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ashleyisawesome BSN, RN

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ashleyisawesome is a BSN, RN and specializes in LDRP.

ashleyisawesome's Latest Activity

  1. ashleyisawesome

    St. Luke's School of Nursing

    Haha WOW!, I graduated 8 years ago, but I do vaguely remember the critical thinking test. It wasn't knowledge based or really something you could study for. It was literally just critical thinking questions. I think they gave you a few paragraphs of a scenario of some kind (not nursing related) and then it asked questions what you would do in that situation. Like I said, there is no real way to study for it. It's just to assess how strong your critical thinking skills are. I guess you could Google critical thinking questions, but I wouldn't bother. Either you have good critical thinking skills or don't, you aren't going to gain them in a few weeks before the test.
  2. ashleyisawesome

    39 IOL

    Have you read the ARRIVE study? 39 week eIOLs are becoming more common due to the study saying it actually reduces the risk of c-section and still birth in primips, regardless of bishop score. I am not sure if ACOG has officially changed their recommendation yet, but I have heard they are going to. My hospital recently changed it's policy. In the past 39 week electives were allowed, but they had to have a favorable cervix. Now they allow them even if the patient is closed thick and high.
  3. ashleyisawesome

    Insulin drips patients on L&D

    My unit's protocol is that anyone (with diabetes) in active labor who has 2 blood sugars in a row that are over 100 gets put on an insulin gtt, and yes we titrate them on our unit. The patient is automatically 1:1 and gets hourly blood sugars until they are off the gtt. The gtt is usually d/c'd once they deliver unless they are type 1 DM, then endocrinology is consulted and they decide what to do with it, but they remain on our postpartum unit unless they are in DKA or something and need to move to stepdown or ICU. I also did insulin gtts when I worked on med/surg, often with a 6 patient assignment.
  4. ashleyisawesome

    Any nurses that have started and transferred out of L&D?

    I have coworkers that have gone on to work in the OR, PACU, NICU, ED, Dr Offices, ICU, med/surg, peds, psych, home health, and probably some other areas I'm not thinking of. L&D is a varied specialty and you will learn a lot. You can spin the experience to work in your favor for almost any specialty. It's good for an ICU nurse because you learn how to deal with complex patients on a 1:1/1:2 ratio, you will learn a lot of the basics you'd learn in med/surg (gtts, I&Os, prioritization, assessment, communication with physicians, etc). You might not be coding patients a lot (hopefully), but you deal with a lot of emergent situations like hemorrhages, stat c-sections, shoulder dystocias, uterine ruptures, abruptions, precipitous deliveries, eclampsia, etc. A lot of our patients have comorbidities like DM, HTN, seizure disorders, psych issues, heart defects, etc. I have even had paralyzed patients that I had to do incontinence and wound care on! You will become very familiar with a well newborn assessment which will help you if you move on to PICU one day. There is also a ton of parent education which is great practice if you want to work in a PICU--you will be dealing with scared parents a lot! Remember there are a lot of roles an L&D nurse fills. Along with caring for a delivering mom and her baby in labor, you might also end up helping with neonatal resuscitation, in the OR as a scrub or circulator, in PACU recovering a fresh post op, in triage dealing with anything from rule out rupture/labor to yeast infections, to preterm labor and obstetrical emergencies. If you work in an LDRP you will also care for postpartum couplets, which is a lot like med/surg lite. And as a new grad, you aren't losing any skills by starting in any specialty. You can only gain skills. Don't take this negatively, but as a new grad you don't really have any skills to lose. For instance I don't know the first thing about caring for a patient on a ventilator, because I have never had to. I may have seen or cared for a few in nursing school under the guidance of other nurses, but in no way would I have ever said "I can take care of vent pts because I learned that in school." I am sure I could learn how to if I picked up a job in ICU, but they wouldn't expect me to know how when I started and they would teach me. Any knowledge you become rusty on or skills you feel like you didn't use much in L&D will be learned on whatever floor you end up on next. That's why they have orientation.
  5. ashleyisawesome

    Panic Attacks During C-Section

    I haven't had many actually panic. They get anxious, and a lot of them cry. I usually hold their hand and explain everything we are doing. I reassure them that we will make sure they are completely numb so they won't feel any cutting, but warn them about the pulling and pressure. I introduce them to the NICU staff and baby nurse and tell them their baby will be in good hands. Sometimes anesthesia will give them a little something in their IV to calm them down.
  6. ashleyisawesome

    Delivery table set up

    We set a new delivery table for each room (usually when a primip is around 7cms, sometimes sooner for a multip). We set it "sterile" with sterile gloves on and throw a sterile sheet over it. The docs wear sterile gloves during delivery and only they are supposed to touch the stuff on the table. We write the time and date on and they are good for 24 hours (if it's an hour or two over we usually just use it, since vag deliveries aren't actually sterile). Sometimes if a precipitous delivery rolls in we'll steal an already made one from another labor room, or I just throw the instruments on in a hurry and don't arrange them all nicely like I normally would. Usually the PCA/scrub tech sets up our tables, but if I am not busy I set my own.
  7. ashleyisawesome

    Nubain before pushing?

    We only have one doctor that orders Nubain in labor, most others do Stadol. But regardless we don't give either if we think they are going to give birth imminently or within the next hour or two. Our general cutoff is 8cm, but it can vary by how their labor is going. We definitely wouldn't give it when they are complete and pushing. How would it take 2 hours to reach the baby? You are putting it right into mom's blood stream, it's going to get to the baby fairly quickly. You can tell because when you give it in labor you will notice 9/10 times your variability will become minimal with little to no accels for a while, usually within 15 mins of giving the med. This can be a problem if the baby is born with the narcotic in their system, as they may have respiratory depression/decreased tone.
  8. ashleyisawesome

    What EFM software do you use, and do you love or hate it?

    We use PeriGen with EPIC. Before EPIC we used McKesson and PeriGen. I like it well enough, but haven't used any other program so I don't know if it's good or bad, but I haven't had any major issues with it.
  9. ashleyisawesome

    Night shift worries

    I left a dayshift med/surg job for nights in L&D and I don't regret a thing. I actually prefer nights. I have had opportunities to switch to days on this unit and chose to stay on nights. It can take some time to get used to, but once you get into a rhythm, it's not so bad. I never wake up to an alarm! I only work 2 days a week, so that probably helps, but I think I could make 3 nights a week work if I needed to.
  10. ashleyisawesome

    Anyone use Gnosis for training?

    We use it! My hospital actually makes all of the residents take the modules too! It is very time consuming, but I learned a lot from it. They make us retake it every couple of years as a refresher, and I feel like I learn something new every time. How it works is you take a pretest for each module, and depending on what you got right/wrong, it creates a list of topics to read through (including some videos, scenarios with questions/answers, and just written information with links to sources. It groups the topics in red, yellow and green. Red are things you got consistently wrong, yellow you got some things right and some wrong, and green are topics you got mostly or all right. My employer only requires us to review the red and yellows, but if you do the greens you get more CEUs. After you go through all of the material, you are tested again to see if your knowledge improved from the pretest. If it didn't you have to go through them again and retest. Each module takes several hours to complete, but my employer pays us to do them from home if we want, which is nice.
  11. ashleyisawesome

    Magnesium sulfate question

    1. Generally they are on bedrest with bathroom privileges, but if they are a postpartum NICU mom, we usually let them visit NICU in a wheelchair with an RN escort. I also let them get into the chair with assistance, but I don't let them walk around without help. 2. No diet restrictions related to the Mag. If they are in labor it's clear liquids, if they are PP they are on a regular diet. 3. They usually have a 1500-2000ml Fluid restriction (including IVF, so we usually run the mag at 25/hr and the fluids at 30/hr). Moms on mag for neuro protection generally don't have a FR though. 4. For pre-eclamptic patients on mag, we usually do q6h mag levels. If they are on it for neuro protection with preterm labor we don't check labs unless they are symptomatic.
  12. ashleyisawesome

    Rooming in on another unit?

    We have a nursery and a nursery nurse on staff. We mostly room in, but a few moms will choose to send the babies to the nursery overnight for a few hours. We still practice couplet care. The nursery nurse will help out with assessments or feeds if we are busy, but she is mostly responsible for keeping an eye on the babies in the nursery (ie, making sure they are still alive) and admitting new babies. Any "border" babies (mom is discharge and we are just caring for the baby) are the nursery nurses responsibility. It comes in handy for the situations you described. If mom is on another unit (usually ICU or Stepdown), we keep baby in the nursery and mom can pump and send milk until she is discharged. I've had a few exceptions where they let us bring the baby to ICU to breastfeed, but an OB nurse has to be there and bring the baby back down when it's done feeding. I don't like bringing newborns up to the ICU though, around critically ill adults who likely have something contagious. We do allow dad into the nursery to bottle/finger/syringe feed, or just hold the baby for a while if he wants. If we have a baby who has to stay, but mom is discharged, it can either stay in the nursery or if we have rooms, mom can room in with baby (but she is not a patient and we aren't responsible for her, just her baby). This happens a lot with our NAS babies, bili babies, and kids with temp issues. It's also useful for adoptions. Usually the birth mother does not want to room in with the baby, but it has to stay for 2 nights, so we keep it in the nursery, or the adoptive parents room in, in a separate room (if we have available rooms). I would not be happy with your hospitals arrangement. It sounds unsafe. If they are going to have a baby on peds, either the peds nurse should take care of it (it is a pediatric patient!), or they should have a postpartum nurse on the unit and that should be her assignment, no switching back and forth between floors. What if you are on peds assessing the baby and one of your moms in PP starts hemorrhaging? I also don't like the idea of mom/baby rooming in on a non OB floor. For one, there are really sick people in PCU/ICU. Second, those nurses don't know how to take care of a newborn. If the baby crashes, by the time you are called and make it up to the unit, it could be too late. They likely aren't looking for or would be able to recognize signs of distress in a baby until it's blue and unresponsive anyway! I would bring these safety concerns up to your manager and propose staffing the nursery. Even if they just staff it with a nurses aide (our smaller sister hospital does this sometimes), at least it would be on the same floor and the aide could call for help easily if something goes wrong. Another idea is to send these babies to the NICU and have the NICU nurses take care of them. Another hospital in my area that doesn't have a well baby nursery does this. It is a bit of a waste of resources IMO--since the babies aren't in need of intensive care, but it sounds better than having a PP nurse split her assignments between several floors.
  13. ashleyisawesome

    Simple mask or NRBM?

    We do 10L simple face mask. I've only done OB in one hospital so I don't know any different.
  14. ashleyisawesome

    Lying to Patients. Is it for the Best?

    I don't think I have ever lied about why I am doing an intervention, but I do try to make it sound like it's not a big deal because I don't want them panicking. If I see a big decel or some recurrent lates/variables, I say "Okay, baby is not happy with you laying on this side, I am going to turn you on your other side and see if he likes it better over there." or "Baby is being a little naughty, we are going to give you a bit of oxygen and see if that helps him behave." If the strip looks flat I might say "baby is looking kind of sleepy so I am going to give you some extra fluids and move you around to wake him up a bit." If I decide to turn the pit off, I say "The pitocin is tiring baby out, so we are going to give him a little break and see if he perks up." If she is having a bunch variables and we decide to do an amnioinfusion I say "Baby is mad that we drained his swimming pool, so we are going to put some more fluid around him so he gets back some of his cushion that he lost." I just try to remain calm and tell them these things happen in labor and we have ways of fixing them. If I don't seem worried, they feel better about the situation. If they ask for more information, I explain it in more detail depending on their level of understanding.
  15. ashleyisawesome

    Cytotec inductions

    We never do cytotec and pit at the same time. Our cervical ripening inductions come in at night (around 2000), get checked/monitored, then get a dose of cytotec around 2200. They are checked again in about 4 hours and given another dose if needed. They stay in a triage room all night. Then they come out to a labor room around 0700 and are started on pitocin if their cervix is favorable/they haven't kicked into labor. If they SROM or progress into active labor during the night, they are brought out to a labor room and either left to labor on their own or started on titrated pit.
  16. ashleyisawesome

    new NRP guidelines

    We've been doing the new Mec guidelines for at least a year now. It's been working out fine. I have had plenty of mec babies and only one had issues and needed resus and a NICU stay (related to mec aspiration) a few months ago. The vast majority of them have no issues and they get to avoid the trauma of being intubated/suctioned right after birth, and get to go right to moms chest, which is good for everyone! We still have meconium aspirators in the warmer drawer, but I haven't seen one used in over a year.