High Risk Weekend

Last week while working there was a slow period one night, so I got out my notebook (I keep a notebook at work with helpful reminders, policies, etc for easy reference)... I was making a "wish list" of sorts of things I wanted to get more experience with and reviewing them for when the time came. I wanted to care for a pre-ecclamptic mom and I wanted to be in on an emergency cesarean for the experience of having to work quickly and to sharpen my skills.

Well, not more than a few days later, both of those "requests" were fulfilled. I had a weekend that could own no other name than "My High Risk Weekend" because of the high-risk patients I was fortunate enough to care for.

Friday night I arrived and was assigned to an outpatient who just arrived from the Dr. Office with uncontrolled pressures. So, she was fresh...nothing done yet... a great starting point. It turned out her pressures spiked super high and we had to admit her and start her on Mag. !!!! I WAS THRILLED!!! Not, of course, because she had to have Mag, but that I was the nurse assigned to her and I was going to start and run the Mag... What a great experience!! I had run Mag before, but it was already started then and the woman was half way delivered before I took her over.

So, having just reviewed the protocol and mathematical equations needed to run Mag for the loading dose, maintaince dose, etc... I was READY!! I even surprised myself at how quickly I figured out the correct flow rate, etc... Anyway, then we had to induce her as well... So all night long I ran the mag, monitored her response to it and managed her induction hand in hand.

She didn't end up delivering on my shift, but I didn't feel slighted at all.... I was simply grateful for the high risk experience I was able to gain. Then the next night I was assigned to her again...she was postpartum now but still on Mag.... So, I cared for her and her "mag baby" - both who were tired and "mag'ed out" - another good experience.

Then, as if it could get any better, My last night of the weekend, Sunday, I was happily caring for a SROM mom who was in labor...Lovely couple. She was progressing beautifully, then we got word on our unit from the EMS that they were bringing a 30 week mom in with massive vaginal bleeding after drug use. I would never normally do this, but I actually chose and was allowed to give up my lovely labor patient for this potential abruption.

And, it WAS a massive placental abruption!!!! I've only read about them... But I actually was able to be involved in caring for her during diagnosis and during her emergency cesarean section. Both mom and baby are stable....And, I am all the more richer for the experience.

It was a physically and mentally challenging and draining weekend. It was awesome.

Modern Medicine

Yesterday I was the nurse assigned to receive two babies.

The first one in the morning was a to a woman who was scheduled for a cesarean section because of breech presentation. When the incision was made and the presenting part removed, it was discovered the baby was vertex - not breech.

Then, in the afternoon, I was assigned to receive a baby whose mother had labored and finally got to full dilatation, only to discover that the baby was breech. So, she was sectioned as well.

If, in this day and age, doctors cannot utilize modern technology or good old fashioned leopold maneuvers in order to correctly diagnose breech deliveries and avoid unnecessary sections and unnecessary laboring (when they refuse to deliver breech), then it is a sad situation, indeed, in obstetrics today.

Thinking for Yourself

I'm still in my preceptorship at work. I feel comfortable going to my preceptor for help when I'm not certain about an issue. But, I realize it is still my nursing practice and ultimately my license on the line when I make a decision. Yesterday is a prime example of this fact.

We were assigned to a post-op patient. Occasionally we do get over-flow post-op patients from the general floor if our census is low. The patient had a lot of orders and medications we don't usually deal with. We usually deal with OB patients and their babies. But, we had this one patient that was fairly critical and required a lot of our attention all day.

There was a medication ordered for routine administration at one point during the day. I asked my preceptor what she thought about giving it considering the patient's current condition. My preceptor thought about it a second, then said, "Yeah, let's give it."

I went into the medication room. I was uncomfortable as I put my pen to the MAR. This was MY name I was signing to this action. This is MY license. So, I put the vial down and opened the drug handbook. At the very end of the section about this medication there was a statement saying this medication was not indicated for patients showing a specific condition: the exact condition my patient was showing!!

I am thankful I honored my feelings. I knew I felt uncomfortable, but could have just ignored that feeling or pushed it aside and given the medication because my preceptor told me to. But, I didn't. I honored my feelings.

Everyone CAN and WILL make mistakes. But, make the mistake yourself. Don't take on other people's mistakes. You will have enough on your own to worry about.

Motives

When a doctor consistently brings in donuts and bagels to the nurses after an on-call night without any telephone calls; would a night nurse be more likely to not call the doctor.

Would one consider this a "bribe?"

Could this possibly contribute to nurses not calling when they should call?

(certainly hope not)

But, is this good practice? Maybe just a friendly "thank you?"

Logical?

Actual thought process of a doctor this week:

Situation: Laboring woman having variables (non-reassuring drops in the fetal heart rate).

Doctor's solution: "Let's break her water, put an IUPC in, then if she needs it, we'll put fluid in."

Hmmm... Why not just leave the fluid in there in the first place?

Dads & Generals

When I was a doula, I remember one of the big issues with a cesarean was the hospital's discriminatory practice of limiting support people's presence in the OR. One doctor would let me in with the couple for support no matter what. Other doctors were not so generous.

And, as an overall rule, if the mother was under general anesthesia, then nobody was allowed in the OR with the mother. To me, at the time, I thought this rule unfair. Afterall, it is the father's baby, too...why should he be prevented from being a part of the child's entrance into the world?

Well, the hospital I work at has very generous, baby/mother/family friendly practices, overall. And, the mother's significant other is permitted in the OR, even when general anesthesia is used. Recently, I assisted at one such birth. It was less than the romantic scene of a father welcoming his child into the world that one would hope for.

The poor man was stunned & shocked from the intrinsic scenes of the OR and a major surgery - His intubated wife. Blood seeping off the side of his beloved's abdomen; pooling at her side. Piles of bloody surgical sponges on the floor.

Even though they kept the blue shield up during the surgery, they lowered it after the dressing was intact while we cleaned her and transferred her back to her bed from the OR table.

For someone who may have never set foot in an OR before to be confronted with these sights during a stressful time of a complicated delivery...I just felt like it was too much. The father could not even pull himself together enough to hold the baby when we offered him it in the OR.

I think that even though it feels unfair, from what I witnessed, it is truly for the best to have the father wait in the recovery room for his wife. He would not then have to recovery personally from the trauma he saw before he can comfort his wife and meet his newborn.

Sleeping With The Enemy?

I have only been working as a maternity nurse for a few short weeks. But, I've already had to make choices about not compromising who I am and what I believe.

This week there was a representative from Mead-Johnson doing an in-service on our unit. We were all "Strongly encouraged" to attend the in-service. I did not have a problem, ethically, with attending the in-service, per se, as there is a certain amount of knowledge about artificial baby milk that nurses need to know in order to help the mothers who use this method of feeding for their babies. However, I did have a problem accepting lunch from the representative. She ordered a large Chinese lunch for all of the nurses on the unit that day. While I didn't want to make waves during my first few weeks on the job, I didn't want to compromise who I was and my strong beliefs in order to eat a free lunch.

Most of what she said was benign. She said the required "breast is best" line. But, there were innuendos that I was uncomfortable with, and I called her on them. She was touting the benefits of enfamil highlighting the new added DHA that improves infant's vision (compared to previous versions of enfamil and other non-Mead-Johnson formulas). Then, she started implying that women who have poor diets may be lacking in the needed DHA that is in enfamil.

There was no way I was going to let that go by....first few weeks or not. Because she was implying this and not directly stating it, I asked her flat out, "Are you implying that women who use enfamil are providing better nutrition than those who have poor diets and are breastfeeding?"

She quickly backed down and agreed with me that a woman would need to be severely malnourished in order to supply a poorer nutrition than formula.

The nerve. Eat an Egg roll and be snowed. Nope, don't think so!