Thursday, March 25, 2010

OB: 1

I feel like shouting it.  I entered nursing wanting to specialize in cardiovascular surgery, but was hoping something else would jump out at me and it has!

After a less than stellar rotation in pediatrics, I really doubted whether I was cut out to be a nurse, to "do what others will not do" as my first professor described the job.  I was struggling with the amount of information I had to jam into my head and the critical thinking type questions. 

After having a spinal fusion and returning from PACU, which is more important to assess for ..
Hypovolemia or Paralysis?

Most of us believe hypovolemia due to the severe nature of the surgery.  We assume once you leave PACU the anesthetic has worn off and although probably still on an opioid the patient can wiggle their toes upon request (even if they are paralyzed there isn't much we can do about it -- if the docs hit the spinal cord or nerve, we can't fix it).

I started my OB rotation three weeks ago, which I was kind of dreading.  I have no urge at this time to become pregnant, to lose control of my body for 38 weeks, gain a ton of weight and feel like crap.  I just am not the girly type.  I probably wore a skirt/dress less than 50 times in my entire life (no joke).  When I started to "develop" and my mom took me to get my first bra I was so angry with her and hoped they would not break the B category.  Unfortunately, I ended up at 34DD and have ponder a breast reduction since the day they arrived and then when part II took place I was so pissed when my dad came home from work he guessed without my evening telling him.  I thought the idea of menses was absolutely gross and a complete pain in my ass.  I know most girls feel special, that they are all grown up, but not this girl.  I was an athlete.  I didn't have time for boobs and periods.  I still feel that way now.  No time for either.  They just get in my way (sometimes literally). 

Fast forward to my first day on the floor at OB.  I was scheduled for a cesarean at 9:30 am.  I had never met the family and didn't even know how to get to triage and into surgery.  I had to put on a few extra items over my gloves as the procedure is "sterile," very different than clean technique requiring very conscious movements by all parties on what they can and cannot touch.  It is without a doubt very nerve racking for a student.  I also had a mask with a shield over my eyes, since I would be in the splash zone. 

I entered the surgical room with another student nurse and we bee-lined it, so we were standing at the inferior end of the patient where we could see the procedure.  We took great care not to touch or get any closer to the sterile field than we had to.  I was absolutely amazed at how many sponges, scissors and clamps were available (had to be over 50).  I realized how easy it was to lose a tool during a procedure, enter circulating nurse who keeps count before, during (after each of the 5 layers is stitched there is a count) and after. 

The attending and the resident started cutting through the first layer of skin and adipose.  They had this amazing tool that can cut or cauterize if needed.  Skin and hair are both part of the integumentary system, so if you have smelled burnt hair, that's pretty much what burnt skin smells like too.  After that they switched scalpels as skin is colonized/clean and all other layers must be sterile.  In other words, the doctor did not want to transfer any possible infectious agents from the skin into deeper tissues. 

It was in that moment I looked at my friend and noticed he was really sweating under his mask and a little pale.  I suggested he might want to sit for a moment.  He agreed and after only one step he stumbled into the wall.  My immediate reaction was "Why did you leave the patient to walk alone when you knew they were a fall risk?"  as I bolted over to him I caught him and braced him as against the wall so he would not hit the floor.  Immediately, TM's boot camp kicked in..."Brace patient, do not try to hold them up, slowly lower yourself and patient to floor, get help."  My instructor arrived at my side to help me lower him to the floor.  The doctors and other nurses were still continuing with the procedure, but were also trying to ascertain what had happened with us.  He was awake and definitely, a little shocked.  His eyes were wide and he was very rigid.  Although, he had just fainted for a second or two it had taken him by surprise and his sympathetic nervous system was in high gear.  My heart was in my throat.  I didn't really have any time to think things through.  I was just acting on instinct.  We got him to lay his head back.  I grabbed his hand and we reassured him that he was okay.  He seemed to relax after about a minute or two.  He was going to be just fine.  I took that time to join him in sitting on the surgical floor to give myself a "TIME OUT" and make sure I wasn't going to passout and recover from the excitement.  I had to laugh at how myself at how my heart rate had just sky rocketed.  Jokingly, I chided my friend for making me so worried.  My sense of humor was back.  I was fine.  Mind you, this all happened in less than 5 minutes.

Back up and on our feet, we were able to see the water, accidentally break and the nurses hurriedly suction it up.  We saw the doctor using a blunt object to forcibly open the layers and before we knew it we saw this object being pulled out.  I was wondering if it was part of the placenta, but nope.  It was the baby!  It was amazing.  It took only a second before we heard the cry.  I was grinning so hard my face hurt.  It was covered in vernix ( a lot more than I thought -- probably because it had not gone vaginally).  The baby was undoubtedly a purplish blue at first, but it turned into a very healthy rosy red/pink very rapidly. 

Our instructor brought the baby over to us and we began or APGAR assessment.  We gave the baby a 9/10 only becuase the feet and hands were a little acrocyanotic.  Activity, pulse, grimace and respiraitons were all good.  I was able to give the baby's eye ointment again trying to remember proper procedure.  When administering eye medications always go inner canthus to outer canthus.  My partner adminsitered the vitamin K shot.  We also assessed vital signs and capillary refill.  All was looking good except temperature.  All my life I have dealt with fahrenheit, but nursing school has quickly converted me to Celsius, so when the temperature came back at 36.9 and my teacher stated the thermometer must be in the wrong place because that was way too low, I wondered how high a baby's temperature should be, since 37 degrees was normal for adults.  Our instructor realized what me and my partner had done and that the temperature was actually just fine.  We then checked for appropriateness of parts (e.g. ten fingers, ten toes, no spots, or fur).  It was simply amazing.  I kept thinking when we entered this room, we had one less person than when we were leaving.  It was such a silly thought, but the entire experience was just ....  AMAZING. 

I hate that I never get any sleep the night before clinicals, but in the 2 days I have been on the floor I find I want to see and do so many things.  I can't find enough time to absorb all this fascinating knowledge, not to mention I have the best clinical instructor thus far. It is just so exciting and I can't see the process of ever having a baby as not a humbling experience.  I think I may have found my calling.


KimZepp said...

Glad to hear you're having a better experience.
With your description, I'm also glad I didn't have to ever have a C section!

JenC said...

That's awesome! I'm glad to hear you found something you love. I think you will be great as an OB nurse - tough, yet sympathetic!

Julia said...

When I get pregnant, I am calling you... :)

I know you would not let me down!