Happy Nurses Week.

Happy Nurses week to all! This past week, the hospital decided that they needed to do something so the patients would know who the nurses are. The way it is, you really can't tell RN's, from techs, from doctors or housekeepers. So their idea was to give all the RN's this big red care that reads RN to wear behind our badge. Our badge does have job title on it, but it's not real easy to read. Really, its a good idea, but they haven't done anything for the LPN's or techs. So maybe they'll get around to doing something for them.

Work wasn't too bad. I had one of those patients that came in on the prior shift, thought she'd been leaking fluid for 48 hours, and the admitting nurse got a positive nitrazine strip so she decided that her water did indeed break. Antibiotics were started due to the possible prolonged rupture, and the patient was contracting frequently. About the time I came on, she had received about a liter of fluid and wasn't contracting so well. I assess her, don't see amniotic fluid on the pad, but figure, I'll wait an hour, recheck her and then I'll see some amniotic fluid. Hour later, I check her cervix, no fluid on the pad, her cervix hasn't changed and, forgive me, she was drier than you would be if the membranes were ruptured. Plus you usually get some amniotic fluid back after checking and I didn't. Call doc, tell her I don't think she's ruptured, but she said go ahead and start pitocin, just in case. 5 hours later, I recheck her after finally getting her contracting adequately (I don't check too often if they are ruptured, especially a prolonged ROM) and again, I don't see fluid, patient states she hasn't felt anything leaking and while she has progressed, there is a bulging bag of water. Maybe she had a high leak earlier and since the baby was sitting low, it covered the cervix and fluid couldn't leak, but my theory is she was contracting and she was leaking urine. Usually urine doesn't turn the nitrazine paper blue, but it does happen from time to time. When she got a liter a fluid, it rehydrated her and that's why she stopped contracting. She was past her due date so it didn't really matter that much in the long run. That's always been a fear: that I'll assess someone and either think their water broke and it didn't, or think that the membranes are intact but they aren't. It's too bad it's not always crystal clear.