Amanda Anderson

I had a patient who was in the isolation room because he was a 29 day old baby from the OR who had surgery for pyloric stenosis.  I had a specific feeding regimen ordered by the surgeon.  This started with 15 ml of Pedialyte, increasing 15 ml until 45ml, then switch to breast milk.  I had to watch out for complications with tolerating feeds, such as projectile vomiting or refusing to feed. 

My other patient was a 28 week gestation baby, and I got to see a Lumbar Puncture done by the neonatologist to rule out meningitis.  I had to do rounds every3-4 hours to change, take vitals, and feed as ordered.  Viewing the Lumbar Puncture was a great experience.  I never knew that was routine for preemies to rule out meningitis.  .  The neonatologist explained his steps as he went through it and was a really good instructor.

I also got to see a newborn preemie who had SVT with a heart rate up to 298 bpm.  The neonatologist gave Adenosine and applied ice on the forehead to reduce the heart rate. It was exciting to see the neonatologist and nurses working together in an emergent situation to bring the baby’s HR down from 298, using a couple different interventions.

This was a very busy shift, we had mothers laboring all night and even a c-section.  When I first arrived I got to get dressed with the appropriate protective equipment for the cesarean section.  This mother was having a section because she had been pushing for 2 hours with no progression.  During the section I assisted with counting equipment and whatever else the nurse needed.  I also helped in two vaginal delivers, both who used no pain medication.  One mother used the birthing stool that uses gravity while pushing to get the baby lower in the birth canal.  On both newborn babies I did vitals and assessments every 15 minutes for the first hour and then hourly.  I also performed the newborn bath.

During this shift I got to help deliver a woman who had an all natural birth who pushed for 2 hours and end up having a very extensive 3^rd degree tear that took over 2 hours to repair and a physician had to be called in to do it because the nurse midwife can not do it.  I also helped with a primigravida who we administered Cervidil, a cervical ripening agent.  This patient had a history of opiate use during her pregnancy.   Her baby showed signs of respiratory distress and was bagged in the delivery room, that baby is now in the NICU. An ethical dilemma with this patient is that she knew she wanted an epidural from the beginning and kept asking for it, but  the physician on call didn’t want to come in just to observe the epidural doing into place because it was a nurse midwife delivering her and that is the protocol.  This was wrong because the patient didn’t receive adequate pain management.  I also helped another young mother with breastfeeding teaching and showed her various techniques.

This shift was pretty slow, as we did not have any deliveries.  There was a mother who came in at 31 weeks in preterm labor, in which I hooked up to the monitors and learned the nursing interventions done to cease contractions and try to prevent preterm labor.  These medications could be magnesium sulfate or turbatamine.  Towards the end of my shift a patient came in labor, who we set up the room for and put her on the monitors for when she would deliver after our shift.  I hope that maybe next week I’ll have the opportunity to see more deliveries, and possible a c-section!

This was my first shift on Labor and Delivery.   I got acclimated with the staff and unit, including becoming knowledgeable on where things are.  I was thrown right into a vaginal delivery as soon as I got on the unit, which was very exciting.  I was taught how to read contractions on the monitor and to watch how for decelerations in the baby’s heart rate.  I was taught different interventions should the FHR decelerate, such as turning the mother on her left side, administering oxygen, or turning the patient over onto her hands and knees to relieve pressure.  I was also taught how to break down a room after a delivery and how to properly remove blood of the utensils to send down for sterilization.  I also gave an IM injection on the patient.  I had a great first experience and I got more than what I expected out of the first shift.  I am very excited for my shifts to come, and my preceptor is a great instructor!