First Day of Internship

My first day of internship was nerve wreaking but I was extremely excited. My preceptors name was Sarah and I was anxious to meet her. I was about 30 minutes early so I had to wait. When nurses finally started showing up for the night shift I kept checking their ID’s for the name Sarah. Someone finally told me that she was going to be about 30 minutes late. So I was paired up with Amanda in the mean time. We had been assisted me postpartum patients and just were finishing their recovery and moving them up to postpartum. The first mom had two little girls that were just precious and very excited about being big sisters. Amanda went and got them each ID brackets that said Big Sister on them. Amanda didn’t have to do anything really because Sarah showed up a little earlier. When I finally met Sarah, I was a little disappointed because she was older and I was nervous about her being like Bufton. I was happily wrong she was so sweet and just cool about everything. She gave me a quick tour of the hospital and showed me where some important things were. We also got to change into navy scrubs. This really excited me because wearing those bright green scrubs where you stick out bothers me. Like I could never be consisted there nurse in those scrubs which make me different. After I changed we decided we would finally move our patients up. This was the same patient that had the two daughters to make points easier we will call her patient A. Patient A had another little girl she was 9 lbs 6 oz. In other words a big baby. She had feeling in her legs so we were able to put her in a wheelchair. I got to push the beautiful baby girl. She was so cute and kept startling when we would hit bumps. We got the baby in the room and the postpartum nurse told us that we were in the wrong room so we headed to the right room. We got mom and baby comfortable and then went back down stairs to work on our other patient or patient B. Patient B had 2 little boys running around and had just delivered another little boy. NICU had come down to evaluate because he was breathing fast and had some grunting after delivery. We helped mom go to the bathroom and ended up straight cauterizing her. We waited to take her upstairs till NICU was done evaluating. We got a call from upstairs that we had brought the right baby chart but not the right mommy chart. So we went upstairs to correct everything, After we fixed our mistake, we went back down and got mom to bring her upstairs. The baby ended up going to NICU so we just took mom. Sarah got a call from the charge nurse that she might get a complicated patient with diabetes, hypertension and a former stroke. Sarah didn’t want this patient so we took our time bring patient B upstairs. We got her comfortable and finally headed down. We did bring this patient to the right room with the right chart. When we got back downstairs, we went by the charge nurse and she said she was giving up a labor patient. We got the room ready which takes a lot more time than I realized. We had to fill out some of the paperwork. We then went to triage and got our patient. On first impression I would have swore she was a teen mom and this was a accidental pregnancy. She looked young and both her parents were in the room and she had a small stuffed frog that she was holding. The boyfriend was there as well. He looked just like Debi’s ex boyfriend like until I heard his name I was worried it was him. She said she couldn’t walk so we took her on the stretcher. We got her to her new room. We were unsure of her beta strep status so we got penicillin ready. We primed all the tubing for her IV fluids. Sarah told me that she loves to start IVs so we were going to start this one. She made it look so easy. We tried a vein on her right wrist because she didn’t want it in her hand. She got good blood return but should not advance the catheter so she was able to get her blood work but not her IV started. She had to poke her again and this time in the hand. She was not happy. It went really well that time tho. We got her fluids started as a bolus so that she could get her epidural ASAP. We started the penicillin to prevent infection.  The doctor came in about this time to check her and told us that she was group B strep negative which means she didn’t need the penicillin . She was 4cm, 100% enfaced,-2 stations. He wanted to rupture her bags. The nurse attempted to advocate for the patient because she was in a lot of pain. She rated it a 10 on a scale of 1-10. She wanted the doctor to wait for the epidural to rupture her but he did not listen and it increased labor and our patient was not handling it well. We finally got the epidural team in just as she needed a new bag of LR. Her boyfriend informed us that she had an epidural with their first child that was born stillbirth. In order to do an epidural, you have to stay extremely still. Our patient was not good at this, he ended up using more lidocaine because she was screaming in pain. She was a whiner and complainer. It did not bother me but my nurse was ready to smack her. She finally got her epidural but did not really feel very much relief. She hated when we put in her catheter and it really irritated her the whole time she was in labor. It made me more in favor of the least invasiveness possible during my own labor. She had variable decerations her whole labor but the babies baseline at this time was consistent with a well oxygenated baby. She had a tendency to be tachycardia when she got upset. We encouraged her to take deep breaths and try and relax. About an hour after her epidural we started to see the baby having more increasing variables and the EFM was taking trouble picking up the heart rate. We watched it for about 4 minutes and then we turned her to her side and gave her a bolus of fluid. The baby was very active and did not like the monitors on him. We were constantly refinding the baby. Sarah said that sometimes after an epidural the mothers blood pressure doesn’t drop right away but with the way the baby looks she was pretty sure it was about to drop. It did shortly after. We ended up putting 10L of oxygen via a non-rebreather mask. We tried to dim the lights and help her relax. I wish I could have put on some soothing music. Her boyfriend loved to joke and tease her. She would get sooo mad at him. That is understandable tho. He was trying to make her comfortable and she would get mad and say I’m fine. We turned her about every 30 minute and she was finally in less pain and more comfortable. We called the doctor just to inform him that she was having variables and that we had turned her, oxygenated her and given fluid. We checked her about every hour and around 0130 she was complete and was feeling the need to push. We started getting her to push. It took her a while to figure out how to push the right way but once she got the hang of it, she really did well. I felt very active I was holding her hand and rubbing her hair while she pushed. I also adjusted her toco and her EFH monitors in between contractions. I felt like I really helped her and it made me feel good and I felt like I was really her nurse. I even was the counter and verbally encouraged her. The boyfriend was a talker and I basically had to tell him to shut up a few times. She pushed for about an hour and then we called the doctor. She really only had to push with 3 different contractions and the doctor delivered the baby boy. There was slight amount of meconium which they figured baby passed in birth canal.  She had a 2^nd degree laceration and a 1^st degree peritoneal tear.  While the doctor was sewing her up I was telling her what was going on with baby. I told her that he passed some stool and there was a possible that he inhaled it so they were just checking him out. The doctor rudely corrected me and was like no that is not true. She hated the episiotomy and was really screaming the doctor ended up using the emergency lidocaine to re numb her. I was hold her hand the whole time and updating her on what they were doing with the baby. I started to feel that yuck feeling where you almost faint while they were doing the episiotomy it just looked creepy and painful. I felt bad that I had to step out but I know you have to take care of the nurse so the nurse can take care of the patient.  I went back in and they were almost done. The baby’s agars were 7 and 9. He had some trouble with breathing right away so NICU was called for reevaluation.  He was sucked because they were worried about meconium aspiration. He was on the smaller side weighing 5lbs 3 oz and 18 inches long. I was so proud of myself for being my patient’s advocate and asking NICU if before they took up the baby if they could let mom see the baby because he was stable. They did and I took a picture of the three of them together as a family. Our patient HATED fudus checks and I did one and was able to identify that the fudus was not firm and to the right which meant that she probably had a full bladder. We put her on the bedpan and she was able to void just a little bit. She discovered that it burns and didn’t really want to try anymore. We cleaned her up and got her comfortable till we would transfer her. The daddy went and checked on the baby in the NICU. We took a break and ate so one of our other nurses watched her for 30 minutes. We then went and took her upstairs. She was doing good and much happier. Daddy arrived back just as we were taking her up. He said baby was doing great and they were bathing him and then would bring him back to mom. We got her comfortable and said goodbye and congratulations. Out next patient was a 29 week and 4 days. She had a high fever, vomiting and lower back pain. The triage had been very busy all night with patients similar to this. We got a flu culture, fibronection test, the doctor order a stool culture but she did not go. She was checked and closed. We got her a clear liquid diet and she drank some apple sauce. The baby was consistently tachycardic because of the mom’s fever. We started her on antibiotics, Tylenol and zofran. I got to give report to the day shift and thought I did a good job. That was my first very exciting day.