Antes

Last week and this week I have been on Antepartums. This means moms that are still pregnant (and usually way too early to deliver) and on bed rest in the hospital. Mostly my day consists of trying to find babies in utero (with a doppler or the external fetal heart monitors), reading strips, and attempting to control symptoms of preterm labor, gestational diabetes, pregnancy induced hypertension. There is a lot of communicating with the doctors and other members of the healthcare team trying to keep things from getting out of control. Usually it works.
There is a patient on our unit who has been here since her 19th week of pregnancy. This week she is at 29 weeks. That is ten weeks of hospital time, laying in a bed, praying that her twins don't come too early. Needless to say she is frustrated and tired, and not always the most pleasant to deal with, but we have all come to care very much about her and the outcome of her pregnancy. Last night she started having contractions that we couldn't stop, and today after a small bleed, her cerclage (stiches that were placed in her cervix to prevent it from dialating) came out, and she dialated to 6-7. So they rushed her back to the OR and delivered her twins this afternoon. Mom is doing well, and both babies went to NICU. It was a tense afternoon for those of us who cared so much, but I think this is a best case scenario. We also have a mom with triplets inside, but hopefully she will stay pregnant for quite a while longer.
Today I got my "cycle" for the upcoming months. This isn't my schedule per-say, but it is the pattern that I work. Every month is the same: I always start on the first Wednesday. So while I can't always know dates, I know that the first Saturday, the second Saturday AND Sunday I will work, but the last two weekends I have off, and the last weekend I have 5 days off in a row- which is AWESOME! That means I can go visit my people! Yay! I'm just happy to be able to plan things in advance now that I know what to expect.
Oh, and also, we had a baby last weekend named: (get ready) KNOWLEDGE SINCERE. Seriously.

Boppi Blanket

So it was another super busy week in the nursery. Tuesday I was pretty much on my own while my cohort was at lunch when we got two new babies at once. Up until this point, I was feeling pretty good about being in the nursery--I thought I could handle it. One baby at a time. But two made me feel a little...crazy. I was still shaking when I got to my car that day. It's intense!
This week I also learned about a new and wonderful device we have in the nursery. One day a "code" was paged overhead. I realized that there are no speakers in the nursery, so if there was an emergency code, like a fire or a tornado that I need to know about, I might not find out. I inquired about this and my coworker agreed that it was poor engineering. "But," she said, "if there is a fire you get to use the Baby Boppi Blanket!" I raised an eyebrow, so she pulled it off the top shelf of our linen cabinet and put it on. Later I had to model it myself. Ladies and gentlemen, I present, the fire safe, Baby Boppi Blanket:
Oh yeah, you are supposed to just slide a baby into each of those pockets (there are two more on the back) and then run down all eleven flights of stairs to rescue babies from the fire. To me, this raises an important question: Which is worse: Burning in a fire or brain damage from suffocation and being jostled around in the baby boppi blanket?

Babies, Babies, and MORE BABIES!

As you may have guessed from the title of this post, this week I was in the nursery, NICU, and breastfeeding clinic. Which meant I was surrounded by babies, all week. I also worked 5 eight hours shifts, and while I know that's what most of the world works, getting up at 5:30 5 days in a row made me want to cry! And as this picture indicates- it was pretty intense at times! The way the nursery is intended to be staffed is with one nurse. One nurse and sometimes as many as 25 babies! The good part about this plan is that our unit nurses the dyad-meaning the postpartum nurses are trained to care for the moms and the babies as a pair, and we try to keep the babes in the mom's rooms as much as possible. First thing in the morning, when the pediatricians are doing rounds, all of the babies come hang out in the nursery. One starts crying, upsets his neighbor, and the next thing you know the whole room is screaming! Not very relaxing! As soon as the doctors are done we try to get the babies out to the rooms. Before a baby can be discharged, there are a whole list of things that need to get accomplished. They have to get a hearing screen, pictures taken, get blood drawn for the PKU test (genetic tests we send away to the state), and get their cord clamps removed (just to name a few). It is the nursery nurse's responsibility to make sure all of this gets done. The other part of the puzzle is that we admit all of the new babies that are born throughout the day. There are alot of things that have to happen within the first hour of life. The babies get a full assessment (takes about 10 minutes), vital signs get checked every half and hour for two hours, they get their "eyes and thighs" (erythromycin in the eyes and hep. B and vitamin K shots in the thighs), and they get their first bath. It gets comlicated when you have a twin birth, or a vaginal delivery and a c-section two minutes apart. HECTIC! Twice this week we had eight or nine babies born during the eight hour shift I worked. Yesterday, doing a new admission, I had an important first- I got peed on. My fault, I was standing at the end of the warmer, and I hadn't put a diaper on him yet...next thing I know-pee all down the front of my shirt. Ugh. Little boys are trouble. I also spent a day rotating in the breastfeeding clinic (interesting, but lots of boobs). And on Wednesday I spent a day in the NICU. They say we might float down to the step-down NICU sometimes (where the feeder-grower babies are, nothing too intense).
As most of you probably know, I went into nursing, in short, because of babies. I wanted a job where I could get paid good money to hold babies all day. Later in the journey I found the Neonatal ICU, and thought that that was my future-as a NICU nurse. I knew it was unlikely to get a job in a NICU right out of school, and the position I did get was almost too-good-to-be-true. However, going into it, I figured I would tolerate the moms, but nursery would really be my forte. After this week, I find myself anxious to get back out on the unit with the mommas! The one thing I really like about the postpartum nursing is the teaching...and you can't teach much to a baby. I was really suprised to find myself feeling this way- I'm a baby nurse! But I guess it just goes to show that God really does have a plan and things happen for a reason. Next week, more babies.

Moments

Sorry it's been a while, but life is busy when you're a working girl! And I've found that after a long (exhausting, both physically and emotionally) day, the last thing I want to do when I get home is sit down and write about it. I need some debriefing time or something. Still loving it though.
This week was my last week training on postpartum. This means that for the remaining eight (or so) weeks until I am off orientation, I will be in the newborn nursery and training with antepartum patients. In the past few weeks I have become very comfortable doing assessments, teachings, and even taking care of fresh post-op c-sections. By the end of yesterday, I was an EXPERT at discharges, sending 4 people home throughout the day (technically 8, when you count the babies too). There are about 400million steps to a discharge, so I feel pretty accomplished being so skilled at them already.
There were also some fun moments throughout the week. On Monday, a person I was friends with throughout most of my childhood and adolescence had a baby. While she and I no longer talk, it was fun to be able to meet her son in his first few moments and get to congratulate her family. Thursday I got an "Applause Card" from my boss. This means that a patient singled me out as having given her great care, and I get a free drink on Carle to thank me for it. Yesterday I saw a new dad not only gag, but vomit while attempting his first diaper change. (We're talking full on, hurling into the toilet 3 times here people)! I stepped out to get him a glass of water while the mom had a go at the diaper. The look on her face when I came back in the room told me that she wasn't much more successful. "It's not coming off" she said, "should I use soap or something?" I tried to hide my chagrin, and said, "no, just put a little more muscle behind it, meconium is thick, but it will come off". To which she replied "But her skin is so delicate, I'm afraid it might tear".
There are also those moments that in actuality, are very sad, but you just have to laugh to handle it. For example: A new mom's drug screen came back positive for marijuana. When questioned about it she said "Well, yeah, they told me I couldn't smoke cigarettes anymore because I'm pregnant, what am I suppossed to do?". OK. Or another new mom who's drug screen was positive for cocaine and alcohol (and as a side note, no, she did not get to take her baby home). When I was taking care of her after her c-section she complained of itchiness (this is a common side effect of morphine). When I brought her some benadryl she said "Ain't it funny, I'm itchin like a crack-head!" Yeah. It's not quite as funny when you actually are. Then when her friend mentioned that the baby looked awfully pale (both mom and "dad" are african american) she says "no, she'll darken up. She's gonna darken up", then after a quick glance at the now-frantic-looking dad, turning to me and grabbing my arm while looking me in the eye "She WILL darken up, right?!" Um...
My job also raises some interesting moral questions. I have found that some days, as you may have guessed already, it is like the Maury Povich Show. Part of our job is making sure that birth certificates and paternity papers get signed. The law states that if a woman is married, her husband's name goes on the birth certificate. Regardless of weather or not he actually fathered the child. He can waive this right by coming in and signing a document giving up paternity. So we have some interesting problems arise because of this law. Like a mom who is married, but has been separated from her husband for 9 years. She has been living with another gentleman for 3 years and he fathered this child, her husband now lives in another state. We aren't allowed to let them leave the hospital until both parents sign the birth certificate. Hmm. And the paternity papers...These papers are not required, but recommended in the case of unmarried couples having a child (if the mom were to die without this signed, the dad would have no legal rights to the child). However, by signing these the man is assuming responsibility (legally) for the child and also waiving his rights to genetic testing. So if it turns out that the child is not his, but he's signed the papers, he still has to pay child support. So, we have situations like: the man is about to put his John Hancock on the paper, and after listening to my speech about genetic testing, mom says "um, honey, you might not want to sign that", you can imagine the drama that unfolds.
Ok, wow, long post, my bad. Next week I'm in the nursery and I get to go to the NICU for a day, but I have to work 8 hour shifts, all five days of the week! Yuck!

"The Katies"

So last week was very informative, but really long and sometimes boring. Carle is trying to start an OB nurse residency program, so last week was spent in residency class. A residency is a "clinical, professional and personal support system that helps new nurses transition from student to confident nursing professional" that consists of courses, preceptors, mentors, and debriefing sessions for the residents. Some of you may remember that I had applied for a few residency programs originally, so it is nice to accidentally end up in one. I ended up with a random low grade fever for the second half of the week, which made it even more challenging to sit through 8-5 classes!
This weekend I drove to Chicago to have some time with my girls and have a mini baby shower for Liz. We got all dressed up and went to high tea at the Four Seasons. It was very fancy and fun!
Today I was back up on Post-Partum. Neither of my two preceptors were there today, so I got stuck with a random nurse named- guess what- KATIE! As it turns out, we have very similar personalities and worked well together. She is full of sass and sarcastic witty comments...much like another Katie I know...we ended up introducing ourselves to patients as "the Katies"! I got to do lots of fun nursy things: give flu shots, discharge teaching, check billirubin levels on babies, suction a baby that decided to choke in front of me...feel lots of funduses (the fancy nurse word for top of the uterus, see picture below)...it was a good day- at least until the end.

There is a patient on our unit who has been hospitalized for about 3 weeks. She is 22 and pregnant with her 6th child. (for those without quick math-she has been pregnant almost every year since age 16). She has been on bedrest for the past three weeks, and we have all taken turns caring for her a couple days at a time. Today, finally reaching 34 weeks (the gestation doctors decided would be safe to deliver at) she was induced. After hours of labor she started hemorrhaging and they had to take her to a crash c-section. The baby was rushed to NICU and as soon as her bleeding was under control they rushed her down on the stretcher to say goodbye to her baby. He is not expected to make it through the night. I am blessed to work on a unit that is normally very happy, but that might just make these rough times even rougher...It was especially hard becasue we all had spent time with her and seem to be greiving this loss as a unit.
In other news, I got my H1N1 vaccine today, so no piggy flu for this girl! Off to bed!

Baby Catching

So this week I felt more and more like a nurse. Yesterday and today I was in Labor and Delivery...and boy have I learned a lot! Like I learned that if a mom says "I need to get my pants off and lay down, the baby is coming" he is coming, and no, he will not wait for the doctor (or any experienced individuals) to come into the room, so when you put your hand out--expect that you will be holding a tiny head as it enters the world! (three times this happened in 2 days-once to me!) See the people in the picture and how they are all nice and gowned and masked? Yeah, me, not so much...I also learned that when I call a doctor, and tell them that I need an order for such-and-such, they just trust me, because I'M THE NURSE! And I learned that babies hear you talking, and if you are trying to find them (in utero) to put them on the fetal monitor, they will continuously run away, making you feel stupid--"outsmarted again, by a fetus!" And I learned that if the attending says "watch out, that bag is about to burst" you should step to the side or else you will get a face (and neck) full of amniotic fluid. (Luckily it was a resident, not me that learned that leason the hard way). I also learned that fifteen year olds are too young (duh) to be having babies, and they cannot handle the pain (You'd think someone was killing the poor thing, and then when she's checked, she's at 2 centimeters--that's 8 to go honey!). I learned that long after I go home at night, I will continue to hallucinate the "ding, ding, ding" sound of the fetal monitor alarms. Also, I learned that I have A LOT to learn! One (of many many) questions I have is "when you are checking a cervix for dilation...where do you look? I mean where are your eyes suppossed to go when your fingers are doing the splits inside some lady's who-ha? (sorry too much info?)...but it's AKWARD!

Anyway, the miracle of life still amazes me- every time I think- "un uh, there is no way that big huge thing is gonna fit through that tiny little opening" and then it does. AMAZING! And I cry. Every time. Not as much as the babies though, so I think I'm doing just fine.

What a DAY!

So Thursday was my first twelve hour shift, and apparently I had blocked out my memories of 12s from the internship last summer, because I didn't really realize what I was getting myself into! I suppose the other difference is that I'm not a student, or and intern --I'm the nurse! I can't say "Let me go check with your nurse" anymore! Luckily for a couple months I still have a preceptor that I'm supposed to check in with, so I'm not totally on my own! Thursday, I was scheduled to be on post-partum, and between my preceptor and I, we had five patients, and during the day we ended up admitting two others. Earlier in the week there were maybe 3 patients at a time down in Labor and Delivery, and 5 or six up on PP (Post Partum). Well Thursday, every room was full (that's like 26-30 rooms on each floor)! It was crazy! I guess it was a good way to start though- jumping right in! Because of all the crazyness, I got to do a lot of stuff on my own-assessments, teachings, giving meds, putting on monitors, talking to doctors...it felt pretty nurse-y! The biggest event of the day (no pun intended) was the birth of a ELEVEN POUND- EIGHT OUNCE baby! That's almost 12 pounds--the old fashion way--no ce-section! We were all very impressed! When I got home, I pretty much passed out. And then I slept for 11 hours straight. And now I have a three day weekend to enjoy- back to work on Monday!