LittleLisaLawrence

In my practice I've noticed that women without epidural do just fine pushing on their own (without instruction - - open glotis). My patients that have an epidural, however, don't seem to move the baby with open glotis pushing. Like the above poster... we'll switch to closed glotis and progress is made. I thought I was the only one who noticed this!

We have QS, but I find myself double or triple charting sometimes like with medication administration or the pitocin level (whether it was increased, decreased or turned off).

i haven't had anything official regarding documentation although i've looked at my preceptors notes and i've kind of formed my own (see below). i feel like i might be leaving out important info or may not be succinct enough. here's an example of my admission note: [color=gray] ___ yr old g__ p__ under care of dr. ____ presents @ ____ weeks ambulatory from home [color=gray](or wheeled up via wheelchair from ed) with report of ruptured membranes [color=gray](or regular uterine contractions). escorted to ldr ___. to br to change clothes and obtain urine sample then to bed. manual test of fetal monitor performed, test lines indicate that the monitor printer is properly functioning. leopold's maneuvers performed to locate fetal back and presenting part. pt encouraged and assisted to move to a r lateral position in bed. efm & toco applied. pt reports active fetal movement--audible on efm. pt denies any leaking of fluid or lady partsl bleeding. pt denies ctx's. pt reports (+) fetal movement today.history in progress. here's an example of my arom note: immediately prior to artificial rupture of membranes, fhr baseline ____, moderate variability, spontaneous accelerations to the ____'s and no noted decelerations. upon completion of arom no umbilical cord is palpated, small [color=gray](or scant or moderate or large) amount of clear, watery consistency, normal smelling amniotic fluid. fhr baseline ____, moderate variability, spontaneous accelerations to the ____'s and no noted decelerations. contractions every ____-___ minutes, lasting ___-___ seconds. abd palpates soft between contractions. contractions palpate mild. here's an example of my 2nd stage note: rn remains at bedside throughout 2nd stage; assisting patient with pushing; evaluating fetal monitor strip. pushing efforts adequate. patient states pain relief from epidural remains adequate. room set up for delivery. dr ___ [color=gray]and nicu aware that patient is pushing. will notify when needed for delivery. here's an example of my delivery note: spontaneous lady partsl delivery of viable [infant's sex] @ [time] over an intact perineum by dr ____. [color=gray]1st degree lady partsl/perineal laceration (or 2nd degree [color=gray]episiotomy)[color=gray] repaired. infant vigorous at birth - - spontaneous cry, pink with bilateral acrocyanosis of hands and feet, placed on pt's chest to begin bonding after fob cut the cord. tactile stimulation & bulb suction of nose and mouth of infant done on pt's chest. apgars 8/9, remains in room with mother. to warmer, footprints done, id bands applied. infant wrapped and given to pt. nursery notified of infants delivery time, apgars, and that the infant is of "average size." nursery nurse on her way to assess infant. what do you ladies think of my notes?

i'm a new l&d nurse (scheduled to get off orientation in 1 week!) and i need help with documentation, specifically nursing narratives. i've looked everywhere for a book specifically for ob charting but to no avail. what do you ladies usually write for events like... - the admission note - arom - amnioinfusion - pt education regarding 2nd stage pushing - delivery summary *examples of the following would be so helpful*

i'm confused regarding scalp stimulation. is it used to evoke an acceleration?

i took mine yesterday (may 1st). waiting for my results is just plain painful! i'll know my unofficial results on monday the 5th.

I took the NCLEX yesterday too! My exam shut off @ 75 questions. When I was on # 74 I was praying that it kept going after 75 because I felt like I was doing so poorly I wanted a few extra questions to prove myself. When do you find out the results?

Here's the link.... http://www.aafp.org/online/en/home/cme/aafpcourses/clinicalcourses/also.html

I think that's great that you ask people if they'd like it - - very sensitive! At out hospital we certainly do allow (for lack of a better word) our clients to take their placenta home. We place them in biohazard bags, we really don't have anything else, and send them on their way. No paperwork to sign. I don't know if they still do but Alta Bates in Berkeley, CA would send their clients home with their placenta and a little treeling to plant over it.

Interesting! I didn't know that. Thanks for sharing.

In addition to the requisite NRP and ACLS what other certification have you guys found to be helpful in L&D? What about also (advanced life support in obstetrics)?

awhonn now offers an introduction to fetal heart monitoring course online: http://www.awhonn.org/awhonn/content.do?name=02_practiceresources/2g5a_onlinelearningcenter.htm#introfhmonline and of course, the tutorial includes nichd guidelines!

you may find understanding diagnostic tests in the childbearing year: a holistic approach by anne frye helpful. as of right now it’s sold out on amazon.com, but you can purchase it on anne frye’s website: http://www.midwiferybooks.com/

Of course it depends on the facility but here's what I had to do... - meeting with my nurse-manager to fill out unit paperwork, decide on a start date and meet my preceptor - complete a urine drug screen and physical (including having blood drawn to check titers for rubella, rubeola, & varicella) - take a medication exam (50 multiple choice questions, no big deal) - meeting with HR to fill out tax paperwork, go over benefits package, ID badge, set a date to attend hospital-wide orientation Needless to say all this took a few hours!

my hospital uses rts bereavement services (found here: http://www.bereavementprograms.com/). *they also have memory boxes available.* tips on bathing stillborns… have a warm basin of water to receive the baby. prearrange for the doctor to hand the baby to you and gently place the baby in water. - this bathes the baby, and bodily fluids will rinse away. - this also preserves integrity of skin and minimizes slippage. - do not rub to wash or dry the baby. - do not use soaps-this will hasten a skin breakdown. we offer baby unclothed, wrapped in a blanket to parents for bonding. if lotion or powder is desired, we place it on the blanket, not the baby. we encourage parents to dress their baby, even tiny ones.