March 11, 2009

Eclamptic

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.

8 comments:

Julieann said...

It is very scary. I worked ICU for five years before going to Labor and Delivery and I have been in L&D for over a year now. Since I had ICU experience they thought it appropriate to give me higher acuity and risk patients.

A few months back (when I was still on PM shift) I was taking report @ BS and the patient was Pre ECLAMPTIC. Something instinctually just felt wrong to me and there was no Mag hung cuz the patient had just arrived 30 minutes prior.

I kept telling the RN, before we start report lets get and order and hang Mag. I WAS VERY VERY NERVOUS and refused to leave the bedside. Patient was G1 P0 30 Weeks, no other significant med hx or prob.

Anyhow long story short the Mag did not get hung becasue the MD wanted me to push Labatelol (which barely touched her) anyhow she wound up 15 minutes after report having a GRAND MAL on me!!!

THAT WAS THE SCARIEST THING I HAVE EVER EXPERIENCED...I have seen chests cracked open in the unit on open heart patients I have run CODE AFTER CODE, TRAUMA AFTER TRAUMA

BUT SEEING A MOM SEIZE WITH BABY INSIDE BRINGS THE WORST FEELINGS IN THE WORLD!!!

I have respect for L&D RN's beyond any ICU RN especially due to the way the patients present to the unit and what could happen to mom and baby. I think some RN's think that L&D is a procedural unit and its a happy place...but the truth is...not always!!!

Praise for what you do!

Mrs. Spit said...

What in the world was she doing in L&D? Never mind the seizures, she could have stroked out with those pressures. ICU anyone?

Sheesh. That must have been freaky for you.

And Julieann: The doc is right. When the BP is above 160/110, you push labetalol/altenol/procardia. High pressures don't necessarily mean seizure, they mean CNS involvement, which may mean seizures. Pressures much over 160/110 do mean the possibility of a stroke is huge - probably higher than the risk of seizure. You get the BP down, then you push the Mag. Often the Mag drops pressures a bit more.

mitchsmom said...

Yes, people (and nurses) tend to forget that a fair amount of patients have POSTPARTUM preeclampsia/eclampsia!

I live the preeclampsia foundation website:
http://www.preeclampsia.org/about.asp

There's no way I would have taken that assignment. We try to do one on one for mag, but occasionally we end up having to take 2.
((hugs))

PE Mommy said...

I'm 7 weeks pp and still dealing with the effects of pe with headaches and bp issues. Was JUST in my pcp's office again today. She gave me 3 shots for the headaches. I hate when everyone says baby is out, it's ok. Good for you for standing up!

Fertilized said...

This made me very nervous just reading.

Morgan said...

There was a lady I was in a Bible study with a couple years ago that had had Pre-eclampsia undiagnosed during pregnancy. Whatever bad that they fear could happen did during her delivery. I don't remember all the details other than that she lost oxygen and the dr.s thought she was brain dead as she was on life-support quite a while.

She ended up surviving, but now needs constant care by her husband or mother. The lady used to be a nurse, and now she'll probably never work again. Her daughter made it just fine- they got her out in time. It was a really sad story. They ended up suing the doctor and winning.

Very scary stuff!!!

pinky said...

It is a good thing you are assertive. Some folks will take anything the Charge Nurse dishes out. I applaud you for taking a stand.

Nurse Lochia said...
This comment has been removed by the author.