MKS8806

I am in search of any resources out there for nurses to help with the expenses of continuing education opportunities, such as conference expenses. I have already reached out to the conference sponsors and my employer and have not had much luck. I didn't know if anyone knew of any other options? Thanks!

Hi Everyone! I have recently taken over the education role for unit (L&D) and our sister units (mother baby and women's surgical). I work for a hospital that is owned by a corporation and we have mandatory education and drills that we are supposed to do at regular intervals. We are required to do postpartum hemorrhage (pph) drills annually. We have a really cool manikin named Noelle, but she belongs to our division, and will be leaving our facility in a few weeks. I have had her for a brief time, but have been unable to run any drills due to our high census at this time. Mother baby has been extremely busy as well. Women's surgical, not quite as busy. When we have overflow on mother baby, sometimes women's surgical will take mom's of NICU babies, and rarely, couplets. So my question is, how do you guys run drills at your facility? Do you have something, other than a manikin to do scenarios? How do you reinact a boggy uterus and heavy bleeding? I'd like to have something tangible, especially for the women's surgical floor that doesn't routinely take these patients. Last year I had three written scenarios and questions that went through risk factors, interventions, blood administration, etc. Thanks in advance!

Typically, when you are starting Mag for seizure prophylaxis, you need to be delivered. At our facility, we control BPs, with PO antihypertensive meds and IVP meds as needed. Once the pressure can no longer be controlled with that or their labs show otherwise, we mag them and deliver.

I work at a facility where we rotate through Labor, Triage, and Antepartum. We are a high risk Antepartum unit that gets transfers from all over the area. A typical day on that unit would consist of 3-5 patients, some continuous fetal monitoring, others get monitored 1-2 times per night. We care for patients that are bleeding previas, IUGR, Mo-Mo twins, preeclampsia, vasa previas, etc. Sometimes the patients are stable and require very little, other times, we are running Mag and crashing them for delivery. When I wok over there, I feel very med-surgey sometimes. I prefer the patients that require a little more intensive care and are a little more unstable. That would be my understanding of the differences between the two units.

Hey everyone, I was wondering if someone could help me get my hands on a copy of awhonn's recommendations for documenting FHTs during the different stages of labor. I thought I had a copy of it somewhere, but can't seem to locate it, and I'm having trouble finding it on the internet. I've been a labor nurse for 2 years and have always charted q30min for low risk, q15min for high risk, including epidural and pitocin, and q5min for pushing. However, I am training at a new hospital for a PRN position, and I've been told by one nurse that I could chart q30min while on pit, while another says q15min, and no one charts q5min for pushing..... I just wanted to review the recommendations, if anyone has access to them and could share. I'm open to hear what others do as well! Thanks!

Does anyone have a link to AWHONN's recommendations?? I've been googling, but can't find what I'm looking for....

I worked at a facility similar to this for about 2 years. We didn't have doctors, anesthesia, or a surgery crew in house at night. Yes, it was scary at times, and there were outcomes that, unfortunately, may or may not have been different, had we had those resources. However, I do think agree with the statement someone made that everyone was very close knit and trusted and helped one another. We also had a very good relationship with the docs on call, where if we said we need you now, they didn't question, they just came. We had more issues with anesthesia and the surgery crew not being in house, not the docs. Yes, there were times that we caught babies because they docs didn't make it, but that happens anywhere, even bigger hospitals, where I currently work and I have those afore mentioned resources. To compensate for these things we didn't have, the facility had protocols and policies in place. You might check these things out to help with your decision. For example, we were all crosstrained to triage patients and in our SCN. So if we had bad babies, we were trained for resuscitation (NRP) as well as starting IVs and managing O2 on these kiddos. (we did have RT in house at all times). We also had rules that if a patient was on Pit at or above 20 milliunits, we had to have an OB in house. We also had to have someone in house if they were managing 2 or more labors consecutively. Believe me, there were definitely issues with patient safety at this facility, but they weren't contributed with not having a doc in house. I was working on the anesthesia and staffing issues before I resigned. But I was completely comfertable with the way the physicians were staffed.

Yes! When I saw the WBC count, my initial reaction was that women in labor generally do have slightly elevated WBC counts. But later (after delivery), I wondered if that should've been a flag. Mom did receive an epidural and her vitals were WNL on admission and throughout the labor ... until the end of course. The baby and mother are doing fine and have been discharged. Baby's blood cultures came back negative. Thank you all for your cordial repsonses. This has really been a learning experience. I truely love my job. In fact, every delivery I am priveliged to be apart of, I feel so lucky and honored to be apart of that experience with the family. I also love that I am constantly learning in this field - keeps me on my toes!

We have very nice cushiony arm boards as well. I have put some netting over the site before if I have a grabby baby and I'm worried their going to pull on the IV tubing or if they're out with mom and I'm wanting to keep the site from being pulled or snagged. But otherwise, I leave them uncovered.

We attach 2 bracelets to our babies - one on the ankle and the other on the opposite wrist. Our bracelets have the sleeve like NicuGals. We have a printer that prints a sticker that is the right size to slip in there that has a barcode, the baby's name and peds name. We place one bracelet on immediately following delivery. The other we keep until after the first bath, then we place the second on. In our SCN, we usually tape the other to the radiant warmer bed to place after the babies are transferred back out to the floor.

Thank you all for your responses. They did send the placenta and cultured it as well. We also sent the deleed secretions to the lab for culture - the Ped told me that, if that was infected, that could've caused the pneumo as well. Thanks again for not....ripping me apart! I've seen some nasty replies on here, but, like I said, I wanted to make this a learning experience! :)

I had a patient recently that spiked a temperature during pushing and the baby was delivered in....not so good shape. The delivering doctor marked on her paperwork that the patient had developed chorio during labor, and I, honestly, didn't see it coming. I've seen patients that are ruptured for 12+ hours that develop a fever and fetal tachycardia, but that was not what my patient presented with. I was wondering if someone could help me identify if I missed something. Here's the scenario: Patient was sent over from the doctors office due to lady partsl bleeding and non reassuring FHTs. Upon initial exam, she was 4cm dialated with a bulging bag, and scant bleeding (there was just what looked like normal bloody show on my exam glove). She was admitted. The patient was GBS positive and Rh negative. Here initial hemegram showed an elevated WBC count of 25. Within half an hour, I had a 3 minute deceleration that required position change and O2 for resolution. IV access was obtained and bolus started. The patient was now 6cm/80%/-1 station. FHTs following were reassuring. GBS protocol was initiated and the patient received 2 doses of antibiotics prior to delivery. Follwoing the second dose, the physician performed AROM and SVE was 7-8cm/100%/0 station. Temperature was 97.7 oral (pt had not been eating or drinking). The patient also had a small amount of bleeding (more than bloody show) and a small clot was expelled with SVE. We started having variable decelerations following AROM and the patient was complaining of feeling more pressure. SVE revealed she was 9cm/100%/+2 station. An hour after AROM, the patient was complete and feeling pushy. We set her up to push and she pushed for an hour and a half. We were having late decelerations with pushing. A little before 2 hours from the last temperature (which was when she was ruptured), the physician said she was feeling a little warm and wanted a temp taken. She was eating ice throughout the pushing, so we got an axillary temp (which was under a warm blanket) which was 102.8. FHTs were 145-155bpm with lates and variable decelerations with pushing. She delivered the baby 30 minutes later in OP presentation. The last 30 minutes we had minimal to absent variability. When the baby was born, the infant wasn't breathing, and wasn't moving, with a HR above 100 bpm. The baby was flaccid and had a temperature of 103 rectal. After the initial 5 minutes of stimulation, we had poor tone, HR above 100 bpm, and severe grunting, flaring, and retracting with 100% blow by O2. The baby had 2ccs of very thick, yellow, mucous deleed. The baby ended up in SCN with a small pneumo, IV access was obtained and the infant was started on antibiotics prophylactically. I was caring for the infant following delivery, so I'm not sure what transpired with the maternal temp. I did see orders for antiobiotic therapy PO for the mom. The infant's temp dropped to 99.7 Axillary after 20 minutes while remaining under a radiant warmer. Does anyone have any thoughts or see anything that I might have missed in my care of the patient?? I'm looking to try and make this into a learning experience. I have 1.5 years experience in OB. Is there other presenting symptoms of Chorio prior to delivery that I missed, other than maternal temp and fetal tachycardia? Thanks for any responses in advance!!

We bolus the 30ml in 500cc.

Level 2 nursery: We allow parents and grandparents and siblings of any age (as long as they are healthy and not sick). All visitors must be present with a parent. We are a little more lenient when it is just one baby in our SCN, but if we have more than one, we are strict on our policy. We have, occasionally, had the doctor order no one other than parents, before as well. I don't think our policy is research based. We have a very small SCN - 3 beds, we have had 4 beds max at one time. The nursery itself isn't very big, so we can't accomodate a large gathering. There are exceptions, of course, if we have infants that we are shipping out, or that aren't going to make it. We would allow for more at that time if possible.

READ THE BOOK!! To know how to react is to understand the algorithm and be able to react based on what's going on. It really isn't too bad. But you do need to study.