CarrieRNC

It does take a lot of time and practice! I remember my first "ah ha" moment when I felt my first cervix! If your thinking it is going to be a difficult exam start off by having them make a fist and put them under their "butt" and make sure they are supine. Sometime multips have very "mushy" feeling exams making it difficult to find their cervix, just keep "climbing around" with your two fingers and you will find it! LTC feels like a nub. Everyone has their "starting point" when it comes to exams. Mine is one finger= 1cm, two fingers, tight=2cm, 2 fingers, loose= 3cm then from there its experience, I can say that 8cm for me is feeling the cervix all around the presenting part but having to "reach" around and 9cm is "loosing" the cervix on one side or another. You will also find starting points for yourself as time goes on. Do you have access to a "cervix box", your educators may have one or we have a wooden slab with holes in it for 1cm up to fully for our new residents to practice on. Hopefully this helps a little and some advice, never do a SVE on someone who is actively bleeding( you should do an ultrasound to check for placenta placement first, then a SSE) and if it is a pretermer always do a SSE and get a FFN before you do a SVE because the gel will throw off the FFN study. Good luck!!

I work high risk OB, 1:1 nursing care(hopefully!) Pt on MGSO4, Delivering Pt., PACU Pt., Pt getting an epidural and any critically ill pt requiring continuous fetal monitoring

Absolutely agree with Smilingblueyes!! The theory of only needing 8-10mu/min of pitocin has proven sooo true in my practice! I tend to slow down in my advancement of pitocin around these units. There is an attending on my floor that has eluded to this and since then I have been noticing that if I just hang out around 9mu/min for a while my patients seem to follow a very nice labor curve without ever going any further! In regards to your decel, don't kill yourself over this, you made appropriate interventions and from the sounds of it I am sure turning off the pitocin a few minutes earlier wouldn't have made a difference! Maybe she was hypotensive AND she was fully, perfect combination for fetal bradycardia. Did you ever get a cord pH???

If she had just received an epidural, was this caused from the epidural(did she get a CSE?)? What was her BP? If it was low, this could have been decreased perfusion to the placenta which in turn could have caused the decel! In this case she really just needed fluid, position change (supine with legs elevated, works great!) and possibly a little ephedrine if she really became hypotensive and TIME!!. I agree that the pitocin probably had nothing to do with it but if everything else you did did not improve the FHR then pitocin should have gone off(she was fully anyways). Usually, depending on your policy, you can turn the pitocin back on to the same setting if its within 20min.

We collect a "cord blood sample" from the cord after every delivery, a hold cord blood order is generated and the tube is sent to BB to be held if needed, not every infant born is typed. IE: if mom is RH neg or if the infant becomes jaundiced, at that point the BB will run the cord blood for type and screen. Does that answer your question?

Great article!! Ironically, we just had a meeting on our floor regarding RN dissatisfaction after a survey that was done earlier this year! A majority of the complaints come from having limited staff and spending too much time finding equipment/supplies! We are just in the process of going live with KBC, our floor will be rolling out next and I think this article will be a wonderful reference as we proceed. There are a lot of nurses that think the EHR will take time away from their patients and make more work for the nurse. I am so enthusiastic about it (I am doing gap analysis for OB) and I am trying to let them know that this WILL be a safer way to chart and also assist us with better patient care!! Thank you again!!

This is a great article about the NICHD nomenclature. A Review of NICHD Standardized Nomenclature for Cardiotocography: The Importance of Speaking a Common Language When Describing Electronic Fetal Monitoring

Look up the NICHD guidelines, this is what EVERY OB nurse/MD/resident/CNM etc should be charting by and it is what AHWONN is supporting. For you, if you follow these guidelines you WILL be practicing "safe charting" and you will always have the backing of AWONN if you follow the appropriate interventions. I work in a level 1 hospital where we do about 4500 deliveries/yr. These are our standards and if you are charting on the electronic record then it should be built into your system(depending on what system you use).

In my case it would be RNC-OB, this means that I took the certification in my area of specialty (in pt OB), reminded me of taking my boards:uhoh3: You do have to have 45 CEU's in 3yrs in that area of specialty to keep up your credentialing. The hospital I work in does not give you any more $ for it but it is recognized and if you are certified you should state it as such.

Does your floor follow the NICHD guidelines? There are only four types of deceleration patterns....variable decel, prolonged decel, early decel and late decel. This is the safest way to chart. I agree, and we all tend to describe decels but what we really should be doing is stating what they are according to the NICHD nomenclature and then stating your interventions.

I have a BS and an ASN, I would never sign BSN or have it on my tag(we do put our degrees on our tags). BUT I am proud of my BS in biochemistry, I worked hard for it, so I will put down BS RNC-OB if it is an email or letter. If I am signing my name I put RNC only though.:)

Does anyone chart electronically??? Have you ever heard of CPG's! (Clinical Practice Guidelines!) CPG's are care plans which drive our practice based on evidence based medicine, this is an interdisciplinary approach........Assessments/interventions, goals and outcomes, and of course education. So all those care plans that nurses are saying are a waste of time are integrated into electronic charts that EVERY nurse will be charting on by 2016!! If you haven't experienced EHR, you will understand when you do and you will look at nursing care plans a little bit differently! There not so bad!

I have been pulled over a FEW times in my 25yrs of driving!(i have a lead foot, sorry:)I have received warnings but only once have I received a ticket and that was just last month on my way to work AND it wasn't even for speeding! It was at 645am trying to get off the exit in the city and I was stopped for "unsafe lane change"!! I did have to merge into traffic to get off, as everyone does at this exit AND to make things worse, I knew he was behind me!! The cop was a jerk! asked me where I was going and I told him(had my scrubs on and my badge in the passenger seat) and he came back with huge chip on his shoulder and a ticket in hand!!!! Didn't say Boo to me and walked away! Needless to say I'm fighting it and just got my court date!

Thank you for all your input! Has anyone out there ever used KBC (knowledge based charting) for any electronic charting?

Remember highlandlass, a care plan is a guide, it is what drives best practice! and you don't have to get a new care plan every time your patient crashes, you individualize it. Something else to think about is the other ancillary depts that are involved in your patients care, this gives everyone a guide and helps to drive the education and outcomes that will only benefit your patient, after all isn't it about the patient!!