JoyfulRN14

Anyone have a policy they would be able to share? Would like to bring this up to our educator and they sure love policies on my unit. Sent from my iPhone using allnurses

We don't do a lady partsl prep (as in anything internal) but most of our MD's do a sponge wiping of outer areas with betadine mixed with warm water. Our midwives do not. Sent from my iPhone using allnurses

Newer L+D nurse here... Had an experience yesterday and looking for tips. Primip, young teen, term, Cytotec induction with early on epidural, Pitocin, AROM, etc. I come in to her being complete for 3 hours and laboring down. She's 0 station, we labor down 2 more hours and she's feels pressure and urge to push, MD says to start pushing. Push 2.5 hours total: 30 mins lithotomy (the "standard" blech), then side lying and switching sides q30 mins. Baby makes it to maybe +1 but mostly just its caput is that far. Mom has been pushing effectively, feels her contractions and feels the urge to push with them. Baby looks beautiful on strip. MD speaks with her and convinces her to have a Csection. Baby has caput, very molded, and bruising around head. Apgars 8/9. In my newness, I can't help but feel like, what else could I have done? I'm thinking baby was probably malpositioned, can you share tips for getting baby to turn at this late stage? I think it just got so wedged in there that it was unable to. Sent from my iPhone using allnurses

I found it difficult after a time. I did night for three years, first two were great and by the third it was wearing on me. Would work three to six in a row from 6pm to 630 am. Sleep all day, be up in the evenings with my husband, and try to go to bed by midnight. Fail, stay up alone watching TV or browsing the Internet, be surprised to see the sun coming up and crash out. And repeat. Just lost the ability to switch back and forth easily. If I lived in a place or had a lifestyle that was more conducive to doing things at night, it may have worked out better. But my town closes up by 9pm, and most of my friends had day jobs. Sent from my iPhone using allnurses

A couple fun books- Baby Catcher by Peggy Vincent, a memoir set in Berkeley, fascinating to see the way midwifery and childbirth practices have changed. Also follow her page on fb, great inspiring stuff. And she's just coming out with her next book Midwife: A Calling. A Midwife's Story by Penny Armstrong, a midwife who first practices in hospital and then starts doing home births in Amish country in PA

Did mom have an epidural with narcotics? There's been research done about use of morphine in an epidural (or spinal during Csection) causing hypothermia. The opioids affect the hypothalamus, which normally does temperature regulation. My educator just brought this up today. She said the med to give to combat this is Ativan. Doing a quick google search, I found this article, and it states using Narcan to reverse this effect. Hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery. - PubMed - NCBI Persistent hypothermia after intrathecal morphine: case report and literature review. - PubMed - NCBI

I left a MSICU job recently and just finished my 5th week on a busy L+D floor. My orientation is 12 weeks total, working one on one with a preceptor. Then a couple weeks working the same shifts as her but we'll each take our own assignments and she'll be my resource person. I felt like such a fish out of water my first week. It's hard to go from being competent at your job to being mostly lost. :) Each week gets better. There is still a TON that I need to learn and become more comfortable with. But I feel comfortable admitting a laboring patient, admitting and starting an induction, managing a normal labor, and being the primary nurse during a normal normal delivery and recovery. My advice would be to do some studying beforehand, unless you're doing a program that has classes up front before being on the floor. Knowing some stuff beforehand will help you feel less lost, and sometimes when it's busy things are just happening around you and there's no time for detailed explanation, so it helps to have some clue. The VERY basics you should know going into your first day - the stages of labor, basic FHR monitoring and how to read contractions on a strip, very frequently used medications (Cervidil and Cytotec for cervical ripening, Pitocin, and meds for bleeding after delivery - Methergine, Cytotec, Hemabate). A lot of your learning will come from working alongside your preceptor and seeing how she interacts with patients and learning how to explain things to them. Here's a great site for self study of FHM: http://utilis.net/fhm/2406.htm Have fun!

I just got a job transfer to L+D from working 5 years in a busy med-surg ICU. I'm doing some self study before starting, and currently working on a FHR monitoring module. My question is about determining baseline. For example, in this strip, I feel like I could look at it 2 ways: 1. Baseline around 175 with decels 2. Baseline around 160 with accels. I feel like it is more like my first thought, with minimal variability. But how do you know for sure? Is it because of the relationship with the contractions? Any advice would be helpful.

We use CPOT: Critical Care Pain Observation Tool. It looks at facial expression, body movements, compliance with ventilator (if intubated), and muscle tension. 0-2 points for each category with a result out of 8. It basically puts into words the things you intuitively look for to assess pain - if your patient is tense and grimacing and fighting the vent, you don't need a scale to tell you it is likely pain. But this way we have a scale to chart it, since "pain is the fifth vital sign" and yada yada yada. We have a great analgesia/sedation protocol to manage pain and sedation, and it is geared toward CPOT to measure pain and MAAS to measure level of sedation. I work in a med/surg ICU.

The whole point of a sitter is so that you don't have to chemically or physically restrain a patient to maintain their safety. If you're being "advised" by her to throw a patient in a Posey and knock him out with meds, that completely eliminates the need for her job. In the end, just remember you have your patient's interests at heart, not your own selfish ones as she did.

As far as in California, the main thing I've really noticed is that ratios are strictly enforced. I've been there in a MSICU here for 1.5 years and have never seen anyone in a more than 1:2 ratio. Our 1:1's are CRRT, rotoprone, induced hypothermia s/p cardiac arrest, oscillating vents, IABPs, and if a patient was insanely busy and crashing the shift before they'll try hard to make them a 1:1. I've seen 2:1 ratios on patients for example that are on CRRT, an oscillator, and a rotoprone bed. One nurse does the CRRT and helps out where she can, and the other nurse is the main nurse. On our unit, we have a separate charge nurse that never takes patients (unless it's an admit 1-2 hours before the end of the shift, and only then every great once in a while). Our hospital also has a Rapid Response Team Nurse, who goes out to other floors to act as a rapid response to floor nurses having bad issues with their patients. If it's a slow night in the hospital, and our RRT nurse is free, she'll help out in our rooms when we're busy. I feel comfortable with the 1:2 ratio, but our unit also has amazing teamwork, and great resources in our lead nurse and RRT nurse.

My hospital is a little smaller that a big city hospital, we're a Level III trauma center (not higher mainly due to not being a teaching hospital, and not having 24 hour neuro coverage). We have a 21 bed M/S ICU and a separate CVICU (post CABG and vascular surgeries). I LOVE working in the MSICU it is such a great amount of variety and exciting and constantly learning new things. I've been doing it for 1.5 years now, and I still come across things ALL THE TIME that I've only barely heard of and have to research real quick after report (scleroderma anyone?) Just wanted you to keep in mind that some smaller hospitals have their MICU and SICUs combined, and they can be great learning environments. I for one like the variety of having surgical and medical patients. Some average patients so you can imagine a day.... (1)70 year old COPD exacerbation with pneumonia, resp failure in the ED and intubated down there. Will come up to the unit, be on a vent for a few days while they get some antibiotics, steroids, etc. And most likely do fine and be extubated. Usually within 24 hours of being extubated, they are eating a diet and shipped out to our stepdown ICU, sometimes med/surg unit if they are very stable (2) 25 year old with acute severe pancreatitis d/t alcoholism.... lots of belly surgeries, wound vac, down to OR for abdominal washouts every other day, on a vent. On TPN and therefore an insulin drip, having to do blood sugars hourly. (3) 60 year old with severe sepsis from pneumonia, also have multiple comorbidities (COPD, CHF, ESRD)... having to play the balancing act between their body's need for fluid d/t the processes happening from sepsis, vs. how weak their heart is d/t CHF and since their kidneys are shut down they are going to need extra dialysis to get off this fluid... oh but wait they are too unstable, they'll have to go on CRRT/SLED, which is a 1:1 patient. (4) 18 year old kid who has multiple stab wounds in the abdomen, which perforated his bowel... causing him to become severely septic. And this sepsis/trauma patient will be handled completely differently than #3 with all the comorbidities. Fluid fluid fluid! Oh and crap you notice after a few days and a few surgeries (and a wound vac because of how big and swollen his intestines are) that there is fecal material in your wound vac! Call the surgeon... off to emergency surgery!

Wow I'm feeling lucky that my unit has some GREAT secretaries, along with great coworkers... I think the majority of us view the secretary as just another part of the team, another coworker in the battle to keep our patients alive. :) For example, if I hear the phone ring and see the secretary is on the other line already, I'll answer the phone (given that I'm not busy doing something else). If I know we just had two new admits and she's busy trying to get all that stuff in, I'll enter in my new orders myself and let her know. It's called TEAMWORK, it makes me sad that so many units seem to lack it. Our secretaries are anything but lazy.... they do their jobs quickly and efficiently so that I can do my job the same. I've realized how much of a boon it is to have an experienced secretary when we've have float sec's come in sometimes to cover... who don't know how to enter in orders that are specific to our unit, etc. I'm in a med/surg ICU, so timing can be a HUGE issue when you have a patient trying to circle the drain. Best wishes in your new unit, hopefully it'll end up being a good environment to work in!

Oh, the post above mine, posted one minute before mine, answered my question :) So you put them in a cover and the whole thing goes in the waste disposal unit, yes?

I have a few questions for those out there using this system. So the used bedpans and other products go in a waste disposal thing (evidently called a "macerator" on the website). Are these small where there's one in each patient room, or is there one big one for instance in your dirty utility room? If there's only one in your dirty utility room, how do you get the dirty bedpan to the room, put it in a red bag, carry it over, and take it out then? Just curious of the logistics of how this works, I think it could be great for my unit and would like to propose it to our UBC.