lionkore

hello friends and neighbors, a question: can anyone describe for me the basics of perineal massage to reduce the chances of laceration or "need" for episiotomy? in reading another thread regarding "dense" epidurals, someone described a technique that was referred to as "ironing out the lady parts" and i am afraid that in trying to do perineal massage for one of my recent pushing primips, i ended up inadverdently ironing. :uhoh21: i was gloved and lubed (of course), had my index and middle fingers just inside the introitus and my thumb on the outside of the perineum, and was gently trying to relax/massage the area in between contractions, almost like i would massage someone's hand only more gently. while doing this i began to notice a trickle of bright red blood that seemed to originate in the posterior lady partsl wall, and i stopped what i was doing. the pt eventually ended up with a midline episiotomy but the doctor did not need to repair any lady partsl lacerations, so evidently if i did cause a laceration by massaging incorrectly it didn't require sutures... anywho. any advice or tips? i am going to start using warm compresses more often i think, but would like to know whether i was taught perineal massage correctly, or simply need more practice. thanks much! kori

Hi, I'm about a year and a half out of school myself, and also new to L&D. I came from a CCU at a different hospital, where we used Introcans all the time (basically just the cathlon without an extension set). I was pretty decent, not the gold standard, but not too bad. Now, here on L&D, we're using Intimas (with "butterfly" wings and a mini extension). I found in the first few weeks of orientation, I was so flustered about doing things well and giving a good impression to my preceptor, that I couldn't hit the broad side of a barn, even when she and I went hunting for Introcans in the supply room for me to use. We finally figured out that I was having stage fright, and she left me alone for my IV starts after that - guess what, I've hit them on the first try ever since, and am even starting to get used to the Intimas. If I have any suggestions, it would be to clear the room of unnecessary folk, take a deep breath before you start, and remember: This is something you can do. You know that you can do it because you have done it before. No wait I do have one more suggestion. and it is a practical one. When you get your flash, advance the needle just a l-i-t-t-l-e more, like 1/8 inch. This will ensure that the entire bevel of the needle is actually in the vein. as opposed to being halfway in the vein, giving you a good return, and then blowing when you try to advance. that was what helped me make the transition from 20s to 18s a little easier. good luck to you! kori

Dayray, I really appreciate your responding to my question. I have put foleys in male patients before without an escort and it was never an issue. I have also put foleys in female patients before at the request of their male primary care nurse, who felt for one reason or another that the woman would not be comfortable with him doing the procedure. It is, and should be, about the patient and her/his comfort level. My own gynecologist is male, and certainly there are male nurses I would trust to examine me if I were in labor, and unfortunately there are female nurses I would not trust! but it is not a sexual issue, it is a matter of competence. again, unfortunately. :uhoh21: And now that I think on it, I have seen our female OB-GYN's grab a staff member for escort when they plan to do a vag exam or AROM. Makes me wonder if the requirement for a physician to have an escort arose when docs were pretty much all males? The point about assuming a sexual connotation to a health care act is an excellent. myself, I identify as bisexual. There is a huge, huge difference between the examinations that come with being a health care provider and any intimate contact between two friends/lovers. People who do not understand that should not be in health care, period. In any case, you have confirmed my suspicion that there is, in fact, nothing written or official that prevents a male nurse from working L&D, other than prejudice. or perhaps overestimating the importance of gender when it is in fact a non-issue. peace, kori

The male docs are required to have a staff person in the room, and we all happen to be female. Perhaps this is an Indiana thing. I wouldn't be surprised to learn that, yet again, my state is just a teeny tiny bit behind the times...

hallo, am orienting to L&D and loving it! and our floor is hosting several students, including a few male students. i remembered that on this forum are at least two, probably more, male L&D nurses, and was wondering about something my preceptor said. she said that males "couldn't" be L&D nurses, in a practical sense, because they would not be able to perform vag exams on their patients without another person in the room. now i know there is a helluva lot more to L&D nursing than vag exams, but was just wondering, for all you guys out there, do you perform the vag exams for your laboring moms? do you perform the exam if only you and the patient are in the room? do you perform the exam if the significant other is present but no other staff member? do you ask another nurse or tech to accompany you? do you ask a female nurse to perform the exam? just wondering. i'd like to point out to my preceptor that there are indeed males in L&D, but i just know she'd ask me about the logistics of it, and i don't know them! thanks so much, kori

to the OP, thanks for asking a question that I also needed to ask, but hadn't formulated yet. :) smiling blue eyes, once again I am in in awe of your knowledge. I just wanted you to know how much I appreciate your posts, they are incredibly helpful to me as I start my journey in L&D (today was my 2nd day of orientation). thank you! :balloons: kori

amen to the eye mask, and also door shut, big noisy fan on. I had garbage bags over the windows when I first started nocs, but they kept falling down... happy Monday! Kori

LTC. I fill in part-time at the LTC facility owned by the health system I work for. It is a wonderful place, I used to work there as a CNA, and I love the residents. The staff really care for the residents and treat them like family. Many staff have had their own parents and grandparents come to live there. It is one of the friendliest places I have ever worked. Nothing "crappy" whatsoever about the care given there. I would live there myself if I were 70 years older and needed to! BUT. and you knew there was a big fat BUT. the paperwork is outrageous. very little autonomy available. very minimal staffing. I am uncomfortable with most of the direct care being performed by CNAs, only because I have absolutely no time to verify their work, and they are still giving care under my license. I absolutely trust the aides that work there, and have never had a specific problem. It is just a general work situation I am uneasy with, to say the least. I like to have fewer patients (5 or 6 on Med Surg, 2 or 3 in CCU) and really know what is going on with them, know the whole picture, be able to put things together quickly. This kind of goes along with my wanting to be an RN, not an MD (that's another thread! :rotfl: ) - I want to be the one giving direct care. I don't want to be the overseer. now that you mention it, I don't want to supervise or manage a dept or anything like that either! give me a good vent + swan + multiple drips etc. any day! peace, Kori

yes, nurseforpreggers, it is a wonderful list! and it is printed out over there on my table for me to use as a study guide/"cheat sheet" to work on before my orientation starts... thank you very much! SBE, thanks for the ephedrine run-down, I could not think of its use pertinent to L&D off the top of my head, because it's a drug I've never given before. Epi I know well, but that's 'cause I've been in the CCU for the past year.

if I may ask, since I won't be starting L&D for another month... what do you folks use ephedrine for? is it used for the same sort of situations as terbutaline? was just wondering, since it was listed above close to narcan, ca gluconate, and bicarb, I mis-read it as epinephrine the first time! thanks much! Kori

many many thanks! I'll also be starting a new postition in L&D soon (mid-August), and I was trying to make a list on my own - silly me, I should know better and ask for help! peace, Kori

Here, we use either Intimas as previously described, or Introcans, which are basically the needle and cathlon, no extension tubing or anything. Usually, if it's just a routine stick, I like the Intimas very well. But in an emergency, when I need to get something in my patient NOW, it's easier for me to just whip the Introcan in there. We stock both on a regular basis. peace, Kori

This is the non-technical way that I understand it. At high oxygen saturations, the hemoglobin more easily "lets go" of the oxygen molecules in order to deliver them to the body's cells. At lower oxygen saturations, the hemoglobin holds the oxygen molecules more tightly due to the overall chemical composition of the blood. The more vertical part of the dissociation curve shows you that there's not much change in dissociation at lower saturations. The more horizontal part of the curve shows you that at higher saturations, it's relatively easy for oxygen to dissociate. good luck! :) peace, kori

OK, I've heard of standing up when the docs arrived, but saluting? BOWING when you received orders?!?!? now I know what I'd have done for a career in the '70s if I needed a HUGE ego boost for no reason...

Thanks everyone for your replies. I feel more confident in my position now. I'm going to ask the manager to address this at the next unit meetings (our Med-Surg and CCU have the same manager and joint unit meetings).