debrasDD99

Thanks everyone for replying to this message. l have had 2 test and 3 papers in the last week so I haven't been on-line, but I did want to give you an update on my patient. When I visited my patient last Wed. the doctors hadn't sewed her up yet. Before I left (around 4p.m.) I suggested to her mom that she should start to make some noise (because we know that the squeaky wheel get oil first). I came back to visit my patient on Thursday afternoon and she looked much better. She was sitting up in a chair, holding her baby, and had just finished her 3 round of antibiotics. She told me that they came and sewed her up around 6 pm Wednesday evening. In response to your question, Smiling Blue Eyes, my teacher had me take my patient's bp every 5 minutes while the doctors were deciding what to do. Her pressure kept going up 150-160 systolic but she had PIH (which was why she was on Mag) and the doctors didn't feel that the BP was much of a concern. I didn't take her temp so I do not know if she spiked a fever. In post conference with my teacher, all she could do was diplomatically tell me that she did not know why the situation was handled the way it was. I have learned so much from your replies. I am student nurse and so I have to walk a very fine line. However, I have been wondering if I was the RN, what should I have done? I really felt that the doctors were not providing safe care, and what bothered me was that nobody stood up for this young woman. I'm glad to know that there is a chain of command that a nurse can take when she sees a problem instead of just standing by watching a bad situation get worse. Thanks again, Deb

Hi All, I am a student nurse doing my OB rotation. My teacher assigned me a postpartum c/s patient to take care of. I was with her from the moment she woke up in recovery until the end of my shift. This young lady is 16 y/o, just had her first child, and the c/s was due to fetal distress. They had her on morphine, pitocin and mag. sulfate. Everything was going fine until around 12:30 pm. As I was assessing her fundus, I noticed that she had blood stains from her incision site. The blood had stained her gown and one of her sheets. I called the RN and asked her to look at it. She did. The blood was not bright red and it had made a small stain on her dressing. The RN instructed me to mark the dressing and assess the site in about an hour to see if the stain had gotten any bigger. In an hour, my teacher comes in to look at the site. The stain did not get bigger on top of the dressing, however there was blood coming from the bottom of the dressing. This was only happening in one spot. My teacher went to go and get some 4 x 4 to reinforce the dressing. When she came back with the 4x4 we went to go and put it on pt.however the pt. is now bleeding from 3 different spots from the incision and the blood is running like a steady stream. My teacher tells me to put pressure on the bleeding while she goes and gets the nurse. Both my teacher and the nurse walks in a couple of seconds later and the nurse assess the situation and says that we need to get a doctor to look at it. There happens to be a doctor (we will call her dr.1) already on the floor checking on another pt. so they have her come in to take a look. By that time, my patient has soaked through several 4 x 4. Dr. 1 looks at the site and continues to put pressure on the incision. At first she says that sometimes incisions bleed, but it is nothing to be concerned about. Then she states that she doesn't want to remove the dressing because is probably tamponading the blood. However, as the pt. continues to soak through the 4 x 4 she realizes that she is probably going to have to remove the dressing and look at the incision. Dr. 1 removes the dressing. The bleeding has stopped, and she inspects the staples and the incision. She decides that it is not necessary to reopen the pt. so she begins to put on another dressing. As she does this, my pt. starts to bleed again. Dr. 1 asks us to call Dr. 2. A few minutes later Dr. 2 arrives. Dr. 2 assess the situation, and at first she feels that everything is OK, but upon further investigation she states that they should probably remove the staples. The nurse asks Dr. 2 to please take the pt. to the OR and sew her up there and then take her to the ICU floor for further evaluation since ICU has a 1 to 1 nurse/pt. ratio and she is short staffed and does not have the personnel to watch the pt. around the clock. Dr. 2 does not agree to this. Instead, Dr. 2 makes out a laundry list of things for the nurse to get for her and states that she is going to remove the pt.'s staples and sew her back up in the room. Due to the fact that the postpartum floor is not setup for this type of procedure, it takes the nurses a long time to come back with the stuff. In the mean time, Dr.1 decides to inject Lidocain around the incision site to numb the area. She tries to break off the neck of the ampule bottle, but she breaks it in such a way there are little pieces of glass everywhere and jagged edges on the bottle. Then she inverts the bottle to withdraw the medicine with her needle and the medicine spills all over the place. Dr. 2 starts to remove the staples. As she is removing one of the staples, blood starts to squart out. She starts to apply pressure, and the blood stops. She continues on with the removal of the staples and once that task is complete she reaches into my pt. (with clean gloves, not sterile gloves) and starts removing blood clots. Now both doctors realize that this procedure has turned out to be more extensive than what they thought, and they call for Dr. 3. Dr. 3 comes in and takes over the procedure. She cleans the pt. out, irrigate her, and sew up the bleeder, then she packs my pt. with a saline soaked gauze and tells her that she will need to go to the OR tomorrow and be sewn up. She then puts on another dressing and leaves. My pt. is wondering why they would just leave this hole in her and not sew or staple her back up. Her mom is concerned about her daughter is catching an infection. The Dr. says that the pt. will be fine and they leave. I visited my pt. today and at 4 p.m. she still had not been sewn up. When the mom asked why, the nurse replied that the doctors were doing C-sections and they would see her daughter before the night was out. She also replied that they now have all the supplies the doctor would need to sew up her daughter on the floor so that the Dr. could perform the procedure in the room. When I checked my pt. she was still having drainage from the incision site, and it was soaking through her gown. This is my question, is this normal? Should the doctors have ever perfomed a procedure such as that in an unsterile environment? Isn't my pt. at an increased risk for infection? If so, shouldn't somebody be administering some type of antibiotic? Also, how long can she be kept open like is? I know that she has a dressing on, but there is a reason why the doctors either stitch up or sew up your outer skin layer. Please explain this to me. I am really trying to understand because on the outside looking in, this seemed like unsafe health care. Thank you, Debra

LOL!! Are you sure you are not pregnant!?! Just kidding. I have been lurking on this website for 3 years now, and this is my very first post. How appropiate for me to post in the 'Nursing School is making me sick' forum. This is my first semester in nursing school, and I am not enjoying ANY of it. Doesn't matter though, I will graduate May 2007. Hang in there!