Week 8: winding down

Week 8 of the school term is winding down. Soon to start week #9.

I had an interesting phone conference with several other students and our instructor this week. It was a breastfeeding discussion type of "class". We all had areas regarding breastfeeding that we needed to research and be prepared to answer/discuss. It was interesting to hold a class that way. Except for that "one person" (not me) who kept dominating the conversation. I really hate that. Please be quiet - you don't have to answer or relate a story to each question/topic. Thank you. (Although, I do get your enthusiasm.)

Women's health is moving along swimmingly. Working this week on abnormal uterine bleeding and the sundry of medical diagnoses that are related to that topic. Next week, I'll be continuing with this topic, because it is such a broad area of women's health. Next week: test for this material, and submit a written case study. Fun fun! Believe it or not, I am really loving this women's health class. I didn't think I would enjoy it as much, but I know I have definitely found my calling when I can enjoy the variety of gyn related topics.

On the work front --- I've been the triage queen again. I actually don't mind working triage. It's a pretty hopping, busy place to be! Keeps my assessment skills fine-tuned. I also notice that so many women in their 2nd trimester have bladder infections. Of course, we have to work them up for preterm labor, and rule that out as well. But, more often than not, many (if not all) of these women lately have been discharged with a diagnosis of a UTI.

I also like triage because, quite simply, it keeps me busy. It makes the whole shift go so fast. Here is my issue: if things get s-l-o-w, I get b-o-r-e-d. Keep it busy, keep me moving, and I am a happy girl.

One more shift this week, then 2 lovely days off to get caught up on my studying!

Just a little synopsis of triage

This is a "typical" shift in triage on L&D.

Come on duty. There are 3 patients in triage. One to rule out labor, and she had a prior c/section. One with complaints of mid epigastric pain, but is only 24-25 weeks. Those first two patients had already been assessed on placed on monitors, with all lab work drawn by the previous shift nurse.

One patient that rolled in while you are getting report from the previous nurse - this lady is from the ER with very strange and vague complaints and is under 20 weeks. (Hey, they're pregnant. The ER ships em right up to us. No triage down there. None.) She has a laundry list of medical and possibly OB related complaints.

The rule out labor lady, prior c/section is having audible decels.

The epigastric pain lady is moaning loudly and dramatically when she sees you walk into the triage area.

The new ER transfer needs to pee NOW & and won't get out of bed by herself. She keeps hitting her call bell, and the secretary on the other side of the unit (the labor side, way WAY down the hall from triage) keeps calling your cell phone to let you know she needs to pee NOW!

Oh, and the great news? The most recent patient just came from the antepartum unit for a prostaglandin gel placement. She's turns out to be the actual sickest pregnant person in the bunch, but is the least demanding. She is quietly waiting in her triage bed.

What do you do first?

Oh, and you're by yourself. No secretary, no nurse's aid, no assistance available.





Just a little "taste" of triage on a very, very busy OB unit.

Triage: tales of woe and suffering

It's amazing how much we can fluctuate in our census on L&D from one day to the next.

For days, we were jam packed, constantly busy with rule out labors that were admitted, babies born left and right, etc. I know I've said that I enjoy doing OB triage, but it was just ridiculous when we were admitting EVERYONE, and there were no beds to admit them to on the L&D unit. And yet, there were more waiting in the waiting room, or standing at the main desk on L&D.

Note to the charge nurse: I really don't care if the patient is a high ranking official/has such-and-such of a profession. If she is not actively laboring or delivering right NOW, she will wait in the waiting room until I have a bed available! Seriously! I cannot discharge anyone until their MD/CNM has determined that they can go home! Without someone being discharged first, if I don't have an empty bed/stretcher for someone to be assessed, that means they have to wait.

Note to patients: unless you are actively bleeding, or the pain is severe, it's more than likely NOT an emergency, and you really should listen to your MD/CNM when he/she tells you not to come in to L&D. Oh heck, let's get to basics: CALL YOUR PROVIDER FIRST. It's their job to determine on the phone if you should come in to the hospital to be seen.

Note to the other triage nurse: if I can fully admit several patients at one time, then surely you can too. If you have time to gripe about not getting your admissions completed from 4 hours ago, then you have time to admit them, do you not?

Baby coming out right now? Yep, I will find a space for you, I will CREATE a space for you where none should physically exist.

Contractions started 10 minutes ago? HA! Girl, you're waiting in the waiting room. That woman over there with the baby coming out of her vagina? She comes first, thankyouverymuch.

Triage queen

First shift back after going to the conference, then subsequently being sick for too many days, and what happens? We're slammed on L&D. Completely, utterly full. I'm triage queen for the shift. No dinner break, but I did manage to get in a quick pee break. I must have triaged at least eight women tonight. Two of which ended up being admitted.

So, even though it sounds like it's not much (triage), you, as the nurse are actually taking care of each patient. It's not like it's just......BING! Triage you to this bed. Next!

Oh no. More like - computer entry of various data (pages of it, or so it seems.......) on each person. Sign consents. Vital signs. Place on EFM. Document everything that's said and done (teaching, assessments, blah blah blah).

Needless to say, I'm tired. And that nagging asthma cough? Likes to raise it's ugly self when I'm in the process of starting an IV. NOT a good time to have a coughing fit!!

This nurse is tired. Off to bed!!