LizzyL&DRN

We are required to take the new OB ACLS course that was developed by the Univerisity of Idaho in Boise. It's a great course. Our clinical educator went to Boise to get trained on becoming an instructor.

With a full bladder during a c/s there is much greater risk of cutting into the bladder while cutting through the layers to expose the uterus. I was recently in a c/s where the foley was not draining. We could not figure out why, it was in the right place and the doc claimed it was the new foleys our hospital bought and that she had had several c/s where this had occurred with this brand of foley. She had a very difficult time getting to baby due to the full bladder and she was very careful not to cut the bladder when going through the layers.

I had rectocele repair 2 years ago without a hysterectomy. I am very pleased with the results. I'm hardly long term only being 2 years out, but i'm still happy at this point. Not sure what other questions I can answer for you.

How many births do you do per year or per month? 250-300 per MONTH How many OB/gyns do you have on staff? 10 OBs and 1 Perinatologist How many family practice doctors delivery babies? 0 How many nurses do you have on staff for L&D for each shift? 6+ Do nurses place cytotec or do the doctors do it? Nurses always do it. Are there any nurses that refuse to place cytotec? The pregnant nurses do not place it, other than that, NO, everyone places it. Are their doctors in house during the cytotec induction? No. Is the surgery crew in house during cytotec inductions? Yes. If you place cytotec,what was required to train you to place cytotec? Education on using it, demonstrate competency in placing it. Is Cytotec used on viable pregnancies or only on IUFD? Both Do you or would feel comfortable placing cytotec? Yes, very comfortable. I have seen very few negative side effects of using Cytotec. Unfortunately, our docs do A LOT of inductions, there are frequently patients that receive cytotec 25 mcg Q4 for 24 hours or more. They often end up in C/S due to failed inductions which is a shame. But negative side effects have been rare on our unit from cytotec. Occasionally there is a baby that won't tolerate labor and needs to be delivered via C/S, but that can hardly be blamed on the Cytotec.

GOOD FOR YOU!!!:yeah: :icon_hug:

Can you print the email that stated you were not to place anyone under 24 weeks on the monitor? Can you also print out the ACOG standards of care in this situation to use as evidence in backing yourself up? Do you have a union? If so I would go to the union for some assistance. I would also consider requesting a meeting with your director and the DON with your evidence in hand to face them with. Include a copy of the policies on file. Good Luck! I don't know that i'd want to work with a doctor like that.

I think you need to learn to speak up for yourself and defend yourself. The situations that you described are quite common happenings on an L&D floor. Sometimes things are moving so quickly the last thing you can worry about is what is mom's blood type. It sounds like all you need to do is explain why you did what you did to this yelling preceptor lady. Nothing you described to me indicates you are incompetent, you are prioritizing which is what an L&D nurse has to do. You ensured the delivered pt wasn't bleeding, checked baby's vitals then went next door to take care of 10cm dilated patient? That sounds perfect to me. And I would have insisted that the primary delivery nurse give report whether or not she had another patient or not. Sounds like you are doing a fine job. I think yelling preceptor lady was mad that she hadn't been guiding her preceptee correctly, that's why she yelled at you.

Pitocin, Lactated Ringers or Normal saline, Lidocaine, Methergine, (not necessarily in room, but know where it is for PPH) Hemabate, (same as above) Cytotec(misoprostil)-same as above two Baby Meds: Vitamin K, Narcan(if mom got narcs), and Hep B vaccine if your facility does that.

I need some help from some creative people out there. I am doing an education class for teens at a local school for pregnant/delivered teen girls. This school offers the girls the opportunity to bring their infants to school with them and prepares them for graduation. The class we are doing for them is covering the topics of labor and delivery, postpartum and infant care. According to the educator there, most of these girls feel judged by most of their health care team. Such as, the pediatrician, OB doc, nurses, etc when they ask simple questions that maybe these health care workers feel they should know since they are having a baby. Anyway, this judgmental attititude has left many of these girls intimidated to ask questions for fear of more judgment. During the class I want to make up a fun game or activity to involve them in the class and instil confidence and fun. I remember I was in a class once where the instructor based the infor on a Jeopardy game. Anyone have any fun ideas for a cool game appropriate for teens? Thanks for your help.

Can it not also be a HIPPA violation? She had no business going in your room, she had no medical reason to go in there right? She wasn't involved in your care. But she was the manager of the unit, so I don't know.... maybe not. Other's thoughts on this???

Think of it this way. Learning Labor and delivery was one of the most stressful things I've ever done. Not sure how others feel about that. But from my perspective you are undergoing a huge amount of stress already. If I were you I would come to work, take the best care of your patients that you know how, protect your license and wait it out. The clicks don't always last and if they truly alieanated you, they are probably doing it to others also. Problems will likely arise from it and the manager will need to take a more professional stance on it and address it. (we went through a similar situation with clicks, it worked itself out) You probably don't want to learn labor in an environment such as what you're in anyway. Forcing you to undergoe an evaluation in those circumstances is truly unbelieveable. You should have forced her to pay you for an hour of your time. I probably would have gone to HR for that or told her absolutely not. I was a gyney patient on my floor, my manager needed to give me some new employee handbook and I had to sign for it. She asked my permission to conduct that type of business while I was a patient before. I too had someone who wasn't involved with my delivery walk in while I was in stirrups. It was pretty aggravating, but I was so tired I didn't say anything. I'm sorry for your tough time.

We have LVNs that work in Postpartum. We do however have one that has her NRP cert so we use her to "catch" babies sometimes in labor and delivery. We have also used our LVNs to work alongside an RN in our triage department. It takes a special LVN to work in triage. The ones we have are excellent. They start IVs, do discharge teaching, hook pts up to monitors and draw blood. I love working with them!

In our unit, NICU staff attends the c section. After they confirm the baby is ok, a "baby Nurse" comes and takes the baby to the nursery to weigh, check temp and give eyes and thighs and the newborn assessment. All this is being done while surgery is being finished up with mom. Once mom is done and comes to PACU, mom and baby are reunited. Usually at our facility ratios in PACU are 2:1 anyway. Obviously if the baby is having issues like grunting, low blood sugar, etc the baby nurse will stay with the baby.

At my facility, they don't order Vistaril, they order Ambien for the same reasons. I think it's more for patient comfort. There isn't a whole lot of reasons to wake the provider for a cytotec induction if everything is going well, unless she becomes active. I think patients are generally pretty anxious when there for induction. It's nice for them to get a good nights sleep before the labor starts.

Could it be a molar pregnancy? That's a great brain teaser...Make sure you post the answer once you find out for sure. Thanks.