Re: Hospital admissions for obstetric patients
From: Jamie (ajfields@pine-net.com)
Fri Oct 27 16:01:19 2006
I don't know why the nurses at Dr. Meenan's institution were
uncomfortable, but I remember 2 OB patients (one antepartum, the other
immediate postpartum) being in ICU at Methodist in Dallas in the late
90s. The nurses were afraid of not recognizing labor in the unconscious
pregnant patient and called us down to assess her at the slightest
change. They were also afraid of a fetal demise on their watch. With
the postpartum patient they were a little less uncomfortable, but
somewhat lax about monitoring for bleeding. Back to the "once the
baby's out everything's fine" mentality.
At Fri, 27 Oct 2006, Efrain Ramirez wrote:
>
>I am curious as why were they uncomfortable..
>
>Ef
>
>>At Fri, 27 Oct 2006, Meenan, Anna L. wrote:
>>
>>Agree with that totally. We recently had a cocaine addict who stroked out
>>at 33 weeks. The ICU nurses were completely uncomfortable with her and
>>when she woke up enough to be sent out of ICU, nobody on the maternity
>>floor wanted her there. Finally got the MFM boys to take her across the
>>river. They have an inpatient unit where folks are comfortable with both
>>complicated pregnancies and medical problems.
>>
>>Anna Meenan, MD
>>
>>On Fri, October 27, 2006 10:52 am, Jamie wrote:
>>> The same tends to go for nursing. Putting an OB patient on any other
>>> unit gives the nurses the vapors. Even ER nurses, IME, can't get rid of
>>> pregnant patients fast enough. Consulting physicians should be careful
>>> that their orders are understood, though, by nurses not familiar with
>>> their specialty, and might have to specifically order assessments that
>>> are taken for granted in their area.
>>>
>>> At Fri, 27 Oct 2006, R. Daniel Braun wrote:
>>>>
>>>>AMEN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
>>>>Dan
>>>>
>>>>On 10/27/06, Zachariah Newton <zbnewton@bellsouth.net> wrote:
>>>>>
>>>>> Ashley-
>>>>>
>>>>> Leaving puristics aside, the ob is the triage officer for all medical
>>>>> care
>>>>> during pregnancy. This is the source of trust for the patient, and,
>>>>> frankly,
>>>>> any consultant who sees an ob patient with heavy trepidation. Such
>>>>> patients,
>>>>> as in your posit, are usually really sick and really sick. A phalanx of
>>>>> consultants typically flow through the assessment. The consultants, if
>>>>> watched closely, frequently have the palsy of trepidation, derived from
>>>>> the
>>>>> pregnancy status. A general is needed to contain the process from
>>>>> getting
>>>>> out of hand. On your service, you are in control, the key element. The
>>>>> consultants provide assessment & recommendations, but remain in harness
>>>>> on
>>>>> your service.
>>>>>
>>>>> As the patient's advocate in a delerious system of health care, admit
>>>>> her
>>>>> to
>>>>> your service, reins in hand, and send out the requests for
>>>>> consultation.
>>>>> You
>>>>> can then make your own judgment on accepting recommendations for
>>>>> intervention that we have all seen can be wildly off the wall and
>>>>> inappropriate on basis of pregnancy status.
>>>>>
>>>>> zbn
>>>>> ---
>>>>>
>>>>>>>>> ----- Original Message -----
>>>>> From: "D. Ashley Hill" <dahmd@cfl.rr.com>
>>>>> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>>>>> Sent: Thursday, October 26, 2006 11:24 PM
>>>>> Subject: Hospital admissions for obstetric patients
>>>>>
>>>>> > Listmembers:
>>>>> >
>>>>> > I have always been of the opinion that patients with a non-obstetric
>>>>> > medical problem should be admitted to the physician best suited to
>>>>> care
>>>>> > for that problem, with consultation by an obstetrician or
>>>>> perinatologist
>>>>> > if indicated. (For example, patients with cardiac problems are
>>>>> admitted
>>>>> > to a cardiologist and patients with end-stage renal disease are
>>>>> admitted
>>>>> > to a nephrologist)
>>>>> >
>>>>> > Others believe that all OB patients should be admitted to the OB,
>>>>> with
>>>>> > consultation by other specialists as indicated. Does anyone have
>>>>> > experience and opinions on either of these schemes? Thanks in
>>>>> advance.
>>>>> >
>>>>> > Ashley
>>>>> >
>>>>> > --
>>>>> > D. Ashley Hill, MD
>>>>> > Associate Director
>>>>> > Department of Obstetrics and Gynecology
>>>>> > Florida Hospital Family Practice Residency
>>>>> > Medical Director, Loch Haven Ob/Gyn Group
>>>>> > Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>>>>> > Orlando, Florida
>>>>> >
>>>>>
>>>>--
>>>>R. Daniel Braun
>>>>
>>>> "The way to health is an aromatic bath and scented massage
>>>> everyday".
>>>> Hippocrates
>>>>
>>> --
>>> JFields, RN, BSN
>>>
>--
>“ The greatest obstacle to knowledge is not ignorance,
>it is the illusion of knowledge.” Daniel J. Boorstin - Historian
>
--
JFields, RN, BSN
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