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L&D nurse. Love crochet, reading, motorcycles and texas hold 'em!

fourbirds4me's Latest Activity

  1. fourbirds4me

    Nurse Deliveries

    In the past week we have had 4 nurse deliveries 2 with the same doc (and the same nurse). He hates missing a delivery and is generally a well respected and well liked doctor. However, he is very upset and is threatening to give orders (or make standing orders) to do SVE on his pts q1hour for primips Q30 minutes for multips... I think he is just upset and if he thinks about it he will just realize these deliveries were just a case of curcumstance and not a breakdown in nursing care. In general we have maybe
  2. fourbirds4me

    trying to decide what nursing field to go into

    Responsibilities as an OB nurse? hmmmm To promote a healthy inutero environment so that the fetus stays well oxygenated and distress free while assuring the mother recieves all interventions (or as few interventions) desired to ensure the desired birthing experience. While juggling physicians demands for delivery before dinner time. LOL seriously... Evaluate pt's for labor check cervices interpret fetal monitoring strips assess vital signs review history's provide education concerning signs/symptoms of labor provide labor support provide education regarding stages of labor-- coping mechanisms ensure physician knowledge of pt. status assist with procedures needed accept newborn assign apgars place fetal spiral electrodes assist pt with personal needs assist with breastfeeding and NB care provide education regarding all interventions use critical thinking skills to intervene in nonreassuring situations sterile speculum exams provide interventions to prevent seizures in the pre-eclamptic pt after delivery... ensure bonding process with parents identify and provide support for the unstable neonate circulate, scrub, assist as necessary for c/s document all of the above and more... and more.... Much luck in all that you endeavor!
  3. fourbirds4me

    Dangerous lessons learned in your first year of nursing

    #1 UTI's are serious business for pregnant women. Was working the postpartum unit... had a 28 weeker in for pylo. I checked on this girl at least 6 times on my 12hr shift. Only complaint was at 0300... pt c/o rt flank pain rated about a "4"... I associated this with the pylo...pt denied meds or other interventions... stated she had had it off and on for a few days... Well at 0600 pt c/o "bloody mucousy stuff when I wiped"... OH MY GOD... BLOODY SHOW... sure enough she was dilated 8cm and delivered about an hour later... #2 There is no such thing as Braxton Hicks CTX in a pretermer. All ctx are to be considered the "real thing" until proven otherwise.
  4. fourbirds4me

    Dangerous lessons learned in your first year of nursing

    I don't think this is an exclusive to new nurses issue. More than once I've taken over care of a pt (from experienced nurses) to find the pit line running onto the floor... (not been connected to the main line) So always assess your lines regularly. Also assess expiration dates... An ineffective labor pattern has been attributed to expired pitocin. Some worst first year mistakes I've seen have been... opening up the pit line to flush the air bubbles through.... For the pt with continuous variable decels... bolusing fluids for the whole labor thinking that would fix it... poor girl ended up getting like 10L When we mixed our own pit.... mixing 2 bags at a time and not realizing one bag got all the pit added and the other got none As for myself... #1...I learned that sometimes we are the pts only voice. For the most part pts are ignorant about what is going on. We are not the Dr's handmaiden ... we are pt advocates and professional care givers. #2...Just because the Dr has ordered it or the Dr is aware of it does not make it right or defensable. As first line care givers it is up to us to make sure pts are given safe care and that policy is followed.
  5. fourbirds4me

    fundal pressure

    Professional organizations have discouraged and even forbidden fundal pressure for vaginal deliveries since 1987. Some boards of nursing have even addressed this http://www.msbn.state.ms.us/rnsuprapubic.htm During vaginal delivery this is a dangerous thing and should be avoiding to prevent maternal and fetal injury.
  6. fourbirds4me

    Ice Packs?

    We use the diaper trick. It's convenient ... plus very absorbent ... can be a little bulky but overall works great!
  7. fourbirds4me

    How many deliveries do you have per month?

    About 100 del/month 4 (large) LDR rooms 2 (Small) LDR rooms... usually use these for outpatients or delivered mags or IUFD... but can deliver in them if needed 2 ORs 1 "exam room" we usually only use for overflow 15 pp rooms (separate unit) that also take gyn surgery
  8. fourbirds4me

    Bad Week...

    Had a phone call about 0330. Pt stating she had woke up around 0130 with a severe HA and that she was being followed for PIH and what should she do. Of course I advised her to come in ASAP. I reviewed her prenatals and hx. She had been coming in twice a week for NSTs because of AMA and PIH all labs had been fine and she had a reactive NST and 8/8 BPP 2 days prior. When she presented to the desk her face was very puffy also c/o epigastric pain. She reported + FM. Based on that information I collected a CCUA and sat her down on the edge of the bed and did BP's in both arms (150/90's) before applying EFM. What happened next is basically my (and probably all of us) worst nightmare. Could not get heart tones. This was confirmed by US (particulary nasty tech who also assigned the 8/8 BPP... but that is another story). The pt and family were devastated. I was also there with them for the delivery the next evening. I just want everyone to know that we have no idea how much power and influence we have in people's live until situations like this. I know this was a total against the statistics case and there was nothing else we could have done for this couple. However, I find myself losing confidence in our US department. Also, one of the new nurses said to me that she had learned her lesson. She would always apply EFM before doing anything else. I tried to explain to her that you had to go by what the presenting complaint was and set priorities accordingly. But of course am questioning myself about that too. But again would be questioning myself the other direction if she had seized while applying efm....... not that the heart beat dissappeared in the 5 min it took to get a urine and a BP... or that the outcome would have changed if it had. Anyway... am rambling now... just needed to decompress...
  9. fourbirds4me

    Staffing ratios for C Sections

    One for Mom... one for baby. Although if baby needs rescuscition the circulator will help and or call for more help as needed. ACOG/AAP staffing guidelines call for 1:1 care for mom and baby in c/s.
  10. fourbirds4me

    Sponge Count for Vag Deliveries

    Oh yes... as well as a filed incident report on the occurance!
  11. fourbirds4me

    Sponge Count for Vag Deliveries

    YES... we do count sponges and YES we use raytec.... 20 of them in fact... to prep with and for docs to use during repair (sometimes they pack the vagina to stop blood flow during repair). Just a story... A few weeks ago I came on shift and took over the recovery of a recent delivery. I got report that the sponge count was off by 4. But that the doc (a resident) was sure that no sponges were left inside and did not want an x-ray. I reviewed chart, hx (pt hep B +) and went in to check in on the pt. 15 min earlier it was recorded that "small, firm, @ U). I found the pt laying in a puddle... gushing... bogey. Fudus would not firm up despite vigorous massage and pit bolus. I did a (high) vaginal sweep... dug out all the clots I could reach and called and got an order for methergine. Ended up being over 1200cc blood loss (by weight). Well, you can guess it... on a hunch I dug through all the clots I fished out and yep... there were the 4 sponges.
  12. fourbirds4me

    Great Delivery / Bad Delivery

    Sounds like you performed to the best of your knowledge... However, remember that knowledge is power. Always know your P&P. Policy always overrides orders. Your hospital will not back you up if policy was not followed. As to the resucitation...at my place we do not have a NICU and RT does not come to our deliveries. We resucitate our own babies and call nursery over (transfer) as needed. Again, if protocol was followed, sounds like you did the right thing. Only problem being if at two minutes you are still stimulating the infant. Was PPV being used? Was there spontaneous resp. What was the heart rate? Were you and your preceptor NRP certified? If not... get certified as others have said... you never know when a good strip is gonna produce a bad baby.
  13. fourbirds4me

    Discharged after c-section and readmitted next day

    Could possibly be post-partum cardiomyopathy... although the temp doesn't really fit
  14. fourbirds4me

    The baby is frank breech

    We deliver vertex/breech twins (under double set-up). And actually had to precip a doubling footling breech last summer (oh my god)... nothing like looking at two little feet sticking out of the vaginal opening with the doc 20 minutes away!!
  15. fourbirds4me

    Ambien, Is It Really Safe For Pregnancy?

    We use Ambien routinely for overnight obs. pts and for cervidil inductions. Most of these pts are continuous EFM and we have never had a poor outcome... in fact most of these babies never even have a noticable decrease in variability. However, I am surprised in the number of pts that it doesn't work with....
  16. fourbirds4me

    delee suctioning

    NRP... Suctioning is part of the resuscitation process