They sent us a 1 week postpartum pt...we do openhearts!

[MIRockstarRN]

Sunday night i was the contact nurse - nursing sup. calls with pt assignment of pt coming from ED that's 18yo 1 month postpartum, new onset seizures, HTN. Please keep in mind that I work on a tele surgical stepdown... openhearts, thors, general surgeries, bariatric surgery, and many cardiac gtts. When we got the fax report from ED it said pt was 1 week postpartum. I called nursing supervisor to ask if it was appropriate for pt to be on our floor as it sounded like more of an OB type issue not a tele issue. She called ED and said pt was fine to come to us, as "All seizure pt's are pt on tele". I told her we didn't know anything checking those OB things they check, she said all you have to do is check BP and call code if pt seizes again (pt was seizing and posturing when EMT's arrived at her house). So pt arrives, me and another nurse are looking over the pt's orders to help out our third nurse and see pt is on Mg+ gtt, and apparintly this new pt needs basically a whole assessment every hour according to orders. We called over to OB to ask them to come over and check the gtt as that is NOT something we do. OB doc came over also. When OB doc arrived, I told him that if this pt needed to be assessed hourily then she wasn't appropriate for our floor. OB doc tells me that if pt was on L&D and on MG+ she would have 1:1 nursing care!!!! :confused:I told him that we don't even do q2 hour blood sugars nor do we have staffing so pt needed to go somewhere else or we could get on OB nurse to care for pt and we could watch her tele. He said pt didn't even need to be on tele! OB doc called birthing center to see what could be done, then nursing sup calls and tells me she is working on moving pt. OB doc says pt can't go back to L&D because she had already delivered and was no longer pregnant, so the problem was trying to find an appropriate bed for her. Nursing sup calls with bed on peds with OB nurse to care for her then tells me that I was out of my scope by trying to get pt moved! I told her that all i did was ask a question of the Doc and found out pt was 1:1 care, she knew it wasn't appropriate for us! Needless to say, all admits after the spat with supervisor were CRAP (not the first time we have had issues with her).

My question for you guys is this: where would this type of pt have ended up in your hospital???

[Elvish, BSN, DNP, RN, NP]

Though it is rare, preeclampsia/eclampsia can manifest itself for several weeks postpartum even if there were no sx during the pregnancy.

I agree that the Mg++ drip was appropriate (given what I know about the situation, anyway) but that her placement was not, and absolutely think you did the right thing by asking questions. If pts are on mag postpartum, they are 1:1 and kept in l&d.

[GrumpyRN63, ADN, RN]

Definitely should have been on Maternal Special Care Unit or if you didn't have one , any ICU, MICU,NICU, CCU but AN ICU!!!!

[racing-mom4, BSN, RN]

We had exact same scenerio last month with a 2 week post partum seizing. She was placed in ICU. She was NOT on tele--

FYI we had her about a week.

[lmc512]

if she is already 1 month PP then there is nothing really "OB" in my opinion that you would need an LDR nurse to do. her fundus would already be contracted down too far to palpate and her vag bleeding would be basically done. now imagine the tables turned and a postpartum/nursery nurse gets a general surg, hem/onc, cardiac service, etc patients from the ER because the rest of the hospital is full! it's outrageous!

[wooh, BSN, RN]

I'd vote for an ICU bed. The eclampsia is a OB/PP issue, but one week past birth, it's not really something that needs their specialized training. As was said above, we're not talking about needing to fundus feel anymore. But with the close observation she needs, she shouldn't be on a floor, she should have been in an ICU with probably 2:1 care. Not sure, but I'd think that in LD,the reason for 1:1 care is that there's generally a baby involved too, now that we're postpartum, it's just her that needs monitoring, not the unborn baby too. But with the mag drip, I wouldn't want a floor assignment that included her!

[MIRockstarRN]

the OB doc said that he was trying to avoid taking up a unit bed, told me that the ED said we could give pt appropriate care. we have 1:5 ratio at nights

[queenjean]

No way. No way is this pt a 1:5 care pt. Maybe 1:2 in the ICU, but NO FRICKIN WAY is this pt anything close to 1:5 care.

[RNperdiem, RN]

ICU patient!

My ICU takes post-partum patients that have nearly bled out or are in DIC or other big complications. This patient sounds like she needs frequent neuro checks and close monitoring that an ICU can give.

[AprilRNhere]

Thanks for clarifying...I don't work L&D. It sounds like you did a great job of advocating for your pt. I'm not sure what our facility would have done..prabably transfered her. I know L&D wouldn't have taken the pt back after discharge...and we would have insisted on the floor that we aren't staffed appropriately...or properly trained in that dpt.

[KaroSnowQueen, RN]

I don't do OB, but I know my youngest DD was pre-eclamptic for months during her pregnancy, and the birth did NOT clear up her symptoms. As a matter of fact, she was followed up on carefully for several weeks afterward, and was told if she readmitted, she would go to that hospital's peri-partum (not sure if that's the exact term, but it was close) unit (pts who were pregnant but shouldn't deliver yet, or those w/pp complications who came back).

[landonsles]

If mom has been d/c'd from hospital already, then she goes to ICU. If she has not yet left hospital, then she comes back to us on L&D.

[Elvish, BSN, DNP, RN, NP]

Not sure, but I'd think that in LD,the reason for 1:1 care is that there's generally a baby involved too, now that we're postpartum, it's just her that needs monitoring, not the unborn baby too. But with the mag drip, I wouldn't want a floor assignment that included her!

On our L/D unit, postpartum patients on mag (no baby, as baby is in nursery) are 1:1 also. 1:2 MAYBE, if the 2nd pt is a light one.