Wednesday, April 15, 2009

More Of The Same

I'm still tired of antes, mag, preemie's, twins, etc. I got another transfer from out of town who was 4cm/100% and 30wks. Their NICU was full so they sent her to us...our NICU is full (after our 29wk PPROM delivered) and if she deliverers we'll have to ship her baby to the children's hospital. So start some mag, listen to her complain about her foley all night. I would have taken out her foley, but not after the 1st hospital gave her 5L of fluid in 6hrs. Not sure that mag was a good idea after 5L of fluid either...but whatever, her lung sounds stayed clear!

I'm ready for a nice, normal, one-on-one labor patient! No more of this "green" mess! And this was only my 1st scheduled night of 3 this week. I'm regretting going in extra on Monday!


  1. Any advice to a graduating RN wanting to get into L&D? Our particular market is flooded with nurses so L&D around here is super picky. What area would help me get my foot in? Any suggestions?

  2. So what exactly is a mag patient? Is magnesium what you give women in pre-mature labor?

    Anywho, sorry you're having a hard time! I hope you get to participate in some non-complicated labors and deliveries!!!

  3. Joy - A "mag patient" is someone who has an IV drip of Magnesium sulfate running (at a very slow rate). In L&D we use Mag for 2 different things: stopping preterm labor and preventing seizures in pre-eclamptic patients. Mag is a muscle relaxer, so with the perterm labor, it relaxes the cervix and stops it from contracting. With the PIH gals, it relaxes their muscles and stops them from seizing!! Lots of people thing that it lowers the blood pressure of PIH patients, but it doesn't really do anything for the pressures themselves, it's more of to prevent the seizures caused by the high BP's.

    Anyone who's had to be on mag can tell you that it is a NASTY drug. It causes hot flashes, it burns as it goes in, it messes up your vision (while you're on it), it makes you feel very "out of body" and gorked out! Mag also can make you retain fluid, so we always put in a catheter and measure everything that goes in (IV fluids, fluid you drink, etc) and what you put out! All mag patients are on fluid restrictions and can only have about 100-120cc fluid an hour including all meds/water/ice chips. That's not very much for a laboring or post-labor mom!! At our hospital we don't let mag patients out of bed either since it messes up how you feel so much, so you're stuck in bed for at least 24 hours most of the time.

    With the pre-term gals we usually leave them on mag until we can get 2 doses of betamethasone (steroids for baby's lung maturity) on board (given 24 hrs apart) and then another 24-hours after that so the full effect is in. With our PIH patients, we usually start them on it before we induce them, then they have it at least 24-hours after delivery, or until their labs come down to a non-threatening level.

    Since mag is a potent drug we have to draw labs at least every 6 hours to test for toxicity levels, we have to listen to breath sounds every hour and we have to test reflexes every hour too, so it's not like we can tuck in mag patients and let them sleep all night! It's an every hour assessment type of thing.

    Mag makes for a very LONG and very different labor experience. It usually serves its purpose though!

  4. Come to work with me! We need night nurses BAD! Besides that...

    I know that I've wanted to do L&D for as long as I can remember. I started "hanging around the hospital" the day I was born...and never really left. I started volunteering everywhere in the hospital when I was 14, then I started working in the day care center, then during nursing school I worked through the float pool as a nurses I got my foot in at the hospital first off. Then during the summer between my Junior and Senior year of nursing school I did a 3-month internship on L&D. My hopsital offers it as a recuriting tool at the school that I went to. I cramed as much into those 3 months as possible, I got to know the staff, the managers, the other nurses, and the routine. This helped ALOT! The manager knew I wanted to come back and work there, and they offered me a job at the end of the summer.

    My senior year of nursing school we all had to do a preceptorship for 3 weeks and I went back and worked with the same nurse that I had worked with over the summer. Then I took boards (twice...) and jumped right back in. I tell all my patients that I have a year of experience because if you add up all the months that I've worked up there (summer, preceptorship, etc) it's been a year!

    So I guess my advice is to look for internships, even if there are volunteer opportunites or nurses aid jobs (nursery, etc) anything to get your name out there and for people to see you interact with patients and other staff.

    Good luck!!

  5. Thanks for your advice, I much appreciate it! And if I lived even remotely close to your hospital(wherever that may be), I'd jump all over the opportunity...too bad the L&D's here have so many choices, they don't even hire new grads anymore! Boo! One day....