OB Rotation 1

Here’s my paperwork that I had to turn in to give you an idea of what it was like.  Forgive the bullshit and the formality, won’t you?

       I arrived shortly after 07:00 and was assigned the patient mentioned above.  By 07:45, I had written down my patient’s history and started working with my assigned primary nurses.  One of the two nurses, Carlee, is a new orient herself, so she was very good for me to learn from as a nursing student; she was great at showing me things and teaching/explaining things to me throughout the day.

     At 07:45, I started patient care with my primary nurses.  I introduced myself to my patient, and then Carlee showed me how to increase the Pitocin running through my patient’s pump. We went in and increased it by 2 milliunits every 15 minutes all day.  Carlee allowed me to increase it all morning with her observation.

     The patient’s doctor broke her water with a fetal scalp monitor and then placed the monitor.  I was told that this doctor prefers to do this on most of his patients.

     The patient planned for an epidural for pain management and was ready for one midmorning.  We hung a Liter of fluid before the anesthesiologist administered the epidural. (I’ve learned that this is to help avoid a major hypotensive episode.)  Anesthesia doctor was great to the patient and was an incredibly good teacher to me, as well.  He talked me through his whole procedure and showed me that he did a combination spinal/epidural.  He explained the spinal portion gave more immediate relief; the epidural was for long term and had a catheter for administration of more meds later.

As far as support for the patient, the patient’s husband stayed at the bedside all day, though he slept most of the time.  He was also unable to stay for the spinal/epidural, but I think that was more out of being squeamish, and not a lack of support.  One set of the grandparents-to-be visited for a short time as well.

     The patient seemed to be coping well all day.  In the afternoon, she requested more pain medication which was administered by a SRNA.  When we asked her a pain scale, she said that she wasn’t experiencing pain, but much more pressure than she had earlier.  I also observed that she had a cough, but she wasn’t on any antibiotics or other meds for it while I was in clinical.

     I got to do an in-and-out cath on her!  I have only done ‘foley’ catheters, but my primary nurses assured me that the procedure was the same, just no balloon and removal of the catheter right after the bladder empties.  I was really glad they allowed me to perform the procedure. 

     I explained to the patient that it should be done because she wouldn’t feel the urge to void.  I also assured her it would not cause pain, (it really shouldn’t have for her because of the epidural) what the procedure consisted of, and that it would take longer for me to set it up than to actually perform the procedure.  (in the patient’s chart, she stated she learned best from 1-on-1 instruction.)

     I pulled the curtain for privacy, put on the sterile gloves, and felt great to be doing something that would keep the patient safe from bladder distention.  Christy, (the other primary nurse) talked me through it and really helped when I had a bit of difficulty. (side note:  I got to do another right away on the walk-in patient we were also assigned to and I felt really good about it.  No problems at all with the 2^nd one!) Christy also explained to me that this could possibly help the patient with her lack of progress in dilation; it would keep the bladder from potentially adding pressure that her body would have to work against.  I measured her output in the ‘hat’ in the commode, and Carlee charted it on the computer.

     I brought my patient ice throughout the day, since that was all she was allowed.  I changed her pads on her bed several times throughout the day.  Several times during the day, I asked her what I could get or do for her, and only one time did she request anything; more ice.  She was a quiet and reserved patient.  It was hard for me to tell if that was her personality or if she was a little unsure of having a student involved in her care, but she seemed to come around a little more after the nurses allowed me to do her cath.  I completely understood.

     At the end of the day, I observed Christy checking the progress of the patient’s cervix.  By the time I left the floor, 15:00, she had changed very little and was around 2.5 cm dilated. 

     I was also involved in the care of two walk-ins:  one was sent home, and one who came in dilated to 4. It was a busy, great day!

So, the patient I was assigned to was a bitch, but whatever, I cath’d her anyway, LOL.  She may have just been apprehensive, or maybe she was snotty because she was a speech pathologist who was already secure in her career.  Who knows?  I was terribly nice and helpful to her, so I have no regrets at the end of the day.

What I didn’t get to talk about was my walk-in.  This girl was FUN-NEEEE.  She works in the cafeteria in the same hospital.  She came in dilated to a 4 already, membranes ruptured!

She had a party going on in her room there at Hospital-of-Changing-Church-Affiliations.  There was a conversation going on around me and the two primary nurses I was working with. Something along the lines of, “Well, it’s gonna be a boy, because she was on TOP.”  And much laughter.  And I didn’t know if I could laugh with them or if I was supposed to maintain my professional distance, but my GOD, you can’t write this stuff.  The girl was like, “Can all ya’ll be quiet until my 3 nurses leave, please!”  She was laughing.

And I was smiling.  Her *3* nurses; me included!

I hope she ended up ok.  We had meconium by midmorning and we started amnioinfusion.  And when I took her temp at 14:00, she had one at 99.1.  Hope that little baby boy ended up ok.

That was a good day.  A good day indeed.