Guest guest Posted March 22, 1999 Report Share Posted March 22, 1999 In a message dated 3/2199 RLPasquale@... wrote: Try up to 3 active laboring patients. You may think she is exaggerating but I'm here to tell you it's the truth, standards to the wind, we do end up with 2-3 active labor patients at a time. The only time you can hand them over, and only briefly and pray that the other nurse charts on them, is when you are pushing. We can tell stories of pushing with one patient, having to leave them with the aide (who are very competent, thank the Lord) and go check on another active patient. What are your policies for c-section moms on PCA's and keeping their babies in the room alone with them? I would appreciate knowing how all of you out there handle this. Debbie Ohio Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 1999 Report Share Posted March 22, 1999 We can have 3 laboring pt.s here in Texas too. The only time they are one on one is during pushing and actual delivery. We don't even get to one on one our MgSO4 pts. , TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 1999 Report Share Posted March 22, 1999 Even though I am not a nurse, I can attest to nurses having more than one patient at a time during labor, it's amazing, utterly amazing how they do it, I am half expect them to have roller skates on. And I do believe that I have heard nurses say that they haven't pee'd during a shift, or eaten, or had much to drink. Marna [OBnurses] 1 labor patient, I wish In a message dated 3/2199 RLPasquale@... wrote: Try up to 3 active laboring patients. You may think she is exaggerating but I'm here to tell you it's the truth, standards to the wind, we do end up with 2-3 active labor patients at a time. The only time you can hand them over, and only briefly and pray that the other nurse charts on them, is when you are pushing. We can tell stories of pushing with one patient, having to leave them with the aide (who are very competent, thank the Lord) and go check on another active patient. What are your policies for c-section moms on PCA's and keeping their babies in the room alone with them? I would appreciate knowing how all of you out there handle this. Debbie Ohio Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 Do you or does your unit have a copy of the book " Guidelines for Perinatal Care " by the AAP and ACOG? In it there are recommended Nurse/Patient Ratios for Perinatal Services. In the facility I work at we were able to use those to get our ratios changed. Now we staff according to those guidelines. It took us a while and we had to do a lot of calling to find out the staffing ratios in the other hospitals in this city, but it was worth it. Sylvia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 In a message dated 3/22/99 5:27:55 PM Eastern Standard Time, wbagnall@... writes: << What are your policies for c-section moms on PCA's and keeping their babies in the room alone with them? I would appreciate knowing how all of you out there handle this. >> It is very rare that our C/S are on PCA's, they usually get a lidocaine spinal with Atromorph or duramorph .25mg given along with the spinal. Similar in pain mgmt for intrathecal MS, in that we maintain IV access and do respiratory checks for 24 hrs. Pt rarely require anything else for pain and if they do, percocet or darvocet alternating with Motrin is usually more than sufficient. The C/S is up from bed within 6 hrs, foley out in 8 hrs, and generally doing very well. FOB or other birth partner is invited to stay during the hospital stay to bond and assist with newborn care. Most Dad's we work with love the opportunity to be " the boss " for a few days, doing diapers and handing baby for feedings etc. Our patient population is usually WANTING to go home at two days (scheduled repeat), three days for labor then C/S as they are usually more tired. We rarely rush anyone out, when they are ready to go, they go. We have an overflow unit, which has been very full lately< and if pt needs to be transferred to overflow they are usually given the option of early discharge with a home visit. Many opt for early discharge (I'm talking over 24 hrs vag delivery is early for us as most stay somewhere between 24 and 48), Also all Group B strep babies stay 48 hrs so Moms do to. Jan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 In a message dated 3/22/99 7:48:15 PM Eastern Standard Time, Plat@... writes: << We don't even get to one on one our MgSO4 pts. >> Ouch! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 We here in Cincy also use duramorph for C/S unless there's a contraindication. Usually works well. Kathy H. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 We also use duramorph for most of our c/s. Occ. we will have a PCA pump if a lady had general anesthesia for an emergency c/s or a failed epidural..but it's very rare. When I worked in Tallahassee, we used the continuous epidurals with the PCE pumps, and had good success with those also. I have only seen the PCE used twice in the 7 years in Orlando..both on Doctor's wives.... Lori Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 PS>>>with our duramorph moms we use standing orders from anesthesia for breakthru pain....Toradol IM, then po, Inapsine for vomiting, and Benadryl for itching, with an order for narcan drip for severe itching(rarely used) Lori Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 We don't use Toradol PP. If I'm not mistaken, I think it has an adverse effect on breastfeeding. We have the usual standing orders, Reglan,Zofran,Narcan, Benadryl,etc. Kathy H. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 We rarely have C/S patients on PCA pumps either. Like Jan said ours usually get Duramorph and don't need anything else until they can get po meds. It works well here. If a patient does experience the anesthesiologist usually has some IM med ordered and we haven't had any trouble with resp depression or any other problems with that. Sylvia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 1999 Report Share Posted March 23, 1999 In a message dated 3/23/99 9:52:05 PM Eastern Standard Time, birthrn@... writes: << Toradol has also been known to increase bleeding. We very rarely use it. >> This is the rationale given by our surgeons for not using it despite it being on our standing orders from anesthesia. The OB's usually write HOLD next to it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 1999 Report Share Posted March 24, 1999 Kathy H. wrote: >We don't use Toradol PP. If I'm not mistaken, I think it has an adverse >effect on breastfeeding. We have the usual standing orders, >Reglan,Zofran,Narcan, Benadryl,etc. Yes, you are correct. Breast feeding is not recommended while taking Toradol, because it hasn't been tested for side effects in pregnancy or after. Also, I'd have a question, since some of those C/S moms may have/have had PIH, Toradol may have a negative effect on the kidneys, and those clients/patients may have some kidney impairment. I used to take Toradol when my kidney stones made appearances that I couldn't ignore <g>, and it worked great, and I don't like to take narcotics, and even if I do, I won't take them while I'm working. My renal specialist though told me not to take it, as it processes mostly through the kidneys, and mine are compromised. ----Jeanine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 1999 Report Share Posted March 24, 1999 Toradol has also been known to increase bleeding. We very rarely use it. Sylvia Quote Link to comment Share on other sites More sharing options...
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