New Year's Chaos

So, it is the last few days of the year, and what does every pregnant family want right now? A birthed baby, of course. Gotta have that tax deduction and there are only a few days between Christmas and New Year's in which to get in all these deliveries so healthcare providers don't get their holiday festivities interrupted.

I hate working this week, but I knew we were going to be slammed, and being on winter break from school, I have the time and need the money.

Last night was a zoo......eight scheduled procedures to come in, not to mention the five triages we had. Three of those stayed and two or them delivered before shift change. Tonight will be no different.....there are seven procedures scheduled and we will be tightly staffed because all those who came in last night will be delivered so half the scheduled staff will be doing postpartum tonight. This will leave just enough nurses to take care of the scheduled procedures.......heaven forbid a triage walk through the door. The powers to be just don't understand that! They fill us up with procedures and make no concession for the women who actually go into labor and just show up.......what? women can actually go into labor on their own? you don't have to schedule their deliveries....grrrrrr!!!

Okay, just had to rant a little.

Hope everyone is gearing up for a great start to the new year! Bring on 2009!!

Unintentional hiatus......catching up

Okay, so I feel like a bit of a slacker. I haven't blogged in two months and I told myself when I started this that I would keep up with it. I have a bad habit of starting something and being all excited about it at first and then, well.....

I must say that ALOT has happened in the past three months. I managed to survive my second term in grad school and again walked away with three A's. I loved the decision making course, it made me really think about how to do a history and the questions to ask and how to put your biases aside to provide proper and thorough care to patients. The nursing theory class, well yuck! I don't enjoy writing papers and that class was nothing but papers! I did enjoy my reproductive physiology course.
The last week of that term I went to Houston, TX to work as part of the disaster relief effort from Hurricane Ike. Yes, I got paid for the stint. If I had the money I would have volunteered my time but I don't. I am a grad student with loans and a family that consists of three children......I have bills, lots of them!
The week I got back from Texas we lost my 23 month old niece. Very long story there, one of which I cannot go in to no matter how badly I want to. Her death was ruled a homicide and the case remains open at this point. The family has had a hard time dealing with this but we will pull through.

So, the third term of school began the first full week of October. I only had two classes this term compared to three classes for the first two terms. I thought this would be a relief to only have to focus on two classes. WRONG!!!!!! This was the worst term I have had in school, any school, EVER!
I took Primary care, which turned out to be a great class. I learned alot and it was by no means easy, but I squeaked by with an A.
I also took Pharmacology. Let's just say, hell on earth! The class was supposed to be a "basic pharmacology" class, to prepare us with basic pharmacology knowledge going into our more advanced midwifery classes. Well, nothing about this class seemed very "basic". I went into this class knowing it would be a challenge and would not be a shining moment for me but, I had no idea. I actually failed the third test in this class, I cried and lamented and lost sleep!!!! Somehow, thanks to the open book quizzes, the alternative med assignment and the extra credit project I managed to barely squeak through with an A, and I mean barely. This had to be the most mind boggling class for me, I just didn't get it. I would study, study and study some more and then take the test and just do horrible....even when I thought I had done well.
I have never been so happy to see a class be finished!

So, this next term I am taking Antepartum, Postpartum/Newborn and a Community assessment class. I have already gotten my Varney's midwifery and have started reading. It's a great book! I already love it! It is such an easy read, almost poetic.

Well, I hope everyone had a Merry Christmas! We sure did! We ate too much, played alot and just enjoyed being with family.

I promise to not go so long without blogging. I think it is a bit therapeutic for me and I should do it more.

Well, in case I don't post again before next Thursday........Happy New Year!!! May you have a prosperous and healthy 2009!!!!!

Help the March of Dimes fight Prematurity!!!!!

Everyone who is concerned about the health of babies needs to be involved in the March of Dimes, they are such a wonderful organization whose only concern is healthy babies.

They have started a campaign called the Petition for Preemies. Join the rest of us fighting for these little ones and sign it!!

Mothers are casting their votes for healthy babies and asking all Americans to join them in signing the March of Dimes 2008 Petition for Preemies. They’re putting public officials – and all Americans – on notice that it’s time to focus on the growing problem of premature birth, the leading cause of newborn death.

Go here to sign the Petition for Preemies
1. We urge the federal government to increase support for prematurity-related research and data collection as recommended by the Institute of Medicine and the Surgeon General’s Conference on the Prevention of Preterm Birth, to:
(a) identify the causes of premature birth;
(b) test strategies for prevention;
(c) improve the care, treatment and outcomes of preterm infants;
(d) and better define and track the problem of premature birth.
2. We urge federal and state policymakers to expand access to health coverage for women of childbearing age and to support smoking cessation programs as part of maternity care.
3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.
4. We call on businesses to create workplaces that support maternal and infant health. View our 14 recommendations. (workplacecriteria.pdf, 90kb)

A Midwife on a Mission

Ruth Lubic is one amazing woman! I hope I still have this kind of energy and passion at 81 years young.

http://www.cbsnews.com/stories/2008/09/08/eveningnews/main4428250.shtml

Towards the end of the interview the reporter says that Ruth keeps babies out of prenatal care when he means intensive care (NICU).

Abbreviations

Okay, at one time I said I would post a list of abbreviations used in labor and delivery......so here it is and I have included some gyn stuff too.

I'm sure if I have missed anything all my OB friends out there in bloggerland will chime in and add to the list (or make any corrections :)

AB abortion
AP antepartum
MAB - missed abortion
SAB - spontaneous abortion
TAB - therapeutic abortion
EAB - elective abortion
AFP Alpha Fetoprotein
MSAFP - maternal serum alpha-fetoprotein
AMA advanced maternal age
AFI amniotic fluid index
AROM artificial rupture of membranes
BBOW bulging bag of water
BPP biophysical profile
CPD cephalopelvic disproportion
CST contraction stress test
CT chlamydia trachomatous
CVS chorionic villi sampling
D & C dilatation & curettage
D & E dilatation & evacuation
DIC disseminating intravascular coagulopathy
DI/DI dichorionic/diamniotic twins
EDC/EDD estimated date of confinement/estimated date of delivery
EFM electronic fetal monitoring.......cEFM continuous electronic fetal monitoring
EFW estimated fetal weight
EGA estimated gestational age
FAVD forceps assisted vaginal delivery
FHR/FHT fetal heart rate/fetal heart tracing or tone
FLM fetal lung maturity
FSE fetal scalp electrode
FTP failure to progress
GBS group B beta streptococcus
GC gonorrhea
GDM gestational diabetes mellitus
GH gestational hypertension (the most currently correct name for PIH)
GIFT gamete intra-fallopian tube transfer
G_P_ gravida, para (TPAL - term, preterm, abortions, living children)
GTD gestational trophoblastic disease
HCG human chorionic gonadotropin
BHCG - beta human chorionic gonadotropin (usually serum)
UHCG - urinary human chorionic gonadotropin
HELLP hemolysis, elevated liver enzymes, low platelets
HSV herpes simplex virus
IP intrapartum
IUD intrauterine device
IUFD intrauterine fetal death
IUGR intrauterine growth retardation
IUI intrauterine insemination
IUP intrauterine pregnancy
IUPC intrauterine pressure catheter
IVF in vitro fertilization
LDR labor, delivery, recovery (all in one room)
LDRP labor, delivery, recovery, postpartum
LEEP loop electrical excision procedure
LGA large for gestational age
LMP last menstrual period
LOA/LOT/LOP left occiput anterior/left occiput transverse/left occiput posterior
LOF leaking of fluid
LTCS/LVCS low transverse C- section/low vertical C-section
MBU mother/baby unit
MVU Montevideo units
NB newborn
NBN newborn nursery
NICU neonatal intensive care unit
NST non-stress test
NSVD normal spontaneous vaginal delivery
NT nuchal translucency
NTD neural tube defect
OCP oral contraceptive pills
OT occiput transverse
PCOS polycystic ovarian syndrome
PID pelvic inflammatory disease
PIH pregnancy induced hypertension
POC products of conception
POD/PPD post-operative day/postpartum day
PP postpartum
PPH postpartum hemorrhage
PPROM preterm premature rupture of membranes
PROM premature rupture of membranes
PTL preterm labor
PUBS percutaneous umbilical blood sampling
PUPPPS pruritic urticarial papules and plaques of pregnancy
ROA/ROT/ROP right occiput anterior/right occiput transverse/right occiput posterior
ROM rupture of membranes
SGA small for gestational age
SRMC single room maternity care
SROM spontaneous rupture of membranes
STI sexually transmitted transmitted infection
SVE sterile vaginal exam
TOL trial of labor
UC uterine contraction
US ultrasound
VAVD vacuum-assisted vaginal delivery
VBAC vaginal birth after C-section


GYN related abbreviations
AGUS atypical glandular cells of unknown significance
ASCUS atypical squamous cells of unknown significance
BSO bilateral salpingo-oophorectomy
BTL bilateral tubal ligation
CIN cervical intraepithelial neoplasia
EMB endometrial biopsy
ERT estrogen replacement therapy
HGSIL high-grade squamous intraepithelial lesion
HPL human placental lactogen
HPV human papilloma virus
HRT hormone replacement therapy
HSG hysterosalpingogram
LGSIL low grade squamous intraepithelial lesion
TAH total abdominal hysterectomy
TOA tubo-ovarian abscess
TVH total vaginal hysterectomy VAIN vaginal intraepithelial neoplasia
VIN vulvar intraepithelial neoplasia

Tired and unmotivated............

I want to be done with midwifery school......NOW! Sorry for the shouting, just feeling unmotivated and just plain over it right now.
I am stuck. I have been working on a theory paper for a week now and haven't made squat for progress. I am over this paper and over this class! Because I have been so hung up on this stupid paper I haven't done my reading for my other two classes in a week. I think if I can just get this paper out of the way the rest of this class will roll pretty well and I can get the other two classes back in gear.
I am on week 7 of this term, so just five more left before the next term starts. I am in a good place with the reproductive A&P class, just two more tests left to take. The health assessment class is interesting so I can really get caught up on it this weekend pretty easily. Just finding the motivation to pound out the theory paper is my real issue right now.

I am also feeling a bit weepy today....worked last night and didn't make it home in time to see my oldest before he left for his first day of middle school :(
He is attending a local private school that is very big on personal responsibility and independence. I am used to dropping him off at school at 0845 and picking him up at 1530, at a school that is 3 minutes from my house. I used to eat lunch with him at least one day a week.
Now, he gets dropped of by his dad at 0730 and remains at school until his dad picks him up at 1720. He has cross country practice after school, so he is not just "hanging out" until his dad get there, he actually only has 20 minutes from the time cross country ends until his dad gets there. This school is also 30 minutes from my house and the campus is HUGE (like >600 acres huge), so I don't foresee the weekly lunches anymore (esp. not with gas prices the way they are). The school he attends is also a boarding school so there are always students, faculty and many other adults around.....it is a very busy campus.
I can't wait until he gets home today......I want to hear all about his day. I know he's totally loving it! He has been excited for school to start ever since he got his acceptance letter, way back in March!

I am going to go take a quick nap, throw some tacos together for supper and then take the middle child to football practice.

Tonight I am going to work really hard on that paper.......maybe if I type it here I can hold myself to it :)

Not 1, not 2, always 3!

I worked at the big house again last night. Since I've been back I've only worked L&D one shift, all the others I have been down on the HRPU (pronounced harpu) the High-Risk Ante-Partum Unit. I do like the HRPU, usually have about 3-4 patients depending on acuity and once you get everyone their meds and tucked into bed the nights tend to be quiet. Just an FYI, never say the Q word (quiet) on a L&D unit, it is sure to get you many dirty looks.....nurses are a superstitious bunch!
Monday night they put me on L&D, and initially I had two patients. One patient had just delivered so all I needed to do was get her recovered and moved over to mother/baby unit. The other patient was a 27+ weeker who had limited prenatal care and had arrived an hour earlier with her water broke. Well, I ended up having to pass off the fresh delivery because the pre-termer didn't even have an IV going yet.
I got her IV going and gave her; fluids, stadol, antibiotics, steroids (for fetal lung development) and magnesium sulfate (tocolytic, help calm the uterus down so it will quit contracting). Unfortunately, despite our best efforts she delivered shortly after midnight by repeat c/s (baby was breech).....under general anesthesia, because she could/would not sit still for regional block.

We had two other 27 weekers come in and deliver on us that night as well, despite us doing all we could to keep those kiddos in!

Just another example of something every labor nurse knows......bad karma always comes in three's!