Needle Stick, Limbo and Stuff

That just about sums it up. All done. The End. I wish I could just re-title the next month's worth of blog as "Interim Permittee", but now the name reaches back to the beginning. It will change again because everything is in flux even as I sit here doing nothing waiting to learn when I can take the boards. Here I am in limbo; not a student nurse, not a Student Nurse, not a nurse. I'm an Interim Permittee. That's a person who occupies the time and space between finishing school and passing the boards. So my last week of nursing school went something like this:

No one could start the IV on the former heroin addict (I was able to draw blood from the IV start, but couldn't thread the catheter) and so an anesthesiologist was called in and s/he re-capped the needle on the lidocaine after using it on the pt (Double bad practice = re-using the needle in case another site needs to be used plus re-capping the needle. Hey, all the cool kids do it. Heck, I had done both earlier.). The needle curled under and went right through the cap and into the anesthesiologist's finger. Blood in the finger of the glove: it was a really bad stick. I had to tell the Dr the pt had a blood-borne disease.

So, kids, the lesson here is Don't Re-Cap Your Needles. Yeah, I know you just learned it in school, too, and you said to yourself at the time, "Why would I ever re-cap a needle?", but it's common practice and it's a major cause of needlesticks. I saw it happen.

My very last day I picked a pt who was at 9 cm thinking that we'd have a baby and she stayed at 9 all night and then came the ugly late decels and the trip down the hall to the OR where I said goodbye to the pt right after shaving her abdomen. Who knows how the story ended. And with that I walked out of the hospital and into the night and out of nursing school without so much as a round of applause or a handshake or... well, anything. I was just finished.

The Velamentous Insertion

This is not really about a velamentous insertion. I just like the sound of the words and I saw an umbilical cord recently that had one (fine outcome; velamentariness not discovered until the placenta was delivered). You can read all about cord troubles here.

Last night, with two patients, one an antepartum patient and one a patient being induced for a low amount of amniotic fluid, I ran into my patients (that'd be mom and baby) and FOB (father of baby) from the night before. They were in the hallway in front of their labor room, babe in plastic wheelie bassinet and mom in double hospital gowns, taking pictures. They called me over and wanted a picture with their cutest little one. I picked the little swaddled fella up and I'm sure I had the world's biggest smile in the picture; mom had scooted next to me, and also had a huge smile.

I love L and D. It's the drama, the blood (it looks like the scene of a crime sometimes after a birth), the family hovering and worried then ecstatic with tears flowing, the cute babies (and even the not so cute ones), being on the verge of life (and death; that happens, too), the tedium of a long labor, the terror of a fast one, the fetal monitor with that quick as nervous baby heart beat in the background when you're starting the IV

which, by the way, I finally did successfully. Yes, last night. There was something about last night wherein everything seemed to come together. I did more things right than wrong, I had patients who deserve a framed picture on the wall in some sort of patient-of-the-month montage and then the happy family from the previous night so excited for me to be in a picture holding their baby and so sweet and thanking me.

The patient actually *fell asleep* while I was starting the IV. I'm all about using a little intradermal lidocaine bleb now! I told her, "This was the easiest IV I've ever started!" which, when translated meant, "This was my first successful IV!"

I just feel like The Nurse now. Somehow. And, more than that, I feel like The L and D Nurse. I have only two weeks of nursing school left and then, who knows. The word on the street is that there are no jobs for new nurses. I'm not going to worry about it. Things will work out, but,

Here's My Question For You:

Should I change the name of my blog when I'm no longer a student?

I'd like some opinions. I'd like to call it The Velamentous Insertion, but then my readership would, likely, drop from three to one (Thanks mom for your loyal readership!).

That is a portrait of me drawn by my daughter. I'm wearing my scrubs (as you can see). No. I don't actually have problems with my liver.

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.