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snwflknurse

snwflknurse

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snwflknurse's Latest Activity

  1. snwflknurse

    How do you monitor for cervical ripening?

    In the process of rewriting policies/standards of care on monitoring for cervical ripening. The shift in our facility has been from cervidil and vaginal cytotec to oral cytotec, although we still do occasional cervidil. Here are our current monitoring protocols for LIVE inductions: Cervidil: Demonstrate reactive or reassuring fhr tracing for 30 minutes prior to initiation of cervidil. Once cervidil is placed (10mg to the posterior fornix of cervix), continuous monitoring x1 hour, then hourly fht's until cervidil dc'ed (12 hours max) Cytotec: 25mcg vaginally every four hours with a maximum of three doses. Reactive NST or reassuring fhr tracing for 30 minutes prior to initiation of each dose of cytotec, and one hour continuous monitoring after each dose, then hourly fht's. No redosing if more than three ctx in 10 minutes. OR 25mcg oral cytotec every four hours with a maximum of three doses. Reactive NST or reassuring fhr tracing for 30 minutes prior to initiation of each dose of cytotec, and one hour continuous monitoring after each dose, then hourly fht's. No redosing if more than three ctx in 1o minutes. Pitocin may be initiated after one hour of discontinuation of cervidil, or four hours after a cytotec dose, but requires 30" reactive/reassuring tracing prior to starting. I should note that cytotec/cervidil are never given to those with a previous uterine scar. The physicians are moving towards oral cytotec, mainly I believe since it doesn't require a Dr. in house to place the dose, it can be delivered orally. Struggling to find monitoring indications/evidence in regards to oral cytotec for a live induction. Any resources or recommendations appreciated. Thank you!
  2. snwflknurse

    md-surge to L&D nursing, what was it like??

    i worked a year in med-surg, then transferred to L&D. i had a year experience in OB as a nurse tech doing postpartum care, which i think was invaluable in my knowing the department before starting. our unit is LDRP and we average 200 deliveries a month. i felt the same way about med-surg, when i was there i couldn't wait to get back to OB. however, i think the skills i acquired in med-surg were invaluable to my current setting. those basic assessment, prioritization, and time management skills are needed wherever you go. my first six months in OB has been great, but intense. one thing i have learned is that it truly is a specialty. it will take a long time to feel competent, the key is to having support from your co-workers and your charge nurse (which thankfully, i do have). most of the time outcomes are great, but your mind always has to be thinking the "what if" scenario and planning for that. when things go downhill in our department, it happens quick and can be very overwhelming. all that being said, i feel very lucky and privileged to work where i do, and i learn something new from each patient, each labor, and each delivery. i am happier now because i'm working where my passion is. i say go for it when you get the opportunity, but use this time where you are at now, to build your skills and improve on those. good luck to you in your endeavors!
  3. Just wondering what those of you lucky ones (like me) are doing to get back in the mindset for school. I feel like I should be brushing up on my knowledge before I get thrown back into the wolves! I am working as a nurse tech this summer so I feel like my clinical skills have grown, but I fear my book smarts are a little rusty...
  4. snwflknurse

    need tips for fundal checks

    I am working as a nurse tech in OB this summer caring for postpartum couplets. I am doing great so far with most of my duties, but am having trouble sometimes with fundal checks. Sometimes, especially on a larger patient, I have such a hard time feeling the fundus. I am so afraid of hurting the patient that I feel like I'm taking too long, or not pushing hard enough to really feel it. And the C-section moms are very tough b/c they are in such pain when I do those checks. Any tips for a newbie like me? I have been working with a primary nurse and she is double checking me, and sometimes I'm still not feeling it in the right spot. HELP! (and thanks!)
  5. snwflknurse

    "don't get stuck in women's health"

    I did take the position. I just wanted to see what you all thought. Thanks everyone! I kinda thought it was weird advice, but wanted to ask those of you who are in L&D your thoughts. I've never heard anyone in L&D say that they wish they hadn't chosen that area!
  6. snwflknurse

    "don't get stuck in women's health"

    I would like honest feedback from those of you who are currently in L&D. I will graduate May 2006 with ADN and am open to lots of areas, but would love to do L&D. I just was offered an internship position as a nurse tech doing postpartum checks/care for moms and babies for this summer. I'm very excited about this opportunity and think it will help me see if L&D is where I want to go. Upon telling a friend (who is a nurse) about this, she told me her advice was not to get stuck in women's services, but to get broad experience so that when pt stats go down, I will always have a job, and so that management knows that they can pull me anywhere. It got me thinking about both sides of things. WHat are your thoughts?
  7. snwflknurse

    tax question R/T student loans

    Anyone know if I'm supposed to claim student loan money as income? It would seem like it, but I just went through the whole Turbo Tax thing and it didn't ask about student loans. Also, it would seem like if it's something I'm supposed to claim, that the loan company would send me a document, just like the mortgage companies and the employers do, reminding me to claim that on my taxes. WHat did you guys do?
  8. snwflknurse

    First Foley!!!!!!!!!!

    Yay! Doesn't it feel great! I just did my first one a few weeks ago, so I know how you feel! Makes you want to do a bunch to practice your new skill "for real". Congratulations!:balloons:
  9. snwflknurse

    student..help osmolarity of dialysis?

    My patient I will have later today is on CAPD, with a solution change every 6 hours. Of course, last night did all my research on the procedure, condition, drugs, etc. The one thing I can't figure out is about the osmolarity of the solution. My instructor wanted me to figure out what it meant. The solution is Dianeal 4.25% with some cefazolin and heparin in it. I would assume that the higher the % of solution, the greater the osmolarity and concentration gradient, therefore the faster the dialysis? So, if the solution was a lower number, like 2.5%, it would take longer to dialysize (sp?) than the 4.25%. It logically seems right, just wanting someone to confirm I guess. I already posted on the student board, and tried to google and use medical sites, but everything I found just told that it came in different osmolarities, not why!Thought I would post over here for some help. Thanks!
  10. snwflknurse

    help...explain osmolarity of dialysis solution

    Thanks, I will post it over there!
  11. My patient I will have later today is on CAPD, with a solution change every 6 hours. Of course, last night did all my research on the procedure, condition, drugs, etc. The one thing I can't figure out is about the osmolarity of the solution. My instructor wanted me to figure out what it meant. The solution is Dianeal 4.25% with some cefazolin and heparin in it. I would assume that the higher the % of solution, the greater the osmolarity and concentration gradient, therefore the faster the dialysis? So, if the solution was a lower number, like 2.5%, it would take longer to dialysize (sp?) than the 4.25%. It logically seems right, just wanting someone to confirm I guess. Thanks!
  12. snwflknurse

    Med-Surgi & Phamacology

    I'm in Lifespan (med-surg clinicals), and Pharm II. 26 contact/credit hours. Frankly, the only thing getting me throgh each day is prayer and coffee, and sometimes not in that order, LOL:chuckle I agree, review, review review. And ask questions. I would definitely see that prof if you aren't getting a lot out of lectures...perhaps there are more supplemental notes? I always do better reading material, vs. hearing it. Good luck! Sarah
  13. snwflknurse

    what is a kvu?

    (slaps self on forehead) duh. that makes sense now...pt with abdominal distention, had a decompression colonoscopy. thanks!
  14. snwflknurse

    what is a kvu?

    My patient at clinicals this week had one, I think it's a radiology test? I looked it up on several lab test websites and no luck........ any ideas what this is? i thought kvu's were units used to measure radiation, not a general type of test?
  15. snwflknurse

    pharm ? re: reflex tachycardia

    yay, thanks! I did some more searching and found that it seems to be triggered by low blood pressure, whether the cause is from antihypertensives or from reflexes of other drugs. hope i can pass this test tomorrow!
  16. snwflknurse

    pharm ? re: reflex tachycardia

    Hoping someone out there can help me. I have a question I am having trouble with and can find nowhere in my book (or anywhere else for that matter). The question states: Describe what causes reflex tachycardia. What types of drugs would you anticipate might cause reflex tachycardia. The chapter we just got done with is Adrenergic Agonists. For drugs that would cause a reflex tachycardia, I have all drugs that work on beta 1 receptors, since these increase heart rate, strength of contraction. This would include the prototype epinephrine, as well as norepinephrine, isoproterenol, dopamine, and dobutamine, all of which are catecholamines. The problem I am having trouble with is "what causes reflex tachycardia". Can anyone help me out here? thanks.