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Shit Shows
May. 24th, 2017 01:46 am The Sunday night shift turned into a complete shit show.
I started with a gyn patient (gynecology; she'd had a hysterectomy), and a couplet, a mother baby pair, we'll call then Couplet A. The gyn pt was fine, it was the third night I had taken care of her. The mom of couplet was a post op day 1 c-section. She was getting antibiotics for an infection (she had had a temperature after the section of 37.9*C or about 100.2*F I think). Baby was a shitty eater, he was super sleepy and wasn't doing well at breastfeeding. He didn't even do well at formula feeding. At most I got him to take 5ml (1/6oz). He was on phototherapy for jaundice, in the high risk zone (high intermediate and high risk bilirubin level babies go on phototherapy). Phototherapy can be dehydrating, so it's important for the baby to get nutrition.
Around 8:30pm, I got Couplet B. The mom had had surgery to remove a cyst on the right nipple and the left nipple was inverted, so she didn't even want to try breastfeeding. That baby also was a shitty eater. He took 1ml around 9pm, and another around 6am. His mom and I tried multiuple times during the night to get him to take more. He just played around with the nipple and then got gaggy. Well. He clearly swallowed a shit ton of amniotic fluid; they suctioned 14ml of fluid out of him after the delivery. I think he still had fluid in him making him gaggy. In addition to that, his breathing at birth was so bad they almost took him to NICU. I think they should have; it was fast and very shallow.
Around midnight, mom of Couplet A got another temperature of 37.9*C, and had no plain tylenol, so I had to give her 2 tablets of norco 10/325 to give her enough tylenol. It brought her temperature down to 37.1*C at least.
At 3:30, I was told I was going to get Couplet C, a mom who was post hemorrhage and also post mag (magnesium to treat pre-eclampsia).
She actually didn't come until 5:15am, thank goodness. She had been on mag 24 hours from the delivery, and her blood pressures had been good, however, she had a headache, which is not a good thing with pre-eclampsia, but no stomach pain and or blurred vision, and her reflexes were fine. And baby was fine as well.
However, she had lost 400ml of blood during delivery, and then another 350ml after delivery, and then some during the day, so her total blood loss was 970ml.
Around that time I got the results of Couplet A baby's bilirubin draw from 3am. Another high risk result, and it had gone way up. Our policy is if a baby has 2 high risk results, they should go to NICU for triple phototherapy, if the hospitalist pediatrician agrees. So I call the on call hospitalist ped... and his phone was off, went straight to voice mail, which is apparently a common thing. I was running around, so I got Halie to feed that baby, and she got him to take 20ml, miracle of miracles.
Then I had to take staples out of my gyn patient, because that particular doctor likes staples out at the crack of dawn. However he was already there check on her and decided to have her shower before the staples were taken out. Fine with me.
Finally my supervisor got ahold of the hospitalist ped and the baby from Couplet A went to NICU. Then a doctor pops up from nowhere and checked on Couplet C mom, fresh off mag and a hemorrhage, and decided she could go home.
So I am giving all this info during report to Lauren, the day nurse, when Lab calls with a critical hemoglobin level from the mom of Couplet A. Ugh.
So then I asked later, and it was a shit show for her as well. Couplet A mom had to receive 3 units of blood, and Couplet C mom had an epidural headache, so they had to do some procedure for that. At least Couplet A baby stayed in NICU. But then she discharged the gyn patient and got a fresh c-section. Man, I felt bad. It was just a shitty assignment.
I started with a gyn patient (gynecology; she'd had a hysterectomy), and a couplet, a mother baby pair, we'll call then Couplet A. The gyn pt was fine, it was the third night I had taken care of her. The mom of couplet was a post op day 1 c-section. She was getting antibiotics for an infection (she had had a temperature after the section of 37.9*C or about 100.2*F I think). Baby was a shitty eater, he was super sleepy and wasn't doing well at breastfeeding. He didn't even do well at formula feeding. At most I got him to take 5ml (1/6oz). He was on phototherapy for jaundice, in the high risk zone (high intermediate and high risk bilirubin level babies go on phototherapy). Phototherapy can be dehydrating, so it's important for the baby to get nutrition.
Around 8:30pm, I got Couplet B. The mom had had surgery to remove a cyst on the right nipple and the left nipple was inverted, so she didn't even want to try breastfeeding. That baby also was a shitty eater. He took 1ml around 9pm, and another around 6am. His mom and I tried multiuple times during the night to get him to take more. He just played around with the nipple and then got gaggy. Well. He clearly swallowed a shit ton of amniotic fluid; they suctioned 14ml of fluid out of him after the delivery. I think he still had fluid in him making him gaggy. In addition to that, his breathing at birth was so bad they almost took him to NICU. I think they should have; it was fast and very shallow.
Around midnight, mom of Couplet A got another temperature of 37.9*C, and had no plain tylenol, so I had to give her 2 tablets of norco 10/325 to give her enough tylenol. It brought her temperature down to 37.1*C at least.
At 3:30, I was told I was going to get Couplet C, a mom who was post hemorrhage and also post mag (magnesium to treat pre-eclampsia).
She actually didn't come until 5:15am, thank goodness. She had been on mag 24 hours from the delivery, and her blood pressures had been good, however, she had a headache, which is not a good thing with pre-eclampsia, but no stomach pain and or blurred vision, and her reflexes were fine. And baby was fine as well.
However, she had lost 400ml of blood during delivery, and then another 350ml after delivery, and then some during the day, so her total blood loss was 970ml.
Around that time I got the results of Couplet A baby's bilirubin draw from 3am. Another high risk result, and it had gone way up. Our policy is if a baby has 2 high risk results, they should go to NICU for triple phototherapy, if the hospitalist pediatrician agrees. So I call the on call hospitalist ped... and his phone was off, went straight to voice mail, which is apparently a common thing. I was running around, so I got Halie to feed that baby, and she got him to take 20ml, miracle of miracles.
Then I had to take staples out of my gyn patient, because that particular doctor likes staples out at the crack of dawn. However he was already there check on her and decided to have her shower before the staples were taken out. Fine with me.
Finally my supervisor got ahold of the hospitalist ped and the baby from Couplet A went to NICU. Then a doctor pops up from nowhere and checked on Couplet C mom, fresh off mag and a hemorrhage, and decided she could go home.
So I am giving all this info during report to Lauren, the day nurse, when Lab calls with a critical hemoglobin level from the mom of Couplet A. Ugh.
So then I asked later, and it was a shit show for her as well. Couplet A mom had to receive 3 units of blood, and Couplet C mom had an epidural headache, so they had to do some procedure for that. At least Couplet A baby stayed in NICU. But then she discharged the gyn patient and got a fresh c-section. Man, I felt bad. It was just a shitty assignment.
