Tuesday, February 24, 2009

What a night!

I just had the best night in L&D since I began school. Finally my preceptor and I had laboring patients. Not cervidil inductions with "therapeutic" rest or Pitocin inductions. Actual patients who were in real labor, on their own terms. Freakin' finally! So when we got on shift, we had a pt who was pushing. Her birth was alright ... her OB showed up for literally five minutes, to yell at her for her pushing, impatiently cut a ML epis, delivered the baby, the placenta, threw a stitch in the perineum, gave a quick fundal massage and abruptly left. I swear he was there for no more than five minutes. We finished her recovery period, did pericare, fundal massage, took VS, straight cath'ed her, got her cleaned up and ready to go upstairs (postpartum). Pretty much within minutes, we were admitting someone else in actual labor. She was sent from the office because she was dilated 4/80%/-2. She denied feeling any of her q 2-3 minute contractions, but happily made progress until 7 cm when she politely asked for her epidural. She was such a wonderful patient. I wished we could have been there for her delivery.

My most favorite patient was this woman who suffered from Marfan's syndrome. She had a PMH of preterm labor and she labored quickly. She came in dilated 4/80%/-2 with regular contractions. We got her comfortable and she labored well. I got to check her cervix twice after she got her epidural. She went quickly from 5 to 7 to complete. She pushed maybe a half a push and her baby was born. Her OB was fantastic. Probably the best OB-attended birth I've ever seen. He didn't break down the bed and put the pt in stirrups. He sat at the edge of the bed, encouraged her to push when she felt ready, basically caught the baby, let dad cut the cord and told him to "present" his baby to the world. Dad picked up the baby and presented him to mom and grandma. Baby went immediately skin-to-skin with mom (this has been the first time I've ever seen the illusive immediate postpartum skin-to-skin.) Mom's OB said that his midwives had been rubbing off on him. Intact perineum, no rough man-handling of the placenta, no loud provider-directed pushing, no alarmist comments; overall, very reassuring, calm and collected. He stayed for a little while afterward, but it was a really quiet, low-key birth. Awesome way to end an 8 hour shift.

Thursday, February 12, 2009

Happy (almost) Valentine's Day

So it's almost Valentine's Day.  I've been super busy but that's nothing new.  My weeks are about 60 hours of actual stuff I have to do (work, school, and clinical.)  Plus I've been trying to buy a pre-owned car in my (non-existent) spare time.  Beloved is going out of town for Valentine's Day so she surprised me with one of my most favorite things (an Ed*ble Arrangement).  Ever since my family sent me one for my birthday, I loved them!  Isn't it cute?  I got her a couple of DVDs she wanted.  

This past week we had to attend an "interdisciplinary team training" day with M3 medical students.  It was mostly boring and somewhat interesting.  We did a simulation together where we were able to mix up what roles (med students could be nurses and vice versa.)  They focused a lot on Universal Precautions.  I'm pretty sure this entire day was someone's thesis as we had to sign consents, do pre and post-activity surveys.  Blech.  After that day, I went to clinical and attended a surgery where no Universal Precaution (ie. surgical time out) was done.  So much for integrating theory into practice.  

Clinical has been going well this week.  I circulated a stat section and recovered the patient.  She ended up going to my floor in Mother-Baby so I saw her the next day when I was working.  Actually, this past Tuesday I saw a lot of moms who delivered on Monday night when I was at clinical.  It's funny because they remembered my face & name.  Kinda hard to explain to them why I see them all the time.  But whatever.  I emailed  the powers that be at work to see if it would be fine for me to stay on as an RN once I graduate.  I don't anticipate any problems.  I'm 0 for 3 in the IV starting department.  The last one I tried I got flashback but then her vein just disappeared.  I'm not stressing it -- it's just one of those skills that you have to just keep working at in order to consistently get it.  

Another project I've been working on is purchasing a car.  It has been going on for the past couple of weeks.  I know I want a H*nda -- either 2006 or newer.  It's kind of been narrowed down to two or three cars.  I'm going to test drive one in a little while and see if I can talk their price down at all.  If not, I will buy the car I've had my eye on for a little while.  Either way, I will post pics once I get it.  I haven't had a car for awhile, but I've promised myself I won't abandon my bike, especially now since the weather has been so beautiful.  I can handle 70 degree weather in February.  Hopefully it's not a fluke.  

I've been eagerly waiting to see some expectant friends in L&D.  Maybe I will run into you all tomorrow?  I'll be in L&D from 3-11p.  Saturday I will be doing Mother-Baby 7p-7a.  Let me know.  

Monday, February 2, 2009

Blogging while stuffing my face

Alas, I am at the hospital again.  I swear I practically live here between my 24 clinical hours and my 24 actual working (and getting-paid-for-it) hours.  I have my computer because I came straight from school to the hospital.  Tonight I'm posted in HRP (High risk pregnancy.)  My new preceptor is a clinician so we don't have formal patient assignments.  Although non-traditional, I think it fairs better for me because I get to do things with different patients.  I pre-opped a C/S, drew labs, and urine specimens.  HRP is good for starting IVs and clinical skills, in general.  The next IV start is all me.  I think I should do alright.  No pressure.  Anyways ... my preceptor is all about teaching and letting me go out there and do stuff.  I'm all for that.  I might start an IV on GuyRN who has awesome veins.  We will see.  Only 3 and 1/2 hours to go.  I'm beat. 

Beloved made me such a wonderful dinner.  Rice & beans with some yummy steak in there.  She's really learned how to cook recently.  I love it.  Alright...I'm headed back.


I am annoyed for the following reasons: 

  • My teacher says that ORIF always refers to the hip.  Google "open reduction internal fixation" and you come up with more things than just a hip replacement.  
  • Same teacher says a moist wound bed is bad for wound healing.  Wrong.  
That is all for now.  At least I still have my coffee in my hand.