Birthday Nurse

Needless to say, it's been beyond crazy at work. I somehow managed to slip by on-call for part of my shift Friday night, I couldn't believe it! Then the calls started coming... Saturday night...sorry I have a wedding Sunday morning! Sunday... the manager of the entire Women's & Children's department called...twice!...sorry, I've got a bridesmaid dress on and I'm getting ready to march down the aisle! Monday ...just got off a mower after 5 hrs in 100 degree heat. Tuesday... I was scheduled to work, and sure enough it was crazy. Somehow we've only had like 3 or 4 nurses scheduled every night, to cover an completely full board. We had more nurses there on time and a half pay than we did straight pay Tuesday night! I delivered a girl on mag about 2100, and as I walk out of that delivery with pressures of 160's/100's I get a page that there's a cervidil coming that I need to take. Since when is an unstable mag patient not 1-to-1? Whatever wor...

Seriously, I have had some sick patients lately! My PIH friend from early yesterday morning that I thought we should deliver ASAP...platelets dropped to 50, livers into the 800's, never got past 2cm. :( Section in the afternoon, then I got to take care of her last night. She felt so much better after she got delivered and her baby is ADORABLE!!! 6hrs postpartum I got a couple quarter sized clots out, increased her main line with some pit in it and hoped they'd go away. Then 45min later, I got a fist sized clot out. 800 mcg of rectal cytotec fixed that...no more bleeding!!! Glad we got the bleeding stopped while we could, her platelets were 40 at midnight. Sheesh ! She was a tough IV stick b/c of all her swelling, and so they had put in a 2 nd IV in before surgery yesterday. We could use it to draw labs off of...oh my goodness. I think all mag patients should have an extra IV to draw labs off of. It was AMAZING! No searching for a vein, no digging, no extra needles...just pu...

So after my melt-down post yesterday...I had a mag gal who had been cervidil'd X2, pit all day yesterday and was 5. Then she was complete at 1915 and we had a baby by 2030! Yea! But then again, the baby was only 4#3, so I would HOPE it didn't take too long to push out! Seriously though, more mag? I think at last count (after starting someone else last night) we have 5 patients on mag. That's insane! Our manager was in helping us 'till 0300 this morning and we had a little chat about an antepartum unit...and those of us from last night NEVER having to work it! Sure, a load of easy ante's is kinda nice every once in a while, but all these pre-terms, mags, etc are too much! I was talking to J on the way home this morning after we called a rapid response on her delivery from last night and she mentioned how nothing was every "low-risk" anymore. Every delivery has some complication or the mom is some kind of sick. Must be something in the water... So after I go...

Why don't I do Mom/Baby (postpartum) nursing? Because I can't handle it. I don't know why I can't handle it, but I can't handle it. I don't understand the charting, I don't really, truly understand the correct "assessment" of it...I just don't get it. Hence why I don't do it. Well, why I didn't do it until last night. There were lots of not-so-nice words going on in my head when I saw my assignment was 2 post- partum mag patients, plus one of their babies. I've done postpartum mom's...never the babies. I'm NOT a baby nurse, I'm a MOMMY nurse...once the baby is on the outside, it scares me just a little because I don't know what to do to it or how to fix it if it breaks. I can't roll it on it's side to get it off the cord, I can't put on a scalp lead to hear the heart beat, I can't run to the back for a C/S if all else fails...besides a pacifier in the mouth I don't know how to fix a baby! Anywa...

One of the big plus sides of working 3 nights in a row is that it makes the days go quick! It seems like I just woke up Thursday afternoon and now it's Sunday morning and I'm going to bed! It's gone quick (and I haven't worked out at all during those days...that makes me a little grouchy!)! I have decided a few things after the last 2 nights: I'm ready to have a baby, I've gone lots of days without a baby!!! I'm tired of Mag! I think our hospital is running a special on Mag. Friday night I sat on my butt the big majority of the night. I had one long-term ante and was triage. I did one trainwreck triage who decided she liked me, and wanted to ask for me by name when she came back for her "real" labor. Hey, a compliment is a compliment! After I sent her home I sat, and sat, and sat, and sat. We got a phone call that a hospital 2hrs away was going to transfer a 33wk PIH patient to us, so we all jumped and got ready for that. That was just before midni...

I don't think there is ever gonna be a shift where I don't do something I've never done before. Last night it was actually "starting" someone on mag, with the 4gram bolus and then the 2gram/hr thing. I've heard too many stories about people forgetting to change the pump rate after the 4grams in 15minutes when they hang the "big bag" and send their patients up to ICU because of respiratory failure, so I was a little nervous. The awesome day shift nurse helped me roll the patient out of the OR and get everything straightened out and the mag started and the paperwork organized and stuff before she left. So I had a fresh section on mag and the patient wasn't one of those who I would call "stoic", actually quite the opposite. This was about her 7 th admission in the last 2-3 months of her pregnancy for various things, but when she got hit with the PIH she got hit hard and really was sick, so even though she was only 33 wks it was a good ...

MUCH better than Tuesday night :) I had a gal who was on Mag for pretty bad PIH . 24-hr urine, then cervidil , then pit...and she was finally complete. She also could barely open her eyes or talk to us b/c of the mag. So the mag got turned off, we labored her down for about an hour, then we pushed for about an hour and a half and had a baby. Poor girl, I really wasn't convinced that she was gonna be able to push a baby out because she was pretty out of it, but she did awesome, and the last half hour or so she actually was 1/2 way on the same planet we were on. I guess that would be the way to do it, be half out of it during the hardest part then come back to reality right before delivery. She and her husband were really sweet. She was pretty alert the rest of the night, even after we turned the mag back on post-delivery and said several times how she thought it was funny how we had kept asking her to "open her eyes and talk". She said she could hear us, but just couldn...

So after my experience on Friday, I walked into work this morning really excited to have at least 2 more inductions to round out my days orientation (I go to nights next week!). Boy should I have never have pre -planned what my day was gonna be like. Walk in, what color is my patent's name? Green. Next to purple names ( DIU's ), green names (ante's) are my least favorite! And this wasn't just an ante, it was stable 27+5 twins who had been on mag since yesterday afternoon. 2 mag patients in a row, give me a break!!!! That means no new patients for 12 hours. Just me and the twin mom. So after that put me in a very sad mood, my day wasn't too bad. I know I should just be happy with what I get and be ready for anything, but two days of sitting on my behind watching mag babies (or answering 24 un -needed call lights) I really am ready for a delivery! This twin mom was really nice though, these are her 3rd and 4 th babies, and we became friends after I let her eat food ...

I apologize ahead of time if I miss totally obvious reasoning for why this happened, but to me it just didn't make sense... G1 29weeks presents to L&D sometime Monday afternoon for higher blood pressures and just not "feeling right." Her mom used to be a nurse in an OB's office, so of course Grandma knows "exactly" what is going on...anyway, her pressures weren't pretty (150's/100's consistently) but since it was a busy day in the office, her doc wanted us to just watch her and treat her pressures with labatalol . Her urine was dipping 4+ protein and you could tell there was some swelling going on. Labs came back " ok " not fantastic, so doc ordered a 24-hour urine to check protein, etc. So that buys her at least a 24-hour stay. She got her first dose of steroids for fetal lung development and hung out 'till Tuesday afternoon. Tuesday, her pressures are even worse and her 24-hour urine came back with 6 GRAMS of protein. That...

This nurse is too tired and too grouchy and too frustrated to really go in depth about her day at work. I don't think I will ever understand why some people (in this particular case doctors) do what they do when they do it. I feel like I did absolutely nothing today, got nothing really accomplished except watching my patient get sicker and sicker before my eyes and then handing her off to night shift to section 45 minutes after I left. A section that should have happened at about 0900 this morning, and by 1500 at the latest.Let's say that at times today, my line monitoring baby's heart beat was flatter than my toco line sitting on a uterus that was picking up only breathing. The toco line was at least a little jiggly! Sigh...more tomorrow when I won't blog things I'll regret later. Bottom line is -- babies today: ZERO