nrse4evr

Hi Wound Care Specialists I am not a WCCS I am a L and D nurse who is caring for a family member with a pressure sore. It was not detected until it had progressed to tunneling because this person is not bed or chair bound and is an active 78 yo. Noticed some drainage and blood on her panties and asked me to look at it. Long story short we have been to the WCclincic have had bone scans to check for osteomylitis, had a ct scan to check for tunneling vs rectal fistula and several debridement episodes. The wound is on her coccyx and buttock. I am so out of my element but am learning. The WCC Dr has had me changing tx modalaties every week from acquacel to silvadene to vaseline gauze. Nothing was helping very much. I ordered some stuff called DermaWound from the internet. Itseems to be made up of sugar and Vit C. I have heard that one of the treatments used in the past is sugar and or raw honey. The wound seems to be getting smaller but the tunneling stays the same. There is no longer any foul odor but drainage in copious amts continues. Anybody got any suggestions? I am losing faith in the Drs and am looking for some experienced nursing advise Please help

Of course it doesn't sound silly. I thank God that there are people like you who feel a calling to LTC. Iwork OB and my Mom was a LTC RN before her retirement. We represented a sort of 'womb to tomb' continum. I always respected her for choosing to work ing LTC. She could have done anything but she loved old people. It would scare me to death. I think there is a special place for those of you who think that end of life and dignity of life and quality of life are more important than length of life and work hard every day to make that happen. You have my thanks and graditude

When pts tell me that they don't want anything for pain in labor I tell them they have 3 options 1. Nothing--Pain is free you can have all you want. 2. Iv meds 3. Epidural

Unacceptable care is unacceptable care no matter which shift it occurs on. Talk with the DON as has been previousy mentioned but also with the individual caregiver ( and I use that term loosely) about the kind of care he/she is providing. Make it non confrontational, but stress the point that the pt deserves better than to be left in a wet bed or to have to smell the stench of their own feces when that can't do anything about it. How would that person like to be treated in the same way!

They have been trying to make BSN the minimun entry into nursing for the past 25 years or so. At one point ADNs were going to be 'technical' nurses while BSNs were 'professional' nurses. i am an ADN and am just as professional as the BSN nurse next to me. A degree doesn't make a nurse better or worse and while I am a firm believer that no education is wasted until ADNs and BSNs and Diploma nurses take dfferent state boards I don't think mandatory entry levels will work.

Congrats on getting the job. I interview nurses hoping for a job in our L and D unit and I can tell you that it isn't so important what you say in response to the questions as it is in How you say it. As a Hirer/Firer I am more interested in the way an individual presents themselves ie. confident but not cocky, willing to learn, not a know-it-all,knows when they don't know. I know that you got the job but i hope this might help others in your previous situation

Dear boyter Let me say first of all "Thank You for Serving!" I am a former 91B medic from a long time ago. I can tell you that your experience as a medic, while maybe not transferable to the RN program, is invaluable in the real world of nursing. In the army you get to do so many things that you will not be allowed to do as an RN. But just knowing about procedures and possibly having witnessed or participated in them is priceless. I was medic for 8 years during peacetime and the experiences I have cannot be reproduced in the civilian world. I am not in the field of academia and so I don't have any advice to offer on what will transfer and what will not, but as I said your experiences are priceless. Even if you have to take all the pre req's you will not lose anything, only gain. All education is valuable in some way. it may also be possible for you to take some of the pre req's while you are still active duty if you are stateside or have access to computer classes. But I am sure that you already know that. Combining military duties and college isn't easy as I am sure you know. Stay with your dream and make a great RN and continue serving. Good Luck

I have cousin who gave up twin babies to a couple she had chosen through an agency. It was probably the hardest and most unselfish thing she has or ever will do. She had the full suppost of her parents which ever way she decided to go. No pressure from them. Her extended familly was not so supportive. Don't know what they were going to do to help her but most just condemmed her choice. Those babies today have the most blessed life with 2 parents who really wanted them and are able to provide for them. The 'Mom' keeks in touch and can visit when she wants, which isn't often, and gets regular pics of the babies. They aren't 'babies' any more and I don't know what adoptive Mom calls bio Mom. But they have worked it out to their satisfaction. I respect my cousin and her parents for their unselfishness and consideration for the needs of the babies.

Just my opinion but I would try to get a med surg position for about 6 mon or a yr to develope assessment skills and time management skill. I know that is not what you wanted to hear but despite not enjoying med surg the experience can teach you alot. From the above mentioned skills to being grateful that you don't have to do med surg nursing. (Sorry about that to those of you who love Med Surg. Remember, just my opinion) Once you get some experience under your belt go for the L and D position. If you can handle thaqt everything else is a walk in the park. Not that I am advocate that other areas are less important, I'm not. It's really hard to be politically correct in this forum and not offend any other specialty. Hey Smiling Sorry bout them Bears. My son is a huge fan and he was devastated. NRSE

Sounds like you experienced birth with an older Dr. Some on occassion still ask for FP. Knowing that this is an antiquated and dangerous practice the nurses at my facility accomodate the Dr by "performing" fundal pressure. Place the side of your hand on Mom's fundus and "push down" The pressure that is applied is minimal. Most of it is in the Nurses face but it satisfies the Dr and doesn't get the Nurse yelled at by this old guy. I have to agree with tntrn (above) that waiting outside in the hall is not a good idea. I have had security remove people when they refuse to relocate to the designated WR. It is also a HIPPA thing. Not everybody has the right to hear the patients cries or her information no matter what THEY may think. Sounds like the Pt and her Dr were on 2 different wave lengths and perhaps would have benefited from discussing the birth plan prior to the delivery. Most OBs will accommodate the Mom's wished if they don't interfere with the safety of both Mom and baby. If they do, the Dr will usually explain why Mom's wishes can't be done. I am not a big supporter of Doulas for in my experience they have undermined my care of the pt by countermanding my orders of needed FSE,IUPC,PIT etc. I always try to explain to Mom why we do what we do but if she has objections I try to take them back to the Dr and mediate a compromise. I have found that the Doula interferes with this exchange more often that not. Just my experience.

Best advise: Treat the pt not the numbers! One of anything is nothing! Look at the strip as a whole not as individual decels or accels. Think about what is happening to your baby and can he or she tolerate the incident. Will my baby deliver soon? Am I remote from delivery and this is a consistant pattern? Is my baby sleelping? What is Mom's position? L and D is about more that just reading fetal monitor strips. That's a VERY important part but just a Part. Good Luck on your L and D nursing. I've been doing it for 30 years and LOVE IT!!!!!!!!!

PS We also try to let every new nurse do a controlled Dr assisted delivery at least once. Then she knows what to do if she has to deliver by herself. Because we are a teaching hospital the pts are asked if they mind if a nurse delivers her baby. We try to only do this on low risk multips who could probably do the delivery better that we do.

Our unit is a level 3 unit with Hi,Lo and everthing in between risk. The rn taking care of that pt will usually notify the Dr when the pt is 8cm or sooner whatever the dr wants. When the Dr gets to the hosp he or she comes to see the pt (nights) then goes to the Dr call room and the RN calls when she is set up and ready for delivery. If as another contributor stated, there is pushing beyond 1 hr we call the Dr to let him/her know the progress unless otherwise instructed to do so. We also have Residents. Lately the residents have been pushing with the pt and that drives my nurses insane! We are very protective of our Moms and refer to them as OUR pt eventho they are really EVERYONEs pt. We like to call the resident in when we are ready to BIRTH. Don't want to tie up everybodys time with pushing. Because the pts usually see so many different residents, attendings, med students, we try to maintain control of our pt throughout the delivery so she doesn't really focus on someone she has never met before standing between her legs. Not the best scenario but it is a teaching hosp. We do about 200-240/month

First of all Cervidil MUST be refridgerated until right before placement. We obtain baseline nst, confirm vertex presentation, either cx check, leopolds, or sono. Then after cervidil placement NPO x 2 hrs then may eat until MN. Most of our cervidils come in at 5pm or 7-8 pm. We place the cervidil, monitor x 2 hrs, feed them, then NPO after Mn with continuous EFM VS not q1h but at least q4 or more often if something is going on. We find that alot of our Pts deliver on the night shift 7P-7A. It is a good induction tool if the pt is a good candidate. As are most induction tools. Some Dr will let their pt be off the monitor 2 hr post cervidil, but untimately it's up to the L and D nurse who is caring for that pt Hope this helps.

Sounds like you got it down. Another really important thing to remmber is to stay as calm as possible, no shouting,yelling that sort of stuff. Mom takes her cue from you and if you want an out of control pt be an out of control nurse. She is already freaked out that her Dr isn't there, the baby is coming fast and she isn't sure that you have ever done this before. Use a calm voice, talk to your pt as if you have done this a million times. Talk to the baby as it is being born. That sort of stuff helps to keep the scene calm and less chaotic into which every baby deserves to be born. As a previous contributor said, babies pretty much birth themselves and we are there to guide them with limited trauma to Mom.