Wednesday, November 26, 2008
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
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
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
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
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
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
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
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
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
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
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
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
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
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