Where would you have placed this pt?

[deespoohbear]

Maybe this should be on the OB-Gyn Board, but I will post it here since there is such a wide variety of nurses on this board.

We had a pt come in the other day to our hospital. She had delivered almost a 12 lb baby at home, and suffered an uterine ruptured. We brought to our facility by EMS, almost dead. Rushed to immediate surgery, then to ICU. After two days in ICU, she is ready to be transferred out of the ICU. What department would you have placed this pt in 1) Med-surg or 2) OB? I am kind of conducting an informal survey.

PS-Baby was perfectly healthy, happy, and signing up for linebacker at Notre Dame.

[OBNURSEHEATHER]

Originally posted by SmilingBluEyes

ummm ok night owl. i will bite. whatzzzup w/that?

Yes, I was wondering the same??????

Heather

[PatrishR]

OB, for sure but I agree with HapeeWendy, Med Surg is a dumping ground for every floor.

I have taken care of on my hospital's med -surg floor, terminal cancer patients, dying alcoholics with liver failure, Hep.C and of course confused elderly patients,

That lady should be in OB or at least a Gyn surgical floor if available.

l

[boggle, ASN, RN]

OB Heather and Blue Eyes, I believe Nightowl's post was a response to a "misbehaving" individual posting last night. Looks like the individual's posts have been deleted. Glad you missed them.

[OBNURSEHEATHER]

Ahh yes! Thank you boggle!

The one night I decide to go to bed early, and look what I miss!

Heather

[maizey]

Ob floor or gyn if available. Med surg has too much other stuff going on as mentioned above. Night owl was responding to someone named nannabooboo who was a real jerk here early early am today. You did not miss anything really.

[stevierae]

Originally posted by deespoohbear

Catching up....been on vacation for a few days.

We do not have an gyn floor. M/S, OB, ICU, and ER pretty much covers the acute care at our small facility. Our floor normally gets all the hysterectomies, and other gyn surgeries. I don't have a problem taking care of hysterectomies and other gyn surgeries, just the fresh PP case. The pt refused to let the surgeon take out her uterus :eek: . I guess he stitched it the best he could under the circumstances. If this pt gets pregnant again I don't want to be anywhere near the place when delivery time comes. I am sure it won't be pretty.

Thanks for all the replies on here. I really appreciate everyone's responses. :kiss

She kept what was left of her ruptured uterus, huh? That is REALLY bizarre--I can't imagine it supporting another pregnancy!!!

Well, in that case I change my mind about where I originally said she should be placed (that is, in the absence of a GYN floor, med surg.)

With a uterus in place that may be at risk for re-rupturing, I think this patient could go to OB--where she would be assessed for bogginess of this uterus, which would be likely, and given Methergine I.M. or started on a Pit drip or returned to surgery if need be for a hysterectomy.

Heather is right--this particular scenario is more similar to a C-section and its accompanying post-op assessments, and the OB nurses are the most familiar with what can go wrong. Med surg nurses would rarely, if ever, deal with assessing lochia and what constitutes bogginess vs. firmness of a uterus.

I have never heard of keeping a ruptured uterus..is this common these days?

[SmilingBluEyes]

she belongs on OB....really. she does. even if she is considered "GYN" she needs the care of a postpartum mom, regardless of her delivery circumstances and uterine rupture condition. She should NOT be dumped in med/surg and GYN, unless OB is full.