Friday, October 22, 2010

Explaining circumcision

As a Mom/Baby nurse, it's my unfortunate duty to ask parents if they want their boys to be circumcised. The "circ trays" are prepared during the night shift, so we need an accurate count so we can be ready, and the docs know how many need to be done.

I do not believe in the circumcision of infants. I don't believe in doing cosmetic surgery on a person without their consent. So this part of my job kinda sucks.

I found myself in an interesting situation with some parents who were Indian. From what I've seen, most people from India don't circumcise. But these two had no idea what I was talking about; I don't think they'd ever heard the term.

So I tried to explain it as unbiasedly as possible: "Circumcision is the removal of the skin at the tip of the penis for cultural or cosmetic reasons." Nice and simple. And judging by the looks on the parents' faces, completely horrifying.

You could see the question in their eyes. "Why would someone do that?!"

I then went on to say that most Indian parents choose not to circumcise, and they looked relieved and said, "No, I don't think he will be wanting it."

Just another day in the life....

Sunday, October 17, 2010

Quick charting funny....

Reading through the doc's notes last week, and one of them wrote this gem:

"Pt tolerating regular diet, passing flatus and chicken and soup."

I wonder how often people actually proofread their notes for clarity....

Sunday, October 10, 2010

Adventures in my first week flying solo!

I'd originally planned to write this after the first night solo.... and then I decided to make it the whole weekend.... but I got lazy and am only now writing, since is it 6:30am on a Sunday and I am Very Not Tired.

The first night on my own was slightly surreal, I guess. When I started off as a new grad, the orientation seemed to last forever. I might as well be a new grad again when it comes to Mom/Baby skills, but here I got three weeks. Which, all in all, is still pretty nice to get a feel for a place and to hone the skills I hadn't used since nursing school. By the end of orientation, I was actually kind of itching to be on my own, and to stop having someone looking over my shoulder all the time.

The first night, my patient load was split fairly far across the unit. I was a little nervous, because I like having my patients close to each other so I can hang out nearby in case of trouble. But none of my rooms were really near a station, so I just hoped for the best.

Nothing terribly exciting happened that first night, for which I am grateful.

The second night, I got a taste of Tele, just to remind me I guess. One of my patients had had a failed induction, ended up c/s. Had some hemorrhaging afterwards, as well, so I was a little worried it'd start up again.

I guess she was still a little numb from the spinal or something, because when I was assessing her, I found that she... needed some cleanup. It'd been a month since the last time I needed to do incontinence care, and there are no CNAs on this unit. So I take care of all that, which was fun since she had a little trouble moving her legs still.

After I finish, I ask her to let me know if she notices any change in bleeding, including any gushing feelings.... So I get a call about 10 minutes later saying, "Uh, I think there was some gushing...."

Nope. Not blood. Sigh :(

So I clean her up *again* and start feeling like it's that animated video where the patient craps the bed because it's the nurse's job to do pretty much everything. (see video here; the bit in question starts around the 2-min mark)

Luckily, no more code browns that night. Though I did have to deal with missing antibiotics, so that was fun. And at the end of the night/first thing in the morning we got back her post-delivery CBC. Her H&H was something like 7/20.

Now this is something interesting, I find. If one of my patients on Tele had that kind of lab result, I'd be slightly panicking. If it was an 87 year old dialysis patient with CHF and UTI that was CTD, they'd pump a couple of units of blood in ASAP and do serial H&Hs q6 hrs. Apparently if it's a new mom after major abdominal surgery, they prescribe PO Iron, TID. I guess they're the experts, but it seems a little weird to me. I mean, if *that's* not the cutoff for transfusion, what is?

(Apparently I can answer my own question by doing some Googling...)

The next three nights I actually got most of the same patients. One of them had the cutest baby ever. She was born at 37 weeks, c/s early for IUGR and a bad-looking monitoring strip. Mom was pretty young, with twins at home that also had health problems r/t extreme prematurity, and a history of substance abuse with a currently-using boyfriend/FOB. On the second day she kicked him out of the room, and he never came back. Which is very very good. Anyway, this baby was only 2000g at birth, and had tiny little pointed ears like an elf. I could've fit her in my scrub top pocket and taken her home with me. I really hope things go well for her.

I'm finally starting to feel tired now (cuz the Benadryl is kicking in), and I have to get some sleep since I'll be working tonight; I'm very bad at napping, so I should get as much as I can now :)

More adventures to follow, I'm sure....