nocturnalnurse

nocturnalnurse has 11 years experience.

nocturnalnurse's Latest Activity

1. 

   NRP instructors... advice on supplies

   nocturnalnurse replied to nocturnalnurse's topic in NICU

   Travel between my hospital and various offices
2. 

   NRP instructors... advice on supplies

   nocturnalnurse posted a topic in NICU

   How do you store and transport supplies? I'm a new instructor and am not sure what would work best. We do not have designated "learning space " and so need to be very transportable. I may even teach some classes at offices and classrooms instead of my normal area. It has to be semi compact, too, as i have basically no storage space at the moment. what works for you? Thanks!
3. 

   What do NICU nurses consider "viability"?

   nocturnalnurse replied to Summers_Off's topic in NICU

   I was looking at the website mentioned for outcomes calculation, and I think I have seen it before, but it appears the data was based off of evidence collected between 1998-2003? Not the most up to date, do you know of any source for calculations that is more recent? I just entered in the lowest or first on all selections and this is what it says "* These estimates are based on standardized assessments of outcomes at 18 to 22 months of infants born at NRN centers between 1998 and 2003...;"
4. 

   Halo sleep sacks

   nocturnalnurse posted a topic in Ob/Gyn

   Our hospital started participating in the Halo Sleep Sack (SIDS prevention) program. We purchase Halos for hospital use and then, at discharge, provide a new unused unopened halo sack for families to take home. (Obviously we also provide SIDS prevention education with this program). I am seeking solutions to the issue of these hospital-use halos being stolen. We can't keep a stock of halos for hospital use despite trying several different strategies. Asking staff to monitor the halos has not proven to be effective. The likelihood of any advanced theft-prevention alarms being purchased for our unit is nil. Any possible solutions out there?
5. 

   Why do epidurals fail?

   nocturnalnurse replied to knufflebunny's topic in Ob/Gyn

   not a CRNA, just a nurse who asked "why aren't these epidurals working?!" and found a great anesthesiologist to explain it all. Better educated nurses=better educated patients=happier patients!
6. 

   Why do epidurals fail?

   nocturnalnurse replied to knufflebunny's topic in Ob/Gyn

   Epidurals can fail for many reasons. Sometimes technique or circumstance causes a poor placement of the catheter. Sometimes patients anatomy can cause problems with how the medication travels in the epidural space. Asymetrical blocks or "patchy" blocks can sometimes result even with best technique. Sometimes a patient's labor is rapid enough the epidural doesn't get time to set up fully. I think, however, that what you may be refering to as failure of the epidural to "work" is actually not a true epidural failure. The nerves that cause labor pain from contractions are easily blocked by epidural placement for the nerves that travel from T10 to L1 (typically speaking, uterus cervix and perhaps even the upper vagina). The second stage of labor, as the baby drops lower, causes pain to result from a different set of nerve fibers-namely the sacral nerves (posterior pain and perineal pain, lower vagina). local anesthesia has a harder time blocking these nerves in general, and with typical placement of an epidural they offten times aren't completely blocked. Our anesthesia team and nurses do a good job to provide adequate education for our patients that epidural labor is not pain free labor and as labor progresses and the baby moves down, epidurals block low pain less. This may result in pressure type pain sensations during second stage. We reassure the patients that often times this means they are getting close and that this pain will assist in directing pushing efforts. Anesthesia will still come up and evaluate these cases and give boosts when appropriate. alernative pain management options such as position changes,breathing techniques, heat, ice, counterpressure can sometimes help, too. Next time you have a patient who's epidural "isn't working", try checking their block with ice or alcohol wips. If their block is up to their umbilicus and they are still having pain, chances are their epidurals ARE working, just not for the nerves being stimulated. The most common pain we have trouble blocking at my facility is suprapubic pain and low back labor. It can be frustrating as the nurse, because lets face it, pain free is best if you ask me! But knowing WHAT is going on for you and your patient can help. This also allows you to let your patient know that their epidural IS helping her some. We have one CRNA that jokes "If you don't beleive me, I can turn it off".
7. 

   Do I still need the AWHONN course if I already have my C-EFM?

   nocturnalnurse replied to perfexion's topic in Ob/Gyn

   C-EFM should prove suficient competency in fetal monitoring. Congrats on passing, by the way! I would think the course, therefore, would be irrelevant. My institution requires the certification and doesn't really care if you take any prep courses or not as long as you pass the C-EFM. The ultimate answer depends on if your employer has a specific policy stating the exact requirement or did the manager just say you had to somehow provide "proof".
8. 

   Abdominal binder question

   nocturnalnurse replied to j0yegan's topic in Ob/Gyn

   I have only had a very rare complaint about a binder causing incision irritation. It has been easily fixed by placing a pad (without the sticky side) on top of the incision before placing the binder on (we usually do this anyway once the dressing is removed). We don't use binders very often but I do find them to help certain new c/s moms when other measures fail. We have certain cultures request them more often after delivery.
9. 

   Low Heart rate after epidural?

   nocturnalnurse replied to borka's topic in Ob/Gyn

   Both bradycardia and tachycardia are known possible side effects of epidural anesthesia. I have seen both. epidural placement particularily at the L2-L3 location block sympethetic outflow to nerves that effect vasomotor nerve fibers that can effect the tone of the muscular wall of arteries and veins-which in turn effects blood pressure and heart rate/cardiac output. It is much more complicated than that and there are other systems that get involved and other reflexes that can be triggered by this sort of anesthesia but the gist of it is that it can happen and you should be aware of it. I had one that got bradycardic enough to need anesthesia to stay at the bedside until the effects wore off. I had another one get tachycardic enough that the anesthesiaologist had to stay at the bedside and push esmolol over and over again until it got better.
10. 

    How long until day shift on your unit?

    nocturnalnurse replied to 24gaDalek's topic in NICU

    You mean people WANT day shift? *shudders* all those people. doctors wanting to DO things with patients, management and other weirdos from the hospital milling about, phones ringing... lol jk I'll probably go to the grave working night shift, happily!
11. 

    The most ridiculous birth plans you've had the pleasure of reading

    nocturnalnurse replied to PeepnBiscuitsRN's topic in Ob/Gyn

    Ok, in my defense I love the Doulas in our area because of the wonderful support they provide to our patients and I'm not against birth plans at all...HOWEVER...I've heard some weirld things, especially recently, and have seen things taken to the point where it is downright dangerous. Some that I haven't quite understood lately have been... don't put a hat on my baby during his hospital stay. This is a big one coming from our local doulas...some small paper that was not a very good controlled study said something about how no hats make the babies breast feed better and voila, it is doula law. do not do fundal massage after I deliver to control my bleeding (Yes, she bled excessively. Yes, we did end up doing fundal massage, problem solved). We've had some come in and refuse uterotonics during/right after 3rd stage and they do always bleed more, this is ok as long as they agree to take something if bleeding become excessive and nipple stim/breast feeding doesn't resolve it but we had one that ended up consenting to blood administration INSTEAD of pitocin, cytotec, methergine, or hemabate after delivery, was just dead set that she would not be receiving meds under any circumstance. do no dry my baby after birth (Ok, I've heard don't bathe my baby, don't wipe of vernix and that is great, perfecly fine, but don't DRY my baby? that is NRP 101 right there). I don't like refusals of antibiotics for GBS + because I've SEEN GBS sepsis and it's ugly but when you then are PROM >36hrs and running high temps with fetal tachycardia and foul smelling fluid and STILL refuse antibiotics I will sit at the desk and call you crazy (and yes then, right after delivery, code your limp, septic baby and wisk it off to the NICU where blood cultures are positive only a few hours after being drawn...). No fetal monitoring. And I mean none. No doppler, no intermittent monitoring, no basline FHR tracing, no fetoscope...nothing. To each their own but...why are you here? imho lotus birth is gross and so NOT natural...that is rotting flesh you are keeping your baby attached to...even animal moms in nature know that you don't do that. refusal of blood sugar checks on high risk newborns. I'm not talking that newborn that was cold once, or was a little jittery once I'm talking type 1 diabetics or even GDM with poor control, severe SGA babies... I'm sure I can think of more if I sit long enough lol
12. 

    Becoming Fearful

    nocturnalnurse replied to climbingeverest's topic in Ob/Gyn

    I am very proud of our orientation for new L&D nurses. Sometimes it seems a bit excessive especially considering we, technically, don't do high risk and don't deliver (on purpose) below 34 weeks. Then that 32 weeker post MVA in severe respiratory distress with collapsed lungs gets intubated in the trama center and we get called down to evaluate the fetus, find a category 3 FHR and race to a STAT C/section before the NICU transfer team can arrive...and voila, our orientation seems about perfect again!
13. 

    What baby catches you every time?

    nocturnalnurse replied to NicuGal's topic in NICU

    I have a thing for those babies that had nothing wrong until a perinatal event....abruption, uterine rupture, shoulder dystocia.... We almost never get to keep them which is fine, I like the stabilization period awaiting the transfer team then helping them. it might be because we don't deliver patients with big problems diagnosed prenatally because we are small with only a level 2 designation. They had all that potential, were 100% normal and in a flash their life and brain is in danger. I really wish we got more updates on these babies after discharge.
14. 

    Terbutaline protocol

    nocturnalnurse replied to OBERrural's topic in Ob/Gyn

    We use terb. Not near as much as we used to not as many doses and only as sub q shots, no longer pumps or iv. We don't have a policy and are expected to know the drug we are administering just like any other drug. If you know it, it's risks, it's contraindications and it's side effects you will know when to not give it. This is true with any drug. It got its warning for a reason so we use it cautiously for tachysystole not resolved with other interventions with associated fhr problems, to stop contractions with certain fhr patterns or complications, to stop preterm contractions as a one time option to see if that's all they need or until other therapies or options are available.
15. 

    Personal fertility issues a detriment in OB Nursing?

    nocturnalnurse replied to Baubo516's topic in Ob/Gyn

    We have multiple nurses and a few obstetricians who never had children if their own, some by choice some not, and all are excellent at their job. Everyone, even those who have kids, sometimes get frustrated with certain situations like the ones you describe. You will have to come to terms with that and not let your feelings effect your attitude at work or care for your patients. Everyone, despite their circumstance, deserves the best care. We as nurses need to reserve judgement of others. If you can do this, give OB a shot. I also truly hope you and your husband find answers and solutions to your fertility. Good luck.
16. 

    Salary?

    nocturnalnurse replied to __patiently_waiting's topic in Ob/Gyn

    Midwest here...a new grad gets paid approx 21/hr. Our shift diff is only 1.25. We get paid the same as normal nurses at my hospital but ate required to be certified and hold current on NRP, BCLS, STABLES, ACLS,ALSO and CEfM and a few of us like me keep our PALS utd too because we respond to peds codes too. Pretty sucky if you ask me but hey I love my co workers so I suck it up lol