The Dog Ate My Care Plan…

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

Posts Tagged ‘delivery’

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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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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Some Boo-boos You Can’t Kiss Away…

Posted by isntshelovlei on April 11, 2010

A lot of boo-boos and ouchies in clinical today. First, I had a postpartum mom with a fourth-degree episiotomy. She was postterm so of course the baby was big, and they “had to” use the vacuum to assist with the delivery (I’m not a big fan of vacuums and forceps and such). To me, the situation just screamed C-section, but hey what do I know? So for those not fluent in the language of OB, a fourth-degree is the most garbungular type of episiotomy you ever want to have. This cut goes not only through the skin (first degree), muscle (second degree), and rectal sphincter (third degree), but through the rectum as well. “Ouch” really does not even graze the surface. I’ve had a second-degree episiotomy myself and while I hardly noticed it compared to the “ring of fire” during birth, afterward it felt like I slid down a razor-blade-lined water slide and landed in a pool of lemon juice. So I could only imagine what my patient was going through. And those puppies take time to heal. Cold packs help reduce the swelling and pain; and sitz baths circulate (warm) water to the area increasing circulation which promotes healing. You have to be careful with sitz baths though; if you sit in that water too long (which is a breeding ground for bacteria) it increases the risk of infection–15 minutes per sitting is fine. Some women also find witch hazel pads (better known as Tucks) to be soothing.

Second, I got to see a circumcision performed. Let’s just say it made me want to go home and profusely apologize to my 10-year-old son. It just seemed like so much trauma for that little piece of skin they removed. However, the doc that performed it informed me that it “really wasn’t that traumatic for the baby.” Yeah, okay–if that helps you sleep better at night… She used the Mogen Clamp method, which I wasn’t familiar with though all of the methods look pretty unpleasant to say the least. For those of you that have the curiosity and the stomach, you can find a video of the procedure here. I will say I’m glad that the myth (or maybe it was just denial) that babies do not feel pain was finally debunked–it is obviously so not true.

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Zzzz…

Posted by isntshelovlei on March 22, 2010

Our first day in Maternity/OB clinical was pretty uneventful–almost downright boring. Part of the problem is that we have clinicals on the weekend. C-sections and inductions are not typically scheduled for weekends. So we are basically just sitting around waiting for someone to spontaneously go into labor (and with all the planned C-sections these days I’m not sure if people still do that…). There was a single postpartum mom on the entire unit. The clinical instructors had to go “find” a baby so that they could show us how to do a newborn assessment. I will admit technically it was just our hospital orientation day (which translates into boring computer training on yet another EHR system), but I was all ready to palpate some funduses (fundi?) or something. I also heard that we’re not even going to be giving meds which leaves not much else to do than a lot of patient teaching–if there’s anyone there to teach…

So although many of my fellow students are still excited about this rotation since some would like to work in maternity, I can already see it’s not my cup of tea. I need more “action”–like in an intensive care or ED environment (but real emergencies–not “my baby has hiccups”). Not that I thrive off of dire emergencies or people being critically ill/injured but when you’ll be working 12-hour shifts I’d like to be doing a little more than reading the tabloids at the nurse’s station (don’t act like you haven’t seen it). Who really cares how Kendra Wilkinson lost 10 lbs in 10 days?–she probably ran 5 miles a day on a strict diet of romaine lettuce…

Of course now I’ve totally jinxed myself and this weekend it will be on and popping (hopefully)…

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