The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Posts Tagged ‘birth’

Silence Is Not Always Golden

Posted by isntshelovlei on May 3, 2010

Our last OB clinical was yesterday—there really was a light at the end of that long, dark tunnel. I really didn’t think I could take another day on the postpartum floor so I was glad when my instructor said I could go to the NICU. But it’s never a good sign when you get there and the charge nurse presents you to the nurse she’s assigning you to and tells her, “I’m sorry, I have to give you a student today.” WTF?!? And like I wasn’t even standing right there! The nurse kept a straight face but you could tell she was less than pleased. So there I was, only there for about 60 seconds, and I was already turned off to the whole situation and ready to leave. You have TWO whole patients who sleep 98% of the day anyway, what is the big damn deal? Lord forbid I keep you from your sticky buns and trash mags…  

But I took a deep breath and kept it moving. It was the last day, and I was determined not to feed the trolls. I did the eternal scrub up to my elbows just to be able to enter the unit but was not allowed to touch anything—not  a chart, not an isolette, and certainly not a baby—for five-and-a-half painful hours. I should have brought a crossword puzzle or something. I’m really starting to rethink my desire to be a NICU nurse. Not because of the less than stellar experience I had (because the nurses in the NICU where I volunteer are great), but because I’m starting to think it’s just not enough excitement (patient care/interaction) for me. I know that some people like relaxed jobs where they sit around and don’t do much, but if that’s all I wanted to do I could have went to school for envelope stuffing or something. The most interesting thing that happened all day was two incidents where fentanyl (big time pain med—100 times more potent than morphine) syringes came up to the unit completely empty. But they weren’t just empty syringes. They were actually drawn up to the dose that was supposed to be in them but there was nothing in those chumpies but air. Gone unnoticed, that would have been one hell of an air bubble… Freak pharmacy thing or…you fill in the blank…

Though it’s no secret that maternity wasn’t my favorite rotation, our last moments in OB will forever leave a footprint on my heart. As we walked through L&D we could hear a woman in the actual pushing stage of labor. And she was a-hollering—totally to be expected when you’re pushing something the size of a watermelon out of a hole the size of a lemon. She had the nulliparous students in the hallway cringing at how much pain she apparently was in. So she’s in there screaming and you can hear the nurses encouraging her to push. There was a climax of activity/noise and then all of a sudden it was quiet. Since we were not actually in the room and able to see what was going on, at first when you hear the woman stop screaming you figure okay—the baby is out. But then you slowly start to realize that it’s too quiet. The critical thinking wheels start to turn and you ask yourself why isn’t the baby crying? Next thing I know they were calling for a neonatal crash cart… 

…dystocia…nuchal cord x 2…baby completely blue…umbilical cord separated from the placenta…blood everywhere…

When you work in health care you will sometimes see how even in a beautiful situation such as a new life being brought into the world, things do not always go as planned. Always count your blessings.

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HESI Smesi

Posted by isntshelovlei on April 22, 2010

It’s that time again—maternity HESI in T-minus 9 hours. For those unfamiliar with this particular form of headache, HESI is yet another test we take in addition to our regular exams/quizzes. I like to think of it as nursing SAT’s. It’s not quite the NCLEX but it’s supposedly a pretty good indicator of how well you’ll do on the real thing. In our program it doesn’t figure directly into your actual class grade (so depending on if you do well or poor on it, it may feel like a waste or a relief) but they’re currently giving us a few points (on a sliding scale) towards our final exam depending on how well we do.

So I’ve been up to my eyeballs in case studies, practice questions, and reviews/rationales most of this week in preparation (I don’t throw away any free points!). And for some reason, one concept that really gets my panties all in a twist is GTPAL, which basically gives you a summary of a woman’s obstetrical history. I wish they would just do away with that mess and write it the hell out. Damn, you don’t have to abbreviate everything!

Here’s a little scenario from one of my case studies I did last night: Jane Doe, who is currently pregnant, has previously given birth twice, twins born at 35 weeks and a singleton born at 39 weeks. All of these children are alive. She also has a history of having had one miscarriage (the more medicalese term would be “spontaneous abortion”) at 9 weeks into the pregnancy. What is her GTPAL?

Well first a refresher on the acronym/abbreviation itself. Gravidity is the number of times pregnant, including the current pregnancy (which is what I always forget to count). Term is any birth after the end of the 37th week, and Preterm is any birth between 20 and 37 weeks. Both term and preterm include live and stillborn babies. Abortion is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living refers to all children who are living (duh). Multiple fetuses (twins, triplets, etc.) are treated as one pregnancy and one birth. It’s just too many variables and parameters and whatnot…it makes me cross-eyed. So…Jane’s GTPAL is 4-1-1-1-3—four pregnancies including the current one; one baby born at 39 weeks; one set of twins born at 35 weeks; one miscarriage/spontaneous abortion at 9-weeks; three living children.

Well I don’t know about you, but I’m spent…

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Touchdown!

Posted by isntshelovlei on April 18, 2010

At first I thought it was going to be like our last few clinicals where I was bored to tears. For the first two hours or so, we watched the nurses eat their full-course breakfasts complete with omelettes, bacon, home fries (which everyone complained were too salty), bagels smushed with avocado (WTF?), and toast—with Smart Balance spread of course. We did not partake in their feast though one nurse offered me a Starburst. When they were done eating they proceeded to cackle about the Kardashians, the Gosselins, and just about every other celebrity as they perused their mile-high stack of trash mags. The conversation then shifted to Martha Stewart, how they liked their Bloody Mary’s spicy, and so on. One even remarked, “Oh, I remembered to bring my iPod today.” None of them wore stethoscopes (not much patient care going on anyway) and honestly you couldn’t tell the nurses from housekeeping as both wore varicolored scrubs.

But it got better.

When it was all said and done I got to see a vaginal birth, a C-section, an epidural placed, and a D&E (dilation and evacuation). Just for that stroke of luck, you can bet your sweet ass that I won’t see anything else the rest of this rotation. The vaginal birth was great—as the mother of three I had been wanting to be on “the other end” for once. The baby was big (8+ pounder) and mom was small which unfortunately landed her with a third-degree laceration (tear) in the end. The C-section was a lot faster than I’d thought it would be—if I had blinked I would have missed it. The patient came in actually wanting to try a VBAC, but the doc wasn’t having it. I think they did entertain the idea at first until her blood pressure went up and the baby starting having decels. Third patient had a history of a LEEP and was dilating slow as molasses (which I’m told often occurs with LEEP patients). She was only 2 cm dilated when they gave her the epidural (I thought you had to be at least 4 cm), but she just couldn’t take the pain anymore—the Nubain just wasn’t cutting it. They were also augmenting her labor with Pitocin (which in my experience creates the worse contractions), and she was now having contractions every 2-3 minutes. Hell I’d want my epidural too. It was the D&E that kinda bothered me. A D&E is a surgical/therapeutic abortion done in the second trimester. Basically the cervix is dilated and the contents of the uterus are removed by vacuum. They use an ultrasound to make sure they got all the tissue out. But it just seemed like there was blood everywhere—they were slinging it and tossing bloody gloves and instruments and whatnot. And right after that—we got to eat lunch! Sheesh…

That’s all for now folks—a nap is definitely in order!

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I Just Didn’t…

Posted by isntshelovlei on March 29, 2010

Clinical this past Sunday was a little more interesting than last week—but not much. I did a newborn assessment, and charted a little in the paper and computer charts. Oh, and I got to help make a couple of beds—exciting stuff for a student nurse thirsty for hands-on patient care right? I did not get to do a postpartum assessment on mom (her regular nurse completed it when I whisked the baby off to the nursery). I did not get to see a birth (vaginal nor c-section). I did not get to pass meds. I did not pass go and I did not collect $200.

It was a little strange at first handling “normal” newborns. I’m used to my NICU babies who have various catheters and such attached to them; these babies were so….free—bundled up like little burritos. Mom was still kind of out of it and preferred that I fed her daughter so I did. It just felt weird being able to scoop up the little peanut from her bassinet and stroll over to the rocking chair with no IV poles or monitors to navigate around. Sitting there with that 7lb bundle of joy made me think back to when my own children were that small (and before they learned to say words such as “no” and “mine”). My lecture instructor said in class that someone always gets pregnant during this rotation—uh, no thanks, I’m retired from that line of work. I already have three strikes, so I’m out of that game.

Sadly, most of the nurses weren’t any better (read: nicer) than the ones we had last semester. I thought (or hoped) that since these nurses cared for hormonal women and babies their demeanor would be a little more accommodating—guess not. No one was outright hostile like my dear Nurse Nasty from last semester, but they did tend to make you feel like some colossal inconvenience. I still don’t quite get that whole “nurses eat their young” thing…

No clinical next weekend since it falls on Easter. Good thing too since I could really use a solid weekend to catch up on some much-needed reading.

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