Re: Hospital admissions for obstetric patients
From: Rita Kucmierz (ritakuc@comcast.net)
Sat Oct 28 19:37:32 2006
I do not think any class would negate the need for an L&D nurse to be in
attendance in the ICU and there are few L&D nurses that would be willing
or want to take on the ICU. The reason would be to give ICU and ER nurses
a broader perspective and a basic familiarity which would make them more at
ease with the situation. ICU and ER nurses assess and evaluate the total
system functioning of a patient and it would be beneficial for them and
their patient if they are able to relate to changes that can occur with the
fetal monitoring.
Rita Kucmierz MSN RN-C WHNP
>----- Original Message -----
From: "Meenan, Anna" <annam@uic.edu>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Saturday, October 28, 2006 11:22 AM
Subject: Re: Hospital admissions for obstetric patients
> Well, you are definitely an asset for your hospital, but if anyone at ours
> suggested that L&D nurses should be cross-trained for the ICU, they'd have
> a riot on their hands. I recall a major fuss being raised when the whole
> Mother/Baby thing started and everyone had to be cross-trained for nursery
> and postpartum.
>
> Anna Meenan, MD
>
>>ICU nurses cannot read fetal monitor strips? This one does--after 12 years
>>in ICU (which I still do prn) I jumped the fence into women's health
>>promotion hoping to make a difference in the things that I saw in ICU.
>>There are instances such as you described that this has been advantageous
>>for my patients. I think that it would be beneficial to have more nurses
>>trained in both specialties and hospitals should provide fetal monitoring
>>classes for their ER and ICU nurses.
>>Rita Kucmierz MSN RN-C WHNP
>>>----- Original Message ----- From: "Meenan, Anna" <annam@uic.edu>
>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>>Sent: Friday, October 27, 2006 10:29 PM
>>Subject: Re: Hospital admissions for obstetric patients
>>
>>>Exactly. This lady had recently done enough coke to stroke her out, had
>>>BP 230/130, was at risk for abruption and preterm labor. ICU nurses
>>>cannot read fetal monitor strips.
>>>
>>>Anna Meenan, MD
>>>
>>>> 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.
>>>>
>>>>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
>>>>>>>
>>>>>--
>>>>>ì The greatest obstacle to knowledge is not ignorance,
>>>>>it is the illusion of knowledge.î Daniel J. Boorstin - Historian
>>>>>
>>>>
>>>>--
>>>>JFields, RN, BSN
