beachmom

I need suggestions please! Our hospital has encouraged skin to skin after birth for many years, and after lady partsl births this is happening. After C/S births, IT'S NOT. Our manager is all for us doing skin to skin in the OR, breastfeeding and keeping baby with mom all though the OR, PACU and back to her room. (If baby is stable and staffing allows.) The OB's, OR staff and PACU staff are all OK with this. The problem is, most nurses are still bringing baby to mom for a few minutes after the C/S then taking baby to the nursery to do the weight, meds etc. Some will then get the baby to mom in PACU. Others will keep the baby in the nursery while they do their paperwork and not get baby to mom until she is back to her room. Grrr. It is much easier on the nurse to bring the baby to the nursery. And it's an ingrained habit. We've had many forced changes by management lately, I think encouraging a change in practice would come better from a coworker (me) than from management. I'm on practice council, and this is one of our goals. I put a flyer on the bulletin board, but I need something more effective. I'm thinking a slideshow or video at the unit meeting, maybe? Do you know a good video? Any suggestions for me would be greatly appreciated. :)

Here's a whole list of names, with pictures. :) 19 Nonsensical Names That Nobody Should Have To Live With | RealClear

No, we don't have a 24/7 OB. Luckily all our OB's live 5-10 minutes away, and they can park right next to LDRP. The clinics are across the street - 2 minutes away. Our peds live farther away, 10-20 minutes. All of us are expected to be skilled with NRP. The next nearest LDRP is 2 hours away, so we do our best. Some of are CRNAs (anesthesia) live 15 minutes away, and that's scary. We have a "stat C/S box" in case the Dr. needs to get a baby out with a local. We all hope and pray we don't have to use it. It was used once in the past, and it was quite traumatic for the pt and the nurses. We have about 600 births/year. Not enough to pay for a 24/7 Dr. or CRNA. Although there is a 24 hour hospitalist if we have a medical problem. Doctors don't have to be in house for epidurals or inductions. Never heard of that. They have to see the pt. at teh start of an induction, and they all answer their phones quickly. Doctors and anesthesia both have to be in house or at the office (2 min away) if we do a VBAC. We have sleep rooms if they need it.

Lots of green in the Portland area and lots of rain to keep it green. Snow and skiing on Mt. Hood. Nice clean water from Mt. Hood melt-off. About two hours from the beach. Lots of culture, arts and diversity. Lots of environmentalists, and health conscious people. I heard it's one of the most livable large city. It has some excellent schools, others not so much. Excellent variety of restaurants and shopping. More parks than most big cities. You need to look into which part of Portland or metro area you live. Some areas aren't very safe. Other parts are much better. LOTS of traffic. Good bus system. I lived there 35 years and then escaped to a small coastal town. I hated the crowds and traffic and love my sleepy little town. If you were a hospital nurse, I would recommend St. Vincent for employment. I have relatives who work there. For a mental health NP, I would have no idea what to recommend.

I know they are different. I'm just saying you can cure strep. Why can't you cure MRSA? If the antibiotics kill the MRSA enough for the wound to heal, why is the person still colonized and infectious?

If someone has a MRSA infection and is on Vanco and Zosyn, and the wound heals, do they still have MRSA? If someone has strep, and they are treated with antibiotics, after 24 hours, they are not infectious anymore. Is MRSA different?

If someone has a MRSA infection and is treated with IV Vanco, when he gets out of the hospital, is he still able to spread MRSA to others? If a person has strep, after 24 hours of antibiotics they are considered not contagious anymore. But with MRSA, I have heard it said people may be carriers forever. I had a relative treated for MRSA, and the doctors just told us to "wash our hands a lot and we will be fine." I thought, no way. If he still has MRSA on him, if he touches ANYTHING in my house, and then I touch the same thing, I can now become colonized with MRSA. But if he is treated with Vanco, and the wound heals completely, is he still colonized? Can he still spread it to everyone he touches? So what's your opinion? If you invite someone in your home who was treated for MRSA, would you disinfect everything he touches?

I can't count the number of women that come in planning on a totally natural birth who decide, at 6 cm, to go with the epidural and are very happy they did. I always tell them I'll support whichever direction they go. I don't know the exact statistics, but I've done PPV on enough natural birth babies to know that just doing things natural does not guarantee a perfect baby. Personally, I've had a C/S and two VBAC's, two with epidurals one natural. There are pros and cons to all the different choices. There are risks to whatever a woman chooses. At home, the woman risks an unexpected postpartum hemorrhage. At the hospital, she risks a spinal headache from her epidural.

I knew a man with a first name of "Fuk." It was pronounced "Fuke". Too bad it wasn't spelled the way it was pronounced. He was an immigrant from one of those small, south Asian countries. I'm sure it was a fine name in his country, just an unfortunate English spelling.

This was a night shift nurse's note in a LTC facility. "No pulse, no BP. Will keep comfortable." She left the next morning, saying nothing about it to the day shift. Day shift CNA, of course, found pt. dead. The nurse was let go. I always wondered what the official time of death was, and if the facility told the family about this.

Considering his actions the last few days, I wouldn't take care of him without a policeman present and any other safeguards I might need to keep myself safe. That being said, he'd get the same care from me as anyone else.

We had a nurse give a pt. two regular Tylenol instead of Norco. Too bad for her that the pt. was a hospital pharmacy tech and recognized the pills and turned her in. Don't know how many patients she had shortchanged in the past. We had a young male patient with pain control issues who didn't agree with his prescribed meds. He broke into the sharps container and a nurse found him sucking on the vials.

Our patients are "alert and oriented." When I started working at the hospital, I was "orientated." I never liked the word "orientated," and now I learn I'm right, it's not American English.

There was a nurse on our unit, whom I will call "Kate," who was recently found "diverting" narcotics. Several months ago I was on the shift after hers and medicated a patient that Kate had. I brought two norco as the MAR said she had two several hours earlier. She said, no, she had only had one and she would just like one again. I know it's a very serious accusation, and to my knowledge at that time, she wasn't under suspicion. Sometimes patients are mistaken, after all, they are sick. Maybe the pt. wanted one, but the nurse gave two because most people want two, and the pt. didn't notice. Maybe she charted two, and then the pt. asked for one, and Kate put the other pill back. I didn't report it. My only proof was what the pt. said. Now I feel guilty. Maybe I should have reported it. How many patients have been undermedicated since then? Luckily she was found out, and the state board is involved, and she is no longer working there anymore. Would you have told the manager at that time?

One of the peds is out of town for a couple weeks, and a locum tenens took his place. We had a 34 weeker in labor and needed a ped at the delivery, so we called Dr. "LT." This is a small hospital that ships out early moms if we can, but it's 2-3 hours to the bigger facility, so this mom was going to deliver here. From Dr. LT's questions before the birth, I got the idea he didn't help with early deliveries. The big hospitals have specialists to attend early ones. Our main nursery nurse that night, whom I will call "Jo", has over 20 years experience with babies and teaches our NRP classes. You would think experience and knowledge would trump a degree. But no. At the birth, Dr. LT took over, did little according to NRP. Deep suctioned the mouth, then asked Jo for a smaller catheter to deep suction the nostrils. Jo respectfully told him that it was not indicated for a vigorous, screaming, baby at age 2 minutes. The baby might vagal down and lower his heart rate. The doctor insisted babies were obligate nose breathers, and he must be suctioned, and then he said "I'm not listening to you." He pointed out some other things we were doing "wrong" when we were following NRP. When he decided to ship the baby, we all thought, "Good, then we don't have to deal with you anymore." Baby was doing well, so I gave him some skin on skin time with mom while waiting for the team. I felt sad for the parents. The other peds would have kept the baby here. Moral to the story: I am SO thankful for the peds that we have here.

Wow, I was doing Dr. Maeyens' transcription when he did that episode! (my job before I was a nurse.) He loved maggot therapy. The maggots come in a cup labled "sterile." He got them from California somewhere. Once I got his extra maggots, put them in paint, and had them wiggle on a piece of paper. I gave it to Dr. Maeyens, telling him it was possibly the only painting in the world done by maggots.

We have one male nurse who does postpartum, nsy and NICU, but not labor. We try not to put him with any woman with known sexual abuse, especially if she is fresh postpartum, just because we don't want her to feel uncomfortable. Some women choose female Ob-Gyn's for a reason. He is wonderful with the babies, and almost all moms are fine with him.

You know you're a nurse when you dread a visit from your non-compliant, diabetic relative, as the last time he showed up at your door, he had a badly infected foot, and it took two surgeries and a six week stay at our house (with me being the caregiver, of course) until he was able to go home.

I emailed him today (he has no minutes on his phone) and nicely told him I was not his caregiver. He needs to accept responsibility for his health or accept the consequences. I'm kinda proud of myself. In answer to why he needs SSI. He can't get a regular job. His only income is going door to door selling honey (hence the bad foot). It's hard for him to pay medical care with that small income. His dad died awhile back and left him about $60,000. He's never had any kind of money before, and he doesn't want to spend it. Yes, he SHOULD spend it on medical care, but he WON'T, so he just doesn't get medical care. He only needs SSI for the health insurance. Although if he loses a foot, he won't have any income. If he puts the money into a house, he won't have rent, and he can get health insurance. Or if he spends it all on medical care then he could get SSI after that. Kinda complicated. He's got a fine IQ, but he has little common sense.

I am an RN. He has never been diagnosed with a mental illness, but he probably should be. He doesn't fall into any typical category. He would never cooperate with a psychological evaluation. He is disabled enough to get SSI, but he has too much money in the bank. He won't spend it on medical care. We've told him countless times to put his money in a small house or mobile home, then apply for SSI. His typical decision making process goes like this: I'll do this. No, I won't. Yes, I will. No, I won't. I didn't do it. I should have done it. My biggest fear is he will come to our town with a bad foot and have it removed. I couldn't drop him off at the foot of his stairs and tell him we'll see him later. He can't get into rehab without money. He's 51 YO. Although if he goes to rehab, that would use up of the money in the bank, and then he could get SSI. I hadn't thought of that. We need to insist he goes to rehab. I need to have a heart to heart and emphasize I am NOT going to keep helping him. He NEEDS to take responsibility for himself or accept the consequences himself. I'm not very good at confrontational stuff. My husband's "heart to heart's" end up being arguments. Thank you all for your comments. You're helping me work up the courage.

My brother in law is diabetic and won't take care of himself. Last year he quit his insulin and medical care. He came to visit last fall with his foot horribly infected. He had a 12 day stay in the hospital, two surgeries and lost half his foot. He has stairs, lives alone and doesn't drive, so he stayed with us for five weeks recovering. He still won't take care of himself. He had yet another crisis last week, and I drove four hours to his home and took him to ER because he wouldn't go to the clinic. (He was planning to come to our house, and I didn't want a repeat of last fall, so I went to his house.) He's very lonely, and I'm starting to think he is neglecting himself so family will give him attention. He has emotional and probably mental issues. We've tried hard to get him to get SSI, etc., but he won't for a variety of reasons. He's very frustrating. My husband and I are quite upset with him right now. If he chooses not to care for his diabetes, that's his choice and I can accept that. But I'm upset that he keeps wanting me to "fix" him, and it is imposing on my life. Occasionally is fine - he's family - but it's getting to be a habit. I'm not sure what to do the next time he has a crisis. Let him lose a leg? If he loses a leg, I don't want him to come live here. I'm having trouble knowing how to set limits. Any ideas?

I know of a 12 pound baby, exclusively breastfed, great latch, plenty of time on the breast. But he was large and needed more than mom was able to give. By the time her milk came in, baby was badly dehydrated, ended up in NICU with renal failure, almost died. That doesn't sound very baby friendly to me. Baby went home from the hospital the first time with a good mom and dad and a grandma who is a midwife. Even the midwife didn't catch the problem until baby was critical. Traditionally a new mom had her mom and maybe some aunts or friends present at and after the birth. She got rest while other women took care of baby. Now we allow one person to spend the night (usually dad, who may never have even held a baby before). And we require an exhausted, painful woman to take total care of a fussy spitty baby. That's not very baby friendly or mommy friendly either. I like where I work. Sending baby to nursery at night is given as an option. Breast feeding is strongly encouraged and supported, but moms are not made to feel any guilt if they want a bottle. All our Mexican moms breastfeed and bottle feed. We joke sometimes that only white babies get nipple confusion.

In ICU there was a pt. that was dying. She was hooked up to the monitor. Every time she was turned, her HR, Resp and BP all decreased about 20%. Then over the next half hour the VS increased to normal. Two hours later, we turned her, and VS all decreased about 50%, then returned to normal. The third time we turned her, VS decreased, and kept decreasing until she was gone. I think it made her more comfortable to turn her, but it was hard on her. Since then I always turned dying pts carefully, just enough to promote comfort.

Any time we discharge a pt. after the pharmacies close, we can call pharmacy to give us enough meds to last until morning. I've done narcotics before. Pharmacy packages them differently. They hand me the little bag with the meds. I give the bag to the pt. and chart it. Community pharmacies always give pts meds to take home. Their license is not on the line if the pt. doesn't handle them correctly. Not sure why yours would be. You have to follow your hospital's policy, and that NP should follow it too. Our policy is different.

I've had a C/S, an epidural/episiotomy and a natural - in that order. (Back when VBAC's weren't "dangerous" ). I tell my patients I'll support them in whatever they choose, and I mean it. There are pros and cons to each. My episiotomy gave me more pain than my C/S. My favorite was my last - I stayed in the shower until they made me get out. Then got in bed and pushed my baby out with only a small tear. I used to be more pro-natural. However, I've had lots of women try natural, then by 6 cm change their mind and get an epidural. They are sooooo happy for the epidural, I've become more pro-epidural. Also, some women, once they get the epidural, they relax, and labor goes quickly to complete. The majority of women come in planning on epidurals. Last night had a woman with a really good one. Baby was crowning, and mom was laughing. The baby's head bobbed in an out of the birth canal. Precious. We can do intermittent auscultation unless they are high risk or on pit. Everyone gets at least a SL. I do get upset with doctors who only want the semi-fowler's position. Usually we have family members help hold legs in pushing. If a woman is large, we may use stirrups. Some doctors and both midwives will use the squat bar or hands and knees. One of our doctors only does the back position. The pt. was pushing, and baby wasn't moving. The nurse asked if we could try side lying. Doctor said no. Doctor left the room, and nurse put pt. on her side. Then had to yell for the doctor quickly to not miss the birth. Dr. had an irritated look, but she couldn't argue with success.