jonesecho

Hang in there. Start looking into the possibility of hospice at home if needed and if grandpa wants that. It may mean a lot to your gram. jonesecho

good for you. you would be fun to work with. jonesecho

your are welcome and good luck with all. everything you study will be useful at some point in your career and in life.

It will be important to know about post-partum fundal heights and firmness. assessment of lochia. meds to know are pitocin, brethine, magnesium sulfate, cytotec, prostaglandin gel, epidurals for labor, stages of labor, problems in labor such as; pih or pregnancy induced hypertension, pre-eclampsia, eclampsia, dic, failure to progress, non-reassuring fetal heart rate, neonatal resuscitation, gestational diabetes, use of pitocin in labor vs. post-partum, assessment of cervix in labor for dilation, effacement, stage. rom or rupture of membranes as artificial or arom vs. prom or premature rupture of membranes, color of amniotic fluid and time of rupture, support during labor, pain meds used in labor besides epidurals. hemabates use post delivery. preparing for a c-section. checking bladder status during labor and after an epidural. these are some of the things you can review and ask about. there are many. there are so many assessments in labor and also in a triage room to determine if someone is in labor, or in trouble needing to stay. good luck.

please take care of yourself and your family, grandpa would want you to do well. thoughts are with you. jonesecho

more prayers and good thought go out to you and your grandparents and family. jonesecho

:twocents:I will explain some things and hope it clears up and does not confuse you more. I worked in OB quite a while. It is amazing how confused people get but not surprising. There are so many variables and things to understand that I can see why so many people get confused or the wrong info. First of all women who are going to give birth should really filter out most of what other women tell them. Many are their own war stories and let me tell you the best info that someone can give you is that there are no rules when it comes to labor and anyone that thinks they can predict everything accurately is a fool. Even a woman who has several children can have very different birth experiences. what your friend needs to read about is the pelvic outlet and their different shapes. Please believe me that you can't look at someone and say they are big boned, etc. and will have no problems. A persons pelvic outlet shape cannot be seen. there are ways the dr. can measure them and predict -although they are not all good at this.There are many big looking women that cannot progress and many small looking women that have no problems. Ultrasounds can be off as much as a pound. I have seen so many where they say CS because of big baby and then the baby is not big and some where the baby was big. The reason they call a CS when the baby is breach is because the infants head is the largest part of the body and if the rest of the body were to deliver but then the head would not fit through the pelvic outlet- you can see the problem there. there are multiple reasons for CS's to be called. It can be a non-reassuring fetal heart rate that cannot be corrected through what we call neonatal resuscitation,/ it can be failure to progress for reasons that possibly the cervix does not keep dilating, or because the baby does not come down low enough either due to size of the pelvic outlet or presentation of the babies head. Again, there are so many variables. Everything is not textbook. There can be an arm coming down along side of the head, there can be a head that is not looking down like it is supposed to. the proper presentation is occiput anterior. the woman's hormones to deliver are all triggered by the body. This is why it is nicest when she is able to go into labor naturally. This is not to say that someone who is induced with either a prostaglandin gel, or with pitocin which is the same hormone the body has to make the uterus contract. the other name for it is oxytocin. i worked for 11 years in this field and felt as though i understood it well. I was not the typical cute little nurse that many doctors like to look at and just make everything seem more wonderful, but i attained the doctors confidence when they could see i understood the processes and had good judgement. if you have further questions i would be glad to answer them. i will tell you that i think it is unprofessional for the dr. to tell her about personal experiences in case that happens to your friend. we all tend to want to do this because we lived it,/ but we need to realize that there are so many scenarios. If she is really convinced the pelvic outlet is too small or shaped in a way that would make delivery impossible along with the ultrasound showing a large baby- well then she could say to the patient there needs to be a cs. there is nothing wrong with your friend asking to try lady partsl birth and going to cs if not possible, or if she isn't shown the reasons why she needs a cs. she could also get another opinion. i have seen other ob nurse who did not do as well at considering all the anatomy and physiology involved with birth. labor and delivery nursed truly have to keep assessing and reporting what they see to the dr. and to the pt. there are many signs of progression and many signs of problems and it takes not only knowledge but experience to know how to sort them out. it is also good to know how many classes the labor nurse had in fetal monitoring. i know of some hospitals that don't put an emphasis on them and just have their nurses learn from experience. i believe they are good to have every couple of years at least. most labor nurses have way more fetal monitor classes then the ob dr. a good ob dr. knows to value their nurse. i had 2 basic fetal monitor classes and then i went to an advances class. the labor nurse has to know how to monitor the mother in labor and the infant's response to the stress of it and the whole time be aware of pathophysiogical problems that can arise in labor, such as; pre-eclampsia, mothers with gestational diabetes or with type 1 diabetes. They need to know problems that can occur with teen mothers, older mothers, etc. the mother in labor does need to have confidence in her dr. and a good nurse will keep her informed while listening to her. a labor nurse's assessment includes listening to the mother's cues on how she feels, etc. they should never think they know so much as not to listen to her. the mother in labor should only have well controlled visitors that she wants in the room. it is very hard for the nurse if they are out of control visitors.i don't have a lot of time to explain what i consider out of control visitors but if there is anyone hard to handle in labor it is not usually the mother to be. i suggest any mom that will deliver in the hospital to go to childbirth ed .classes that will review the room , equipment and what will happen. the reason why is there is so much to teach that she will be better prepared. good luck to her and let me know if i can answer anything else. when i was young and had my first child i was not a nurse yet and did not have good experience with the childbirth. it was quite a long time ago and things have changed ,thank God. this made me all the more eager to change the experience that my pts. had when about to deliver their baby.

No the curves go down so the openings go down towards the respiratory tract. I have then seen the tubing go behind the ears and down under the chin. Not tightly or they will feel like choking. I have also seen the tubing put on top of the head. I always placed under the chin. Just be sure it is all centered well so as to deliver correctly and be comfortable. Some places also have foam t cushion around the ears, and if using a long time it can also be humidified and should be if an infant or child.

i wrote once to you. i think sometimes there is a look when we cannot breathe. it is uncontrollable. if you have ever even had pneumonia and can't breathe well it is a feeling full of fear that a person cannot control. it may just be a look from being hypoxic also.

Much of this woman's deficits would be from the head injury. when there are contusions or bruising or consucssions, there is swelling or edema which causes pressure, which causes injury and malfunctions in the brains and the nervous system, thus the ss of stroke or cva. as swelling goes down and healing occurs she will probably get some functions back as long as they weren't permanent damage. I question why she was not getting solu-cortef per iv for swelling. rehab is important so she keeps function and loses less. depending on the parts of the brain most affected and how well she heals will determine her recovery. the weakness can be from the brain injury and nerves/muscles-but pneumonia alone will make a person very tired. she may shock some of her caregivers. I have seen people like this regain most of their capabilities. I hope this will be the case. the trauma of the accident probably cause the hematuria, and then having a catheter could cause some incontinence. hopefully that will return to normal also. your second group of nursing diagnosis all look good. i hope this was some help.

Bless your heart. It is very hard when our loved ones are ill and we can't make everything better. Be supportive when you are there and honor her wishes. It is hard being a nurse when a reletive is ill. We cannot function like a nurse. We are the grandaughter or the daughter. I am hoping the best for you. do what helps you in these times. If that is prayer and having people pray for you and your family do that. If it helps to have the clergy at the hospital include you in the prayers do that. It sounds as if the chf is worsening and the low platelets can even be part of the infection. Have they called it DIC? I commend you for standing by and trying to give your family the best advice. Remember we are not all seeing and all knowing. Stay strong and take care of yourself in these hard times. :heartbeat

I agree that it is really not an appropriate thing to say at all and a good term to disuss. If anyone that is a patient or one of their family members heard this it really sounds bad. I have been a nurse for 29 years and I have heard it and more believe me. We all need to think more about some of the things we say before saying them. Just the fact that you have thought about this lets me know you are caring and sensitive to how we as nurses come across. I think the stress of nursing makes some nurses talk like this and let's face it there are other nurses who would never even think about the term or care. good point though.

I worked 11 years in labor and delivery. I think if you like this dr. as a person and he listens to you i don't see anything wrong myself with how this reads. As you know ob has a high rate of lawsuits and very high malpractice insurance for a reason. I think what he has there are intelligent and well documented reasons for what he does. This may not be popular with a lot of nurses, but I don't necessarily think he is a control freak, If I had time I could explain his rationale for these points as I am sure you understand most of them. However this is a free world and if you wanted some type of home birth, etc. you should. I will say that I would not want to be home if an unusual or dangerous situation arose, and I have seen them. good luck. they look like good rationale to me. nurse for 29 years total in many areas of nursing.:loveya:

I think you still need to talk to the right person. Preferably a true expert on death and dying. Look up the psychological term of projection please. Make sure you are not seeing what you are feeling so to speak. I think you need to discuss with someone your feelings on death and your beliefs or dis-beliefs. In order to be the most effective nurse you need to be able to be there totally to give them the most comfort and support you can during this transition. I think the most important thing is knowing their wishes before they get to this stage as far as who do they want with them -etc. This would be very important. good luck. I think there are certain people who should be in this type of nursing. I am not saying one way or another if you are it, I am just saying be sure you are in this type of nursing for the right reasons.

tell him to read this. I am 54 and worked for years as a nurse in the hospital. If I were him I would hold off on the ear guaging. My nephew has some ear plugs and swears they will close up if he wants, but I think it is too severe and permanent. some places have people cover tatoos and take out certain earrings if a pt. that is confused could grab them and tear the ear. I know things like this don't define a person but unfortunately others make judgements and he just doesn't need anymore obstacles in his way. Have him do other things to define who he is. If he is a giving and caring human being then channel that by assisting in a soup kitchen for homeless men, etc. He probably does not want to work at wendy's all his life, although there is nothing wrong with that. tell him I said best of luck to him. I hope if he makes this step he eventually becomes a nurse if that is what he desires. sincerely, a nurse for 29 years.