Saturday, July 22, 2006

Down to the nitty gritty...

I am finally in my clinical area. Today I received my first paycheck and I must say, nursing school has certainly paid off. I am in orientation, and will remain in orientation for the next 11 weeks. The upside...I have two awesome preceptors that love their job and are excellent teachers. The staff is an interesting cast of characters that support each other the way that nurses support each other in hospital utopia. Keep in mind, all this is coming from an observation period of approximately 4 days. Case in point.

On my third day as a bonifide nurse, I had a patient that had been pregnant 14 times with 4 living children and 10 miscarriages, one of which was induced. (For those who follow the OB short hand that's gravida 14, para 4, T=4, P=1, A=10, L=4) She was an interesting case with a history of cocaine abuse and a laundry list of sexually transmitted diseases. The funny thing is that she REFUSED to sit on the toilet. My nurse said the toilet seat should have been afraid of her ass instead of the other way around. Anyway, after her delivery, we were preparing to send her to post partum. She was in her wheel chair and everything when she decided she had to go to the bathroom. Her estimated blood loss was 150cc. Which is unusual for a multipara. I assessed her before multiple times we put her in the wheelchair and each time her uterus was firm, except for one assessment where I kinda thought she was a little boggy but even then my preceptor went behind and re-assessed the uterus which was firm and at the umbilicus.

So the patient was in the bathroom, squatted over the toilet looking at her butt as she was peeing, leaking blood etc. She said, "I want to get out from over the toilet, but I am still bleeding." At the moment, my preceptor was at the nurse's station giving report. I re-assured the patient that some blood loss was normal. I asked her to stop looking at her crotch and put on her mesh panties/pad and return to the wheelchair because the way she was bent over looking at her crotch could cause her to become lightheaded and faint. She finally sat down and then she started complaining about the bleeding again. She complained and I checked her, she complained more and then I went to check her for the 10th time and she was gushing a little blood around her pad. I thought perhaps it was because the blood was pooling from the way she was sitting so I walked to the nurse's station and asked a few of the nurses to come and take a look. They asked her to return to the bed and palpated the patient's fundus/uterus.

*This is the point where you would want to stop reading if you have a weak stomach!

As the nurse rubbed her abdomen, about four to five very large clots shot out of the patient followed by a very large volume of gushing blood. It was like a horror film. The nurse said, "Go get one of the attendings." At that moment, my preceptor turned the corner and she took over. I was so glad, because I had no idea what to do next. I was so glad that the other nurses were able to jump in and help with my patient in the absence of my preceptor. What happened when the attending physician arrived was something I have never seen before in my life. The doctor put on a rubber glove and inserted her entire hand almost up to the elbow inside the patient and proceeded to perform what I imagine to be a manual D & C.

They were pulling stuff out of the patient and pulling it apart in an attempt to assess what is was. The placenta was expelled hours before, but they thought that perhaps there was more tissue inside of the patient. The patient was sitting in a pool of blood and other miscellaneous stuff. The patient thought that she was dying, her blood pressure was 67/25. So then we gave her a huge bolus of lactated ringers. Then they gave her a bunch of pills rectally. I left before they decided what to do next.

*The gross stuff is over now!

There are a lot of sad stories on my unit. Women laboring alone. A 250lb 14 year old in active labor with chronic hypertension, type 2 diabetes and a 23 year old boyfriend who gave her trichomoniasis and genital herpes. A 16 year old having a baby with a 17 year old boyfriend who has a 2 month old daughter with another girl. These kids are too young to be having these sort of problems, but this is only week one. I am sure that the stories get even more astounding. Everything is going well. I guess it is to early to say for sure, but I think I am really going to like my job.

DiVa...surprised that she is adjusting to work so well!

2 comments: said...

glad things are going well at work. I have seen a few of the "kids having kids" at my job. Drop me a line Diva

S. R. said...

Well, that is indeed the nastiest lochia story I've ever heard, but a great one!