My First and Second Born

1. WAS YOUR PREGNANCY PLANNED?
#1 - Not really
#2 - Heck no. I was on the pill and taking it religiously!

2. WERE YOU MARRIED AT THE TIME?
#1 - No
#2 - Nope LOL

3. WHAT WERE YOUR REACTIONS?
#1 - "Uhhhhh... shit!"
#2 - "That's not freaken possible!" (In fact the dr had to do an extra ultrasound and show me the baby's heartbeat just so I'd believe it)

4. HOW OLD WERE YOU?
#1 - 17
#2 - 26

5. HOW DID YOU FIND OUT YOU WERE PREGNANT?
#1 - EPT
#2 - Blood test & Ultrasound

6. WHO DID YOU TELL FIRST?
#1 - My bf
#2 - My bf

7. DID YOU WANT TO FIND OUT THE SEX?
#1 - Oh heck yeah
#2 - Couldn't wait

8. DUE DATE?
#1 - It was changed from October 20th to November 18th
#2 - October 12th I think

9. DID YOU HAVE MORNING SICKNESS?
#1 - VERY BAD! I lost so much weight
#2 - YES! I was miserable for 8 months

10. Cravings?
#1 - Taco Bell, Apple Juice, and Pickles (& juice)
#2 - Milk

11. WHO/WHAT IRRITATED YOU THE MOST?
#1 - Hmm, I think I was pretty mellow during my pregnancy. I wasn't overly emotional. Oh wait. One day I was on the phone with my bf and my nosy aunt kept getting on one of the other lines (she was at our house doing laundry) and was running her mouth. I hung up with my bf, went out in the dining room where she had her back turned to me and I called her name. She turned around with a nasty attitude and said "WHHAAAT?" LMAO I punched her in the face. Left her with black eyes for a week (right Paula?) Wow, I couldn't believe I did that. My fam still wishes they could punch her in the face LMAO
#2 - My crazy ass boss, his wife, and the secretary.

12. WHAT WAS YOUR FIRST CHILD'S SEX?
#1 - FULLLLLLL boy
#2 - No doubt a boy

13. DID YOU WISH YOU HAD THE OPPOSITE SEX OF WHAT YOU WERE GETTING?
#1 - Yeah, I wanted a daughter because a few years earlier my daughter was stillborn at 6 months.
#2 - Yes, same reason as #1

14. HOW MANY POUNDS DID YOU GAIN THROUGHOUT THE PREGNANCY?
#1 - Maybe 15?
#2 - Until the last month only like 10 pounds.

15. DID YOU HAVE A BABY SHOWER?
#1 - HECK NO! I'm still pissed that my mom didn't throw me a baby shower. Damnit.
#2 - NOPE! Next time around I'm throwing my own damn baby shower LOL

16. WAS IT A SURPRISE OR DID YOU KNOW?
#1 - It was a surprise that my mom didn't want to throw me a shower.
#2 - Again, it was a surprise that I didn't have one LOL But then again, I didn't know many people in Georgia and I don't think the father's family traditionally throws one. I don't know.

17. DID YOU HAVE ANY COMPLICATIONS DURING YOUR PREGNANCY?
#1 - Actually it wasn't so bad. Just really painful. I have NO torso room for a baby. He was INSIDE my rib cage and the only way I could breathe was to arch my back. Of course, that killed my back.
#2 - Yeah I was text book "Pregnancy & Every Complication That Could Possibly Happen 2nd Edition". Sugar in my urine, ketones in my urine, protein in my urine, bladder infections, high blood pressure, pre-eclampsia, preexisting diabetes, gallbladder attacks, severe morning sickness that I had to be medicated for... and for some reason I'm willing to do it again against medical advise LOL

18. WHERE DID YOU GIVE BIRTH?
#1 - St Ritas Medical Center Lima, OH
#2 - Rockdale Medical Center Conyers, GA

19. HOW MANY HOURS WERE YOU IN LABOR?
#1 - I was sent to the hospital at 11:00 pm Sunday night and he was delivered at 6:00 am Tuesday. I still only made it to 5 cm with Pitocin and breaking my water LOL
#2 - I wasn't technically in labor. I was hospitalized with severe pre-eclampsia and had me on every freaking monitor in the world, which made me more miserable. One monitor kept saying I was having steady contractions so they gave me Terbutaline to stop the contractions (I was only 35 weeks along and had a cesarean before. They didn't want my uterus rupturing) Terbutaline is like HELL IN A SYRINGE!

20. WHO DROVE YOU TO THE HOSPITAL?
#1 - My mom
#2 - Marty

21. WHO WATCHED YOU GIVE BIRTH?
#1 - My bf was in the room
#2 - Marty

22. WAS IT NATURAL OR C-SECTION?
#1 - C-Section
#2 - C-Section

23. DID YOU TAKE MEDICINE TO EASE THE PAIN?
#1 - I asked for an epidural
#2 - I got a spinal I believe just before the cesarean.

24. HOW MUCH DID YOUR CHILD WEIGH?
#1 - 7lbs, 14 oz
#2 - 8lbs, 5 oz

25. WHEN WAS YOUR CHILD ACTUALLY BORN ?
#1 - November 14, 1995
#2 - September 5, 2004

26. WHAT DID YOU NAME HIM/HER?
#1 - Cody Allen Adkins
#2 - Colin Joseph Polak

27. HOW OLD IS YOUR FIRST BORN TODAY?
#1 - 13
#2 - 4

My big belly at 35 weeks before delivery. I had pre-eclampsia that turned real bad and they had to delivery Colin early.

Hyperthyroidism Study Guide

Here is my Hyperthyroidism study guide based on what Ms. Carson posted. I just added more details. If anyone finds something inaccurate, please let me know.

Hyperthyroidism

AKA Graves Disease and thyrotoxicosis
Increased production of T3 & T4
More common in women
Increased incidence with family hx

Possible Causes

• Autoantibodies


• Iodine Excess


• Stress


• Meds

Clinical Manifestations

• Restlessness/Anxiety/Psychosis - may be interfering with family, personal, and work relationships.


• Exopthalmos - bulging of the eyes ("startled look")


• Goiter - swelling of the anterior neck caused by low iodine, causing the thyroid gland to produce thyroglobulin (colloid) which accumulates in the thyroid follicles.


• Heat Intolerance/Sweating/Fever


• Tachycardia, increased cardiac output, Heart Failure


• Weight loss despite increase in appetite


• Prolinged menses


• Elderly - new onset atrial fib

Lab Values

• Low TSH - TSH is produced when thyroid hormones are low. Low TSH is present when hormones are high.


• High T3 & T4

Diagnostic Tests

• RAIU - radioactive iodine uptake test - elevated


• U/S - shows nodules

Collaborative Care

• Beta Blockers

Given to ease symptoms, esp restlessness, tachycardia, & increased bp

• Antithyroid Meds


• PTU: blocks the synthesis of T3 to T4

Safer in pregnancy

• Tapazole: Blocks syntesis of hormones

More toxic
**With ANTITHYROID MEDS watch for rash, N&V, agranulocytosis, Lupus
**Teach patient to watch for S/S of infection. MD may tell them to stop taking meds and to come in at once for blood work.
**Teach patient NOT TO USE DECONGESTANTS!

• Radioactive Iodine Therapy

Iodine taken up almost exclusively by the thyroid gland.
The radioactivity destroys thyroid cells
**WATCH FOR THYROID STORM!! (See Below)

• Subtotal Thyroidectomy

Attempts to get thyroid levels to normal first
5/6 of thyroid gland removed
Iodine prescribed beforehand to reduce blood loss
Monitor pt for S/S Iodine toxicity:
Swelling of buccal mucosa
Excessive salivation
Coryza
Skin Eruptions
Iodine Meds
No longer used as PRIMARY treatment
Decreases the release of thyroid hormones
Decreases the vascularity of thyroid (hense it's use prior to surgery)
Better given in milk or juice
GIVE MED THROUGH A STRAW! May stain teeth.

Nursing Care

• Teaching (see information given above)


• Activity Intolerance:

Group activities together
Schedule frequent rest periods.

• Anxiety:

Provide reassurance to pt and fam that mood issues are related to hyperthyroidism and should resolve once hormones are under control.
Provide treatments in a calm and unhurried approach.
Do not put patient in a room with ill or talkative patients.
Provide a calm and quiet environment.
Frequently reinforce treatment plan.

• Imbalanced Nutrition:

Well-balanced and frequent, small meals
Increase fluids to counter fluid loss from sweating and diarrhea
Avoid caffeine and alcohol.
Encourage high calorie and high protein foods.
Monitor I & O

Care of the patient after a thyroidectomy

• Risk involved


• Parathyroid Removal - Laryngeal nerve damage


• Thyroid storm


• Infection


• Hemorrhage


• Preop:


• Review hx


• Teach support of neck


• Preparing the room for postop:


• O2


• Suction


• Tracheostomy tray at bedside


• IV Calcium


• Post-Op


• Assess at least q 2 hrs for hemorrhage and breathing


• Semi-Fowlers position


• Assess for hypocalcemia


• Can pt speak?


• Home care:


• Decreased kcal


• Avoid goitrogens


• Excercise


• Monitor for hypothyroidism

Thyroid Storm
Almost always fatal if not treated

S/S:

• High fever (>101.3)


• Tachycardia (>130 bpm)


• Extreme GI Symptoms (ie diarrhea, weight loss, abd pain)


• Altered Mental Status

Management:

• Lower Core Temp (Tylenol, cooling blankets, DO NOT GIVE ASA!)


• Humidified O2 (Also monitor O2 with ABGs and Pulse Ox)


• IV Dextrose (replenishes depleted glycogen stores in the liver)


• PTU given to prevent more production of T3 & T4


• Hydrocortisone (treats shock and adrenal insufficiency)


• Iodine (decreases output of T4)


• Beta Blockers + digitalis (reduces serious cardiac symptoms

Senior Practicum coming to a close :-(

Ok so working back to back hard 12's is kinda hard on the feet but I love what I'm doing. I started out in NICU, went to L&D, and now I'm catching babies right after they're born and taking care of them in the first few minutes of their life. So far (knock on wood) all of the babies are getting really decent APGARS and I only had to give one baby oxygen. Just a blow by to help him out. But I LOVE it!!!! I think I'm going to add NICU to my list of nursing jobs I want to apply for.

I felt so good at the end of my second 12 hour in a row the other day when my faculty liason came by. I was walking down the hallway when I heard her ask the nurses at the nurses station how I was doing. They all said I was doing really good and one lady even thought I was unit ready! Awww that made me feel good. I'm supposed to shadow my preceptor but even that isn't enough sometimes. I butterfly to all of the nurses! I attend all of the deliveries and help out with the laboring mother and then switch over to the baby in the warmer getting APGAR scores and all that. The doctors and midwives have even been real supportive of me! One of the midwives I know really well on a personal level and I ran into her last week. I hadn't seen her in AGES!
I think this hospital has a hiring freeze going on, but I would love to work in this particular department. I hear it's real rough working there on other units because they don't have techs. Just RNs. (Don't they know how invaluable techs are to an RN?!)

But I did great on my evaluation. Better than I thought I would have! There haven't been any issues so far but you know there's always something. Nope, not this time! At least not according to my preceptor. I thanked one of the nurses the other day for allowing me to help her out and told her she was a great teacher. I learned so much from her. But she turned it around on me and said that I seek out the knowledge and I want to learn. I go way above and beyond what they would ever expect out of me. Holy heck working at this place makes me feel so much better about myself and my skills (as I'm learning them).

Being the ultra-sensitive type I know I will get teary eyed walking out my last day (Monday). I will never forget what I learned here. I've had great clinical experiences before, but never as great as this one. The whole staff has been wonderful and we've all gotten along great. I need to find something for them this weekend. I know how they love sugary stuff so I might just load them up with chocolates. Maybe something else that I can think of. Too bad I can't afford to get them a foot massage gift certificate at one of my fave spas here in town. If I win the lottery I will! LOL

Anyways, I know that was pure rambling and I don't mean to "toot my own horn" but for once I really feel good about myself as being a nurse. One thing I really lack is self-confidence. It's funny, if someone talks bad about me it really doesn't bother me. But I will tear myself down on things. Hmmm, shouldn't it be the other way around? HAHA! But nursing has given me some incredible self-confidence.

Like I always say: "I'm loving it!"

An Essay I wrote regarding the loss of my brother, David Ulrich

Here is an essay I wrote for my creative writing class in 2006.

I read the bumper stickers, “Make April 15th just another day”. My initial reaction is one of immense sadness. A reminder of the pain of a loss too fresh to be numbed by time. I know the economical meaning behind the bumper stickers, but my mind keeps drifting back to the last April 15th. “It will never be just another day to me”, I think with sadness.

It was just a typical morning, yet one I will never forget. I’m amazed at how the smallest details are branded into my memory. It was one of those mornings where you are sluggish to begin your day. The warm shower was too relaxing to want to leave. I remember leaning against the shower ledge, allowing the hot water to rinse away any residual tension in my back. Somehow I managed to pull myself away from this simplistic, yet thoroughly pleasant start to my day.

The next few hours were so routine. I got ready for work and dressed my 9-year-old and 7-month-old sons for the day. I drove my older son to school and my youngest to day care. Little did I know about the tragedy about to unfold with my family in my hometown up north.

I arrived at work and got started on my tasks for the morning. I made my usual cup of coffee. Cream and two packets of sugar substitute. I threw my bottle of water in the freezer. I always enjoyed my bottle of half frozen water after my morning coffee. I sat back down at my desk and sent an email to a few of my colleagues. They were both into health and fitness and went on brisk walks at break time. I just enjoyed walking with them and having some nice laughs. They were so full of energy, just trying to keep up with them was an enjoyable feat. We agreed to meet at our usual time. 10:00 am. The ten minutes I spent walking, talking, and laughing were the last ten minutes of normalcy, as I knew it, for the rest of my life.

We were on our last lap heading back towards our desks when the receptionist, Debbie, stopped me. “You have a call. I think it’s your husband. Do you want me to transfer it?”, she said. Nothing sounded urgent in her voice, but something seemed out of place. Just that feeling you get when something seems wrong even when everything is in place. “Why is he calling me so early?” I thought. My husband worked very late hours and normally wouldn’t be awake for at least another hour or so. But even that didn’t alarm me. Something else was going on. I walked quickly up the stairs and met the transferred call at my desk.

I answered the phone and waited for my husbands voice to greet me with his usual “Hey Beautiful”. Instead, he wanted to know how I was doing. I replied that I was doing good, I just completed my walk with my friends. That’s when he said, “We’re going to Ohio.” That’s where I was born and raised. My entire family still resided there. I made a point to go back and visit at least once a year. This year we were planning on going at the end of May. My son would be out of school and my step mother would be graduating from medical school. The weather would be nice and mild. So my husband telling me we were going to Ohio didn’t seem too out of place.

“Yes we are. Next month.” I said to him to a half-jokingly tone. I was waiting for his response.

“No, we have to go now.” He said. That’s when I felt the initial shock, that sinking feeling deep inside that your world is about to change. In the few seconds that he paused, my mind played a million scenarios. What could possibly be wrong?!

“Your mother just called…” My mind raced. Ok, my mother called. She’s ok. My grandmother? She was the only grandparent I still had living. I’ve always feared the day something would happen to her. Please don’t tell me something happened… My dad? Maybe something happened to my dad. He was decently healthy, but you still fear the unexpected would occur to one of your very own parents. The people who gave you life that you take for granted will always be there for you. “Who? What?” all of this raced through my mind in the space of one second. Until I heard my husband say those words. “Your brother died last night”.



Shock.



Silence.



Disbelief.


At that moment the world did not exist to me. There was no world around me. My heart did not beat. There was no air in my lungs. I was not at work. My desk, the phone I was holding, nothing existed anymore. My entire body went numb.

As quickly as everything left me, all of it hit me like a ton of bricks. The power of the entire universe hit me. Painfully.

“No”

That was all I could say. That was all my mind, which previously raced with thoughts and ideas, could process.

“No”

I heard my husband on the other end of the phone, “I’m so sorry baby.” I could tell he had been crying. He met my brother on a few occasions on our visits up north and he really liked him. He was the little bratty brother I warned him about. But he was rather impressed by him. And he knew how much my brother meant to me. He was my spiritual twin, born years after me. The person I shared my childhood with. My best friend. The person torn away from me as we grew into separate people. The person who turned to gangs, drugs, and violence. The person I tried to save. The man who turned his life around and achieved his lifelong dream of being a firefighter. A paramedic. The wonderful father to his beautiful 5 year old daughter. My brother. Gone.

“No. I’m coming home” I said to him. That was all I could think of saying. I completely underestimated the degree of shock I was in. I didn’t realize that I couldn’t move on my own.

We said our goodbyes and hung up the phone. That’s when the immense flood of emotions came over me.

“No. No. No. No. No. No.” I knew I was thinking it, but I didn’t realize that I was saying it out loud. Not until my friend, who sat in the cubicle next to me came over.

“Is everything ok?” she asked me. At that moment I broke down into tears. She grabbed me and lead me into the restroom across the hall.

She held me as I broke down. A few more people made their way into the restroom. The whole time I lost myself in the immense sadness of losing my only brother. I didn’t know what happened so I couldn’t make sense of it. I couldn’t rationalize it. I couldn’t bring him back. There was nothing I could do. My thoughts turned to his daughter. My beloved neice, Illana. She was only 5 years old. This can’t happen to her! It’s not fair! My thoughts turned to his girlfriend of 8 years.

My brother. My baby brother. A few weeks shy of his 24th birthday. The fireman. The paramedic. I thought of his life, once plagued with violence and drugs, turned around to be well-liked and very respected. The one who shared my childhood with me. The only person in the world who understood my childhood, and me, the only one who understood his childhood. Gone. It was all gone.

That was the day, April 15th, the one I am reminded of. “Make April 15th just another day”. For the rest of my life. Maybe 60 more years, that day will never be just another day. It will forever be an anniversary. The day a very special man left my life. But perhaps each anniversary will become easier. And I will find peace. And maybe someday we’ll meet again.

Amyology

A friend of mine actually sent this "quiz" to me to fill out and tell about myself. So just in case any of you were wondering... LOL!

***********FOODOLOGY******

*********

What is your salad dressing of choice?
Ranch

What is your favorite sit-down restaurant?
Ruth's Chris

What food could you eat every day for two weeks and not get sick of?
Sushi

What are your pizza toppings of choice?
Extra cheese, Banana peppers, extra cheese, pepperoni, extra cheese, mushrooms, extra cheese

What do you like to put on your toast?
Normally nothing, but I do love apple butter

***********TECHNOLOGY***************

How many televisions are in your house?
3

What color cell phone do you have?
Black/silver

Do you have an Ipod?
Yeah

***************BIOLOGY******************

Are you right-handed or left-handed?
Right

Have you ever had anything removed from your body?
Two Babies

What is the last heavy item you lifted?
A patients leg while she was pushing. My arm went numb after 20 minutes LOL

Have you ever been knocked unconscious?
Nope

************DUMBOLOGY******************

How many pairs of flip flops do you own?
2

Last time you had a run-in with the cops?
When I totaled my Camry. My father in law (25 years Dekalb Police Department officer) showed up and started arguing with the investigating officer

Last person you talked to?
Colin

Last person you hugged?
Colin

**************FAVORITOLOGY****************

Favorite Season?
all of them for different reasons

Holiday?
Christmas

Day of the week?
Friday

Month?
December

***********CURRENTOLOGY*****************

Missing someone?
Always

Mood?
Dumbfounded over a dream I had last night LOL

What are you listening to?
"Open Season" on TV

Watching?
Facebook

Worrying about?
Passing the semester

***************RANDOMOLOGY*****************

First place you went this morning?
The bathroom

What's the last movie you saw?
Knowing

Do you smile often?
Yes

Sleeping Alone Tonight?
Probably

***************OTHER-OLOGY*****************

1) Do you always answer your phone?
Rarely

2) It's four in the morning and you get a text message, who is it?
One of my bonehead family members

3) If you could change your eye color what would it be?
Brown

3b) If you could change your hair color, what color would you change it to?
A mood effect... changes colors with my mood... or even a rainbow

4) What flavor do you add to your drink at Sonic?
I don't generally go to Sonic, but I do like their banana shakes

5) Do you own a digital camera?
Yes

6) Have you ever had a pet fish?
I have tons now - I always have an aquarium or two. Good fung shui

7) Favorite Christmas song(s)?
O Holy Night

8) What's on your wish list for your birthday?
Money

9) Can you do push ups?
Half of one maybe, I don't know LOL

10) Can you do a chin up?
Sure... NOT

11) Does the future make you more nervous or excited?
My personal future I'm excited about. Politically I think we're screwed regardless of who is in office HAHA! The future of mankind? I don't know. I just wish people could be more open minded about people who are different from them (color, race, gender, social "class", sexual preferences, religious belief, etc)

12) Do you have any saved texts?
No I deleted them all

13) Ever been in a car wreck?
3 - 1 was pretty bad

14) Do you have an accent?
I really don't think so. When I lived in North Carolina I was told I sound Canadian. When I moved to Georgia I was told I sound Yankee. When I talk to people in Ohio they say I picked up this southern stuff. What do yall think? LOL

15) What is the last song to make you cry?
Either that Christmas Shoes song or songs that remind me of my brother

16) Plans tonight?
Finishing touches on this damn take home quiz that I've spent all week on.

17) Have you ever felt like you hit rock bottom?
A couple of times yes. But it was years ago.

18) Name 3 things you bought yesterday?
Lunch at the hospital... that was it. I try not to spend money LOL

19) Have you ever been given roses?
Yes

20) Current worry?
Passing my last nursing semester & money

21) Current hate right now?
Being worried

22) Met someone who changed your life?
Many every step of the way

23) How did you bring in the New Year?
We went to my father in laws house and hung out with Marty's step sister and her family. It was actually pretty nice!

24) What song represents you?


25) Name three people who might complete this?
Probably noone

26) Would you go back in time if you were given the chance?
To my childhood? No. Too painful. I would LOVE to go back to when I lived in Virginia Beach. Not to my situation, but just the times I'd walk on the beach to be alone.

27) Have you ever dated someone longer than a year?
I dated my high school sweetheart and first husband for 4 years before we got married. I dated my current husband for 4 years before I married him.

28) Do you have any tattoos/piercings?
No tattoos but I have 3 holes in each ear and I used to have my tongue pierced. That was fun ;-) hehe

29) Will you be in a relationship 4 months from now?
Probably many

30) Does anyone love you?
Lord I hope so

31) Would you be a pirate?
Would love to be. During lecture one day I would love to swing from the ceiling and take over the microphone. Har har.

32) What songs do you sing in the shower?
Hi ho Hi ho it's off to school I go...

33) Ever had someone sing to you?
No, but once I held my husbands head to my chest when we were dating and sang "Eternal Flame"

34) When did you last cry?
A few days ago.

36) Do you like to cuddle?
Yes

37) Have you held hands with anyone today?
Nope. It's a lonely day.

38) Who was the last person you took a picture of?
My son at the Braves Game

39) What kind of music did you listen to in elementary school?
just whatever was on the 80s pop station

40 Do you believe in staying close with your ex's/prospects?
For me personally, I do. My ex husband and I are still great friends. I don't try to screw people over and I love keeping in touch with the people in my life. Hell, my ex mother in law and I get along better now then we did when she was my mother in law!

41) Are most of the friends in your life new or old?
Mostly new

42) Do you like pulpy orange juice?
Yep!

43) What is something your friends make fun of you for?
My friends? That I'm a complete and total nut LOL

44) If it were possible, would you want to know the day you were going to die?
No I don't think so.

45) If you could change your name, what would you change it to?
Anything but Amy

46) Would you drink an entire bottle of hot sauce for $1000?
I would drink an entire bottle of hot sauce for free but I'd do most anything for $1000!

Midwife for a day & a1c update!

Before I start in about my day I have a good announcement to make. My last a1c (a blood value that measures the amt of sugar on someone's blood cells for 3 months to determine how well someone's blood sugars have been) was 7.9. A non-diabetic is less than 6.0. Most drs try to keep diabetics below 6.5. Anyways, I had my blood drawn a few weeks ago for my q 3 mo a1c test. I made a bet with my dr that I brought it down to a 6.8. He said if it's a 6.8 he'd cry. A 7.9 to a 6.8 in 3 months is a really significant drop. More to that in a second.

So last week I had the IUD pulled and discussed with my OB/GYN the degree of danger I had with another pregnancy. He wanted to know what my a1c was. I told him in December it was 7.9. He kinda gave me this look like "Uh oh". He said "Well, I want my diabetics under a 7.0." That's when I told him I bet my other dr that it will be a 6.8. He was hoping that for my sake (& the babys sake) that I was right.

Well, I got my blood test results yesterday. I was wrong. It is a 6.5!!!!! YAY FREAKEN YEAH! I couldn't be happier. Being put on this new insulin mix has worked great for me.

So anyways: Wow talk about a busy day! I came in and EVERY bed was full. And we still had scheduled cesareans coming in. So I attended yet another cesarean. I swear the cesarean rate at this hospital is 99% LOL Anyways, now that I pretty much have the routine down I was able to be in on more of the action. The OR is a well coordinated dance and I finally got rid of my two left feet.

So that delivery went well.

Later there was finally an impending vaginal birth. Actually the midwife delivering, I attended one of her deliveries before at another hospital. Didn't quite know what to make of her.

But today I was talking to her about students that she gets from midwifery schools. She gave me some ideas on some great schools. I'll def be looking in to those! But I was just shocked because this midwife seems unapproachable from a healthcare workers point of view. I don't doubt for one second that she's fantastic with her patients. In fact, I see alot of what I want to be in her.

Anyways, so later on I was walking down the hallway and she was talking to the patients nurse. The midwife asked me if I wanted to assist her. Assist her?! Hell yeah! She told the nurse she'd call her when we were ready. Ok, assist with what? Assessing the patient?

I walk in and she kicks everyone out of the room except for "Grandma". Uh, ok? Didn't take me long to realize that she had me down in the dirty telling the patient to start pushing. PUSH?! WHAT?! NO! I'm not ready! Whew! Fortunately mama didn't push out a flying baby and I just stepped back to coach her and hold her leg and head up. Grandma held up her other leg. After a number of contractions the baby was delivered. It was so cool!

So anyways, I survived. She was actually somewhat taking me under her wing! I've NEVER seen her like this!

(Amanda, your midwife ROCKS! LOL)

So I pulled IVs, hung drips, cared for a baby with O2 saturation problems, attended a circumcision (somehow getting into a conversation with the dr about body piercings LOL don't ask), assisted with a vaginal delivery, and readied the patient for a cesarean. Ok, and countless other things.

OB NURSING ROCKS!

Oh and I also ran into a midwife that took care of me when I was pregnant with Colin! She actually remembered me all these years later. She remembered the degree of preeclampsia that I had and how Colin was a preterm delivery (down to remembering the cesarean and the dr that delivered him). I told her that we're looking to have another one but I'm scared about having a repeat. She had a few encouraging words and mentioned that many times women don't repeat, but some do and that I need to be prepared for that. Damn I miss her LOL She told me if I stayed around longer the dr who delivered Colin would be showing up. (No I didn't hang around, I was too tired after working 12 busy hours LOL)

Yesterday in L&D... cesarean sections/breast feeding (Don't read if you're sensitive to TMI)

Wow, yesterday was one of the busiest days in L&D! We had 3 scheduled cesareans right away, and lots of mothers laboring LOL

I got there to find out I had 0730 and 1330 cesareans! YAY! I love watching cesareans, especially observing the role of the circulating nurse. It's very interesting to help out in the prepping process and working in PACU.

I helped prep both patients. I watched the computerized admissions process, and pretty much have that down. It's pretty self-explanatory. Then it's on to starting an IV and giving medications to prevent a reflux situation and decrease the acid. We also give Alka-Seltzer. By now the pt has been NPO since midnight or earlier.

We give them Chlorhexidine bath wipes to clean up with and then we shave their belly/pubic area. A foley has to go in, but we wait until they have received their spinal. So when the OR is ready we contact the dr and take the patient to the room. We assist with the spinal administration (keeping the patient still and in the right position). I always joke with my patients when I'm holding their head down to help ease their tension. I usually say something like "Well I'm glad I decided to wear deodorant today". That always puts a smile on their face. Then I talk to them while everything is being done.

Once everything is set, we lay them down on the bed and the Foley is inserted. It's good because the patient doesn't feel it. Compression stockings that are pumped up with air to prevent DVTs are applied to both legs. We cover them up with blankets from the warmer (the OR is always real chilly) and then we strap their arms and legs so they won't fall. Then the bed is tilted at a slight angle to prevent vena cava compression by the enlarged uterus. They also have a Bair Hugger blowing warm air on them as well.

That's when the dr comes in after scrubbing and gets gowned up and sterile gloves applied. Sterile drapes are applied and curtain is raised. After the dr draws the line on the stomach where the incision will be we go and get the father/significant other and sit them next to the mother behind the screen.

I usually stand back here and watch as the dr cuts through each layer. The creepiest part is watching as the dr & asst grab the abd muscles and rip them open. Ugh LOL I won't forget that now when I have my next cesarean!

Then they get down to the uterus. This is where it starts to get a little bloody. Fortunately blood doesn't bother me at all. Soon you see the amniotic sac bulging and that's when you step back cause once the dr punctures it, it can produce quite a jet of fluid! Sometimes it's just a trickle, but it's funny to watch. Then you see that head! Baby is all snuggled up inside it's mother. It's awesome! That's when the asst starts pushing down on the mothers abd and the baby slowly starts coming out of the incision into the drs hands. Finally the baby is delivered and they suction out the mouth and nose. The umbilical cord is cut and the baby is placed in a sterile crib.

The NICU team takes the baby and wipes it up real good and gives it a little oxygen, if needed. They suction it out and do 1 minute and 5 minute APGARS. The dad is allowed to come over to take pictures and trim the umbilical cord. The baby is wrapped up and taken to the mother real quick. She gets to see the baby for a little while, how stable the baby is dictates how long she can see the baby. Then they put the baby in the crib and take it to NICU where the baby is further assessed and interventions are taken, if needed. The baby gets it's first bath and then is footprinted.

If the baby is doing good the baby meets the mother in PACU or back in her room. If she wants to nurse we try to get the Lactation Consultant to meet with the mother to show her the best ways to do it. Or rather observe and then if there's problems with the technique, she helps them out. I've learned so much that I will use with my next baby. Unfortunately with Colin being in the NICU and being tube fed I didn't get to nurse him right away. But I did pump and for a week I would bring breast milk to the NICU for them to give him in his tube feeding. So he did start out with the best milk possible. But when it was time to try nursing him it was hard.

After he came home I continued to pump. I would still try to nurse him and it worked to some degree, but it hurt like hell the first minute or two. I know that means he had a bad latch but I couldn't do anything else. When he was hungry he got hysterical when I tried to reposition him.

Eventually I would go back to the bottle (with pumped breast milk). I was SOOOOOOOOO sore! But it meant the world to me to give my son breast milk. But damn it was always so messy HAHA He would nurse from one breast and the other would be leaking. I would go through breast pads like they were tissue paper.

I still remember going back to church. All it took was one hour in church and my pads would be soaked and it would go through my shirt. So I would have to carry Colin over the wet areas and pray people didn't want to hold him. Ugh. It was so frustrating but I stuck with it. Especially with him being premature I knew breast milk was crucial.

Unfortunately the pediatrician recommended that we suppliment with formula. Colin couldn't handle regular formula and had to take Nutramigen. It was like KILLER expensive. We don't qualify for WIC so we paid full price for it. (Boy it sure would be nice to get some of our tax money back that we pay an arm and a leg for LOL) Eventually he was able to take Prosobee when he got a little older.

After 3 months my milk totally dried up. I'm happy knowing I tried my hardest and I did give my son a good start in life with the breast milk :-) I didn't get to breast feed Cody because my ex felt breasts were "sexual". So I missed out on that. But fortunately my husband is all for it. And I look forward to trying again!

Anyways, since I think I'm coming down sick (sore throat and stuffiness) I need to take it easy today. And I had to much cleaning planned today. Wednesday and Thursday I work 12 hour shifts and then class Friday. Saturday we are watching the Georgia Bulldogs and then Sunday Easter. Back to work Monday morning for another 12 hour LOL