Sunday, February 22, 2009

Good And Bad

The ob used the amnio-hook (looks like a thin knitting needle) to break the pt's water. Sometimes when this happens the cord can suddenly get squished in the wrong way. No one said the word "prolapse", but one minute later that babe's heart rate plunged to 60 and stayed there one minute, two minutes, OB says, "I can only take one more minute of this," three minutes and suddenly there's a crowd in the room, the sodium citrate is in my preceptor's hands and being downed by the pt who is already wheeled out the door in her bed and to the OR for the emergency c-section. Babe's heart rate comes up a bit in the OR so the pt lucked out and got a spinal rather than being put under.

Babe comes out and the cord is around the neck, under the arm, around the abdomen, around the leg. It looks like this little one had been tied up in umbilical cord and the wee one was big and green-tinted from the mec but cries the instant s/he hits mama's tummy and then doesn't stop crying, thank goodness.

There are times when a c-section is the best of western medicine. It's amazing how quickly a baby can be removed via surgery and, when the baby crashes like this one did (we'll talk about induction in a sec here) then we can all sing the praises of technology and advances in medicine. But that's the tough thing, too. C-sections represent the worst in western medicine, too. "Failure to progress"? What does that mean? Clocks are ticking. Women are supposed to open their cervices in labor at the rate of 1 cm/ hour. Are you kidding?

And even at the groovy, pro-women and birth-is-a-positive thing hospital I'm precepting at, induced labors happen for some questionable reasons. "Cervidil was placed." I see that up on the board and sometimes it's just because the ob wants all of his/her pts to deliver when the ob is going to be on for the night. Or they are 40 weeks and a day and, hence, "post-dates". So, they get cervidil or cytotec in hopes of forcing the cervix to "ripen" and then we "pit" 'em (give them pitocin via IV at gradually increasing rates). Then clocks are really ticking, especially with ruptured membranes (broken bag of waters). Sometimes things don't go well when you try to force the body to do what it is not ready to do. Pitocin makes labor much more intense and painful, so then the pt gets an epidural and a foley catheter and a blood pressure cuff constantly inflating on the arm. And lots of obs pit all of their pts just to move things along.

But, with my pt with the nuchal cord and the green babe, that c-section was going to happen at some point by the looks of things. It was good that the ob was in the room and ready to go even if it was stupid to AROM (artificial rupture of membranes) the pt in very early labor.

So, I'm graduating in three weeks and there are no jobs for new nurses in my neck of the woods. We're all being told to move out of state or at least to places no one wants to live to get a job. So, I'll go from being Student Nurse to Nurse in Limbo. It's frustrating and discouraging and I've stopped studing for the NCLEX because I feel...defeated, exhausted, and, well, what's the point?

The cupcakes! You've got to try these. Use my usual recipe for chocolate cupcakes and then this here recipe for cinnamon-chocolate frosting and yum! I left out a tsp of the cinnamon and dusted the cupcakes wih it and added red hots. Next time I'll add more chocolate to the frosting.

NCLEX tip #3: Memorize your fundal heights. Geez, I ALWAYS get this wrong and it shows up in so many px (practice) tests: "click on the image at the spot the fundus should be at 23 weeks gestation/ 2 days postpartum" (whichever) and I could tell ya, I could feel it on a pt, but on paper/ a computer screen I never click the right spot.

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