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NurseNora

NurseNora BSN, RN

L&D
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NurseNora has 51 years experience as a BSN, RN and specializes in L&D.

NurseNora's Latest Activity

  1. NurseNora

    CNA in L&D

    In my last hospital CNAs did a lot in L&D, but not much direct patient care. Ambulating a patient to the bathroom was about the only patient care they did. They set up delivery instrument tables. Then collected instruments after a delivery, counted them to be sure none were missing, and prepared them to be taken to CSS. They restocked patient rooms and fetal monitors. All were trained to scrub for sections. After a section was finished, they again counted and prepared instruments to go to CSS. After the room was cleaned by housekeeping, they restocked it, made up the OR table and infant warmer. At one point they were also cross trained as Unit Secretaries. We called them Techretaries.
  2. NurseNora

    Only Crusty Old Bats will remember..

    Scrub dresses that snapped at the neck and tied at the waist. Once an anesthesist left the patient to wander around the room, stopped by me to "check the chart" and stuck his hand in the back of my dress between the snap and the tie. "Walter, get your hand out of my dress!" Silence fell as the entire surgical and pediatric team turned to look at us. He never bothered me again, but nothing more was said to him as sexual harassment wasn't recognized as a problem. The only females allowed to wear pants were the few female doctors. IV alcohol for preterm labor. Dose calculated by weight,but it worked out to about 1L the first hour, then a maintenance rate of about 150ml/hr for at least 24 hours. The patients started to giggle, then cry, then vomit, then pass out and be incontinent for he rest of the treatment. Physohex baths for all newborns. Breast fed babies were allowed to nurse 3 min per side the first time, add one min per side with each feed to prevent sore nipples. It didn't work. Bag Balm for nipple care. Deladumone to dry up the milk for bottle feeding moms. It didn't work. Auscultating FHR q15min during labor because there were no fetal monitors yet. Taking Mom to X ray for pelvimetry to check for CPD if labor was not progressing. Yes, I delivered a few babies between X ray and L&D. Start the Pit at 5ggt/min and increase by 5gtt/min q15min, using the roller clamp to adjust he rate. More than once, it was time to increase the rate by the time I finally got it adjusted. A full pubic and perineal shave on admission and a soap suds enema. It was a big deal when we mov d to mini preps where we left hair on the mons. Now, most women come in preshaved. Demerol 50 mg Largon 20 mg q3h for pain in labor. We used a fair amount of Narcan on the he babies. Sometimes we added Scopalomine to the he Demerol and Largon for "twilight sleep". Those who got that often really acted out, but they had retrograde amnesia so didn't remember much. Paracervical block for labor pain, watching FHR fall and waiting for it to, hopefully, come back up as baby metabolized the giant dose of lidocaine it picked up from the mother's bloodstream. Handheld Penthrane masks. Some places are now starting to use N2O2 masks for labor pain, it hear good reports about it. Labor room to delivery room to recovery room. Leather wrist restraints on the delivery table so mom wouldn't reach for the baby and contaminate the doctor. General anesthesia or spinal blocks (rarely saw a true saddle block) for delivery. Mom flat for 8 hours after delivery if she had a spinal to avoid a spinal headache.
  3. NurseNora

    Only Crusty Old Bats will remember..

    We called it a brain patch. I'd forgotten that.
  4. NurseNora

    False Pregnancy (Pseudocyesis)

    A hydatidiform mole is a pregnancy. The placenta just takes over and grows abnormally into small white grape-like clusters. They grow quickly and the uterus becomes much larger than it should be according to dates. Since there is no fetus, she wouldn't be feeling fetal movement. martymoose, I've taken care of a 52 year old woman in labor. She was not amused. Her teenaged children were horrified that mom and dad were still doing it.
  5. NurseNora

    Fetal demise

    A lot can be addressed in your discharge teaching. When you're talking about dealing with breast engorgement, especially if she was planning to breast feed, an opportunity may arise. It will arise when talking about PP depression, you can warn her about reaching her due date, the first Mothers Day or whatever and how that may bring an unexpected grief. Resolve Through Sharing is an organization dedicated to helping families with the loss of an infant and has good in hospital resources. If yours isn't involved, check it out and perhaps you could bring it into your facility.
  6. NurseNora

    Cytotec and FHR...what would you do

    You're all right, I misspoke. I meant to say "previous baseline."
  7. NurseNora

    Vaginal Exams

    Remember that the dark lines on the fetal monitor paper are 3cm apart.
  8. NurseNora

    Cytotec and FHR...what would you do

    What's the patients temperature? What's the activity level of the fetus?if it's between 9pm and 1am, it's probably baby's aerobics time and it'll come back down when baby quiets. I still wouldn't give it until it got back to baseline, but those are two important parts of your assessment to tell the doctor when you call to say you're holding the Cytotec.
  9. NurseNora

    Neonatal assessment team

    All our labor nurses are NRP trained. Second nurse is one of these labor nurses unless high risk for some reason, then NICU nurse and NNP present for assessment and stabilization. If baby is stable I send second nurse out after second Apgar because I've got the baby skin to skin, and I'm not moving it until it's finished eating. I can recover Mom and a healthy babe together. If I gave any question about the babe, I'll keep the second nurse there.
  10. NurseNora

    Urgent Csection

    If the counts don't agree, you get an X Ray. That's all there is to it. Since you were doing it for bradycardia, the doc could have called it an emergency and done it without counts at all, and then gotten an x Ray. One suggestion, the primary job of the Circulator so to wait on the scrub tech. You do need to listen for tones in the room after anesthesia (if regional), but if you already have Brady, you don't have to listen long. Tell the doc "it's still down" (listen for six seconds and multiply by ten), or "I can't find it." Either way, he knows he needs to get in fast and not tie and Bovie every little bleeder on the way in. If the rate is in the normal range, you can listen longer to be sure, knowing that there isn't a big hurry and there's time to do the counts to your satisfaction. If you have any question, ask for another count, sometimes everyone gets in a big hurry, especially if they start off that way, and seen irritated with your request. That's their problem. You took responsibility for your patient's safety. You did the right thing. You out could ask to do a few more scheduled sections if you feel you need more practice. But just know that you will always feel like a one armed paper hanger in any emergency section. Keep your priorities in mind and it will get easier with experience. Remember--you did the right thing!
  11. NurseNora

    L/D RN learning to scrub for c/sec

    when I first was taught to scrub, I had to go to the OR to learn. I thinkOR technique is best taught in the OR. Since sections are done in L&D, the basic technique is done on routine abdominal cases, especially hysterectomies (remember any section could turn into an emergency hysterectomy). After a couple weeks in the main OR, we started going to L&D to scrub the sections done there. Where I now work, our techs scrub. It's cheaper to pay a tech than an RN to scrub. The RNs who circulate are trained just in L&D and don't go to the OR, although the OR does present occasional inservices on problems that have been identified or on new policies that affect us.
  12. NurseNora

    Overcrowding in L&D

    We've canceled elective inductions and scheduled repeat sections, sometimes even turned off the Pit and discharged inductions that have been started but not kicked into labor yet. I've also had women on stretchers in the hall with folding screens. Once I had two women laboring in recliners in the residents lounge. I turned a family waiting room into a 4 stretcher Post Partum ward. That's one of the things I love about OB, you never know what you'll find when you come into work.
  13. NurseNora

    Run-in with a doctor

    Learn the difference between assertion and aggression. It took me a long time to work that one out. No matter how rude or offensive a physicians behavior, he/she still deserves to be treated with respect. So do you. You do not have to stand there and just take it. Say this needs to be handled privately, or that you want this discussion to take place with your manager or supervisor and walk away. You out also have to develop a bit of a thick skin. Some things are said very bluntly that feel rude, but really aren't. Many nurses find the OR intimidating and think the staff is mean to new people. A lot of it is just that some things need to be done now. If you're in the way, you may just be told "Move!" If you're about to contaminate something, you'll not be asked to please not do that, someone (whoever sees the impending contamination first) will just tell you what to do very bluntly. And it's that way in emergency situations too. Taking offense at what or how something is said will only increase the tension in an already tense situation. So, someone is blunt and a little rude once in a while: learn to live with it. Some one berates you, your intelligence, your professionalism, your skills: politely leave the situation and go to your charge nurse for follow up. It really doesn't happen often. When I was a young nurse in the 60s, doctors could and get away with really bad behavior, but that has changed. We aren't expected to stand when a doctor enters the room anymore either.
  14. NurseNora

    FINALLY LEAVING ER 😃😃 OB here I come

    Be prepared to feel lost and stupid for a while. You're used to knowing what to do and feeling competent and moving to something so new is a real shock. You'll learn. No one expects you to know it all, that's why there are orientation periods. Ask questions. Get out your old textbooks and read up. Join AWHONN, there will be discounts on books and programs that are really helpful. And you get journals. you have good skills from ER that will transfer to L&D. You're used to not knowing what's coming thru the door next, and the feast or famine workload. You understand triage although there are some differences specific to OB. One problem many new people have is taking care of two patients in one package, only one of which can be seen, but you'll learn. Good luck and remember to have fun.
  15. NurseNora

    variable deceleration vs early ones

    The difference is that 30 seconds mentioned by the previous poster. A variable deceleration varies in shape, timing, length and depth. The main way of identifying a variable is by how long it takes to reach the deepest point. The mechanism of variables is a vagal response to cord compression. They may occur with contractions that put pressure on the cord, or randomly: the baby moves into a position that puts pressure on the cord. Variable decelerations are the ones seen most commonly.
  16. NurseNora

    OB dream job - only psych experience

    AWHONN intermediate and advanced fetal monitoring classes are for nurses with six or one year of experience in fetal monitoring. There is an online Basic class available at their website. Don't spend too much money trying to impress the manager. Go go to the unit and talk to some of the staff nurses about the department and their needs. Maybe getting some breastfeeding certification wold be helpful. Every department says they want experienced nurses, but they wind up hiring some nurses without OB experience anyway. Apply for the job you want, that will get your toe in the door and give you more information about how to make yourself more attractive to them.