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RNnL&D

RNnL&D

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L&D RN and mom to 4

RNnL&D's Latest Activity

  1. RNnL&D

    opinions about epidurals

    i totally agree. :yeahthat: my last child was also born at home. by far, the awesomest of my births. (is that a word? ) but twins!!! way cool!
  2. RNnL&D

    ACLS for Labor Nurses?

    All of our L&D nurses are ACLS certified or become certified within their first year on the unit. The hospital offers a three day class that you are paid to attend, that includes a review EKG class. We recover our CS pts in our own RR. And, unfortunately, I have been in a code in OB. We did have the pt on the monitor, were doing compressions and had pulled meds before the code team even arrived. While we may never be completely comfortable performing ACLS, I feel safer knowing I have a basic idea of what to do in a code situation.
  3. RNnL&D

    Video cameras banned in L&D

    I suppose the first time a video is entered as evidence in a case against the hospital, we will discontinue the practice as well. As far as I know, that hasn't happened. I have heard of cases, at other facilities, where the video aided in exonerating the hospital staff, rather than showing any malficience.
  4. RNnL&D

    Video cameras banned in L&D

    Wow! I'm surprised by the number of facilities that don't allow taping the birth. We allow videotaping of the entire birth from any angle they want, as long as the videographer isn't in the way. One of our many forms included in the admission packet is a video/photography policy info/consent form. It informs pts and families that they must ask permission from staff before taking their picture, they will not interfere in the pt's care by being in the way, and they will discontinue video/pics if asked. It seems to be a good system for us.
  5. RNnL&D

    When do you open up your Pitocin?

    I'm surprised it's that high anyway. It doesn't seem like we see it that often. I understand what you meant, Becki. I just hate to see new studies that recommend even more intervention.
  6. RNnL&D

    When do you open up your Pitocin?

    You're right. There is a simpler way. Hopefully, someday, more hospitals can get back to that. Reading other's comments, I realize we are bit different from the norm. I am glad I work in a lower intervention unit. We do have the patients who get every intervention ever invented, but we also get to experience the births with next to no intervention...IV's, external monitor, a delivery bed......
  7. RNnL&D

    VBA2C w/ 1st at 25 weeks

    I think what RNfrom MS meant was, the only reason that might preclude a woman from having a successful VBAC would be CPD, true CPD. I agree with those who suggested finding a midwife. Being aware of the risks, you have the right to refuse a CS. No doctor can perform an operation without your consent. I hope that you are able to find a supportive provider. I agree with Heather also. This doc sounds like he's paying lip service to possible VBAC while actually planning a repeat CS.
  8. RNnL&D

    Case of the mistaken stat C/S or my mistake?

    No, not usually. You are right, it generally looks like a progressive dip. Anytime the monitor loses contact, the FHR should be confirmed against mother's pulse, to be sure. You said the resident listened. Like stood there and listened to the monitor or actually adjusted Mom's position and the EFM, then listened? IMO, before deciding on a stat CS, FHT should be confirmed, bt you're right, there's no way of knowing w/o checking maternal pulse. Don't beat yourself up about it, just make it a point from now on to compare the two. Then you won't worry yourself unnecessarily.
  9. RNnL&D

    When do you open up your Pitocin?

    Scary. How about we let the cord stop pulsating, and let the placenta comes when it's darn good and ready? Golly, I must work in a low intervention unit. You know, the only retained placentas and manual removals I've seen were caused by impatient docs who were a little too agressive with their cord traction.
  10. RNnL&D

    Pitocin titration

    Yes, it is related to the high rates of Pit and hyperstim. You really need a protocol with clear max dose, and protocols for decreasing Pit in the event of hyperstim and/or fetal intolerance. A baby with lots of deep variable decels is telling you he's not happy. That should be more significant to your docs than creating the perfect contraction pattern, kwim? IMO, you're smart to be uncomfortable with that. I am loving my job more and more.
  11. RNnL&D

    Pitocin titration

    I haven't seen the literature, but just from experience, I think you hit the magic level (around 10 seems to be what works with most of my pts) and increasing beyond that doesn't seem to make a difference.
  12. RNnL&D

    Pitocin titration

    I'm curious what your rates of PPH are with Pitocin rates that high. It sounds very dangerous to me.
  13. RNnL&D

    Pitocin titration

    I feel, at my facility, that the nurses have this autonomy. We use 10 u Pit premixed by pharmacy in 500ml bags. Our low dose protocol is 1mu q 30 to a max of 20. High dose is 2 mu q 30 to a max of 24. We seem to be pretty conservative with our Pit compared to what other posters have mentioned. Rarely do these protocols not work, but I have seen an order to continue past the max dose but never past 30 mu, and generally not without an IUPC. We titrate to moderate to palpation ctx q 2-3 minutes. In the event of hyperstim and/or fhr decels, our policy covers decreasing or turning off Pit. If a doc insists on increasing beyond what we feel is a safe zone, we have no problem insisting on an IUPC. I feel pretty empowered to titrate Pit as I see fit, because our policy is pretty clear cut and I can readily point it out to any doc that doesn't agree.
  14. RNnL&D

    When do you open up your Pitocin?

    We open it after delivery of the placenta at physician request. Some docs and midwives do not use it. And as not all of our pts get IV's....... How can you determine the need for Pitocin after delivery, before they deliver? Yet, another just in case standard of care.....
  15. RNnL&D

    IV policy

    So, help me understand, if a pt refuses an IV, then abrupts with no warning and loses her baby, the hospital is essentially telling her it is her fault because she didn't want an IV? It would be interesting to see hwo many bad outcomes there are just because someone didn't have IV access.
  16. RNnL&D

    IV policy

    Nope. Only pts desiring medicinal pain relief, those on Mag, pitocin, antibiotics, etc. Our low risk pts do not have to have them. It is a rare occurence that an emergency arises where you can't get an IV in quickly. I understand the just in case rationale, but don't really agree with it. It's kind of like asking if we should have Mity Vacs on every delivery table, or anesthesia awaiting at the bedside for every delivery, just in case, kwim?