ldcmw1

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Our policy is wait one hour but I have never seen it done. We usually try something different after that. ldcmw

Sorry for no paragraphs! I just kept typing away in frustration! Will do better next time. I will be writing up a QI on this and I will be taking this up with the Chief OB. Mom delivered about a hour after I went home. Baby went to regular nursery and as far as I know all went well. I'm glad but there is so much information out there on late pre-term infants these days, why would you take the risk of delivering someone early for no good reason. Thanks for all your support!!!!

Mrs. Ortiz - Where is the pain? Is she bleeding. Obviously she is not going to get up to ambulate yet. The dry mouth has me stumped but I thought I remember it could possibly be a side effect of having a morphine PCA. O2 Sat is still 96% and there is no previous report of what it was before or respiratory rate was before that so how do you know her condition is worsening without that information. The resident should come and see her. Ms. Douglas - I would report to the resident her cramping and when you got off the phone with him put her on the external fetal monitor. As far as the gush of clear fluid that isn't so alarming. It isn't blood tinged or green and is normal if she is ruptured and cramping.

Thanks guys for all the positive feedback!!! I'm just so frustrated!

I worked a 12 hour shift yesterday and did c/s's until 3 pm when I picked up a patient from another nurse I was upset after getting report. The patient was a frequent flyer. 26 yrs old g5 p4 at 35 6/7 weeks admitted many times for low back pain and pre-term ctxs. Received betamethasone 3 weeks previously. Her chief complaint when arriving on the unit at around 5 am was contractions. She was so uncomfortable the nurse checked her right away and charted she was 2/70/-2. Called the MD and he told her to treat her for a UTI and to start ampicillin 2 grams. He didn't ask for a UA to be sent even after the nurse requested it. She started the IV gave ampicillin and handed her off to the day shift nurse. MD saw pt around 8 am and checked her cervical exam 2/70/-2. Patient was contracting upon admission and was still contracting when MD saw her but no cervical change. He ordered Nubain 10 iv and 10 im. Patient was ok for about an hour but then was uncomfortable again and MD told nurse to give pt an epidural she was in labor. Patient got an epidural and was nice and comfortable she was still contracting every 3-5 minutes when nurse checked the patient around noon. Patients cervix hadn't changed. MD ordered pitocin to be started. The nurse caring for the patient questioned it but the MD was adamant. When I received the patient at 3 pm she was on 22 mu of pitocin. The patient had just been checked at 2:45 pm by the MD and she was 2/70/-1. The patient had made no cervical change for 10 hours clearly she wasn't in labor and we are essentially inducing someone who is not even 36 weeks. I explained to my charge nurse I was going up the chain of command. I spoke to my assistant manager and manager and explained the case to them. I didn't feel supported by them and they told me to speak to the physician and ask him for the rationale of why he was doing this. I called the physician and he explained that the patient was in labor. I stated that from all the information I gathered the patient hadn't changed her cervix for 10 hours. That isn't labor even if you are contracting! He told me the patient had made cervical change and I asked him when? He said her last exam I just didn't make a note of it when I checked her. I stated it was charted by the nurse and the only thing that had changed in 10 hours is that the head went from -2 to -1 (very subjective). He then stated he didn't have to explain to me why this patient was on pitocin and being admitted for labor and hung up on me. He then called the charge nurse and told her he didn't want me taking care of the patient! I then went in and spoke to both my manager and assistant manager and told them what transpired. They told me they would support me if I called the chief OB and I was happy with that but felt like he wouldn't support my decision and would say "What do you want me to do?" The chief OB still does fundal pressure on his patients when he does deliveries so how do you think I'm gonna get anywhere with him! I handed the patient off to another nurse and finished my shift. I didn't feel right taking care of her knowing what was being done to her was wrong! The sad part is that she wanted to deliver her baby. She was sick of being pregnant!!! I'm just so over this mentality!!! I was only trying to do the right thing and protect this innocent unborn child!!! I feel like being a patient advocate gets me nowhere except being a difficult nurse to work with!!! I'm just so sick of it!! I'm frustrated and want to quit!!!!:angryfire

Smith sounds like she should be a one on one!!! She is sick, sick, sick!!!! Teen 1st pregnancy!!! High Risk for pre-clampsia and with blood pressure's that high she could stroke out!! Nothing is said about her lab results on admission? I have rarely ever had a patient with blood pressures that high and I've been a labor and delivery nurse for 12 yrs. She would be on Magnesium Sulfate where I work!!! This assignment is ridiculous!!! Anyway I know this is hypothetical but she would be #1 to see. Check her BP, Neurological status, edema, reflexes, does she have epigastric pain, fetal status, urinary output. Has she been started on steroids for fetal lung maturity? #2 Ortiz, 2 hours post-op, check bleeding (at dressing site and lady partslly), o2 sat, lung sounds, pain assessment, urinary output, vital signs. Check PCA with another RN against orders! Does she have pneumatic teds on. #3 Linden what has her temp been? What antibiotics has she been on? Is she in pain has it recently gotten worse. When was the last time she received an antipyretic? Lab results? Is she getting plenty of fluids? #4 PPROM, she seems pretty stable. Take vital signs, has she felt baby move, is she having pain or contractions? How much fluid is she leaking? I would want to know about her latest ultrasound(how much fluid does she have, position of baby). Have her call you if she feels pain, ctx, decreased fetal movement, bleeding, anything coming out of the lady parts.

Interesting case!!! I'm curious to know what became of mom and baby and sounds like the baby had an arrythmia. I just had this happen to me a few weeks ago. We knew the baby had an arrythmia and she came up to our unit from the perinatal center to be induced. Baby looked fine for about 30 minutes then converted to arrythmia and fhr was in 70's. I told OB there was no way we could induce her. He did C/S baby came out fine and converted at birth.

My question to you would be why is she on continious monitoring? Evidence based research doesn't seem to support this? I do feel sorry for her and she needs to be treated with respect and not be shuffled all over the place! At my facility once they get their second dose of steroids they are weaned off the Magnesium Sulfate given indocin for 48 hours and put on procardia.

Where I work to use Labetalol IV they have to be hooked up to a cardiac monitor. Not the case with hydralazine. Yes, the hypertension is a symptom of the problem but it still needs to be treated! Do you want your patient to stroke out. I'm guessing as an EMT your patient does have an IV. I prefer hydralazine myself. It increases uterine perfusion. Be careful to use labetalol on a patient with asthma it is contraindicated. Lastly, you don't want to drop the blood pressure too much or the fetus won't like that.

I was taught the same way Pitocin on the closest port. You should always always have all your fluids on a pump when running Mag Sulfate. Especially if they are on Mag for PIH! I've never worked anywhere that it hasn't been the case.

Thank!!!!

Help!! I'm orienting a nurse to our labor and delivery unit who has about 6 months of experience in this area. I'm having many problems with her. She is slow, doesn't prioritize properly and seems to lack intiative. I'm constantly reminding her to do things that I've told her to do many times before, questioning her on why she is doing this before that, taking an hour to do an admission assessment, and the list goes on. I'm beginning to think she might not be cut out for our labor and delivery unit. Our unit is very fast paced and can even overwhelm very experienced nurses at times. On the plus side she is awesome with the patients and on a personal level I like her. I'm at a loss as what to do. Any words of wisdom from those of you who have been there before would be greatly appreciated.

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I just can't believe they insert the cytotec in the office!!! How much of a time lapse from the time they place the cytotec to when they come to the hospital to be admitted? What dosage are they using. That seems a little scary to me. Not for nursing but the MD's doing that.