Senior Job Shadowing 3

Time: ​2:00 P.M.- 11:30 P.M. Date: ​August 7th, 2018 Place:​ Prairie Lakes Hospital, Watertown, SD Total Hours Spent Shadowing: ​9.5 hours

Observations: My day started out meeting Jen along with the rest of the staff and getting a tour of the OB floor. I got to see a supply room, which had all different types of tools they used for labors. Tools including: forceps, scissors, fetal monitors, umbilical clamps, and a urinary catheter. There were so many more but who’s got the time? After seeing all of them and learning about what each do, we got to work! We went to the break room and changed into some scrubs. After getting into our scrubs we looked at our patients today. We had one patient who was was only two centimeters dilated, another women who was eight centimeters, one that was five centimeters, and one that was ten and ready to deliver! After going from room to room introducing ourselves and asking what we could do to help, I got to help ladies get through their contracts by showing them different ways to ease the pain, things like the pushing on their knees to relieve back pain and helping them with the peanut ball. A peanut ball is just an exercise ball that women can sit on to help them ease the pain from their contractions. After helping the ladies with their pain, I followed Jen around giving the women pain medication like ibuprofen, nitrous oxide, and pethidine. Finally, one of the patients were ready to start pushing! As I entered the room, I put gloves on my hands along with a face mask too. The OB/GYN, along with an OB/GYN intern, walked in and started by talking to the soon-to-be mother. He told her what was going to go on during the labor and what he was going to do after the labor, giving her all the information and trying to settle her nerves a little. I didn’t hear much of what he was saying with all that was

going on, but I could tell that he was doing a good job of calming her down. While the doctor was talking, the nurses set up the room. First we got the bed ready and took off the end so the women could put her legs in the holders. Then we put protectors around the floor and a bag hanging from the end of the bed to catch all the water and blood that comes out. Next we got the tray ready by putting all the instruments laid out. Some of the instruments include: one mayo scissors, one kelly clamp curve, one kelly clamp straight, rubber suction bulb, a lot of sterile gauze, and gloves. After that, the OB/GYN’s started to put their clothing protectors on and sterilize their hands to put their gloves on. It was time to start pushing! The mom pushed for almost two hours. Jen told me that usually new moms push for longer. So while not much progress was going on, we went on another trip around the rooms helping with labor pains and monitoring the baby. We had put one of the women into the whirlpool, one of them one the peanut ball, and the others were ready to go on a walk. Hours went by and around nine o’clock the women who had been pushing since seven, was getting really close to being a mom. I went back into the room and got to see the last couple of pushes. As one nurse was holding one of the women’s legs and the husband was holding the other leg, she gave two more strong pushes. Soon, the baby’s head came out and then slowly the rest of the body came out too. The Dad cut the umbilical cord, with blood splattering everywhere, the internal clipped the end of the umbilical cord that was left on the baby. They set the baby on the mother’s chest, waiting for it to urinate or poop. We checked the baby for vitals, weighed her, and took her measurements. While the OB/GYN pulled out the placenta and showed it to the intern and I, he showed us the inside where the baby was and then started to clean out the uterus and decide what kind of tear she had on her uterine wall. We determined it was a second degree tear. While the OB/GYN was getting close to done, we took the baby to get cleaned up. Jen and I gave the baby a bath and took her back to her

mother. By then it was ten-thirty and it was time to chart. Jen showed me where to put things and what they mean, but as she was putting it in the computer, I got to into the nursery and hold the babies until it was time to go. By the time we were almost ready to leave, two women were already ten centimeters dilated and the other one was only at four centimeters. All of that was just one day! I was so excited for the next day!

Time: ​3:00 P.M. - 11:00 P.M. Date: ​August 8th, 2018 Place: ​Prairie Lakes Hospital, Watertown, SD Total Hours Spent Shadowing: ​17.5

Observations: Today started out with getting in some scrubs. After we scrubbed in using this hard textured soap up and down our arms, in between our fingers, and all around our hands. We did this for about five minutes, making sure every spot is cleaned. Next, she told me today was going to be interesting. We went into the break room to get up to speed on what was going on today. Another nurse who had been there during the morning and day walked in to catch us up. She told us about each mother and baby, then told us about their tests they received and the results. She also told us what the stats of the baby and mom have been, along with what meds they have taken and when they were taken. After we were up to speed on what was going on, we got to work. The first thing we did was go into the rooms and ask the women if there was anything we could get them. Since most of the women had a lot of company, we didn’t want to take the baby away from them to do assessments. We took the babies that were not being visited into the nursery to check their vitals. We brought two babies into the nursery, first we checked their temperature and then we checked their lungs and heart. We kept them in the nursery for a while after so the mom could get some rest and something to eat. During this time, I got to hold and rock the babies while Jen did more assessments on the other babies that were there. After all the babies went back to their mothers, we had to do assessments on the moms. To assess the mom, Jen took her blood pressure, checked her heart, and then checked where her uterus is. To check where her uterus was, Jen put her hand on the mom's stomach under the belly button to push and feel if the

uterus was going back to regular size. At this point all moms and babies were healthy and doing well. For a while after finishing assessments, Jen charted and I got to talk to her about what her pathway for nursing was like. It was around seven o’clock when a woman called to say that she was coming in because was having some discomfort in her stomach. We pulled up her chart and saw that she has had three miscarriages. To set up her room, we put sheets on the bed, a robe for her to change into, and an ultrasound machine to find out what the baby was doing. While we waited for her to get there, we answered bedside calls. Before she arrived we had contacted the woman's OB/GYN to let him know that she was coming in and to see if there was anything special he would like us to do or discuss with her. At around eight thirty she came up the elevator and we showed her to her room to help her get into her robe and into the bed. We put the ultrasound gel on the woman's stomach where her uterus is. We turned the ultrasound machine on and used the transducer probe to see inside the uterus. It turns out that the woman was undergoing a lot of stress and that was why she was having so much discomfort. Jen helped her by telling her some ways she can deal with stress and to stay away from things that stress her out. She was discharged and sent home after we monitored her for a while. At nine o’clock we went around the rooms again to make sure the moms and babies were doing okay. We took one baby boy that we were not able to get assessments on before because of the many visitors he had. We did the regular assessments but found that the baby had a low temperature. As I wrapped him up and sat with him under the warm lights, Jen went to check on the room that he was staying in. She came back and told me that the mom was so hot she turned it down because she sweats so much. Jen told me “one of the hardest things was having to tell mothers that their babies have this or are doing this because of something

they are doing or did.” For the rest of the time I sat under the warm lights with the baby boy and talked to Jen.

Time:​ 3:00 PM-7:00 PM Date: ​November 13th, 2018 Place:​ Prairie Lakes Hospital, Watertown, SD Total Hours Spent Shadowing: ​21.5

Observations: Today was the most exciting day I had at the hospital. We got up to the floor and there were people everywhere. Jen told me that it was going to be a really busy day and that I would get to see things that she hasn’t ever shown anyone else. We got into our scrubs and scrubbed in, this only took us seven minutes because we were in a rush to go help. We got out to the floor and went into the break room to get Jen and I caught up on what was going on. We had seven patients, with three that have given birth already. We went to check on our patients who have not given birth yet, we had two who were eight centimeters dilated. I went with another nurse to evaluate and give shots to a baby boy. We went into his room to grab him from his mom, then took him to the nursery. First, we checked his temperature by putting a thermometer under his armpit. Next, we checked his lungs and heart by listening through a stethoscope. After finishing that, we checked his ears. We used a Otoacoustic Emissions, which is a tool that measures the sound waves in ears. The baby had to score an eight in each ear to be good, he scored an eight in the right but a four in the left. After charting those tests, we gave him his influenza shot. He now was all done with his evaluation, so we took him back to his room. When on our way out Jen called me over because a women was coming in with her baby girl, who has hyperbilirubinemia. The mother and baby came up the elevator, she stepped off and the baby was the color of a pumpkin. We brought her into the nursery and put an IV in her, then we put her under bili lights. We left her under there for hours.

Finally, one of our labor patients were at ten centimeters and ready to push. We walked in the room, got our gloves and our face masks ready. Now, she has already been pushing for a while before I walked in, so I didn’t see anything preceding up to the moment. The doctor told her “one more push” and she gave one more big one. Next thing you know, there was a beautiful baby girl in the doctor’s hands. The dad cut the umbilical cord and we set the baby on the mom, so it could urinate or stool. We checked the baby and made sure to make her cry, so she could clear her lungs. As all was good with the mom and the baby, the doctor stitched the mom up while we checked the baby’s lungs and heart. We left the room to give the parents time with their new baby girl. We came back a few minutes later so that we could clean the baby up and take her vitals. We took her to the nursery and gave her a bath. Then we took her vitals by checking her temperature, lungs, heart, and blood pressure. We rolled her back into the parents and checked the mom’s vitals, we took blood pressure, checked her heart and lungs, and gave her pills for pain. After all the assessments on our patients were done, we had to go help a new nurse handle a patient who was pregnant but also had a drug problem. She was so uncomfortable it took us three to try to help her. She was ready to give birth and kept asking for drugs, but we had to watch what we were giving her to make sure it was safe. While Jen set up the whirlpool and the other nurse called the OB/GYN to ask a question the soon-to-be mom was insisting on knowing, I did get to help her do some stretches and exercises that helped with the pain she was having. Jen did tell me that “these women are harder to deal with because not only are they going through labor, but they aren’t allowed to do drugs anytime during the labor so it’s difficult for them.” After we got out of the room it was eleven o’clock and I was ready to go home.

I learned a lot through these three days of shadowing.During the experience I could see myself going into the medical field. Throughout my time, I got to see what it was like being an OB nurse and I loved it. This was truly a great opportunity.