fourbirds4me

http://www.goarmy.com/jag.html I agree Army is a great way for a new lawyer to go... nurses too for that matter. AND they have a great loan repayment plan

Our units use hospital laundered scrubs... (they are horrible... NO POCKETS!!) However, I believe recent studies have shown no difference in infection in the OB setting. That being said... I believe it is also recommended that common uniforms be worn in OB areas because of infants security.... although OR, Sterile processing and radiology all wear the same scrubs http://www.infectioncontroltoday.com/articles/1a1feat4.html A pilot study was conducted at the University of Central Florida to determine if the practice of hospitals purchasing and laundering scrub clothing was based on ritual or reason. This descriptive pilot study was conducted during a four-year period in order to determine the effect on the perinatal infection rate of wearing home laundered scrub clothing in labor and delivery. Prior to the study the infection rate was 1.7%; at the study's end, it was 1.0%. The conclusions of the study support home laundering of scrubs in that home laundered scrub clothing can be worn safely in labor and delivery units, including operating rooms contained in those units. The practice was found to reduce costs without increasing surgical wound infections.11 The Association for Professionals in Infection Control (APIC) created a State of the Art Report (SOAR) designed to assist IC professionals in the development of policies and procedures related to the use of scrubs and similar apparel by HCWs outside controlled environments, such as the surgical suite. Surprisingly, there is little scientific evidence that the utilization of scrubs in the operating room setting is a means of infection control in the healthcare facility.

Well... this is just another event in the long line of short staffing issues at my hospital. Sometimes I feel like I only post when everything just gets TOO overwhelming. Of course... I too, feel like this pt should have been at least 1:1 and should probably have been transferred. We even have a policy that says pt with obstetrical complications should be 1:1. However, she happened to be one of my 3-4 pts that night (including a labor... going natural... progressing quickly...complete...coaching her to breath through ctx for over an hour while the doctor, anesthesia and 2/4 nurses on the floor were in a c/s.) At one point I realized that I hadn't been in to see her in >2hours. Our manager refused to get us more help... saying there was no one else that could come in. Finally the DR on call intervened and called administration to get us some help. This had tragedy written all over it... THANK GOD... we dodged the bullet once again. When I last heard...This pt. is still undelivered... she was transferred the next day to level III. Her mag levels got up to 8.5 ... at which point she stopped contracting and starting complaining of shortness of breath and severe headache and nausea. I LOVE the people I work with... like my hospital... LOVE my pts.... HATE that our management doesn't have a clue... HATE that pts don't get the care they deserve and that everytime something like this happens my license and livelyhood are on the line. The funny thing is... this wasn't the most critical pt that night. Another nurse transferred a 33 weeker with "asthma" to our PP unit. She had just had a pulmonologist consult and was electrolyte replacement... MAG and K Phos... OOOOPS. Nurse just wasn't thinking. Very much concerned about clearing space for waiting labors. Turns out this pt was in congestive heart failure. Had multiple undiagnosed heart problems that only manifested with the overload of pregnancy. DAMN why can't ... "but the unit was sooo busy" be a defense in court!! Thanks for listening... Paula

Both arms... sitting. Lateral positioning is an intervention to lower BP. I agree however that if while lateral if the BP is still elevated... it is more of an indication for delivery.

30 weeker, twin gestation, contracting q 2-3, dil. 1+,75,-2, BP's 145/85, +3 DTR's, On Mag.... 6gm load, 3gm/hr. When she was still contracting q 2-3... additional 2gm load and ^ to 3.5 gm per hour. Q 15min vitals. Q 2 hr mag levels. PIH labs. Q hour I/O and DTR's. Level II hospital w/ approx 100 del/month. Our closest level III is 100 miles away. Just throwing this out there. I don 't want to tell the whole story until I get some feedback...

I will push a primip pretty far. We have several docs who have no patience with waiting and will cut an epis with the baby still high and vacuum them out. So I will usually let them crown pretty far if they have an epidural and the doc is on the way. Not so much if they are going natural or are a multip. It is very much a judgment call.

It is very common for us to deliver a 16+ week demise. However, this is mostly due to circumstance. Since these moms tend to go from nothing to delivery in a very quick time. However, our docs always come in to deliver the placenta (which is usually stuck like glue) and to make sure everything else is ok.

What do you do when an emergency walks through the door. How do you handle stat sections... prolapsed cord... abruptions... precipitous deliveries etc...

Our protocol is usually 1:2. However we rarely have 2 pit pts. We usually will take outpts as needed. It is very hard to keep 2pts because they become 1:1 during epidural placement and during second stage. That leads to no continuity of care.

We generally DO treat unknown GBBS... I guess most of our docs say beter safe than sorry. We use Amp because (as I understand it) it is more readily available. The CDC says "Penicillin remains the first-line agent for intrapartum antibiotic prophylaxis, with ampicillin an acceptable alternative." We also treat if there are intra partum risk factors. Depending on the ped, unknown GBBS and inadequately treated GBBS babies get a CBC and blood cultures. One of our peds gets a CBC on ALL GBBS babies regardless of whether Mom was treated or not. NO GBBS baby leaves prior to 48hrs.

Amp 2gm loading dose... then 1gm q 4h until delivery... You can view the CDC reccomendations here... http://www.cdc.gov/groupBstrep/gbs/hospitals_guidelines.htm

Kegels DO work... however if done incorrectly can do more harm than good... this article is good and instructions are at the bottom... make sure you allow relaxation of perineal muscles between Kegels... http://www.nlm.nih.gov/medlineplus/ency/article/003975.htm

You did the absolutely correct thing. I agree with the others who have posted... if the MD refuses to come in... it is not enough to document... It the situation warrants it is up to us to implement "chain of communication" to insure the pt is properly taken care of. No one wants a dead pt or a compromised infant... let alone sit on a stand to try to explain how they got that way! (even if it was the drs fault)

I've never had one live that long at a non viable gestation. The only one similar to what you describe ended up in a battle between the dr and nurse about whether or not to try to resuscitate/ use heroic measures... all the while the baby lay alone on a cold isolette. I think it lived about 30min.

OH... I also wanted to say... Don't be afraid to leave. You have to find a safe place to work. You have worked to hard for your license to jeopardize it. What is gonna look worse to a future employer.... that you left a job ofter 5 months because of unsafe staffing... or an action against your license because of mistakes made because of a burned out, stressed out nurse in an unsafe staffing situation.... ((((((((HUGGGSSSS))))))))... and take care of YOU!!