?

Hey everyone, I am having a hard time finding a ND for my pt. It has to tie in with a liver/hepatic focus. Pt male 74yo in ICU for post op pancreatectomy (yea the whole thing...apparently they can do that now) and whipple procedure. He had a tumor on his pancreas blocking the bile duct. He previously had a stent placed so he does not have jaundice now (which I would have used a ND on that if he did). He is diabetic and pretty uncontrolled. Now he will need insulin injections all the time. Malnourished from poor appetite, upset stomach, wt loss for 2 months before this procedure. On CT liver or spleen are not enlarged. T-tube is draining well. hgb/hct are low but he was transfused with 4 units and now are close to normal. Albumin/protein low obviously. AST high ALT normal. BUN 30 Cr 1.9 Also had an acute MI first night post op. I dont know how to tie this into liver.........HELP PLEASE!!!!

I wish all of you guys the best of luck! I am in 172 and I have my PE tomorrow so I am freaking out. If you have any questions let me know!

When were you going to challenge it for? I am in 171 right now. Are you starting in the fall or something? I could have challenged out of it too but I wouldnt recommend it. Its good to get in the habits of how the program works and how they test you (and what would a little review hurt?). Its alot different from my other nursing program. I think there are some parts of it you cant test out of either. I will have to check my handbook for it. There is a copy of the student handbook for the nursing program available in the bookstore that will tell you everything you need to know about the program and testing out of it. Its pretty big and its like $11. Does this help at all.

I am a 'scrub tech' in L&D. That is my title. I am not a surgical technologist like you are thinking we are calling ourselves. Alot of hospitals have nurses aides trained to scrub in a c/s. I dont think that there is anything wrong with that. Its not like its hard to do.....

HELP!!! Ob OR Standards Hi there, I am a scrub tech in L & D and we are having some trouble finding out what the standards are for the OR. We recently had a supervisor decide that we were going to have the OR open/draped every shift at all times no matter what. Usually we say we can have the OR open for 12 hours as long as its draped. Now some are saying 24 hours (which I strongly disagree) so I decided to investigate. All the resources I found about length of time open say use asap and dont drape. Most importantly there must be someone monitoring the instruments at all times. This was from the AORN website. My nursing director says we are under a different 'umbrella' than AORN, as an example, we let a family member in during c/s unlike main surgery does. Does anyone have any resources I could check out or tell me what the standards are at your hospital? Thanks!!!!

That is a great point about the family members. We actually have them change into a pair of clean scrubs and don cap/mask/shoe covers....I wish I could have thought of that quickly when my nursing director mentioned that! Thanks for your help!