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undergrad RN
I'm a twenty-something Canadian student. After stumbling through a few years of college, I finally managed to get into the nursing school of my dreams, where I hope to graduate in 2012 with a nursing baccalaureate degree. I want to offer an honest look into how a modern nurse is educated, both good and bad. Eventually I hope to compare my education to my day-to-day career and see how it holds up. Whatever happens, it should be somewhat entertaining. Find me on allnurses.com!
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Friday, January 14, 2011

Recap of Week 2 of Postpartum Clinical

First of all - THANK YOU to all the kind suggestions on counting apical pulses on infants. I started tapping it out and it helped me with the counting. Part of why I was so confused with the heart rate was, I think, because my stethoscope is so good. The Master Cardio picks up every little sound and I was hearing the lubbs AND the dubbs and I was having trouble initially telling them apart. I have got it now, though :) Also, when my instructor watched me do vitals, I saw her write in her little notepad that I was keeping a good count! Thanks again!

Let me see here -

Last Saturday, I was fortunate to attend a prenatal class at the hospital (it didn't feel very fortunate at 7 AM on my only day off, but I digress). The instructor was a PT, which surprised me, because she was so super knowledgeable I had her pegged as a RN/Midwife. It never occurred to me that PT/OT might actually function outside of the Ortho unit. Sorry, PT/OT, I was foolish to doubt you!

It was snowing like crazy here but luckily I made it and all of the expecting couples did too. The class was an excellent recap of pregnancy, labor, delivery, and postpartum. The instructor had some really good suggestions on mobility (PT shines through!) and pain relief. I was impressed to see her put the coaches to work. I always wondered how the dads felt in the delivery room. She gave them all jobs to do and made sure they understood! She provided LOTS of teaching on the pros and cons of epidural and c-sections. She made absolutely no doubt that labour was going to hurt but she also reinforced that she was giving the parents-to-be tools to deal with it too. She kept stating "You aren't SICK, you are HAVING A BABY. So, if the nurses tell you to do something for yourself, it's because you aren't SICK and you CAN!" We could have cheered :) It was a very good class to attend and I was grateful.

On Tuesday, we were back on the unit for another buddy shift (RN shadowing). I was assigned to the nursery, which is on the postpartum unit, and it's where the neonates come to be assessed after delivery before they rejoin their moms in their assigned rooms. The nursery was a very busy place. We had 2 or 3 infants in there all night. They come down from L&D "fresh from the oven", so to speak, and are weighed, measured, given initial assessments, Vitamin K, initial baths, and vital signs taken. I had just arrived in the room when someone parked a bassinet in front of me and told me to take the baby's vitals. Man - that was suuuuuch a gong show, I'm embarrassed to tell you about it.

Quick tangent - I upgraded my watch to the kind that pins on - which has been coming in extremely handy.

So I get the little bundle quasi-naked and get to work counting apical beats. I am excited to use my new pin watch. So there I am, stethoscope on this baby's chest, trying to count the heartbeats and remember which minute I started at and which "ten" I was on (90? 100? Wait, was that 80? I think it was 80). Of course when you take an infant's heart rate, you need to count for the full minute. So I kept having to start my minute over again and 5 minutes later I am proudly waving my notebook around saying I GOT IT!!! So the RN asks me for the vitals and I'm like.... oh.... I was so pumped about getting the HR that I forgot about all the other vitals. So another 5 minutes later I've got the axillary temp and I think I've managed to count resps but that baby kept making little noises and moving so who the hell knows. Then my instructor pops her head in and asks if those were within normal limits for neonatal vitals and I was so out of sorts I couldn't remember and I had to go check. FYI - they were! lol :)

My RN gave me an initial bath demo and then asked me for a return demonstration. The baby she gave me was a 9-10 lb behemoth (he was only 38 weeks! LGA? Um, yep) and, luckily, a total gem to work with. I had him stuck under an arm and he was so good in the bath - by good I mean screaming, but not too much - and omg my arm was getting so tired. Then I tried to get a C-hold around his scapula/neck/head and scrub some vernix with the other but he was so darn big that my hand started cramping. I have to say - washing vernixy baby was not my favorite nursing experience. Combing goopy mommy bits out of baby's hair was rating kind of high on my eeeeeeeuuuuuugggghhhhh scale. However I was very satisfied with the sweet smelling, cuddly result once he was clean and dry.

On Wednesday, I was assigned to my first patient - a mid-20s G5 P3 or something similar who was 3 days post C/S and due to be discharged the following morning. She didn't need much care at all, BUT I actually did get a chance to do some teaching. Probably two of my biggest hurdles to overcome were 1) actually touching and handling a neonate without dropping it, and 2) providing breastfeeding advice to a mom, having never been a mom myself.

This mom kept complaining of feeling engorged even though baby was feeding well. I managed to try some strategies with her including warm and cold compresses, manual expression, and pumping to a comfortable level. She actually listened to my advice, although it didn't work, and never made me feel like I was just some random student trying to tell her how it was (which is what I was worried about). I call that one a success. I am, however, having trouble assessing funduses (fundi?) on larger moms. Anyone have a tip for me?

Then I had my second assignment, Day 1 C/S first time parents. I was SO busy. I managed to do all kinds of things - my first initial bath witnessed by my instructor, infant assessment, Vitamin K injection. My patient family kept me busy too with PIH (pregnancy-induced hypertension) precautions (v/s q4h) and some voiding concerns. I got to d/c a foley, spike a new IV bag (3rd year skill, yippee!) and give teensy handful of meds including a Voltaren suppository, for which my instructor said I did a great job with good confidence(!). I did a full independent newborn assessment in the mother's room, which was scary because she kept asking me questions and she was a pretty intense first-time older mom, and I managed to provide some good teaching on Vitamin K and an overview of the infant assessment and things I am looking for. Then she wanted me to demo a swaddle. I think she was expecting some kind of pro-star super tight baby burrito but all I gave her was taco salad and I think she was a little disappointed, whoops :)

Today we had our first major project of the rotation, providing anticipatory teaching on various subjects and covering them from birth to adolescence. I did it last night, per usual, and was up all hours. My subject was on child learning and education in Alberta. It was an enjoyable topic, but like any project during clinical, effort is proportional to grade and the project was worth 10%, so... *shrug*

As an aside, I am still absolute crap at interpreting written orders. I don't know where physicians learned to use a pen but I don't understand how, if it takes close to the same amount of time to write legibly versus illegibly, this* isn't some kind of real patient care risk. I know it's kind of a laughable quirk for a lot of people, but it could really hurt somebody if they misread it. And I don't mean someone who's been practicing with that doc forever and knows what is ordered. I mean me, as a new RN in a year and change, coming onto a unit for the first time, or a float RN. Who the hell can read these? Don't we think that should matter a *tiny* bit more? Although it'll just be my fault if I fail to follow up with the doc. Because THAT takes so much less effort than just writing a tiny bit more legibly in the first place, right? {/soapbox}

*Add - I know this isn't a particularly bad example of illegible writing. But really, if I were to hand this in as charting, would my instructor call it okay and safe, best practice?

I am really happy with my clinical so far. I don't hate maternity. I don't know if I LOVE it, at least not yet, but it has definitely been a great experience for me. First day off since clinicals started tomorrow... we had a lot of snow fall here so I think it's a perfect day to go tobogganing! Have a great weekend, everyone :)

2 comments:

JANINE said...

Lol, I just upgraded from a wrist watch to a pin-on watch during this clinical rotation as well. Glad you're not hating Maternity. I enjoyed that rotation a fair bit!

Also, doctor's handwriting is the WORST.

Cartoon Characters said...

Actually, when you are participating in a resus of a baby it is a great idea when listening for the heartbeat to always tap it out so everyone can tell what it is without you having to say. Most peds prefer this.

Have you heard any murmurs yet? they are fairly easy to hear....

You don't need to take off the vernix, it actually is a good thing to keep on baby! :) I know people like to see "clean" babies, but really, vernix is a natural baby cream and is useful... :)

Feeling fundi of large women: try gently pushing the pannis towards her head and then gently scoop in from below the mound of excess fat...usually you can palpate. :) the fundus is always in the same place and the larger women can make it difficult to locate landmarks. Same with a fetal monitor - with the larger abd - lying on her side, move the u/s piece closer to the body as opposed to out on the actual abd. :)

Ya, common c/o - illegible handwriting of MDs...where |I have worked we can refuse to carry out orders if we can't read them and will contact the MDs to clarify or to rewrite. I am a big fan of printed/standing orders.

Glad you "don't hate" maternity! :)

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