Thursday, August 20, 2009

Only 2

Only 2 birthdays in the last week :( We've been having babies right and left it seems...I just haven't been involved in them. That makes me sad!!! I want some babies!! It seems like I've had cervidils and antes a lot lately. Boo.

Neither of my birthdays have been terrifically outstanding either. Pretty "run-of-the-mill" almost...for lack of a better word...boring! The first one was a close friend of the get this...the doc stood in the room and pushed with her for an hour and a half!! Seriously?! I love this doc, she's great, one of our favorites. But come on. I can think of only a handful of things that can make an L&D nurse feel more useless and a waste of space than standing at the perineum and pushing with the patient the entire time. Makes it even worse when the patients husband is there, and so is her sister...who is a pediatrician. So for an hour and a half I stood in the corner, dumping some astroglide everyonce in a while while doc, patient, husband and sister carried on their own wonderful conversation and the doc did my job!! I was a little sad :( The poor kid crowned for about 20 minutes "stretching". Mom didn't have any major tears...but that poor baby head was bruised and looked horrible!!

2nd birthday was a C/S after pushing for an hour with a kid who wasn't in there straight and a doctor who ran out of patience and a mom who wasn't the hottest pusher. Baby ended up being >9#...the most exciting part of the whole section was the section that happened across the hall at the same time.

We only have 2 OR's, so our rule is not to run them both at the same time (to ward off the emergency walking in). The first time I ever saw them run @ the same time was a couple weeks ago when we had to crash a patient...let's not do that again. Until Monday night. We had just taken my mom back and baby had just come out, when the charge nurse sticks her head in and says that the scrub tech needs to open up the other OR for another case. Huh? When we hear that we suspect emergency, so the scrub tech left to open and prep for the other case and sure enough, pretty soon the other patient came back. After my 2 docs were done closing, they broke scrub and left my OR. So I'm left in a pool of blood, my patient still draped, and the CRNA hanging out at the head. I asked the docs if one of them could do a final count with me and I was told bluntly "we can't. we didn't do the initial count so we can't do the final count." And they walked out.

So now what? I scrubbed in and at least covered the incision. Then counted and thankfully found everything. Then I called out to the desk to see if someone could come back and help me move my patient. My patient was number than a 2X4 and not the smallest mom. So I started cleaning her up by myself and finally the 64yr old charge nurse comes back to help me move out. All the more interesting. So 30min after closing time...we roll out of the OR.

I was NOT a happy camper and when I asked what the emergency was next door...I found out it was a failure to progress section and the doc called it right after I went back for my section. There was no fetal distress, no maternal distress, no fever. No complications, just no cervical change. Then she said that ACOG standards are "30minutes from decision to incision" and insisted that they go back that instant. The charge nurse tried to get her to wait, but she said no. Then they said she could go to the main OR if it was an emergency, but she said no, she wanted to go to our OR's. Seriously?

Thank goodness everything turned out OK, all the instruments, laps, sutures, blades, everything was present and accounted for when I counted and when 2 other people went back and counted. The whole situation made me nervous and a little frustrated. Patience doctors...patience!

Babies today: 1f/1f
Babies total: 58M/70F = 128
Vag:44M/52F = 96
C/S: 14M18F = 32
Babies 'caught' = 2f0.5m

Wednesday, August 12, 2009

I Hate IUFD's

We've had 5 IUFD's (Intra-Uterine Fetal Demise) in the last week. 21wks, 33wks, 32 wks, 35wks and 36wks. Come on! That is WAY, WAY, WAY too many. I haven't taken care of a demise in a long time, since that one last Christmas that hit me so hard. I feel like I've helped with almost every one, but last night was the first one that I've actually taken care of since last December.

I hate them so much. All these babies who never have a chance, most of the time we never even know what happens. Mine last night was a rare case, he had a chromosome anomaly that the parent's had known about for most of the pregnancy. They were prepared, then were expecting something like this, and they knew exactly what they wanted. That makes it so much easier on us nurses, and in some ways, I think it makes it easier (at the time) for the parents. They had all their family there, they had all the little outfits for him there, they had their cameras, they had a name, they had everything and they had a plan.

The baby was perfect. He was handsome, adorable, and looked AMAZINGLY good for probably being dead for going on 36-48hrs. I was thankful for that. Mom, Dad, and all the family got to hold him. Dad got to give him a bath, they took picture after picture, they all helped with footprints, I did plaster molds for them, and when I left, Dad was sleeping in the recliner with baby on his chest. Wow.

I hate IFUD's. They're my least favorite part of OB nursing, because they're not fair. Not fair at all. And there's nothing that I can do to prevent them.

Babies today: 1m
Babies total: 58M/68F = 126
Vag:44M/51F = 95
C/S: 14M17F = 31
Babies 'caught' = 2f0.5m

Monday, August 10, 2009

Ante City

I promise, promise, promise that I still blog once in a while! Somehow, when I'm so exhausted in the morning, blogging's the first thing that gets put off. So I have to wait 'till I have a day off to do it! Those seem to be pretty few and far between anymore...

I was scheduled to work Thurs/Fri/Sat last week, and I did. But Wednesday I went in and worked extra at the last minute. I was mowing all day long, and they called looking for help during the day shift that afternoon, and I couldn't do that. But then the 2nd time they called me @ 1700 looking for help that night I felt too guilty to say no. So I jumped through the shower and went in. I don't think I've caught up on sleep after that...

It has been raining antepartums and pre-term patients for the last week! I swear, we'll have 5-9 antes on the board every night...and when there's only 17 rooms total...that doesn't leave room for too much else! I can't wait for our new unit that is supposedly going to have an antepartum wing...and I hope heavens to betsy that I don't have to work it more than once or twice a month. Antes aren't too bad...but I didn't work medsurg for a reason! We have everything under the sun sitting on our unit...a couple pneumonia patients, kindey stone patients, patients with diabetic issues...and the thing is, is all these things are fine, but they don't really have anything to do with being pregnant! You treat a kidnestone patient the same way whether she's pregnant or not, same with pneumonia. So besides a NST every shift, or in some cases, every day...they're a med-surg patient. But medsurg or any other unit won't touch them if they're they sit on our unit taking up nurses and rooms. All fine and good until you have 349 babies in a month, and then things get a little tight! They don't stop coming in either...we clean out a bunch of the "green names" (antes) and another troupe comes in to stay for a few days. It's taking 2 or 3 nurses just to take all the antes every shift!!

I was the "resource nurse" on Thursday nights. That really just means that you're in charge of assignments and the bad guy telling someone that they have to take care of the next triage that just walked in. Our unit is pretty good about figuring out who should take the next patient, so it's not too bad of a job...most nights. When we got there it was crazy, and it never really slowed down. People kept walking in...and staying...and more people kept coming in. I think at one point we had about 9 nurses there. I had all the antepartum patients, we had one patient who was a cervidil on an insulin drip, we had 2 DIU patients, we had a patient who pushed for 3 hours and then had a C/S and bled and ended up with a bakari balloon, we had no rooms aka nurses on postpartum so we "couldn't" move out any of the delivered was the never ending night. I never want to be "in charge" again!!! Here I thought it would make me feel all grown up to be the resource nurse and make me feel like I was finally "stable" as an L&D nurse...not so much. It pretty made me want to run and hide and tell someone else to handle the issues of not having enough nurses to take the patients!! Thank goodness for my amazing team who helped shuffle patients and make sure everyone got what they needed.

I only had one baby out of all 5 days I worked. That delivery wasn't even very exciting, she was complete when I got there, we pushed for 10 minutes and had a baby @ 1913. And then it was back to triaging "preterm labor" patients who came in doubled-over in pain, I put them on the monitor, got a FFN, checked them and found them closed, watched them "contract" for an hour, re-checked them, dipped their pee, maybe gave them a glass of water and miraculously cured them and they walked out after I had to wake them up. Do people have nothing better to do at 3am than come to the hospital? And are people really so tired of being pregnant at 24, 28, 30, 31 weeks that they want to be in labor so bad and have a baby in the NICU for months? Tough it out a few more weeks and take home a healthy baby!! I worked Wednesday night, Thursday night, Friday night, Saturday night, and I went in extra last night from midnight to 7. So I've got tonight off...and then I start my "real 3" for the week!

Babies today: 1f

Babies total: 57M/68F = 125

Vag:43M/51F = 94

C/S: 14M17F = 31

Babies 'caught' = 2f0.5m

Tuesday, August 4, 2009

Still Here!

I'm still here...don't worry...haven't fallen off the edge of the earth. Even though, after working 6 out of 7 nights in a row...I was pretty sure that it was going to be a good possibility. I had a couple nights of antes, a couple good deliveries, several quite nights...except of course the one night that I asked for "call." That night it was crazy busy.

One of my nights included a double-forceps delivery. Mom was a very petite woman, and baby kept turning OP and wasn't very tiny. Finally after pushing for an hour and a half the doctor came in and used one pair of forceps to turn the baby and then another pair to expediate delivery. This particular doc is a pro at forceps, and is one of only a few who I would trust to use them. But still...they always make me a little nervous. Especially since this was the doc who the LAST forceps delivery I saw with him was when he missed the stool he was sitting on and fell and knocked out one of the nursery nurses. This delivery went off without a hitch besides a nasty 4th degree tear for mom...

Another night tested my patience to no end. My patient had some psycho-social issues, plus some mental dissabilities. That was a little difficult for me. I'll be honest, I hated my psych rotation in school, I have always had a hard time with it and accepting it as a real disease just like cancer, diabetes, etc. I know it is a real disease, it's just always been something I've personaly sturggled. The patient was not handeling labor well, she wasn't tolerating any pain, wasn't taking suggestions to help with coping and had limited coping skills all together. Her cervix wasn't changing, and when it finally did start changing and after an IUPC, she started begging for a C/S. I talked to the doctor, and we did end up sectioning her, good thing too because her baby was >9#!! Afterwards, I felt like a horrible nurse for not having more patience, for not pushing for a vag delivery and for giving in to the section so easily. Honestly, I was pulling for the section myself just because I didn't know what to do next! So next time I'll have more patience...

To round out my 6 our of 7 nights...a very fun family came in, 2nd baby, SROM, 4-5cm. Got her a block quick, settled her down...and then something just didn't feel right when I put the foley in. There was a major crease on the baby's head, like major molding. After a very awkward exam, I finally asked someone else to come and check, cuz I wasn't 100% sure it was a head I was feeling. Sure enough... it wasn't! So we headed back for a section.

One of our night nurses delivered during my stretch, so it was cool to get to see her and her baby while they were there. I wonder how perspectives change after being on the "patient" side of our job :)

Babies today: 1m/1f + 2f
Babies total: 57M/67F = 124
Vag:43M/50F = 93
C/S: 14M17F = 31
Babies 'caught' = 2f0.5m