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?! :)

1 comment:

  1. I'd definitely say that the preterm twin mom was definitely in labor. She was making cervical change, despite fluids and terb x2 - the doc really should have just sucked it up, admitted her, got her an epidural if she wanted it, and let her go. Obviously, she wasn't going to stop laboring. Regarding pain medication for her - she may have been sedated between contractions, thus the sleeping, then awake and in pain when she had the contractions. Just be careful not to over do it on the narcotic/sedating pain medication. If she's sleeping in between, she really shouldn't be getting any more sedating medication. Vistaril/promethazine/phenergan should should not be repeated more than every 4-6 hrs, due to how long it lasts. Nubain/stadol wears off within 1-2 hrs, so that's ok to repeat. Just watch her respirations too. Remember also - sedation will go to the babies - and will last longer in them, so if they deliver within 4 hrs of any sedating medication, be prepared, and have narcan available.

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