snwflknurse

In the process of rewriting policies/standards of care on monitoring for cervical ripening. The shift in our facility has been from cervidil and lady partsl 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 lady partslly 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!

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!

thanks for the reply. we have computer charting (electronic fetal monitoring) but our monitors also print out a paper strip (which is handy to quickly jot a note of an event and then transfer to computer when time allows). our paper records are archived somehow and then our labor is charted electronically and printed and archived to pt's medical record #.

i am a new rn to l&d/antepartum/pp after 1 year in med/surg. i am loving things so far, off orientation x1 month now and doing well for the most part. what i really struggle with is how to keep up with the charting demands (ex: fht's every 5-15min depending on pt risk factors and stage of labor). i am really struggling b/c i want to be there for the pt as an additional support, especially when they get active, but of course this is when charting demands (per protocols) get more intense too. so far, unless my patient has a great support person, i have not been able to stay up on my charting...i am usually fine during 1st stage but really fall behind during pushing, etc, when i am guiding and assisting with pushing and doing what i love to do and really, i feel, helping the pt to focus and bring that baby down... i know this is something that will get better with time, but i find i always stay over about 30 minutes to an hour catching up on charting especially if my patient delivers near the end of shift (which they always seem to!) any advice, tips, or feedback appreciated! thx.

Order states: "Wet-to-dry dressing changes to ______ tid." No scheduled times. I work afternoons and am increasingly becoming frustrated that when I report off at 2300, it is somehow my fault that it didn't get done three times that day. In the past three instances, dressing changes were done in AM's at 1000 or 1100. I would do it once my shift, usually between 1700 and 2000, and then report off and be questioned as to why it wasn't done three times. More specifically "you should have done it twice then". I realize patients don't want to be woken at night for dressing changes but it really doesn't make sense to do a tid dressing change at 1100, 1600, and 2200 does it? That's not very spaced out....I would think close to q8hours would be more ideal...? Can anyone tell me how this is handled in your facility? The last instance I am speaking of my patient went to surgery at 1300 before I came on, I did dressing change at 2000 when he was back, and STILL got grief about not doing it twice! Argh!

I just started on a busy med-surg unit in October for my first job. I did a little bit of clinical time on this floor, but it wasn't recent. I only had three weeks of official orientation, and am a part-time 24 hour week, 8 hour a day position. The other nurses are very helpful, but I just feel really inadequate and SLOW. The ration nurse to patient is 1:4 so I dont' think that's the issue. anyways, just coming up on my 90 day review, and I have lots of concerns about ME. Maybe I'm just being too hard on myself, but I have had some super difficult, high-acuity assignments lately, and it seems like more nights than not, charting gets pushed aside out of NECESSITY, not choice, so I end up staying over. It's so frustrating, b/c something always seems to happen to make me get behind and I guess it irks me that others can sit at the desk and talk while I'm busting my butt the whole shift and then some. I guess I need to discuss with my manager about my charting...maybe I'm overcharting or something?! BUt I feel the charting should not only reflect my assessments, but what I did about it, and if I got called to court one day you would very clearly be able to see what happened with the patient while under my care. We do computer charting, and it is charting by exception, except our institution just instituted yet another required form for each pt. each shift that is adding to the workload, and has to be done at the end of shift. Trust me, I don't LIKE staying over, and people are starting to make comments to me like "you're STILL here", etc. I'm trying not to take it personally but, I guess I've never struggled with efficiency before and so I can't seem to figure out what the problem is. Here was my assignment tonight: Elderly woman 3 days status post colectomy/colostomy. Required turns q2h and multiple (like probably 15 call lights). Sort of confused. Not to mention every time I went to assess her roommate (see next pt) she had to stop me for something CHronic pain pt. back from an extensive abdominal/rectal surgery 1 hour into shift. Can you say PRN? prnprnprn...(and she already had an epidural running). Had to do three full checks on her, admission to unit charting, and get her up once. Lumbar laminectomy pt, two days out with extreme anxiety and an even more anxious wife. PCA, very difficult to ambulate, turn for checks, etc. Then, three hours before end of shift I get a GI bleed back from surgery. He had TPN, lipids, IVpush meds, PCA not to mention the three required checks when he hit the floor. Plus, in true form, multiple problems with pharmacy tonight! I mean, it was just SOMETHING all night long! please somebody tell me it gets better! I'm feeling very very discouraged!

I currently work as a nurse tech in OB. They only let you be a NT if you are going into your final year of nursing school here. I work with an RN and together we have anywhere from 5-8 postpartum couplets (so 10-16 patients). Our hospital is rooming-in. I can do assessments on moms and babies, PKU, baby weights, hearing tests on babies, teaching, answer call lights, help with breastfeeding, and the list goes on. At our hospital the NT do strictly postpartum care. The only thing I am not allowed to do for legal reasons is give medications. On our unit, we have Unit Assistants that set up the tables for delivery, scrub in for c-sections, etc, clean machines, stock rooms.

The advice about turning the mind off... It used to be hard for me to leave my mind off the patients. I think that giving a great report to the next nurse helps me sleep the next day. Not only did I give great care to my patients throughout the night, but I let the oncoming nurse know exactly what was going on with the patient so she can provide the same level of care (hopefully) and be up to speed with the patient. And, I second the above ideas about not eating, no coffee after 3 am, sunglasses on the way home, and no computer. Read a boring book or watch a relaxing tv show. Don't watch the news, that is NOT relaxing!

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!)

I went on BCP's when I was 16 for the same reason....would get like 3-4 periods a year and they would last like 12 days and be terrible. I stayed on BCP's for a few years (three?) then went off them. My cycles were still irregular and sporadic My husband and I were trying for a baby, although not charting or anything, just not "not trying". I ended up getting pregnant April 3, 2003 (according to pg calendars) and delivered 12/31/03. Funny thing was, I had not had a period since January 28, so they had a hard time estimating my due date~it was actually 12/25/03. I breastfed my daughter for 11 months (quit around Thanksgiving 04) and didn't get a period at all while nursing until this January (just over two months after quitting breastfeeding, my daughter was 13 months old). SInce that time, I have had a period every month (not on BCP's or any hormones at all). Granted, they haven't been clockwork (one was a 45 day cycle, 40 days, and 21 days!) but I have at least been getting them. So, to answer your question, maybe having a baby did regulate my cycles so although they aren't exactly the same, at least I'm getting one every month so far. Don't know if a baby is an option for you right now though~hope that helps~

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!

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?

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!

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

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?