Nurse_Educator

One question I have: is this a sudden jump in fundal height, or has she been measuring large all along. If she has been measuring large all along, that is not as much cause for concern, probably a large baby. If it is a sudden jump, then I would want to know why. Was the EDC given with her very first ultrasound compatible with her menstrual dating? How have amniotic fluid levels been on ultrasound? Have they visualized the baby's stomach (should have amniotic fluid in it to rule out TEF), and viewed the baby's kidneys as well? Fundal height is one part of an overall assessment, and personally I don't give a lot of importance to it. It can vary with a full bladder and also with the provider's skill. On a personal note, with my first baby, I panicked at 33 weeks when I realized I measured about 26cm. Made my doctor order an immediate level II ultrasound, suspecting IUGR. I am tall (5'10"), thin and was "small" at 33 weeks. Delivered a 7 pound 10 ounce normal baby at 40 weeks. Let us know what the next ultrasound says! Marilyn

Hi, This information is from the CDC Fact Sheet on Parvovirus and Pregnancy: Usually, there is no serious complication for a pregnant woman or her baby because of exposure to a person with fifth disease. About 50% of women are already immune to parvovirus B19, and these women and their babies are protected from infection and illness. Even if a woman is susceptible and gets infected with parvovirus B19, she usually experiences only a mild illness. Likewise, her unborn baby usually does not have any problems attributable to parvovirus B19 infection. Sometimes, however, parvovirus B19 infection will cause the unborn baby to have severe anemia and the woman may have a miscarriage. This occurs in less than 5% of all pregnant women who are infected with parvovirus B19 and occurs more commonly during the first half of pregnancy. There is no evidence that parvovirus B19 infection causes birth defects or mental retardation. A blood test for parvovirus B19 may show 1) that you are immune to parvovirus B19 and have no sign of recent infection, 2) that you are not immune and have not yet been infected, or 3) that you have had a recent infection. If you are immune, then you have nothing further to be concerned about. If you are not immune and not yet infected, then you may wish to avoid further exposure during your pregnancy. If you have had a recent infection, you should discuss with your physician what to do to monitor your pregnancy. If I'm infected, what do I need to do about my pregnancy? There is no universally recommended approach to monitor a pregnant woman who has a documented parvovirus B19 infection. Some physicians treat a parvovirus B19 infection in a pregnant woman as a low-risk condition and continue to provide routine prenatal care. Other physicians may increase the frequency of doctor visits and perform blood tests and ultrasound examinations to monitor the health of the unborn baby. The benefit of these tests in this situation, however, is not clear. If the unborn baby appears to be ill, there are special diagnostic and treatment options available, and your obstetrician will discuss these options with you and their potential benefits and risks. I hope this helps!!! Marilyn

As someone who is responsible for coordinating orientation on the unit I do have a few thoughts on this. 1. Is there something like a skills checklist or a list of skills that you need to complete prior to your orientation being over? If so, I would request one, then request assisngments with my preceptor to help me accomplish what is on this list. 2. Goal setting, goal setting, goal setting! What are their goals for you? Do you know? Have they been layed out clearly so you know what is expected of you week by week? You should be given opportunity to meet your goals! I would request weekly goals and weekly meetings with my preceptor, and my nurse manager to review these goals. If they haven't been met, why not? Is it for lack of exposure? Or other reasons? An example: Successful IV start per (blank) hospital policy Circulate vagianl delivery with minimal assistance Accurate lady partsl exams Recover vagianl delivery Perform accurate newborn assessment A goal always starts with an action word, and is measurable. Meaning either you did it successfully or you did not do it successfully. Keep a journal in a notebook of who your preceptor is each day and what you did each day, with ancedotal notes. This is important as well. Hopefully this will help you to start planning an OBJECTIVE orientation. Marilyn

Hi, I have a quick question regarding your reply: How does your institution clean the tub with jets? Do you have a policy you follow regarding soaking after use and how the actual inside lines / jets are cleaned? We currently have built in tubs without jets. The reason for not getting jets, as I understand it was infection control related issues with cleaning the lines / jets. We do have patients use them, but many times they still opt out of the tub and back in bed for their epidural! Marilyn QUOTE=shay]No kidding, Blue Eyes. Having worked with labor patients in both built in tubs and portable tubs, I can tell you, providing nursing care and labor support to a pt. in a built in tub is MUCH MUCH MUCH easier. Plus, let me just say something a little nasty....when you spend so much time and effort to fill up the stupid portable tub, get the patient in, yadda yadda yadda, and then they go and get an epidural 20 minutes later, it's REALLY frustrating. I can tell you from first hand experience, a built in tub WITH JETS will cut your epidural rate. A portable tub with no jets isn't worth the money, IMO. Yeah, being submerged in warm water is great and all, but when I was in labor and used the tub (when I was laboring at home prior to going to the hosp.), it was the jacuzzi jets that helped me. The warm water immersion was nice, but when your hips feel like they're going to explode, that water blasting on your body is a blessing. The last hospital where I worked had built-in tubs with jets and a 40% epidural rate.

Hi Kelly, I work at a community based "level 2" hospital. We have a tertiary center where we send our transports, based on the letter of agreement that we have with them. Part of our letter of agreement includes education, our tertiary center offers "Basic Fetal Monitoring" four times a year to all of the hospitals in our network. All new L&D nurses must attend! I am then responsible for the yearly competency and exam that all of our labor and delivery nurses complete. It includes multiple choice, and a lot of strip review. I use the AWHONN Fetal Monitoring book as one of my references when developing the competency. It is a time consuing task every year, to develop the test, but we are then able to see which, if any, staff need remedial help with monitoring concepts. I recommend that you attend the AWHONN or the Dr. Murray workshop yourself as well. You will get lots of good ideas on how to set up your own program. Marilyn QUOTE=KellyLynn]I am researching what other facilities do to have their nurses trained in Fetal Monitoring Interpretation. I have the daunting task to delelope one at our hospital. Unfortunately there are tight budget constraints and will not allow us to send all staff to programs such as AWOHHN or the formal certification by Dr. Murray. Are there other programs out there? What do you use? Are there any programs that will share or allow to purchase. I just don't want to have to reinvent the wheel so to speak. Thankyou, Kelly

Smiling Blue Eyes gave you a wonderful answer. We also always check for clonus when we do a preeclamptic assessment. The nurses check patellar, and usually biceps reflex as well as for clonus. It's a good baseline to have, especially if you need to start Mag. Marilyn

We are a larger hospital, 200+ deliveries a year. We do all our own c-sections on the unit. I recommend hiring / training a couple good scrub techs for your unit. You can teach them do to instruments on the c-sections, or they can help out on PP or Nursery if L&D is not busy. That way you have maybe only 6 staff that you have to competency for scrubbing on cases. You will have to teach the RN's to circulate, but that should not be a huge issue. Is Anesthesia there 24/7?

Hi, My name is Marilyn, and I am new to this discussion board. A little history about myself. I've been a nurse for 24 years, (boy do I feel old, although the average age of a nurse is 44 years old right now!). I spent the first 5 years of my career as a mother/baby nurse, the next next 12 years as a labor and delivery nurse, and the last 7 years as the Clinical Nurse Educator for the Obstetric unit at our hosptial. So I very much keep my hands in the patient care pot on the unit, as well as write policies, develop competencies, help prepare for JCAHO, present inservices etc. I work at a Community based hospital with an average of 2,000 deliveries per year, many of them high risk. I have really enjoyed reading many of threads on this board, all of you are such a wealth of information! I hope I am able to contribute something meaningful. Take care, Marilyn