Thursday, July 16, 2009

Wednesday

Sunday night kept a 30wkr with no pre-natal care pregnant one more night on Mag prior to her C/S in the morning, plus a few triages. Since when are Mag's 1-to-1?!

Went in extra for a few hours on Monday night from 2300-0200, did a C/S recovery. Then wasn't expecting to get off @ 0200 after the desperate phone call I'd gotten, but since I was there I decided to just go to the gym anyway. That was a little weird working out by myself @ 0300 and 0400...but it felt good when I was done!

Last night...got my butt kicked. I took a girl who was 6-7, blocked, on pit. Figured she'd deliver soon. Then another SROM who was 1/80 who had been 1/80 all day. She'd had a leep, so I figured after that band broke she'd start making some change. Planned on MAYBE getting her delivered. Well...things just snowballed from the get go. Assessed both patients, then my 1st girl had heart burn, then my 2nd girl needed checked and an IUPC, she was 2-3 at that point. Then I couldn't trace her baby so I put a scalp lead on (2nd one ever...yay for me!!!), then walk into my 1st patient's room and the doc's in there and she's complete, so we rushed to get the room set up, then I pushed with her for an hour.

While I'm standing at the perineum pushing I notice my strip in my 2nd room looks horrible. So I called out the desk because I obviously can't do anything about it while I'm pushing. "We'll send someone in." 5" later it's still having deep variables after each contraction...call back out to the desk. "oh ya, we'll send someone in." Finally it starts to get better and someone comes and and tells me that she's 7. Ok...

Then right after my 1st delivery (with a nasty 3rd degree repair) someone tells me, your other patient's complete and the doc wants you to start pushing. Ok, well then someone's gonna have to take my recovery...

So from one delivery to another, and since we had turned the pit off with her bad strip we started pushing and were only pushing every 5-7minutes. Finally the doc let me re-start the pit and we delivered in about 2 hrs. By the time I sat down to chart I had been pushing/delivering for about 4hrs straight! And had I charted ANYTHING in the computer? Of course NOT!!! I loved both of my patients and husbands, so that made it a fun 4hrs at least :)

I finally finished moving, charting, taking care of the couplet that I was keeping about 0330 or 0400 . Just in time to get a preterm twin rule out. I ruled her out pretty quick but then had to wait for a fetal fibrinectin to come back and finally sent her home about 0630 just as day shift was pullin up.

Another crazy night at work...I think we had 6 or 7 deliveries between 1900 and 0700. Sheesh...this is AMAZING job security!!

Babies today: 2f
Babies total: 56M/64F = 120
Vag:42M/49F = 91
C/S: 14M15F = 29
Babies 'caught' = 2f0.5m

Thursday

So after my stint on Mom/Baby on Tuesday...I picked up the back half of someone's shift and went in 2300-0700. 2 great couples (one of them I saw 3 times since she was a cervidil and already tucked in when I got there) and what I thought was a great delivery right before shift change.

Then I found out on Sunday that they had just shipped the baby off to the high-end children's hospital in town because she had pulmonary hypertension and was not doing good AT ALL!!
She was pretty unstable and they were thinking about maybe a heart/lung bypass machine. Poor girl! Poor parents! I loved them!!! I haven't heard anything else about the baby...but I'm worried. I hate it when anything goes wrong with one of my babies. And I hate it even more when it's a term baby where everything's expected to go perfect! Sigh...I know it was nothing to do with the delivery or anything I did, but it's still tough to swallow.

Babies today: 1f
Babies total: 56M/62F = 118
Vag:42M/47F = 89
C/S: 14M15F = 29
Babies 'caught' = 2f0.5m

Tuesday

Well, I guess this is technically talking about LAST Tuesday...shows what my life has been like! I went in at 1730 for J so she could go to a party, and so I took her c/s recovery. I had admitted the girl the night before...just a little on the high-drama side of the scale. I finished her recovery and the anesthesiologist wanted to keep her on L&D overnight with hourly vital signs re: some panic attack issues on the OR table (we don't ask questions...we just follow orders...). So I was set to take her for the night, then they tell me that actually, I'm going to give report on my post-op and go take a full team on Mom/Baby for the night. Come again?

So...wait 'till 1900, give report to ANOTHER labor nurse to take my recovery back out to the floor, then hightail it over to Mom/Baby to get report on my team of postpartums and babies. I'm already flustered b/c I'm running behind schedule and that threw my whole night off.

Here's the kicker that made me mad...I asked if there was any chance that they would call me back over to L&D during the night and they said no. They would call in L&D nurses for X1 1/2 and leave me on postpartum. This is turning into an issue for me. I don't mind floating if I need to, and I did it and whatever. But I still don't understand how it is our problem if mom/baby nurses don't want to come to work. I don't see how the river only flows one way. L&D nurses can cover for mom/baby and SOME mom/baby nurses can do feeder grower in the the NICU. But NICU can only do NICU, and nobody from anywhere else would dare touch a still pregnant mom except for us. So who gets shorted in the end? And yet who's problem is it to fill in for all the other unit's being short? Whatever...

But I survived, did a little breastfeeding 1-on-1 and grew more thankful that my REAL job is one that I LOVE and that I don't have to settle for something I can just tolerate. And I proved to myself that I CAN handle a postpartum team and leave with everyone breathing at the end of the shift...I do feel lonely over there without my group of nurses. It's even weird if I have to go back over for something...I feel very alienated, and it's obvious I'm not "a part of them" that night. Hmmm...something to think about!

So kudos to all you postpartum nurses out there! THANK YOU for all you do and for doing it so I don't have to!!! :D

Monday, July 6, 2009

Here We Go Again...

And the craziness at work hasn't slowed down over the holiday weekend at all!! Took my labor patient back for a section @ 2000...what a painful section it was. I had all kinds of pain orders from the doc after the section was over. It was going to be that kind of recovery. Then when the patient slept through most of recovery, I didn't want to keep pushing meds on her. Then got a nice chewing out from the postpartum nurse because the patient (who had no pain tolerance) rated her pain 7/10 when she got over to the other side. "Why didn't you start XYZ pain meds in recovery if she hurt so bad?" Well...because she was sleeping through recovery and couldn't keep her eyes open even when I was checking her fundus. Didn't sound like she needed pain meds to me!

Moved that section recovery and took a ROL who walked in 3cm and ruptured. 20 minutes later she was 6cm so I called the doc and said "you better head this way..." and she did. Then as I'm hanging up the phone "the scream" happened. I ran in, patient was easily complete, thank goodness the laborist followed me in. We got her in stirrups. Someone called the doc who was on her way and she said "don't let her deliver, I'm on my way!" Far be it from me to tell a multip who's complete, unblocked and +3 not to push. Doc walked in as the laborist was delivering the placenta. Thank goodness the laborist backed me up 100%.

I'm half way through my vag recovery when one of the breech PPROM (preterm premature rupture of membranes) started having very ugly decels. The laborist who had just walked out of my delivery went down to check her and there was a foot in her entrotis (vaginal canal). Time to head back to a C/S! I was really the only one who could take her, so I (kind of) handed off my recovery and ran down the hall with the new C/S. She was still contracting away so they slept her ( I went from never doing a general anes C/S to 2 in a week!). I went to go put in a foley and when I spread her labia, the ENTIRE foot was sticking out. There is just something all wrong about that. I didn't think I could get the foley in, and the laborist said " just push the foot out of the way..." so I did and somehow got the foley in. Not really sure how that happened, but if I NEVER see a foot hanging out of a vagina again that will be OK with me...

So finished section #2 for the night. There was another ROL that I should probably have taken but another nurse already had her started, so I took the next one. The first patient delivered, mine didn't. I gave the nurse a hard time and said that I should have taken that first ROL because then I could have beat a personal record and had 4 babies in a shift. But looking back, 3 babies is MORE than enough, considering that I didn't admit my vag delivery 'till after she was already over on postpartum. I'm sure I missed something on charting, but everyone was breathing when I left, so I'll fix charting tonight if I need to. I'm getting on a role here, I'm not gonna know what to do if I go a night with less than 2 or 3 deliveries!

Babies today: 1f/2m

Babies total: 56M/61F = 117

Vag:42M/46F = 88

C/S: 14M15F = 29

Babies 'caught' = 2f0.5m

Sunday, July 5, 2009

7 Wasn't Enough...

I was so thankful to have a day off yesterday! I knew how crazy it had been, so I took brownies up to work last night about 2100. The board looked beautiful!! Couple green names and 2 ROL's. Why can't I work on nights like that!?!

So I dropped the brownies off and on my way out the door I made a funny comment about "now I don't want my phone to ring tonight because I've already driven over here once tonight!" I should have kept my mouth shut...!

Sure enough, about 0245 my phone rings. When I'm in a dead sleep I don't really think about what I'm doing and I just grab the phone and answer it. Sure enough "we need help! People just keep walking in!" Ok...I'm on my way. I couldn't say no after what I'd said earlier, and after the week we'd had, I know what it's like when nobody will come in to help. Only as I was getting ready to walk out the door did I realize that it was torrentially pouring buckets outside...no wonder the flood gates had opened at work (pun fully intended...).

When I got there I took one of the nurses SROM girls. After looking closely at the board I don't think it was quite as desperate as it had sounded on the phone, but I'm guessing it had all hit at once and when people keep walking in, there's no telling when they're going to stop walking in! So I checked on my girl, I actually used to work with her at the hospital day care before I went to nursing school. That was cool. She was ruptured and contracting, but hadn't really changed much from the office per the nurse who had admitted her. She didn't want any pain meds quite yet, so I let her rest for awhile. The doctor had given pit orders but I decided that since she WAS contracting, I would give her an hour or two to see if she did it on her own.

Baby looked great, and finally about 0530 the patient said she was getting more uncomfortable and wondered what she was dilated. So I checked her and something just wasn't quite right. I couldn't really find a cervix, and couldn't feel any suture lines, it was just all kinds of funk. So I had the original nurse check her and she didn't know what it was either...but she was definitely more than the 2cm she was when she came in. So we grabbed the ultrasound and then had the laborist come verify presentation, sure enough, it was a butt. You would have never know from where we were picking up heart tones, but then mom mentioned that "I have been feeling the baby kick me down low." Hmmm...well, no vag delivery for you! So we called the doc, Mom was about 5-6cm, and we took her back for a C/S. Baby was born just before 0700, little girl, perfect, adorable and sure enough...butt first!

So...8 deliveries in 1 week, I caught a baby, I checked (and almost pitted) a breech baby, I did a crazy, messed up C/S with a bakri balloon, rectal cytotec on the table and general anesthesia, I got along good with the docs, and I got 1 day off before I do another 3 in a row! Ah..the life of a labor nurse :)

Babies today: 1f
Babies total: 54M/60F = 114
Vag:42M/45F = 87
C/S: 12M15F = 27
Babies 'caught' = 2f0.5m

Saturday, July 4, 2009

Thursday

By Thursday night I was seriously dragging. We had all gotten our butts kicked all week long, and you could tell all us nurses were getting near the end of our strings...

I took my patient back for a C/S about 1910 after her being a cervidil the night before and then on pit all day and having made NO change. That and the fact that every time she rolled or changed position baby would have a nice 5-6min decel. A C/S was definitely the best decision for her and her baby. She was a young mom, first baby, and she was giving the baby up for adoption after 24hrs.

Got her all ready and back to the section we go. That's where things started spiraling out of control. We had a great anes team on that night, and usually it takes all of about 10 mins to get the spinal in and the patient comfy. So we started working in the back, since we didn't really want to move mom and cause another decel anes tried to put the block in while Mom was laying on her side. This is nothing new for them, and it's usually no problem. Well the CRNA tried...and tried...and tried...and tried...about 30 minutes of trying. The patient started getting a little uncooperative and stressed out about the block as time went by. We finally called the anes doc to come and he tried a couple times on her side, and then said we had to sit her up. So we sat her up and he got it in, then the patient started freaking out that she couldn't breathe. She said it was only on one side and even though she was satting 100% on room air she started getting out of control. They waited long enough for me to get the foley in and prep her and then they slept her. At that point, I knew I was getting in over my head in things I'd never done before. So...let's just keep the ball rolling!

It's amazing how fast people start to move when the mom's actually slept instead of with just the block. That's impressive! So baby came out fine, but then of course it couldn't just be all said and done with...the uterus wouldn't firm up, it stayed soft and "soggy". So...1 dose of methergine IM. Still boggy. So let's try something else. 800mcg cytotec...rectally...on the table...by me. Seriously? This is not a skill I learned in nursing school OR during orientation! Anyone tried to shove 8 little pills up a rectum while the patent's strapped down on a narrow OR table on her back? Without breaking sterile technique during an operation? MORE than a little difficult. Add in the fact that this patient isn't the smallest patient I've ever taken care of either. Seriously...

Too bad her uterus still didn't clamp down...so let's try some hemobate...nope...more methergine...nothing. So when all else fails, pull out the bakri balloon. This is a balloon that actually goes into the uterus vaginally and is filled with fluid to completely fill the uterus and put pressure on it so it stops bleeding. Never done one of these either. So let's list the NEW things that BirthdayNurse got to do during ONE c/s:
1. General Anesthetic
2. Rectal cytotec on the table
3. Bakri balloon
4. Hemobate intrauterine

That's too many new things to learn in one night!!! So 2hrs after we got in the OR, we left the OR. I'd never recovered a patient with general anesthetic, or a bakri balloon, or one who was as out of control as this girl was after general anesthesia, so I very willingly handed off my recovery to a different nurse and took her patient back for a C/S.

Thank goodness the 2nd section went according to how it was supposed to, other than her begin 29wks with PPROM, but baby was great for 29wks, mom did fantastic, and I got a chance during recovery to finish charting on BOTH patients! After moving my recovery I finished up another recovery for another nurse who was going home, meanwhile people kept on walking in the door...

After finishing up the last recovery, I went back out to labor land and picked up someones blocked/comfy/tucked-in labor patient who turned out to be the same girl I had sent home the morning before after she slept all night off vistaril. I was happy she came back in labor.

I took another multip ROL who was actually ruptured but only about 3cm. She wanted a block too, so I got her comfy, charted and sat down for about the 1st time all night. It was about 6, so I went in to check my ruptured girl one more time before I started some pit on her and low and behold she was about 8cm with a nice bulging bag. The doctor was sitting out at the desk and when I told her she said "well, let's rupture her and then I'll deliver her before I leave." Ok...whatever you say! So AROM, drag in some delivery equipment and have a baby at 0635!

Another 3 baby shift...and my 1st boy of the week! I was seriously starting to wonder if there was something in the water to get all these girls! And 2 of them have had the same name, and 2 of the other's have rhymed!

Babies so far this week...7. I think I'm done for the week!!!

Babies today: 2f/1m
Babies total: 54M/59F = 113
Vag:42M/45F = 87
C/S: 12M14F = 26
Babies 'caught' = 2f0.5m

Wednesday

After Tuesday night I was already tired and it was only my 2nd shift! The fact that I picked up an extra 6hrs Monday night really threw me off, and I couldn't even tell you what day it was!

Wednesday I took a patient that followed me in the door for a rule out labor (ROL). I ruled her out after an hour, made her mad that I was sending her home, and tried to explain that I couldn't "force" her to leave but that I really thought she'd be more comfortable not in our beds and not being able to drink, eat or smoke her cigarettes. She finally decided to leave.

Then I took another ROL, got her in a bed, then got a page that somehow it was my turn to take ANOTHER patient. Ok...so I ran for about an hour and a half, the on-call doctor for the 1st patient decided that since she lived an hour away she should stay and would "probably go into labor during the night." I got her settled, gave her 50mg of vistaril to help her sleep (same sleepy effect of benadryl) and she slept the rest of the night. Hmmm...maybe not real labor?

2nd ROL went home, and I finally sat down to chart on BOTH patients. All fine and good, got everything caught up, I was good to go! Then another ROL walked in, of course it's my turn. She was definitely in labor and wanted a block so IV, block, check her and she was pretty near complete. Her doc came in, we had a great delivery! All right then! This was another doc who isn't always known for being super friendly but she came and sat at the desk with all us nurses and chatted for a while waiting for her other patient across the hall to deliver. I really like it when the docs sit out with us and socialize and just share in good old conversation. It breaks a lot of the the doctor/nurse walls down and makes everyone seem a little more human.

Right at shift change the same ROL that I had sent home 12 hours before came back and her cervix had changed, so she got to stay this time. You could tell she wasn't very happy, but in my mind, she got to go home for 12 hours, she got to eat and she got to smoke the cigarettes she wanted. She couldn't have done any of that if she had stayed. I'd say she was better off at home.

Total deliveries for the week so far...4

Babies today: 1f

Babies total: 53M/57F = 110

Vag:41M/45F = 86

C/S: 12M12F = 24

Babies 'caught' = 2f0.5m

Tuesday

I could sum up this last week in 1 word: CRAZY!! But...to be fair, I'll post about each day. Since it's Saturday now (and this recaps Monday through Friday) I may be minus a few details...but all my numbers are correct!

Monday night started the ball rolling. I took report on a very nice patient from one of the day shift nurses. The patient was a multip already in labor, already had an epidural and was comfortable. So it was the waiting game on her. She labored very nicely.

About 1930 I took a triage who came in contracting, it was her 4th baby. She was in great control, but was ready for an epidural ASAP, so I got her blocked, comfy and then sat down to chart. Meanwhile, my 1st patient was starting to have a few variables, so I went to check her and she was complete. I set her up and we only pushed a few time, called the doc in and had a very nice delivery! I came out of her delivery, stuck my head in to check on my 2nd patient and she mentioned she was feeling a little bit of pressure. Sure enough, she was complete. So I somehow managed to hand off my 1/2 way done recovery to another nurse and went to my other delivery. She pushed about 2 times, we called the doc and had another great delivery. I check the times and it was 1hr and 5min apart from my 1st delivery. Nice work for before midnight :)

The doctor for my 2nd delivery can more often than not be a little difficult to get along with, even though I've never had any troubles with her at all. We had a great delivery, she was very chatty, happy and sociable the whole time. When I came out to the desk afterwards, one of the other nurses said "whatever you did to get on her good side, don't get off of it!" I don't know what I did either...

As I was sitting down to chart my admission database on my 2nd delivery patient (who said that admission stuff has to be done BEFORE the baby comes out?!), I head a blood curdling scream from a room and any labor nurse knows the sound of "the baby's coming" scream and that was for sure it. I dashed into the room, threw the cover off the delivery cart and sure enough under the sheets there was a head full of dark hair crowning up nicely. The actual nurse was standing at the bedside holding the sheets up looking slightly panicked (I don't blame her!) I grabbed the top pair of gloves off the delivery cart, reached down and caught the baby just before the laborist walked in. Baby went to mom's tummy, cord clamped and cut and I let the doctor take over. Hey, a TOTAL step up from the last baby I caught...at least I had on gloves, and I didn't get anything on my scrubs! It was a slightly awkward angle to catch a baby since I was standing behind mom, but whatever works I guess...

What a way to start a week. All girls! And chalk another baby up that I've caught :) I'll take one of those ANY day!! Counting the 2 babies I had + the one I caught we had 322 babies in June! That's alot!

Babies today: 3f
Babies total: 53M/56F = 109
Vag:41M/44F = 82
C/S: 12M12F = 24
Babies 'caught' = 2f0.5m

Wednesday, July 1, 2009

Friday Night

Probably should talk about Friday night before I talk about the craziness of last night!

Friday night...I walked into a girl who was unblocked and on pit but who really hadn't changed all day. I walked down with the day shift nurse to check her right before shift change...she was 8. (Still unblocked). Got the room all set up, gave her a few more contractions...checked her again...she was 9.5...few more contractions, complete. Please let the doc get here! I didn't put her in stirrups 'till I had the doc present and accounted for and I was sure I was gonna catch the baby...but I didn't. Nice delivery, she was so proud of herself for going un-blocked, and with good reason! I love it when they think they're only 2 and then realize that they're like 8 or 9 or complete. It's amazing how well they stay in control that way vs. knowing that they're getting closer and closer. I wonder if it really is a mind game!!

So I hung out with my postpartum cuplet (since I've been trained now...hahaha!). Did the whole breastfeeding thing, etc, etc. Then about 430 I got a R/O labor/SROM who was indeed in labor and SROM'd. I got her block, comfly, did my charting and checked her about 0630 and she was complete! Got the doc there, pushed 1 and a half times and had a baby at 0658...handed off the recovery to the day shift nurse and left the unit at 0710. That's how I like it! Get the fun of bonding with the patient, do the delivery, sign the chart and walk out. I think every delivery should be that way :)

So...3 shifts this week...5 babies...all vag...what a week! Reminds me why I love my job (most of the time!)

Babies today: 2m

Babies total: 53M/53F = 106

Vag:41M/41F = 82

C/S: 12M12F = 24

Babies 'caught' = 1f1/2m