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

1 comment:

  1. Cytotec comes in 200mcg tabs, so it may be possible for you to just get 4 tabs... but your L&D unit may not like that, because it may be too easy to accidentally grab the wrong one. But perhaps they could have some 200mcg on hand, just in case. Also, I've heard of some docs dropping Cytotec into the uterus after a C-section to help avoid a hemorrhage (what I heard was from a birth instructor / doula who saw a doctor do this routinely -- have you ever heard of that? It seems like it would be a cleaner way of doing it, at least; and also a more direct way, but I could be mistaken.

    -Kathy

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