Tuesday, December 30, 2008

No Breakage!

I know I shouldn't post this when I have two more nights left this week...but I can't remember a night being as good as last night. It started out way hectic and I wasn't sure how it was all gonna turn out, but it was busy enough that it kept me going and the night was actually really good! The worst I had of it was chasing babies, but even that was ok, at least the babies were behaving! My cervidil I expected to labor just because that doc has the reputation of delivering people off cervidil's, but she was pretty quiet all night and baby was a perfect angel, best looking strip I've claimed in a long time! She slept most of the night too, so I'm glad she didnt' hurt too bad.

I walked in at the same time as a R/O PROM, and was trying to do that and get the cervidil started all at the same time. By the time I got the cervidil situated I caught the on-call doc for the R/O and he proceeded to do the 1-million dollar workup on the PROM and then decided that she was just leaking urine. This after a sterile spec, an amnisure (I had done that already...), a sono, and a vag exam. At least he's thorough...but it took 2 hours to send her home when it should have taken about 30minutes. Oh well.

So I'm back for the 2nd full shift of 2 1/2 in a row. I was so proud of my girl from Sunday night...she delivered vaginally! I stopped and saw her before I left today and her baby is so cute! I don't think her strip ever looked all that wonderful, but no crash section so I feel better about that. She said she only pushed 6 times...for a prime that's not bad! Now it's time to sleep before I head to the gym and back to work. Good morning, everyone!

Monday, December 29, 2008

Afraid of...

So I was thinking last night after I worked an extra 6hr shift that right after times I think I'm really getting this L&D nursing thing, something else happens that shows me I still have SO much to learn that it scares me all over again! What am I still freaked out about as an L&D nurse? The list seems endless...

~Decels, no matter what kind, still scare the snot out of me, because it only takes one decel to never come back up again...

~Crash C/S- I seem to get flustered at the littlest things, and at the wrong times anyway. If I can't open a scalp electrode at the right end, how am I gonna rush a patient back for a stat section all in one piece without forgetting something important!? I'm sure it's something that after I do it I won't be so terrified of it, but until that happens...

~A REAL shoulder dystocia - I know how to do suprapubic pressure, but what if that doesn't work?

~ That one time there's no heartbeat...heaven help me if that ever happens.

The list could go on and on and on. I guess that's one of the reasons there's never a dull moment at work, there's always that "possibility" that everything can change. I used to say I was afraid of catching a baby, but I did that, so I guess it's time to tackle some more of my fears. Just not all in the same night...please!

Saturday, December 27, 2008

Cluster of Quiet Nights

It seems like I've worked a ton this week, even though I really don't think I have...I worked Christmas night, it was fretty quiet, but got kinda "clinic-y" since the offices were closed. Lot's of "I'm cramping after I've been up and going crazy the last few days" so lots of hydration, vistaril and home. I had one long term ante who's gonna be around for awhile r/t a complete previa. Gave her a colace, took some vitals and visited with her. Other than that...she slept all night. I did one or two triages too but they all ended up going home. Read through some good trivial prusit cards though!

Last night was a little busier, but still really, really "clinic-y" I started out with the same ante from the night before, sent another one home about 2000, then got a ROL about 2100 that was in labor (I suspect 8 hours of shopping gave her a pretty good start). She and her very supportive parents and FOB were really fun and nice. Since it was the middle of the night, the docs were pretty "non aggressive" and didn't want much done to "encourage the process" so she got to do (at least until I left) it all on her own, no pit, etc. She was doing good, never really did get into a "good contraction" pattern, she'd have a whole slew of them for an hour, then they would kinda disappear for a while. She didn't make great gang-busting change, even after she SROM'd. She'd gone from 3-5.5cm in about 6 hours, but had just gotten an epidural and really comfy. I called the doc to see if she wanted some pit since she was SROM'd and she so not yet, wait 'till 0700. When I went in and re-checked her before I started pit at 0650 she was 8-9! So I didn't start the pit. I wonder how it all turned out for her.

I'm starting to see day-shift a little differently now that I'm on nights. Never would have thought it when I worked days, but now I've decided I love the night crew. What a switch! I love walking into a blocked, foley'd, comfy, excited almost 9cm room when everything is ready, but I guess that's just me sometimes. One day I hope to give report to a nurse and not get the feeling from her that I totally forgot something and that I actually did do a good job of taking care of my patient for 12 hours!

Wednesday, December 24, 2008

Messed Up Schedule!

Ok...this not being able to sleep at night is really starting to get to me. It's after 0300...and why am I not tired? It's weird to think that at this time yesterday morning I was still shaking after catching a baby. But I'd do it again (and hopefully will again someday!) in a heartbeat!

P.S. Everything but one little tiny spot of meconium came out of my scrubs and my brand new long sleeved shirt I was wearing underneath. That made me VERY happy, even though my mom wanted to know why I was doing laundry at 5am...!

Tuesday, December 23, 2008

Did You Play Baseball in School?

New favorite quote from a patient/family member...

New Grandpa: "Did you play baseball in school?"
Birthday Nurse: "No...but I watch my brother play and I play softball in the summer. Why?"
New Grandpa: "Because you're the best catcher I've seen!"

This after I delivered his new granddaughter all by myself :)

I've wanted to "catch" a baby forever...seriously! But I really, truly believed that it would come after working as nurse for much longer and with a doctor right behind me guiding me through the process, not with one glove on as the patient is puking after pushing for 7 minutes. But, there is NOTHING like that surge of adrenaline, ask the scrub tech (who came in as I'm suctioning the baby after the friend went down the hallway looking for someone to help me) who was standing behind me watching my knees shake as she's handing me stuff to clamp/cut the cord and draw cord gases! Oh my goodness, I thought I was gonna fall over!

But the real story...I'm crawling into bed at home after sleeping most of the day then going shopping (never again this close to Christmas...). My phone rings and it's work: "We're swamped and one of the nurses is sick...is there anyway you can come in?" Sure, I've got nothing better to do, so I jumped through the shower and made it to the hospital in record time. They were right, the board was full! I got a prime who was 7cm, blocked/comfy and on pit. I go in, do my thing, flip her a couple times to get the baby to have early's instead of variables and about 0130 she's about 9. The doc's in the lounge but doesn't want to come until delivery, which means to him until the ears are out. So about 0230 I go in, she's complete and +1 I put her to stirrups, she pushes really well and after all of 3 pushes the baby's crowning quite a bit with pushing so I page the doc to the room and chart that he's been paged.

Then the dreaded words "I feel sick..."
Vomit X1 and I really can see the ears!

Vomit X2 and oh look, I barely got my ONE gloved hand under the head and am now covered in amniotic fluid. I'm not sure what I was thinking but I think it was something along the lines of "Hmmm...the head's out now...I hope the doc gets here quick" and mid thought came...

Vomit X3 and now I'm thinking "oh look, I'm holding a baby...and there's no one else in the room! Uh...now what?"

And then I'm trying to hit my emergency badge and sending the friend of the mom down the hall to find me some help and I'm asking Grandma to slide the delivery table over to me and I'm telling the mom "good job, look at your cute baby" and I'm talking to the baby "oh look how cute you are...talk to me, tell me all about it!" and I'm grabbing on the delivery table for the suction bulb and trying to remember to keep the baby upside down and suction mouth then nose and then I'm trying to find the cord clamp and somewhere in here I'm thinking "I have one glove on, and it's not even on the hand that's holding the baby..." and "hmmm...now I see why the docs wear those big blue gowns over their scrubs...I hope this all comes out in the wash!"

About this time 3 nurses and the scrub tech walk in and (still with one glove on) I clamped the cord, cut the cord (totally forgot to ask if anyone else wanted to do it...), drew cord blood for nursery (missed the tube the first time and added some more decorations to the front of my scrubs 'cuz I was shaking so bad), and was waiting on the placenta when the doc walked around the curtain. "Hi doc!"

I'm not exactly sure how mad he was when he walked around the corner, the only thing he threw was a pair of gloves, but he didn't say anything mean to me and wasn't short with anyone that I heard. He delivered the placenta and sewed up a few skidmarks, but that was it! Honestly, I don't think there was anything I could have done differently. She pushed 3 times and I called him and it was the puking that pushed the baby out, she wasn't pushing with contractions.

So I filled out a variance report, did about half the girl's recovery and left about 0430. I'll work a shift like that anytime. I feel guilty about the doc missing the delivery, but I can't stop smiling! I feel like I got some of my confidence back after Sunday night. So, maybe I should try out for the baseball team? :)

Babies today: 1f
Babies total: 28M/25F = 53
Vag:21M/22F = 43
C/S: 7M3F = 10
Babies 'caught' = 1f...this demands a new category!!

Tired of Being Frusturated

~~ Sorry the time/date is wrong on here! It should have been about 2045 on the 22nd...but I got called into work so this got posted after I got home :) ~~

So after I left work this morning I really am not sure that I'm ever going to feel confident in this job! I know there are shifts when nothing seems to go right, and everyone has them...I think I just had one. What a way to top off an already long weekend (even if I was on call Saturday night!).

Started off the night with one ante who was in for a PIH eval and a 24-hour urine, 38 weeks, no big deal. Well then at 1855 another gal walks in, and guess who got elected for triage duty? So I took her back and got her started, it took me an hour before I got into my original patient'sroom.

Finally get both of them somewhat settled and my PIH baby starts randomly "dumping." Baby was all around a little 'sleepy' but nothing too overly horrible, mom's uterus had some irregular irritability that she was sleeping through. Then every 2 hours or so she would have a big titanic contraction and baby would drop down into the low 70's then by the time I would get in there and turn her it would come back up. I turned her back and forth every time, I gave multiple fluid boluses, she slept with oxygen on, the whole 9-yards. The baby had been doing this randomly since she'd come in that afternoon and the doctor had been made aware of it and hadn't given any new orders.

About 0200 another triage rolls in, of course I'll take it! It's a high-maintenance/out of control ROL. She was 3.5, I'll give her that, but it took us 45 minutes to get an IV started because she wouldn't hold still, wouldn't listen, etc. So finally get her a block about 0430, meanwhile my PIH baby is dumping again and I'm holding my new girl in position for a block, my antibiotic needs to be hung 30min ago for my first triage, and what do I hear when I get out to the desk "by the way, your baby dumped." "Thanks, did anyone go in there to check on her?" "No." Thanks. I know everyone's busy, but I couldn't leave the room. I know there was at least 1 nurse sitting at the desk because she said she watched it! Anyway...

I think I almost have everything caught up by about 0545. My "ROL" is now complete and can't feel anything. The doc's updated and said to labor her down and she'll be in soon, everyone else is caught up and charted, both of my other patients are sleeping, so I got everything ready for the delivery. Deep breath in. PIH baby dumps again at 0630 right as day shift is walking in...

My 3 patients are split up between 2 day nurses...go figure. The one getting my antes wants to know why nothing's been done about the PIH baby. I have tried everything, everyone else has seen my strip and has no suggestions, I was even told "sometimes you just can't fix it." Get through report on the antes with the gal gonna deliver my "ROL" breathing down my back very upset that she's not delivered yet, right as the doctor walks around the corner.

I can only do so much people! I AM still new at this...the one thing that made me feel better was that the nurse taking my antes said "looks like you were spread a little thin last night." I figured that it was just me and that I was being a baby about it. She said "there's a time to learn and there's a time where someone needs to step in and help you when you need it." I felt like I needed it last night, that's for sure! I felt stranded and like none of the other nurse there really cared or wanted to help me. So I'm sure I forgot something, and I'm sure I got on a couple people's black list for not doing the right thing and making stupid decisions, but I'll get over it in time and learn from it and do better next time.

Thanks for listening to me rant and rave! I really do love my job still...I just hope my job still loves me...!

Sunday, December 21, 2008

I'll Take Call

I've never had a "call date" (being on-call for at least 6hrs on a night your scheduled to work...) and trust me, tonight was the perfect night for it. I kept thinking in my head on the way home from work this morning how I would 100% take the call option if they called and gave it to me tonight! After last night, I needed some time to think and just take some deep breaths.

I really didn't think that the whole shift last night effected me that much until I was writing about it this morning and bawling my eyes out...and then when I woke up from my nap this afternoon crying again after dreaming about it. I was feeling so guilty because I didn't shed a tear last night when everyone around me had lost it. I was really wondering why it wasn't getting to me when I knew it was a horrible situation and now I haven't been able to stop myself from tearing up every time I think about it since.

So after I decided in my head that I would take call tonight I got to thinking about the parents I bonded with last night...at least I felt I bonded with them. I wasn't there for the actual delivery, but I was the one who got to help them make the few memories that they will always have of their little boy. I was the one who got to help them make things to remember him. I didn't want to leave them without saying goodbye, and I hadn't had the heart to wake them up when I left this morning. So then part of me really didn't want to be on call tonight because I'm pretty sure they'll be gone by the time I go in tomorrow night.

My mom and I were out shopping pretty close to the hospital tonight, and I just felt inside that I had to do something to let them know that I was still thinking and praying about them. So I just got them a simple card. I didn't really know what to put inside, but I told them how lucky their little boy was to have them as parents, because even if he didn't get to grow up with them, they'll still always be his parents, and he'll still always be their little boy. I ran the card to them and left some candy with the poor nurses who didn't get the chance to be on call tonight. I don't know if it was the right thing to do, but when I went in and dad came over and gave me a bug hug and started crying again and just said thank you over and over again I about started crying too. I don't know how anyone could keep being thankful when your baby is gone forever, but they were.

So many people have told me how lucky I am to work in such a "happy place." I am, and I am reminded of that so often when I go to work and get to witness miracle after miracle. But then nights like last night happen and it's like a blow in the gut when it reminds me how the happiest place in the hospital can also be the saddest place in the hospital. Death is never a happy event, there seems to be some extra sting when it's a baby, and even more when that baby never even got a chance to live. It's nights like last night that remind me what it really means to be a nurse, and what it really means to support people and be there for people. I think sometimes as a L&D nurse I have a chance to make an even bigger impact on people at times like last night than I do when everything goes as planned.

This afternoon I dreamed that I was in heaven and all of a sudden a little boy ran up to me and threw his arms around me and said "Mommy, Daddy! This is her! This is the nurse who held me and helped take care of me and helped tell you that I loved you after I was born and didn't get the chance to tell you myself. She was the last one to hold me and rock me before they pulled up the covers." I don't know where that dream came from, but it some how shed a little bit happier light on the situation. I feel so honored to have been the one who got to help those two parents who never really got to know their son make some kind of memories with/of him before they told him goodbye. I got to be a part of that, and that's pretty special.

Saturday, December 20, 2008

When Life Just Isn't Fair

So I was on call tonight just long enough for me to change out of scrubs and head to a Christmas concert with my parents...then got called and told there had been a scheduling mis-hap and if I could please come to work. Ok, no big deal, that means time and a half for the first 6 hours. I figured (that's the last time I "figure" anything about this job!) that they would want me out of there ASAP since I was a call-back and making extra money. So...what do I walk into?

J met me in the lounge as I was putting my stuff under the counter and going to change and said "girl, get ready to cry your eyes out. You're walking into a sad situation." Great...what happened now. So over the next 2 hours as I piece the story together...G1 came in for a cervidil the night before, good pregnancy, no real problems, labored all day on Pit, good strip, got to complete, pushed and wouldn't descend, went to the back for a C/S...baby came out dead. Parents declined an autopsy, but from the x-rays the most popular theory is that it was a heart/lung problem and baby just couldn't transition. They coded the baby for 2 hours before they pronounced the time of death.

The baby was perfect. Completely perfect. I just don't understand. I've been thinking...I couldn't even really tell you what I did for the last 12 hours. I felt like the biggest jerk in the whole wide world every time I had to walk into that room because I didn't know what to say, and I felt like I was totally invading a completely personal/intimate moment every time that door squeaked open. When I had to take the baby for the NNP to draw blood for the genetic studies and then do the plaster hand molds I felt like I should be fired because I was the one taking the baby away. Why did it have to be me to take him away?

After about 0200 when Mom and Dad had said their goodbyes and all the pictures were taken and everyone had cried and it was time to take the baby to the morgue, I was the one who had to put him in his bassinet and cover his little face for the last time and I was the one who had to roll him out of the room away from his mom and dad. Carrying him down the back steps to the morgue and then standing in the hall waiting for the security guard to open the door. Then leaving him wrapped in a blanket on the cold shelf, all by himself. It's not fair!

They were expecting to take a very long awaited and prayed for Christmas baby home with them on Monday. Now they're taking nothing but some bloody blankets, some hats, a strand or two of hair taped on a piece of paper, and the Christmas stocking that goes in every bassinet during December. When they were taking pictures they had him dressed up in the most adorable outfit with his Christmas blanket in the stocking and mom said "We've been waiting to take pictures with the stocking for a long time."

When I was tucking Mom and Dad in for the night they said thank you for everything I did. I didn't do anything. Really, I felt like all I did was invade their privacy and take up time that they should have been spending with their baby. They were the most amazing couple I've seen in a long time. They were grieving the death of their first baby and they were thanking me? It's just not right. So many things tonight just weren't right.

Thursday, December 18, 2008

1/2 A Shift

So when I was at work Monday night I figured I would do my good "nursing duty" and sign up to be on-call from 1900-0100 last night (Wednesday night). There were already 6 nurses scheduled, and I don't remember the last time I heard them calling someone in from "off the door" where we sign up for extra shifts, so I really didn't think they'd use me.

I finished teaching piano lessons about 1700 and thought I would just call to see if they had an idea if they would need me or not...and the day charge nurse said "Come in!!" and sounded pretty desperate. So I dashed to the gym, only got in a 40 minute run and then jumped through the shower and went to work, and they really used me the whole 6 hours! I only had a cervidil, but everyone else was either doubled up or in the back doing sections, so I guess they really did need me! I guess the "ante" world hit today and there were 7 or 8 antes who were gonna be longterm or at least until they were seen by MDS tomorrow, plus a few cervidils and a c/s left over from day shift and that was enough for 7 nurses I guess! See if I ever feel it my "duty" to sign up for extra shifts again and not think they'll use me, ha!

But an extra 6 hours is an extra 6 hours and it makes up for going home early on Monday night. Now I get a day off and then work Friday/Saturday/Sunday, what a way to totally take up a weekend. But it's weekend pay, and then I work both Christmas day night and New Years Day night, so that will be some good $$ on the next pay check if it doesn't go to taxes. Good thing too, I need Christmas money!

Speaking of Christmas, we still don't have ANY Christmas stuff up and we us ally have 4 trees up between all of us in my house (mom's got a tree, then the 3 of us kids all have tree with 'our' ornaments on it...)! That's what happens when you get busy with programs and all the other Christmas stuff going on. But it's still kinda depressing and doesn't feel like Christmas yet. But I'm also wondering if it's even worth it at this point...

Babies today: 0...I'm getting sad that I haven't had a baby in awhile. I know we don't do as many deliveries on nights, but it's starting to make me sad!
Babies total: 28M/24F = 52
Vag:21M/21F = 42
C/S: 7M3F = 10

Tuesday, December 16, 2008

Home Early!

Cervidils...cervidils...cervidils! But I survived my 2nd night of "unsupervised" nursing...and both my patients were breathing when I left! I was 1/2 expecting to get put on call, but I didn't...until 0315. I was the only person who hadn't had a "call" date yet, and the one person who wanted to go home had left about 2100, so I was the next one up when we only had a recovery and my 2 cervidils.

I was on call for 11 1/2 hours Sunday night, but they ended up sending people home that night too so I didn't have to go in. I'm signed up for call tomorrow from 1900-0100 and am crossing my fingers they really don't need 7 nurses! Then I work this weekend and I'm sure I'll be there for the duration of it, but that's ok...I need Christmas money!

Got some pretty snow today that started right after I got home, so I'm glad I got to drive home and miss it instead of driving home in the thick of it at 0700!

Babies today: 0
Babies total: 28M/24F = 52
Vag:21M/21F = 42
C/S: 7M3F = 10

Friday, December 12, 2008


So I went into work last night kinda sad that it was my last night on orientation, I even took brownies! Imagine my surprise when they told me I wasn't on orientation last night...I was just on my own and here's your patient that's 8cm. So, deep breath in, grab a pager and go. And guess what...I survived (and so did my patients!) :) The night went pretty good!

Really nice delivery about 2000, first baby, mom and dad were both super excited and fun to talk to and get to know. Everyone showed up on time (nursery included) and it was a fun birthday party! Got the recovery all done and Mom moved over to her postpartum room before my triage showed up, so I was pretty excited!

Triaged a R/O pre-term labor who was contracting, but not changing so vistaril'd her and sent her home before 0100.

Then sat on my behind until about 0625 when the C/S that was scheduled for 1400 showed up in labor. Now here's what I can't figure out...when I took the traige at midnight, and there were 3 of us sitting around with no patients, how is it my turn to take the next one who walks in the door? It wasn't that big of a deal, and I only left about 30min late after charting and doing all the admission for the gal, but I'm afraid that it's a sign of things to come...the new kid on the block gets dumped on because it's easy. That's gonna make for a not happy nurse if I get the short straw every time...but maybe I'm just tired!

Anyway, it was a good 1st night truly "on my own" and I don't have any horror stories to tell like some of them do about their first night off..but that's ok! And it was probably a good thing that I just walked in and found out it was my first night off instead of worrying about it the entire day before. I was proud of myself and the confidence is building. Let's hope I haven't jinxed myself for the next time I work...

Babies today: 1f
Babies total: 28M/24F = 52
Vag:21M/21F = 42
C/S: 7M3F = 10

Sunday, December 7, 2008

What A Weekend (Take 2)

Thank heaven for auto-save! I went to publish my post about my weekend and lost internet connection and thought I deleted it. I was about to just update my "baby stats" and leave it at that...but I found the saved completed draft :) Go Blogger!!!

What A Weekend!

Maybe it's because I hadn't worked for 8 days...but this weekend was an adventure! I loved having 8 days off, but I'm afraid it may have been a little too long, cuz all of a sudden 3 in a row seemed like a LOT!

Thursday night we did a cervidil that did nothing and ended up being cut Friday afternoon, and I also had a ROL that was a G7 who came in banging out contractions every 2 minutes that were off the chart. We watched her for the last 4 hours of the shift and she never changed, but was still contracting pretty regularly after fluids, vistaril, terb, and a morphine/phergan combo IM. But nobody wanted to send a term G7 home still contracting that often. I think they sent her home mid-morning on Friday.

Friday night was when it got interesting. I think every L&D unit has "codename patients" who are frequent fliers for a very LONG 9 months and everyone celebrates after they deliver :) It seems like some docs specialize in these kinds of patients too. Anyway, we have one doc in particular who is a WONDERFUL OB, but really seems to attract the "interesting" patients to his practice and they come in with all kinds of crazy histories and backgrounds. So this particular patient of his has been frequenting our unit for the last several months, very non-compliant with everything, tells the nurses how to run the show, asks for meds by name for symptoms (Can I have some zofran for my nausea? Seriously, what patient asks for zofran by name?) and is quite dramatic. Everyone on the unit knows her name. Non-compliant diabetic, multiple other health problems, on both oxycodone and oxycotin at home for pain, multiple positive drug screens, the works. She had a complicated history with several miscarriages and had lost several babies near-term. She had started dilating early on so she had a cerclage in but would still come in "in-labor" every few weeks. Anyway, the doc had checked her in the office and she was about 2cm around her cerclage so he sent her over to the hospital. He sat there and waited for 4 hrs and she never showed up, so he went to his Christmas party. Then she showed up...and we got her!

She screamed and moaned and had the worst looking strip I've ever seen. Seriously, a flat line. Flat, flat, flat, flat, flat. I looked at it again last night and it's one of the strips that makes you nauseous to look at. It looked like she was contracting a little, but a little difficult to monitor so not really sure. The doc said to give her morphine. We second-guessed that, but his comment was "if that kid's already flat, what's morphine going to do to it? It can't get flatter..." Did the morphine touch her, nope. Interesting that the urine screen came back positive for everything! Doc came back and checked her after his party and she was actually 6cm with her cerclage! He broke her water and it was the most disgusting mec I have ever seen. It didn't even look like mec fluid, just like pure meconium. All that at 35wks. Poor kid was super stressed out! So section and kid was in the NICU, had a .7 shift to the left by the time it was down to the unit and sugar dropped from 50 to 25 in a matter of minutes. Ouch.

I was pooped at 7am Saturday morning! Then got 5 hrs of sleep and went back last night. I had a delightful couple from out-of-states and did a really nice delivery about 0100. First vag delivery I've done in what seems like a very long time! Toss in a triage and I was ready to come home and SLEEP!

One more night of orientation this week then watch out out pregnant people, I'm on my own! I guess if I look at it, I've been flying almost solo for the last couple weeks anyway, but still, that last snip of the cord seems a little scary. One of the nurses told me something really good a few nights ago though, "you still have the same resources after you're off orientation. We're all still here, we'll still answer questions, you can still ask for help. Nothing really changes that much." That's a good thing to remember :)

Babies today: 1f/1m
Babies total: 28M/23F = 51 (50 is my first big milestone! Yea!)
Vag:21M/20F = 41
C/S: 7M3F = 10

Wednesday, November 26, 2008

Off for 8!

I really do like work, I was just telling someone last night about how much I love work. But after working 6 out of 8 nights...I'm ready for a few nights of sleeping when it's dark outside! I know it could be a lot worse, it was never more than 3 in a row, but still, that's a definite switch to the night shift!

Last night had the potential to be crazy, but turned out not too bad. We started with 3 antes, but one was a set of 35wk twins that everyone thought was going to deliver. We went 2 out of 3 home before 2100, and I had the twins pretty settled down but then another "early labor" patient walked in about 2145 that kept me running. I think ER sent up 4 patients in an hour and a half last night! That is too many...

The twin mom had come in early in the afternoon and had been 2, then later on 3, then even after terbX2, vistaril and fluid she was about 3-4. She was rating her pain and had gotten some nubain right before I got there. The doc said that she really had to declare herself in labor before she got an epidural, so we stuck to nubain. She kept telling me that she "hurt" and I gave her a total of 10mg nubain, 2mg stadol and a vistaril during my shift. When I checked her right before I left I called her 5. That's 1cm change in 7+ hours. When I would be in there moving monitors, etc she would mention that she was hurting, so I would go get more meds, and when I'd get back in there she'd be sleeping. So, I figured that if she was able to sleep through her contractions, then I should just let her sleep. Ethically speaking, was that right or wrong? I didn't want to wake her up for pain medicine for pain that wasn't enough to keep her awake. Every time I would have to go in there and move something I would have to wake her up and she'd be asleep again by the time I left the room...

Our biggest struggle was the 16yo "in early labor" patient who came in. VERY limited pre-natal care (like 2 visits) and who obviously didn't really know what to expect with the whole labor thing. She was by NO means making gangbuster change. She was 1 when she came in and I could finally "really" call her 2 when I left. That's not much change in 9 hours. Baby didn't look the greatest either, so that was what we were really concerned about. It wasn't bad like "decel" bad, but bad as in we couldn't really call it reactive most of the night. We tried flipping, we tried O2, we tried apple juice, we tried fluid bolus, we tried acoustic stim, we tried scalp stim. Not much result. I was a little frustrated at times because it seems like I'd go in and do something, and come back out and everyone would be watching my strip and making all these suggestions about it and sending me back in there to try something else. Thank you for the suggestions, really, I do appreciate them. But if it's that important, say "let's go try this...together" don't sit with your feet on the desk drinking a coke and say "you need to go back in there and try this." Especially when it's 3am and I haven't eaten since before I went to bed the morning before!

I am starting to feel more and more OK with doing lots of stuff on my own, and developing autonomy. I know I probably shouldn't be - but I'm starting to feel pretty defensive when some of the other nurses who think they know everything about everything start telling me what/how/when to do something or when they feel the need to make suggestion/comments about everything I've done or not done yet. Hello, if I ask for help, then please help me. But if I don't ask you for help, and there is no dire emergency or disaster, please don't feel it necessary to intervene with everything I do. Especially when you're not my preceptor and don't really know the first thing about my patient! I really like it how we kinda watch each other's strip, and the night nurses seem especially good about backing each other up and covering each other's backs, but I think there's a line too. Just because I'm new doesn't necessarily mean that I'm stupid, does it? Let me learn and figure things out on my own (within reason)! Ok, off my soap box now :)

Neither of my patients had delivered yet when I left this morning, but I'll bet the early labor gal got some pit this AM and I'll bet twin mom progressed and probably delivered.

Tomorrow's Thanksgiving! And I don't have to work until NEXT Thursday night! What am I going to do?! :)

Tuesday, November 25, 2008


So besides a C/S recovery last night, the only thing worth mentioning is the gal that came about midnight...carrying her baby. These are always a little scary just because you never know what to expect! (The last one of these I took from the ER brought her placenta with her and said she's dropped it carrying it down the steps and it was full of sticks and leaves and grossness...) The lady from last night said this was her 5the baby, and she just wanted to make sure it was OK. She said she had left her other 4 kids asleep at home and she didn't want to stay, but she'd already set up adoption stuff and wanted to bring the baby in.

Baby was ok, just cold from being outside, so he went to the nursery. The laborest checked out Mom and found a bunch of clots to get out. We asked if Mom wanted some pain meds but she said no, she'd just delivered a baby, it couldn't be that bad...so the laborest did a 45min D&C in the room with NO meds. There were three of us standing in there and I think we each at one point in time had to leave the room just to get some fresh air so we didn't hit the floor. She got a full placenta bucket out of membranes and clots, etc. Have you ever LISTENED to the sound of a currette scraping the inside of a uterus?! The laborest decided to use it as a learning experience for all of us and demonstrated the sound of a clean and unclean section of the uterus. Oh. My. Word. We were all standing with crossed legs and feeling really, really, really glad it wasn't us on the table...

After 20units IM Pit and 10cc IM Rocephin (that's a LOT of IM med...) Mom left with some prescriptions and a follow-up visit. She wanted to peak in the nursery just before she left to see baby one more time. On the way out to her car she told me "I wish I hadn't looked. He's so perfect. Now I'm going to cry all the way home." So then I was about crying on my way back upstairs. What do you say to a mom who just gave up her baby?! And not because she didn't want it, but because she knew that the best thing for the baby was to be with someone who could really take care of it. It kinda breaks your heart in two.

Back for #6 out of 8. I'm ready for a few days off!

Monday, November 24, 2008

Another Quiet Night

I'm hoping this week doesn' t take the same pattern as last week with each night becoming more busy and crazy than the last! I started out the shift right by going to the gym and doing a good 5 miles, which made me feel better. I was crossing my fingers that work would be slower, and it was VERY slower! I did a 2130 delivery and then took over on a cervidil after I moved my delivery over about midnight. My delivery was a really fun girl who already had 2 little girls and as soon as I walked in the room right before 1900 the little 3 year old came running over and threw her arms around my legs and started talking up a storm and didn't stop 'till I tucked her into bed in the postpartum room with mom! The delivery was super smooth too. The same doctor did it that came and played with us on Thursday during all the drama. Every time I work with her, my level of respect goes up for her. She is a good doc, and she is a lot of fun too.

Besides the cervidil that I watched contract and cramp all night I did a triage about 0330. Cramping every 10 minutes doesn't usually mean you're in labor, but somehow when a doctor tells you that it could "happen" either this week or next all of a sudden everything means you're in labor. Watched her VERY quiet uterus for an hour and sent her home with some keflex for her UTI and went back to watching my cervidil.

I even got time to cuddle with a baby from the nursery. That's my favorite part of night shift :)

Babies today: 1f
Babies total: 27M/22F = 49
Vag:20M/20F = 40
C/S: 7M2F = 9

Friday, November 21, 2008

4 Stories from Night #3

I haven't done 3-in-a-row in a while, but it really wasn't as bad as I thought it was going to be. I'm exhausted and going to bed at 1900 tonight, but I'm really OK with that! We were busy enough last night to keep us all on our toes...

Story #1: Gotta love those shift-change catastrophes. When I walked in right at 1830 last night, the unit looked slightly deserted but everyone who was there was a little high strung. I guess about 1810 a lady had walked in 33wks and said that she had severe right upper quadrant pain. She said it may be contractions, but they just felt funny. The nurse got her on the monitor, got about a 5 minute reactive tracing and then it was the crash. Baby didn't look HORRIBLE, but dropped from 150s to 90's. When I got there she was being rushed to the OR, general anesthesia and the doc was yelling "get the NNP, we're going to have a 33 weeker!" They thought her uterus was rupturing, but when they did the C/S her abdomen was full of blood and her uterus was intact. After they got the baby out, there's a hospital-wide page "Any general surgeon call L&D STAT" Now how fun is that to hear at shift change? Meanwhile, she's still gushing blood and we're activating the Mass Transfusion Protocol. I was standing there debating in my head what exactly I should do at the moment. My preceptor wasn't there yet, there were already about 4 nurses back in our OR and I knew I didn't know enough to really be a help back there. The secretary was on the phone with blood bank trying to get blood stat, and after our MTP drills last week I DID know what to do about that, so I said "I'll go get blood" and sprinted down to blood bank. I didn't feel like quite the idiot that I did during practice last week 1) I knew I wasn't just "pretending" and 2) I didn't have on OR shoe covers and I wasn't skating down the hall! :)
I got down there right behind another nurse who had come down from the OR that I didn't know about it. She took the 2 units they had ready but said "we're gonna need more than this" so I waited for the next 2 units and had just about caught up with her by the time I got back upstairs. When I got back to the OR there were seriously about 20 people in there between all the OB people and the general surgeon and his crew that came over. Our OR's aren't that big to start with, and that was WAY too many people and WAY too many people trying to talk at once. It turned out that one lobe of her liver was a complete hematoma and the other had a huge laceration in it. They had used 45 laps before the general surgeon got there and completely opened her up. She is now residing in ICU and wasn't doing too well the last I heard. Baby was on a vent in the NICU along with the 5 other kids that NICU admitted between 1900 and 2300 last night... THIS ALL BEFORE 1900!

Story #2: By the time we got report on our actual patient for the night it was almost 1930. This poor gal was a cervidil from the night before and after sitting at 30mu of pit for most of the afternoon was still a TIGHT 2. Section time! That's all fine and good except for the fact that liver chick had just been taken up to ICU and the ENTIRE OR was a mess and covered in blood. One S/T for the night, says it will take 1 1/2 - 2 hrs to clean the OR before we can do the next section. My doc wasn't too happy about that. I have my girl all ready to head back to the OR minus her fluid bolus (I wasn't going to bolus her then find out that we were waiting 2hrs for the section). My preceptor (D) was in the back trying to help clean so I really did the whole prep thing on my own. I've decided there's a BIG difference between "knowing what to do" and actually being the one incharge of doing it and making sure it gets done without someone right behind you. I really felt like I was on my own and if something got screwed up, it was all me because I hadn't even really touched base with D! It was a little nerve wracking, I've never REALLY been let on my own before without SOMEONE claiming me.

Anyway, we finally head back to the section, probably sooner than we should have, but we do. I'm in the back with anes, the doc and the S/T while D is trying to finish up cleaning the other OR. Everything's going decently ok until I realize that we keep cutting though layers and nursery still hasn't showed up. I know I'm spoiled, nursery comes to every delivery and I can focus on mom and I never really have to worry about baby. Anyway, we keep cutting, we get to the uterus, then we're to the sac and still no nursery. I've called the nursery to see where they are, no answer. I stick my head out into the OR hallway and don't see nursery, call D and she calls nursery...baby comes out, it's still just me, the docs, anes, no D...baby's on the warmer, it's still just me, it's 5min APGAR time and it's still just me...I'm shaking really bad and the only thing running through my head is "warm, dry, stimulate, warm, dry, stimulate, warm, dry, stimulate..." baby's crying, not really lustily, so just for kicks I pull out some blow-by and keep hoping that everything's going good with the docs because I'm a little preoccupied at the time. Finally nursery shows up and I'm still shaking but have a crying baby!

About this time we get the call that some 30-something week twins are coming back for a section and so there goes our scrub tech and now it's just me and the two docs, still no D...I'm still shaking. Another doc comes in and scrubs and plays scrub tech. Thank goodness that these were good docs and they weren't too scary and were laughing about the whole thing. We had to count 3 times to get all the counts correct but everything was there and besides me still shaking everything went down without a hitch. I don't think I really started breathing until that patient was on the bed and in the recovery room!

If I learned anything it's that "hey, I just did my first section totally on my own and I survived!" So while it was a little intense at the time, I think I just jumped a big hurdle. My first section on my own and my first delivery without nursery there...and I'm still breathing and mom and baby are happy!!

Story #3: Not as exciting as the first 2...gal walks in about 0130 c/o leaking and UC's. We'd just sent her home about 3 hours before, but this time she'd changed her cervix. Long story short she delivered at 0246 about 10 minutes after her epidural and still couldn't move her legs at 0630 thanks to a nice dosing of fentanly by anes to get her comfy quick. She did great though and in my heart of hearts I think she really could have done it without the epidural, but I wasn't going to be the one to tell her that! Did that delivery pretty much on my own too WITH nursery this time!

Story #4: 0530 ( I really think we should lock the doors about this time until after shift change because this is when nasty stuff happens...) lady comes in thinks her water broke. Multip, says she woke up to "wet sheets" about 0430. Didn't wear a pad in, doesn't appear to be in distress about anything and can't amnisure r/t intercourse in the previous 24hrs. I checked her, she's 4 and unchanged since her Tuesday office visit. Fetal head was very ballottable, and I didn't get fluid when I "bounced it" so I sat her on a pad and kept an eye on it. About 0600 there was maybe a quarter size spot of fluid. Got an order for a sterile spec by the laborist, who of course is in the main OR getting ready to start an hist so says she'll be over in about an hour. Patient was denying contractions even though toco was picking them up about very 5-7 minutes. I told her to let me know if she felt a gush or an increase of leakage. I gave report about 0650 and just about then she called and I went in and if her water hadn't broken earlier it had broken then! She got up and went to the bathroom and I changed the chux and let the new nurse know. As I'm walking out the door I was told decisively "she's grossly ruptured and 7-8cm and no IV access." Sorry, she wasn't that an hour ago and she hasn't felt her uc's! I had no reason to start an IV! J texted me and said she delivered about 1100 so I don't feel TOO horrible anymore. By the time I left I was just ready to go to bed. Off for 2 and then back for 3 more!

Babies today: 1m/1f (I haven't had 2 babies in a while!)
Babies total: 27M/21F = 48
Vag:20M/19F = 39
C/S: 7M2F = 9

Thursday, November 20, 2008

Back For More

So I was all set for nights to be lots of sitting around after Tuesday night. Last night, I think I sat down and took a drink about 0200 or so...Chipotle is still pretty tasty about 0245 when you're starving!

We did a delivery about 2130. Kid was seriously +1 or +2 when we started and she could have delivered a lot sooner of she had given any effort to pushing. There were 3 of us in her face really trying to get her to do anything. There was no pressure against that kid's head with that first 45 minutes or so of pushing. Then her lower uterine segment oozed and oozed, methergine, still oozed. So she got extra pit, and she's gonna have some bruises on her stomach from our "mashing." I think it's the weirdest thing when you check the fundus and the cervix sticks out like a tongue. Ha!!

Our cervidal across the hall came in the same time we started pushing in the other room so another nurse kinda helped us tag team. She came in saying "I've been having UC's since this morning and they've been a "9" " So why didn't you come in earlier today? Anyway, she ended up not getting cervidil, baby started looking not so good and she changed her cervix and got a block, kid still didn't look too hot, so we flipped, we turned, we bolused, we O2'd, we did it all. Still had lates with every contraction. Finally the doc showed up about 0500 and we started some pit about 0600 to see how it went. It seemed that if the contraction pattern was decent the kid looked ok, but when the pattern went dysfunctional it turned nasty. She was doing pretty good, until about 5min after we gave report and then the kid dumped, so she was rolling into the OR when I left. I felt bad for her, what a long night!

Back for night #3...

Babies today: 1f
Babies total: 26M/20F = 46
Vag:20M/18F = 38
C/S: 6M2F = 8

Wednesday, November 19, 2008

Night #1

So I'm nervous after the first night goes decently well...I actually thought about sitting down and blogging about 0200 this morning since I was doing nothing, but thought it wasn't very good "nursing practice" to do my first shift with a bunch of new people. The night group seems really relaxed though, and it was a good group of nurses to start out with.

I wasn't sure what kind of welcome it was when I looked at the schedule sheet when I got there and my name wasn't on the list. I guess the message hadn't gotten relayed that I was beginning orientation last night, and the nurse that I was supposed to orient with was orienting someone else, and it was slightly a mess. But I refused to go home, so after some assignment switching and swapping, I ended up with a different nurse and a different patient, which I was ok with. That nurse ended up leaving about 0100 and so then I got passed around to whoever else was watching over my shoulder. Ha! I felt bad for our cervidil patient, she was scheduled to come in at 1800, but then her doctors office had told her 2000 so we called her about 1915 asking where she was and she had the message when she got back from dinner. She came rushing in and was a little frazzled. What a way to start out a hospital admission!

I'm finding that the cervidil's run a little different than a pit induction. It's kinda the opposite order of importance. With the pit, the docs don't want to be called until you have them on the monitors, an IV started, etc, etc and are usually standing around waiting on the all important IV access before they can AROM and then get pit started whenever you get the chance (so they can get to their office on time). I guess with the cervidil they needed to be called ASAP to get the orders to put the cervidil in, and the IV and all that jazz aren't so important. So once I get the order figured out I think I'll be ok. It's still the continuous monitoring and I just have all the specific do's/don't's to figure out. I feel bad for the cervidil patients though, they hurt and cramp all night and there's nothing really I can do for them. Most doc's don't want an epidural for a cervidal and it's more annoying than really changing the cervix in most cases. The orientee that stole my preceptor, both of her cervidils delivered though! Oh well, maybe that will be me next time!

It wasn't bad for a first night, but I'm going to be sad if I don't get a baby at least once in a while. We had an 8hr computer downtime too, so that was something else I learned...paper charting! All the "old" nurses say it's way easier, but it's not easier when you've learned how to do it on the computer and have never done the paper stuff. It's just as confusing as them trying to do the computer charting.

I took brownies in last night, I'll remember next time that a couple of the nurses are allergic to nuts...oops! There was still about 1/2 a pan left so I left them for day shift so they didn't think that I didn't love them anymore. I'll bet they'll be gone when I go back tonight!

Babies today: 0

Babies total: 26M/19F = 45

Vag:20M/17F = 37

C/S: 6M2F = 8

Tuesday, November 18, 2008

Here Goes Nothing...Well At Least Something New

I haven't put a pair of scrubs on since last WEDNESDAY morning! That's only 12hrs shy of a week! I must say, I'm feeling kinda glad to put them back on, simply because I feel like I haven't really done all that much this last week. I'm not married, I don't have kids, I'm still living at home (rent is WAY cheap and I don't have that bad of a family...), and besides several gym workouts, church over the weekend and some stuff with friends Saturday night the busiest I've been is when I cleaned all day on Friday! Maybe it's just me catching up on all the time I spent in college NOT being lazy, but I'm ready for something to do. So now I'll work 3 in a row and we'll see how I feel on Friday morning when I'm crawling into bed!

I haven't worked a night shift since the night that I found out I passed my boards. I can't believe that night was almost/only 3 1/2 months ago! I'm sure night shift as a real nurse isn't going to be that horrible, and that it even may be fun! More time to get to know the nurses and hopefully see/do some more cool things. I keep telling myself that if I can handle a 12hr shift in a dark room by myself with a sleeping patient doing 1:1's I can handle actually being up and moving and with other people. I'm excited 'cuz all the new nurses that started just before I did are on nights, and so I'll finally get to work with them again. I'm taking in brownies tonight, so hopefully that will help draw me into the hearts of the night shift without too much grief! Haha! Wish me luck!

Sunday, November 16, 2008

Question About Nursery...

So I haven't worked since Wednesday, and don't work 'till Tuesday, and I'm feeling like I'm missing something without blogging! I told myself that this blog wasn't going to be an online "diary" I was going to keep it work-related. So here's my weekend musing re: work.

I've talked to several people and after reading lots of other L&D blogs, here's my question: in a delivery in "your" hospital, who all is there for the delivery? Obviously the doc and the L&D nurse, but is there anybody else typically "required" to be there?

I know at our hospital all of our nursery nurses work really close to us L&D nurses. Our Well-Baby nursery (where all babies are admitted to at birth) is right next to our nurses station and they can see our "board" with patients and docs and progress, etc. All the nurses that work in Well-Baby are NICU nurses and everyday 2 float out and do "admits" and come to all our deliveries. Right before delivery, we hit our "delivery" light and it pages everyone on the floor that we're delivering and a scrub tech come in to assist the doc as well as a nursery nurse to take care of baby. They devote all attention to the baby, do the APGAR's, the footprints, and meds right there in the delivery room. It's also nice in a C/S because then nursery can take baby (and dad too most of the time) to the nursery before the section is over and get baby all cleaned up and assessed in a room warmer than our OR and have that all finished and have baby read for mom when she gets back to the recovery room. It is SO nice because then we as L&D nurses can focus on mom and her recovery, helping the doc, pay attention to uterine tone, etc. I think sometimes we get spoiled though... :)

Anyway, from what I've heard/seen/read our hospital is in the minority when it comes to this. I know that the hospital where I did my clinicals in school the nursery nurses came only when they were specifically called and it was up to the L&D nurse to take care of mom AND baby after delivery. It's taken me long enough to feel comfortable just taking care of mom after delivery, it would take me another couple years to feel comfortable taking care of both!

All of us L&D nurses are NRP certified, etc and I know we do have instances where 3 or 4 of us deliver at the same time and we don't have a nursery nurse for the first few minutes and we've all survived when that happens. We all do know what to do after baby comes out, but it just adds a little extra chaos to the room when we're trying to do it all and we're not used to it.

But I just wondered what the "norm" was at other hospitals and what other nurses thought about it. Or even if you're not a nurse and remember your own birth stories and what impressions you got from who was in the room...

Thursday, November 13, 2008

She Did It!

I was so excited when I got a text message from J this morning. My 35 week VBAC did it this morning about 0900! I was so pumped for her! I guess she was 1, 1, 1, then got to 4 and stayed at 4 the rest of the night. I think the doc was about to call it when she came over this morning and she checked her and she was complete!

I was over at the hospital working-out this afternoon and so I stuck my head in to see how she was doing and both she and baby were doing great. Baby was an automatic NICU admit because he was only 35 weeks, but he was rooming-in with mom and dad and was doing great! He was 6# something so he would have been huge if he had gone full term! I was so proud of her, she was super excited and I think her labor was more like what she wanted then what she had thought it was going to be like. I just really wish I could have been there to help.

See if I ever doubt a laboring mom again! From here on on, I'm going into every labor believing that they can push out their baby if they want to. Everyone's capable until proven otherwise I guess :)

Wednesday, November 12, 2008

Bye Bye Day Shift :(

So the good news about going to night shift is no more alarms going off at 0515 every morning for work :) That makes me happy! It makes me very, very, very sad that I don't get to work with J anymore though. I actually got a little choked up and teary last night when I was writing her a card.

J has been the most amazing preceptor/mentor whatever you want to call it, she's been it and more. She was the one who first every taught me anything on the floor about L&D out of nursing school. I worked with her for 3 months last summer as an student intern, did over 50 deliveries with her last summer and I really think that it was because of her that I got the job offer on L&D after graduation. She was the one who encouraged me through the last year of nursing school and even more this summer after I had to re-take my boards. She's done all of my precepting and has taught me everything that I know about L&D nursing. Everything I can do I have her to thank for it, and even when I didn't believe in myself she believed in me. She let me watch and learn and then even when I didn't want to she would make me do things myself until I felt comfortable. From fixing a decel to actually knowing the difference between a cervix and the other "mushy stuff" in there, she's really taught me everything. I don't know what it's gonna be like to go to work and not see "J and B" on the board next to a patient. It makes me sad :(

I didn't really have time today to think about it though, I think I sat down for a total of about 10 or 15 minutes to eat lunch. I had one girl (not the induction that I signed up for yesterday...) that came in SROM'd about 0100 this morning, she delivered @ 1135. At 1140 a 35weeker showed up SROM'd, so I very graciously and painstakenly (NOT!) let someone finish up my recovery, cuz' this 35weeker was kinda a mess. Not a mess, mess, but just the whole "being 35 weeks and SROM'd 48hrs ago" thing can get intense.

She was going to "attempt" a VBAC, but somehow, I think she may be a C/S before midnight tonight. She wanted to go au natural, didn't want to start pit, and was about 1/50/-3 all afternoon, even after she consented to pit and an IUPC about 1600. Poor girl. I really think she could have done it if she was 39 weeks/SROM'd/4cm/100/-2. When I called to check on her she was still unchanged but they hadn't called the section yet. I hope most that her kid comes out healthy. There's something that can be scary it seems about 35 week babies. They're past the time for steroids for lungs, but yet they're still too early to come out! Hopefully the kid will come out screaming and go home in 2 or 3 days with mom and dad.

So I go to night shift next Tuesday/Wednesday/Thursday nights. Every time I've worked nights before it's been doing 1:1's on the psych unit or something. I figure if I can stay awake sitting in a dark room for 12hrs all night, I can stay awake while actually doing something. My greatest fear is that since I'm the new kid on the block (speaking of, they were in concert here last night!) I'm going to end up with all the antes and recovery patients for awhile. Boo. Guess I do have to work myself up and pay my dues. And antes and recoveries are patients and people too, and I can make a difference to them too. Gotta look at the positive!

I should have known better to read At Your Cervix's blog last night before I went to bed. I had horrible, vivid dreams last night about my 27 week twins on mag going into labor and us rushing her back to the OR and her pushing and pushing and finally one baby flew out across the room still in it's sack. But then the other one got stuck and didn't come out, so the doctors decided to leave baby B inside to keep growing. It was weird, and I woke up kinda afraid to go see what happened to her once they turned her mag off last night. But it was all good and she's going home tomorrow :) Still, freaky dream!

Babies today: 1f
Babies total: 26M/19F = 45
Vag:20M/17F = 37
C/S: 6M2F = 8

Tuesday, November 11, 2008

More MgSO4...One More Day!

So after my experience on Friday, I walked into work this morning really excited to have at least 2 more inductions to round out my days orientation (I go to nights next week!). Boy should I have never have pre-planned what my day was gonna be like. Walk in, what color is my patent's name? Green. Next to purple names (DIU's), green names (ante's) are my least favorite! And this wasn't just an ante, it was stable 27+5 twins who had been on mag since yesterday afternoon. 2 mag patients in a row, give me a break!!!! That means no new patients for 12 hours. Just me and the twin mom. So after that put me in a very sad mood, my day wasn't too bad.

I know I should just be happy with what I get and be ready for anything, but two days of sitting on my behind watching mag babies (or answering 24 un-needed call lights) I really am ready for a delivery! This twin mom was really nice though, these are her 3rd and 4th babies, and we became friends after I let her eat food and actually walk to the bathroom vs a bedpan. Shoot, I'd be friends with the nurse who let me do that too!

Hung around after work for the staff meeting and then worked out my schedule through the end of the year with the staffing lady. It makes it a little more complicated when I can't just follow someone else's schedule! Tomorrow's my last "day." I'm about to go write some thank you cards to all the nurses who have been my "friends" during orientation, and I think I might start to cry a little. I'm not so sure about going to this night shift thing. I know exactly who I can trust on the day shift and who will look after me and answer my questions. I feel like once I go to nights I'm gonna be out there on my own and I feel like I'm taking a big step backwards and gonna have to re-learn it all again. Talk to me after next week and my first 3-in-a-row in a long time!

Oh ya, I did sign up for an induction with one of my favorite docs tomorrow. G4P3 history of rapid labors :) It's about time!

Babies today: 0
Babies total: 26M/18F = 44
Vag:20M/16F = 36
C/S: 6M2F = 8

Sunday, November 9, 2008

Do Some People Deserve A Baby?

So this is the blog that relates to Friday at work, and since it's Sunday morning, that should say something! J wanted me to do at least one more day of antes before I'm done with orientation, so we figured there should be some on a Friday after they've had all week to pile up on the board. Sure enough, we got a Mag patient on for PTL (pre-term labor) and then another one...

The mag patient was too fun, she'd come in the end of our shift on Wednesday, so had been there for a while, she was 1cm/100%/-1 and 30-something weeks. She was so sweet, and so scared, and ready for the mag to come off! Poor girl! She was so tiny that the toco was picking up anything little thing so she looked like she was really crampy and irritable, but I think she may had one or two decent contractions every hour or so. Personally I think the vistaril that we gave every 6hrs was doing her more good than the mag was...She hadn't really changed her cervix so I think the plan was to turn off the mag late Friday night and then send her home.

Then the "other patient." I don't even know where to start, but is there really any need to use your call light 24 times in a 12-hour shift, and especially when you're off the floor for 2 hours? I. Think. Not. 24 times!!! An internal med doc that works at a different hospital in the area, just moved from east coast with her dr. husband and toddler. She was like 28 weeks or so and had started her pre-natal care before they moved here so she'd only had one or two visits with her doc here. This was her 3rd admission this week to the unit, first time with a slight fever (sent her home), the second time with abdominal pain (sent her home) now she's back with another fever. But this "fever" I'm not so sure about. As an internal med doc you should know that when you're wearing your long pants, socks, a hospital gown and 5 warm blankets your temp is going to be a little higher than normal. This woman was having the 3-million dollar work-up done, and was pretty much writing her own orders. She'd had two sets of blood cultures drawn, every other blood tube filled, she was scheduled for an MRI, she had 2 different antibiotics done, she was asking for a CT scan. She was on speaker phone with some physician friends while they were in the middle of surgery, she was being seen by internal med docs, general surgeons, OB's and was making calls to the radiology department scheduling her own stuff. She personally was calling the lab every hour to check on the growth in her blood cultures (there wasn't any in over 24-hrs). It was way past the point of annoying, it was way past the point of funny, it was just plain DUMB and a total waste of the hospital resources. She NEVER ran a temp for me (orally or axillary) all day. I like to think that I have a good bedside manner and will go above and beyond for my patients, will really do my best to accommodate for them, but the thing I hate the most is when I'm taken advantage of. And that's exactly what happened. J and I were both near tears a couple times because she was so manipulative. Ack!!! We decided what she really needed was a psych consult and to head up to 6th floor! What really made me sad was when her mom (who had just flown in because her daughter was 'deathly sick') and her husband wanted to bring her little boy up to see her. She hadn't seen him in 2 days. She came up with about a dozen reasons why they shouldn't bring him up to see her. "It's too cold." "It's too far to drive." "He would be too loud." Come on, you don't want to see your little boy, but you're gonna have another baby? That makes me sad...

Babies today: 0
Babies total: 26M/18F = 44
Vag:20M/16F = 36
C/S: 6M2F = 8

Wednesday, November 5, 2008

3 Left And Counting...

So after today, I only have 3 shifts left on days! That just kinda hit me today, and it makes me sad! I'm still a little (ok, a lot) nervous about going to nights, I think just because that means that I'm almost on my own and nobody's watching my back, and I've never worked nights on L&D before. I've worked nights a lot as a CNA, but not on L&D. I love the day nurses, and now I have to learn a whole new group of people, how they tick (or maybe what ticks them off), a different routine to the unit, it's like taking a big step back! And I'm going to miss working with J, she's been my nursing "friend" for a long time, and she's the one that's taught me everything I know about L&D nursing. Shoot, now I'm getting all emotional and depressed about it!

Anyway, today was another good delivery on my own. Another multip induction, really nice, young couple. I wasn't sure how it was all going to go at first, I think it took them a little time to warm up to me, but I think they were ok with it all after a few minutes. I know that not every patient is going to like me, and that my "style" of nursing or my personality isn't going to mesh perfectly with everyone, but I hope that I try to be at least friendly and pleasant to everyone. It sure makes it easier for both the family and me if we get along!

I really wondered what they were thinking when I started getting the "how long have you been a nurse" "how long have you worked here" questions. I HATE it when people ask me that, because I know what the first thing would be that flashed through my head if I found out that my nurse had only been out of school for a few months. I'd be asking for another nurse! I always try to avoid the topic if I can and pretend that I've been doing this for years and that I know exactly what I'm doing. After the issue couldn't be dodged anymore and I told them I graduated in May, been working on L&D for about 3 months, I said "I hope it's not that obvious that I'm new..." she laughed and said "I noticed, but it's ok. It's nice to have a nurse that still excited about it." So I THINK that was supposed to be a compliment. I try really hard to not act "new," but I'm not really sure how to do that. As far as the excitement thing, I hope that I still act excited about it all when I've been practicing for 15 years. How can birth not be an exciting thing? Even the docs say that they get goosebumps after delivering thousands of babies. That's what it's all about!

Delivery was really nice, typical "come in pretty dilated, stay that dilated for hours on pit then all of a sudden be 'doink' ". I caught it this time though, didn't wait for the doc to figure it out! Actually, when the doc came over at lunch she called her the same thing I had, and it always makes me feel better when the docs agree with me.

Nuchal cord, so saw variables pretty early. I'm a freak about decels, no matter if they're earlys, lates, variables, they just freak me out. I'm always afraid that one time it's gonna go down and not come back up. It's the worst thing too, to be standing at the bedside, hear that constant "thumpthumpthumpthump" and then you can just hear it drop "thump...thump......thump........thump..........thumpt......thumpt....thump..thumpthmup" I hate that sound. I'm sure that someday I won't be so terrified of them, but any drop in the heartbeat for anyreason, makes me grouchy!

It got really clinic-y this afternoon, must be the storms coming in. I had one gal who had "one big cramp since about 1400." Toco picked up nothing...for an hour. One straight line, baby looked great (for upper-20ish weeks), by the time I had all her bazillion papers filled out I had discharge instructions. We had ED patients coming up right and left, PIH work-ups, anything with tons of paperwork, we had. Spend 4 hours, and feel like all you did all afternoon was computer chart and paperwork. Lovely...

Now I have a day off, back on Friday. It's pouring down rain outside, it's my favorite to sleep when it's raining. AND I don't have to get up at 0500 in the morning! That makes for happy dreams tonight! :)

Babies today: 1f
Babies total: 26M/18F = 44
Vag:20M/16F = 36
C/S: 6M2F = 8

Tuesday, November 4, 2008

I Did It Mine Self

It seems like forever since I've actually gotten to do a delivery! I guess I should kinda get used to that, 'cuz I know I'm not gonna get to deliver every shift when I work nights. Speaking of, it looks like it's gonna be in about 2 weeks, but more on the mixed feelings on that in another blog (not tonight!)

I knew when I went to bed at 0000 this morning that I was gonna be in for a long day. I went up and visited all my buddies who are still in school in Lincoln this weekend, and so had a great 5 days off, but then of course got back late last night and was all geared up from my long weekend and didn't get to bed when I should have. I don't think I really woke up 'till about 1000 this morning.

I had a prime induction, the kardex (our cheat sheet that gets filled out when patients pre-register. It has basic health history on it, G/P, special requests for delivery, etc, etc) said that there was limited English, so that made me a little nervous. It's hard enough to calm the fears and trepidations of a prime, let alone when you're not sure if they're understanding the words you're saying. I have this really bad habit of talking loud"er" when I get nervous or excited or really into what I'm saying, add that to the natural tendency to talk louder when you're not sure if someone's understanding you and I figured I'd be yelling all day and I'd get more pages from J saying "you're talking loud again... :) " (yes, I HAVE gotten those from her before when I forget to shut the room door all the way...). Anyway, it turned out that the dad spoke pretty near perfect English, and the patient herself spoke very good English. Grandma in the corner not so much, but she was cute and sweet anyway.

This gal went much better than any of us thought she was going to from coming in 1cm this morning. She was post dates by almost a week (she'd been scheduled last week for an induction but gotten postponed because we didn't have enough rooms). She went pretty steady, 1cm/hr until about 1430, then just took off and was complete by 1515. J had her own induction the next room down, we were pushing at the same time, and she actually delivered first. One of the other nurses kinda stuck her head into my room twice to just make sure I was ok, but I really, truly did this one on my own. I pushed with her for about 50 minutes, saw the progress and the "pop" around the corner/under the bone, and made the doctor call at the "perfect" time all on my own. That made me so excited! Not calling the doc in time is always my underlying fear, and I know that I'll do it at some point, but until I've actually caught the baby without a doc for the first time, the thought scares/excites me to death. Honestly, I want to "catch" the baby on my own more than anything, but I kinda want to do it with a doc standing there behind me, at least the first time :) Now that we have our own OB hospitalists that are there "24/7" (except for the days we don't have one scheduled), we get in BIG trouble if a nurse delivers a baby. But still, I really want to do it!

Anyway, really nice delivery, kid came out with a ton of hair! Got to do a little pubic pressure for something that wasn't even shoulder's, but I pushed anyway. I was way excited and proud of myself for doing really, the whole thing, by myself. I know it's not THAT big of a deal, and I've been doing them "on my own" for a little while I guess, but it was a total self-confidence booster actually doing it on my own, without anyone in the room, blah, blah, blah.

Still didn't put me in the mood to go the gym after work, but I did anyway. Not convinced that it does any good, but I usually am glad I went when I get home. I'm getting to bed a LITTLE earlier than midnight, but still, 0515 comes way too early in the morning...

Babies today: 1m

Babies total: 26M/17F = 43

Vag:20M/15F = 35

C/S: 6M2F = 8

Thursday, October 30, 2008

Question For All the Blog Experts...

I've seen several blogs where people say "people found my blog by searching for...X" how do you see how people find your blog? I have something that tells me who's visited my blog, but I can't tell how people find it, like what they search for and then my blog pops up? Is it something I need to add to my blog or am I just not looking in the right place?

Nursing Talk

I got a really good comment a couple days ago about nursing jargon and abbreviations, and it made me really think and smile and remember back to just a few months ago when I was learning how to "talk like a nurse" and to save my fingers when typing or writing, and since I'm a bad speller, how to save some face and just abbreviate! So I'll make a little list to maybe make reading my ramblings easier. I'm sure I'll forget something, but hopefully it will help a little!

Primip/prime - woman who this is her delivery, it is frequently her first pregnancy too. These labors usually take a little bit longer because the woman's body has never done this before. These women usually come in and have lots of questions and are really nervous, as I would be too! I like prime's because I get to really ease their worries and concerns and help them through the labor.

Multip - women who have had a baby before. Their labors are "usually" faster because their bodies have done this before. Their cervix has already stretched out once, and it just has to "remember" how to do it. They may dilate early in pregnancy and come into the hospital for delivery after walking around 2-4cm for weeks on end. They sometimes seem to get "stuck" about 4-6cm and then all of a sudden go to 10cm in about 30 minutes. As a nurse we watch them for clues that they have "made their move" and are ready to deliver. These women usually come in with fewer initial questions and depending on how their previous labors/deliveries went may be more or less nervous. Women who have only had a c-section are also considered multip's but if they had a scheduled c-section on their first baby (for breech or some other reason) and this is their first vaginal delivery, they may labor like a primip because their cervix has never dilated.

C/S - c-section. Surgical procedure to remove baby from uterus instead of pushing it out through the cervix and vagina. Women have c/s for many reasons. All the doctors I know of will do a c/s if the baby is breech. Many doctors will suggest a c/s if they think the baby may be too big to fit through the mom's pelvis. If a women attempts to deliver vaginally and she "stalls out" she will probably get a c/s, if baby goes into distress then it can be a "throw stuff around the room and get the baby out as soon as possible" c/s. Some women may choose to have a c/s simply because it takes less time and they get to pick their baby's birthday! As far as recovery, it's just like recovering from abdominal surgery ('cuz that's what it is). They haven't figured out how to get a full term baby out lapriscopically, so it's a nice straight line incision right along the bikini line. Most doctors sew up the uterus and muscle tissue, and then use staples on the skin. No sit-ups for 6-8 weeks afterwards!

AROM - artificial rupture of membranes. This is when a doctor/midwife, someone other than the baby in natural labor, breaks the bag of water surrounding the baby. This is usually one of the first steps of an induction (along with the pitocin). After the doctor breaks the water, at least at our hospital, the mom is an inpatient and not going home pregnant. Lots of women worry that breaking the water will hurt. It doesn't "hurt" any more than a regular exam. There are no nerve endings in the bag of water, so it's simply a cervical exam, with maybe a little more pressure and it may take a couple extra seconds. The cervix must be dilated enough for the doctor to at least get a finger inside of it and reach the bag of water. Usually doctors will use an "amnihook" which looks like a plastic crochet hook to simply poke a whole in the membranes. If the woman is barely dilated, they may use an "amnicot" which is like a condom that fits over one finger and has a small little point on the end to break the bag. After AROM (or after the water's broken period) women usually notice that the contractions feel "different." All the fluid that was in front of the baby's head is gone and there's not cushion between the baby's head and the cervix. Without the bag of water in the way, the baby's head is sitting right on top of the cervix and can't float back up with each contraction, and really pushes against the cervix and helps it dilate. Most women really notice that after your water breaks, with every contraction you leak a little (or a lot) of warm amniotic fluid. Some women think this feels gross, others just think it feels weird. Usually the fluid leaks for a while, then baby's head tends to act like a cork and hold it in, then as baby is delivered, all the amniotic fluid that was behind baby comes out and either makes a mess on the floor or sprays on the doctors/nurses/scrubtechs/dads who don't duck just right :)

SROM - spontaneous rupture of membranes. Same as AROM except it happens on it's own. It can happen anywhere (in bed in the middle of the night, when mom goes to the bathroom, in the WalMart parking lot...). Sometimes it's a big gush, sometimes it's just a little trickle. When you think that your water's broken on it's own, look at the clock and see what time it is, check to see what color the fluid is (usually it's clear, sometimes it can be kinda brownish), and note if it smells funny (fishy, really bad, etc). There will be a test, 'cuz those are all answers to questions we're gonna ask you when come to the hospital...

R/O SROM - rule out spontaneous rupture of membranes. This is just a way of labeling the patients who call and say they're coming to the hospital. These patients usually say "I'm leaking" or "I felt a gush." There are different tests we can do to tell if your bag of water is broken or if it's something else. The best test is to let you sit on an absorbent pad while we ask you a bunch of questions and then check to see if there's a puddle under you in 10 or 15 minutes, but if that doesn't work, we usually do an amnisure test. This is simply a vaginal swab that we put in a solution and then stick in a test strip and if there's amniotic fluid then a mark will appear on the test strip. If there's still question afte this test, we can have a doctor do what's called a "ferning" test. This is another sterile vaginal swab that is done with a speculum and is put on a microscope slide. Amniotic fluid will make a 'ferning' pattern under the microscope. The other secret is that if it "swims" under the microscope, it's not amniotic fluid, it's something else...

ROL - rule out labor. Another label patients get before they come in. Usually they come in and say "I've been having contractions X minutes apart." We'll have you change into a gown, put you on the monitor and ask you a bazillion questions about when you started having contractions, how long they last, how often they happen, when you're due date is, who your doctor is, when you ate/drank last, what meds you take, what you're allergic to, if this is your first baby, etc. If you're termish (after 37 weeks) we'll usually check your cervix, let you walk, lay in bed, watch TV, etc, for an hour and then re-check your cervix. If you've changed, there's a good chance you're in labor. If you haven't really changed, well, then it's up to your doctor if you get to stay or not :)

PIH - pregnancy induced hypertension. I could do a blog just on this, 'cuz it can be a major complication of pregnancy, but just the quick and dirty version is: for some unknown reason some mom's can develop high blood pressure during pregnancy, and this can be dangerous because it restricts blood supply to the uterus and placenta and baby. If you go to the doctor and they take your blood pressure (usually sitting straight up and after walking into the office) and it's "higher than they would like" then they send you over to the hospital. We'll take you into the room, have you pee in a cup and calmly get into bed and roll to your left side. They we'll track down baby with the fetal monitor and then take your blood pressure after a few minutes. There's something magic about the left side (or any side really), but it rolls baby to the side and off the main blood vessels in your chest and abdomen, miraculously, most women's blood pressures are fine when they get to us :) Yea! We will also dip your urine to check for protein and depending on what your urine dips and what your blood pressure is we might draw labs and check different levels. PIH is just the beginning of more serious complications that can occur if it's not caught in the beginning. It's better to be safe than sorry...always!

Mec - meconium. This is the first bowel movement that your baby has. It's usually thick and black and tarry. Every baby has this at some point (hopefully soon after it's born!) When meconium can become a slight issue is when your cute little baby decides they just can't hold it anymore and poops before he or she comes out. This turns your normally clear amniotic fluid a brownish color. Whenever a doctor AROM's a patient we note the color of fluid that we see with the initial gush, and if your water breaks on it's own, we'll ask you what color fluid you saw. If we do see meconium in the fluid, there will probably be an extra baby person in the room at delivery. The thing we don't want to happen is for the baby to take a big deep breath when their head comes out and suck in a lung full of meconium fluid into their lungs. The doctor will usually take a second and suction out the baby's mouth and nose right after the head comes out before they delivery the shoulders and the rest of the baby. They might also stick a small suction catheter down the nose or mouth down into the lungs to suck out any meconium fluid that may have gotten down there. If meconium gets into the lungs it can cause an infection just like if anything gets into the lungs that isn't supposed to be there. The extra baby person really keeps a close eye on baby and the nursery nurses will also watch extra close just to make sure baby doesn't develop any breathing problems from the meconium in the first few hours. Most babies do just fine.

LEEP - Loop Electrosurgical Excision Procedure.I had to look up all the technicalities on this one myself to make sure that I explained it right. I just learned about it myself a couple weeks ago from my favorite nurse J :) A LEEP is (from the info I got and what I was told) is a type of cervical biopsy. A small wire loop is attached to an instrument (electrosurgical generator) and when scraped against your cervix during a pap smear slices off a small amount of cells that the doctor can send to the lab to have examined. Before the procedure your doctor should use some type of anesthetic to numb your cervix before he takes the cells off (but it STILL doesn't sound too comfortable to me...) and then he will probably use some anti-bleeding devices after the procedure and you should be able to go home within a few minutes after the procedure. Where a L&D nurse has any concern with a LEEP procedure is the fact that it causes scar tissue to form on the cervix from where the cells were removed. This may cause the cervix to have some problems with the cervix dilating during labor. Sometimes the cervix will dilate just a little bit and then seem to really get stuck and it may even take some manual dilatation to break the scar tissue (some people may prefer to have an epidural or some type of pain relief before this happens). After the scar tissue is broken, the cervix usually dilates normally. I believe that there is a similar procedure, LEAP, but I'm not sure what the exact difference is (something about how it's performed, maybe one uses a laser instead of a wire, I'm not 100% sure), but I do know that it gives the same results (scar tissue on the cervix).

So there's 10 new words/phrases to add to your daily vocabulary :) I'm sure I missed one or two, so ask if I spit something out you've never heard of. All you really good L&D nurses who have been doing this way longer than I have, if I explained something wrong or you have something to add that I forgot, tell me and I'll stick it in!