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mzjennifer

mzjennifer

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mzjennifer's Latest Activity

  1. mzjennifer

    Kristina, Heather, Fergus....

    Please, fill us in a bit more on this 30 weeker. Apgars? How is he/she doing now? Being without o2 for 7 minutes...any brain damage? Kudos to the nurses who cut the epis and delivered this kiddo (while that imbicile doc just stood by....grrrrrr) Jennifer
  2. mzjennifer

    Hey Kday, OBnurse Heather and others

    We do about 60-70 deliveries per month. We rotate on our floor only (unless you WANT to go to another floor when it's slow): L&D, mom/baby, and post-op/gyn (clean surgeries/medsurg pts only). What you can do to help convince them that it's a bad idea: 1. You cannot cross contaminate between mom/baby to med/surg pts - occasionally we do that, if we only have one med/surg pt and a few mom/babies - then that floor nurse gets all of those pts. BUT - if we have 2, 3 or more med/surg pts, then one nurse gets those pts ONLY. 2. You cannot keep your uniform uncontaminated by working med/surg, so therefore, you cannot take any c/s pt or labor pt that walks in the door. We are pretty strict on this - even if you leave the floor, you MUST cover your uniform with a cover gown while off the floor, in case you circulate for a c/s later in the shift, or have a L&D pt come in. 3. If you take any med/surg pts on your floor - they MUST be clean - no infections, pneumonias, c diff, cellulitis, etc, must have had CLEAN surgical procedures (hysterectomy, urological surgeries, lap/open chole, lap appendectomies, etc). 4. Examples of ok medical pts that we take are also: diabetics (stable, not brittle), some asthmatics, leg emboli, etc. NO LEVEL OF CONSCIOUS CHANGE/DEMENTIA PTS. Hope this helps some...our policy is pretty clear on who we can and cannot accept as a med/surg pt. Personally, I wish we only took GYN surgical patients...after all, we ARE an OB/GYN floor. Jennifer
  3. mzjennifer

    Fundal Pressure

    I was in one delivery that fundal pressure was used. Let me outline what led up to it's use: Pt was a midwife homebirth attempt. Brought into the hospital after 2+ hrs pushing at home. MW thought baby was OP, after the pt pushed for 2 hrs. Pt was pushing when admitted, 10cm/+2 station (MW exam, I did not examine her). MD arrives, we prep pt for delivery. MD observes her pushing attempts, examines her. Finds her to be OA, not OP like the MW thought she might have been. MD cuts RML epis (ouch! MD was not happy to have to do that either). MD then applies vacuum, and tries vacuum extraction with fundal pressure (NOT me....I was operating the vacuum for the MD). Vaccum used x2 - popped off on 2nd attempt with fundal pressure. MD then used low forceps and delivered a viable male. (Trying to recall if fundal pressure was used with the forceps too...I don't think so). Apgars 8 & 9. Mom ended up having a 3rd degree lac extending from the RML epis too. NOT an easy delivery!! Had some PP hemorrhage, under good control with IV pit, cytotec (per rectum), and methergine. EBL was 400-500. Now that I read others responses on fundal pressure, it makes me concerned about exactly what our hospital policy is on it. Like I said before, I was not the nurse doing fundal pressure, as the MD wanted a nurse who had already done fundal pressure in the past and knew what she was doing. I did NOT feel comfortable doing fundal pressure, since I had never done it before. PS - this was the first and only time I've seen it used in the 4 months I've been an RN at this facility. Jennifer
  4. mzjennifer

    What do you think need your expertise!

    Jami - I have not seen this used. We give labor patients a pitcher full of ice water, a cup of ice, and give them clear juices (apple, grape, cranberry). They also get broth (chicken or beef), jello, italian ice, ice pops. We stick to an all clear liquid diet, just in case a c/s needs to be done. Also keeps the belly pretty settled, in case of vomiting (which often occurs anyway). We avoid IV's if at all possible. Jennifer
  5. mzjennifer

    hydrotherapy in labor

    We have two centrally located jacuzzi tubs. Each are in their own separate room, along with a toilet, sink, and privacy curtain. We use them in probably 50% of all labor patients. They are a tremendous help in getting labor moving (nipple stim from the water bubbling) and relaxation in the middle stages of labor. I'm still relatively new, but I haven't heard of any pts deliverying in the tub (precip del's). Did have one that delivered 5 minutes after getting out of the jacuzzi....and another that delivered within 30 minutes from getting out (was 2cm going in...45 minutes later was 8cm and bulging membranes). We have waterproof dopplers to do intermittant FHTs. They're ok..quality is not the best, but it works. We check FHTs q 15 min while in the jacuzzi. Also have a call bell right next to mom the whole time. About belts...we charge the first time, then save the belts in a bag with their name on them for future visits. (We do a lot of NST's on our floor & have lots of frequent fliers). We don't wash them out between visits. They don't seem to require any washing - they stay very clean. We keep them all alphabetized in our supply closet, and make a note on their prenatal record that they have belts (we keep a copy of all prenatal records on file on our floor for every 30-32+ week pregnant pt in the area - 2 doctor groups and 2 midwife groups). Seems to work well for us. Jennifer:p
  6. mzjennifer

    Orientation time in Labor and Delivery

    I hope that wasn't a typo...did you have only 12 hours total in those 6 weeks in L&D?? Or were they 12 hour days? I'm a new grad (May 2001). Did 1 week general hospital orientation, 1-2 weeks postpartum & gyn orientation, and have been in L&D for orientation for the last 4 weeks or so. My manager is already talking about when to switch me to nights (my position I was hired for was FT nights...am orienting on days right now). I take boards on Aug 1st. I have only been exposed, so far in L&D to high risk...had ONE low risk last night...but it was a precipitous delivery, the MD & CNM did not repond to pages, and my preceptor RN ended up catching the baby. NOT the way to be oriented in L&D, she said!! Needless to say, I'm scared to death of the time that I will be finally on my own....though my manager reassures me that I will not be alone for a while....ha ha...I managed this labor yesterday almost entirely on my own. My preceptor had 2 other labor patients that she was trying to manage, while TRYING to keep up with what I was doing. Luckily, I was giving her frequent updates as to what was going on with my patient. I am VERY glad that I grabbed her when I did...this pt when from "pushy" to delivery in less then a few minutes. I've never seen a baby pop out so fast! Jennifer, new grad in L&D
  7. mzjennifer

    PIH and blood pressure

    You bring up some good points! We take blood pressures on the left lateral side in PIH'ers also - and record that BP. I would be very concerned about leaving someone with a BP of 180s/120s WITHOUT the intervention of laying in the left lateral position. You did not mention if you had her change position and recheck the BP. From what I've read, doesn't PIH eventually resolve itself within a few weeks after delivery? I would be quite concerned about those elevated BPs post-delivery. Are there any plans to keep this pt on antihypertensives beyond the PP hospital stay? What about frequent BP checks at home? Back to the original question....I would document the BP when she's supine, and then after she's been laying on her left side for 10-15 minutes. I would then consult with the MD about whether the anti-hypertensives should be given. I believe that they should be, considering that she will not always be on her left side, all day long, to keep the BPs in the normal range. Wouldn't want her to have a CVA from continued high BPs!
  8. mzjennifer

    Studies Support Home Birth Option

    >>>> First, please excuse me for not cutting and pasting the above quote the way that everyone else does...I'm still trying to figure out this board. Second, in my state, as far as I know, the only recognized midwives (legally) are CNM's. I know that there are other highly skilled midwives who are not CNM's that practice in my state (and other states). But, I also consider legalities in this state to be important. I would not feel comfortable giving birth with a midwife that is not legally recognized, due to many legal implications. Does my state need better legislation to include these also highly skilled midwives as practitioners -- YES! I hate how legalities vary from state to state. When I decided that I wanted to be a midwife, I wanted to go straight into it and not become a nurse first....but in my state, that is the only way to do it and be legal. Now that I am a nurse, I have to say that I am glad that I got the basic background of nursing school to learn about all of the different illnesses, diseases, treatments, etc. I feel that nursing will give me a wider knowledge base in which to build my midwife career. All in all...I do support all midwives, whether CNM, LM, DEM or CPM. I wish we could introduce better legislation in my state to standardize all midwives. 'Nuff said
  9. mzjennifer

    Studies Support Home Birth Option

    I have recently started to give this some thought....even though I work in L&D in a hospital, I would be very interested in delivering at home if I have a 3rd child. After seeing just how much intervention goes on (and, in my opinion, is not necessarily warranted in every case), I've seriously given homebirth some thought. But definitely NOT an unassisted homebirth. It's much better to have a CNM there to monitor just in case something goes wrong. I've read some websites that advocate unassisted homebirths, and that just scares me - thinking about what COULD go wrong...why oh why would a sensible woman want to give birth without a CNM present at home??
  10. mzjennifer

    Test post

    Just a test post....trying out the settings for an avatar...hope it shows up )
  11. mzjennifer

    Your freakiest OB patient?

    I just had a postpartum mom yesterday -- dx w/ stage 3 breast CA at about 28-30 weeks gestation. 10cm by 5cm tumor in one breast (wow!). Cancer is estrogen sensitive...pregnancy seems to have triggered it, or made it worse. Had mastectomy very soon after. Induced at 36 weeks so she could start chemo. Baby born with respiratory distress (not sure if betamethasone was given antenatally??). Baby was put on c-pap yesterday, and was transferred out to a higher level NICU (we are level 1). Mom seems very shell-shocked (who wouldn't be??). Dad doing a lot of crying. Was a very tearful night at work last evening. I left after working 13+ hours, just as the baby was being transported to level 2 NICU at the other local hospital. And yes, I started to tear up too. Very sad to see. Can only hope and pray that mom and baby will have good outcomes.
  12. mzjennifer

    If I was to graduate TODAY I would make $12.25/hr!!!!

    I live in rural PA also, but as a new grad in L&D, I'm starting at $18.50/hr. You really need to check around. The other local hospital is starting at $18.45/hr. It's becoming quite competative!
  13. mzjennifer

    Context Based Learning

    We use something similar to that - case studies. Only one instructor right now uses them to teach her section of theory (cardiac). I'm a senior nursing student in an associates degree program. I'm going into my last semester next week (yeah!!). I have mixed feelings about the case studies. I'm very much used to traditional lectures, but the case studies really make you think critically.