March 11, 2009
The last 3 weeks, I've been picking up extra shifts at work. Basically filling a few holes that were left when my co-worker lost her job. And every shift I've worked during the week over the last 3 weeks, I've come on to find that we need another nurse back in labor and that the charge nurse is reluctant to send that nurse. I'm not one to shy away from a doable patient load, but when it's going to compromise patient care, just so the charge nurse doesn't have to take a post-partum mom or two, I'm going to raise a little hell. Which is what happened Monday. I head back to labor to find 6 patients, and 2 nurses: myself and one nurse who is 35 weeks pregnant and only staying until 3a.m. Granted, the patients were 1 vag recovery, 3 outpatients and a patient receiving cervical ripening agents for induction. The other patient was why I got a little irritated. She was a very unstable eclamptic patient. First time I've care for someone who actually had an eclamptic seizure. She had delivered over a week before, was discharge and a few days later, had and eclamptic seizure. She had been in ICU, was transferred back to us, stable, but shortly before my shift, her pressures shot up to a very unsettling 200/120 with a severe headache. So good ole Mag Sulfate was restarted. They had expected me to take her in addition to 3 other patients, because she was a delivered mag patient. No way in hell. She really needed to be one-to-one care, but I agreed I could do the induction with this mom, but that they HAD to send another nurse back. I have never had a patient make me as nervous as she did. I think everyone took for granted that this mom was delivered, and most moms we care for on Mag Sulfate are stable. But eclampsia is a very serious condition, one people do die from. And the fact that she was as sick as she was made it even more critical to keep a close eye on her. With every Mag patient we check reflexes every 1-2 hours, respirations every hour, strict hourly I&O, oxygen level, blood pressure at least every hour and lung sounds twice a shift. She did stabilize through the night, but close to the end of my shift, she started moving backwards a bit. Usually you see pre-eclampsia during the pregnancy and you figure everything is all well and good after delivery because "delivery is the cure for pre-eclampsia". But there is still a risk afterwards, and thankfully, most the time if it were to rear it's ugly head after delivery, mom is still in the hospital and she can receive care. It's scary to think that on rare occasion, it can happen after discharge.