Warning! Vent ahead!

SmilingBluEyes · Jul 17, 2007

I hear you. I am glad to work in a place that has no such residents, or OBs. We know not to pump a lot of fluid IV into women, and thankfully, so do they.

As to all the intervention? It's a real problem everywhere. I have found I have to fudge details a bit just to keep the OB OUT of the room, AROMing against patient wishes, or starting Pit when they are making excellent progress. It's a sad thing I have to lie sometimes, but I will if there will be no harm to pt and it's in the name of honoring her wishes.

In a teaching hospital, it's a different story. I know and understand. That is why I chose not to work in one, myself.

I know you came to vent, not have us problem-solve. I hear and respect your words and feel your pain. I just wanted you to know that!

AJK2004 · Jul 17, 2007

I am an ER nurse, so I apologize if I didn't get all of your abbreviations. You OB RN's have a language that's all your own

My sister had post partum cardiomyopathy because I think they pumped too much fluid into her.

I think she was retaining prior to labor, facial swelling, she had protein in her urine, BP wasn't too bad, but higher than normal. Legs were very swollen. Was never diagnosed preeclamptic.

Before she got her epidural, they gave her a liter of fluid W/O. That epidural wore off, completely stopped working, so they had to re-insert (does this happen often?) they gave another liter W/O before the next epidural. Several hours later, she never dilated and had to have a c-section, so guess what? They gave more fluid.

A few days later she got home, baby was fine, I went over to her house and she looked like a space cadet. I checked her pulse, it was 30! She said she felt like she was going to die:uhoh21:

When we got to the ER her bp was 180's over 100's. hr was low 30's. The thing is, she was never high in the hospital or bradycardic. So I don't think anyone missed anything.

I guess my point is just because most mom's are young(she was 32) doesn't mean they can tolerate enormous amounts of fluid, I see it in the ER too!

My sis got some Lasix and went to tele, but she was very "jumpy" Was she prone to having a seizure at that point? Because I don't think the tele nurse knew, and neither did I for that matter. She would fall asleep and then startle herself out of sleep. Is that called hypereflexic? Can that happen post partum? It freaked me out(I stayed overnight just in case). Should she have been on Mag?

She's totally fine now, baby is almost 1, but she did have alot of palpitations, PVC's for the first 6 months PP. I don't think she will have anymore children, though.

Thanks for any input!

Elvish, BSN, DNP, RN, NP · Jul 17, 2007

You fudge details on labor pts, SBE, I fudge the IV fluids post c/s. If pt is taking PO well in the first 24 hours, I knock her fluids back to KVO and just don't tell anybody. Our post c/s orders say clear liquid diet x 24hrs too, and I bump them up to reg way before then. Really. Most of them are starving. I give them some crackers & fruit; if they do ok with that, on up to regular we go. It's just so ridiculous to have them on CL for so long.

I have a friend that had PP cardiomyopathy too, AJK. It is very ugly, and I think it was all the fluid they poured into her as well. When they put her back in the hosp to diurese, she peed like 12 liters in 24 hours or something. She was on meds for like 6 months too. Ridiculous.

mer_RN · Jul 17, 2007

i think that many OB doctors don't even realize their patients are getting as much fluid as they are post delivery, vag or c/s because they don't bother to write a d/c IV or hep lock order. therefore the fluids technically should be continued indefinitely. then if you call the resident to get a d/c IV order for a completely normal pt they flip out like you are wasting their time.

PoppaD · Jul 18, 2007

It's interesting how MD's always seem to site their concern for pt's safety as their primary motivation for suggestion/demanding oversight of APRNs...

How many RNs would actually make this kind of mistake???

SmilingBluEyes · Jul 18, 2007

Our orders state "saline lock" when tolerating PO fluids. We often saline lock them within 6-8 hours after their c/s and it works out fine. I tell ya, overloading fluids on all women is borrowing trouble. We also advance their diet as tolerated.

PegRNBSN · Jul 18, 2007

In our hospital we have started something called and augmentation/induction bundle. It has info that must be filled out by the resident, attending OB/FP/CNM or RN. You must indicate gestation (anything less than 39 weeks is a red flag), EFW, presentation and dilitation, and any previous uterine scars. If ANYONE involved in the care has a problem starting Pitocin on a patient they can take the bundle information to the attending (if it is a resident, FP or CNM) or another OB for consultation if it is an attending.

It really makes everyone think about all aspects before Pitocin is started. A really good QA/QI tool.

It is a sticker that must go on the progress notes.

crissrn27, RN · Jul 18, 2007

Arwen, I just don't know what you are talking about. The little dude that delivered my SIL at your hospital (should I say our, now?) knew just who to call when he ripped the cord off the placenta. :uhoh3: :lol2:LMAO.

The place I am leaving does 24 hours clear liquids too. And overload on the fluid. When I had dd I figured it up, I had a total of 3000 cc over 14 hours, including my bolus for the stupid epi that didn't work. Guess what? My BP was 140/90 for about 2 weeks after and I looked like a bloated dead fish. My norm is 90/50. All that for a normal NSVD. Crazy. Maybe it is a regional thing?

If we have a repeat C/S pt, they do 1000cc bolus, run who knows how many (maybe 3 liters, maybe more) during, then they do 125/hr for AT LEAST 24, sometimes 48 hours post. Without fail, these girls puff up like Mrs. Puff on Spongebob when she is mad. I know for a darn fact that we have had some undx CHF, I might not be the moms nurse, but I can hear those lungs when I walk in the room.

I am glad to hear that I will be working with some people who know what they are doing, the few who don't are everywhere, so I guess I'll deal when the time comes.

33-weeker · Jul 21, 2007

This is one reason I had my babies at home. NO IV!!! I have old repaired heart defects. I didn't need liters of fluid to cause me problems where there were none. I had a fluid overload after the twins anyway - 3 days on tele unit w/ lasix, peeing liters - even after no IV in labor. Had I birthed in the typical L&D, I'd be dead. :uhoh3:

One thought... the downside to fudging on the fluid I&O is that there will be less problems to encourage your docs to change their ways.

Can you encourage evidenced-based practice at your facility where fluids are concerned by citing some studies and collecting data from your patients' outcomes? Would be a good PI project...

Elvish, BSN, DNP, RN, NP · Jul 23, 2007

When I say I fudge IVF, I don't mean I knock the fluid back & chart as if I didn't. I kick it back to KVO and document the amount actually infused that shift. Then in the AM I leave a note for the docs or catch them on rounds and tell them what I did and why. I've never had anyone have a problem with it, MD, nurse, patient, or managment.

I went back & reread what I wrote & realized it sounded like I was falsifying their I/O. Sorry!!

cheshirecat · Jul 25, 2007

I would just take the IV down and tell the doc shes tolerating oral fluids fine, and I do not want to overload her. Don't think we have the same problem in the UK.