Nursing School week 3/ #12
Nov. 10th, 2012 11:36 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pantsheadThis week wore me out, for no particular reason. I guess we've just reached that point in the semester. I was back in Maternity/OB for clinical this week. We spent our last day on the Labor & Delivery floor, and then spent a day in the newborn nursery. In the nursery, our focus was on learning to do a full assessment of a newborn. The physician also checks all of the babies before discharge, but it's an RN who checks the baby at birth unless a) It is known in advance that the baby is likely to have some problems adjusting to life outside the womb--such as known deformities, or maternal conditions like diabetes that cause the baby to become hypoglycemic at birth or b) The baby needs to be resuscitated at birth. In both of those cases, the baby goes to the NICU (neonatal intensive care) immediately after birth.
Among the things we're learning to look for (in an approximately head-to-toe fashion): The skull--the fontanels (soft spots) should be soft and flat; the bones of the skull might be overriding on each other after a vaginal birth but will straighten out over the next few days; the bones should not be fused together yet. The features--eyes should open, the tops of the ears should be level with the eyes, the nostrils should both be patent (allow air through them), the lip and palates should be intact, the baby should be able to suck on a finger. The baby's neck should be able to turn. The baby's clavicles should not be broken (not uncommon, apparently). Overall, the baby's position should be 'flexed'--ie: huddled in a little ball. Babies who splay all their limbs out, or are fairly limp, are probably not getting enough oxygen or are not fully mature. Fingers and toes should be the correct number. The sound of the breath should be clear, and you should be able to hear some bowel sounds. The umbilical cord should have the right number of arteries and veins. The spine should be intact (no gaps when you run your finger down it). The genitals should be fully developed (underdevelopment is common in premature babies, but they do catch up later). Reflexes like grabbing with fingers and toes, splaying the toes when the foot is stroked, sneezing, sucking, turning in the direction of a stroked cheek, and flailing when startled should all be present. The lack of any of these gets noted--some things can be signs of anomalies (spina bifida = non-intact spinal column; low-set ears is common in people with Down syndrome); some are signs of maturity (creases on the palms & soles of feet develop as the baby matures, so preemies have smooth palms); some are signs of adaptation (extended/splayed posture, blue hands and feet = lack of oxygen).
We haven't really seen any babies who were not 'normal' nearly-full term babies. For some of us in the group who don't have children, it was as much about simply getting comfortable with the babies as anything else! There are 3 mothers in our group, so of course they were a little more experienced in this regard.
In lecture for OB, we learned about the Stages of labor, which my group has already done in Clinical. We learned more about what happens in each stage (the movements the baby's head goes through, etc...) and also types of pain management in each stage. We also learned about fetal heart monitoring, and how to interpret signs of distress vs. normal reactions.
In Mental Health we had our 2nd exam, and then on Friday we learned about personality disorders. One of our Clinical requirements is that we go to 2 community-based support groups and write about our experience. So, this morning I went to a nearby (open) AA meeting. (Many meetings are closed--they are for alcoholics only. This area has meetings at just about every hour of the day, though, so it's not hart to find an open meeting somewhere.) I'm not sure what type of meeting I will go to next.
I'm going to try to be good and get my homework all done early this weekend so that I can start getting the house ready for Thanksgiving week. We don't have any more exams until after break--hooray!
Among the things we're learning to look for (in an approximately head-to-toe fashion): The skull--the fontanels (soft spots) should be soft and flat; the bones of the skull might be overriding on each other after a vaginal birth but will straighten out over the next few days; the bones should not be fused together yet. The features--eyes should open, the tops of the ears should be level with the eyes, the nostrils should both be patent (allow air through them), the lip and palates should be intact, the baby should be able to suck on a finger. The baby's neck should be able to turn. The baby's clavicles should not be broken (not uncommon, apparently). Overall, the baby's position should be 'flexed'--ie: huddled in a little ball. Babies who splay all their limbs out, or are fairly limp, are probably not getting enough oxygen or are not fully mature. Fingers and toes should be the correct number. The sound of the breath should be clear, and you should be able to hear some bowel sounds. The umbilical cord should have the right number of arteries and veins. The spine should be intact (no gaps when you run your finger down it). The genitals should be fully developed (underdevelopment is common in premature babies, but they do catch up later). Reflexes like grabbing with fingers and toes, splaying the toes when the foot is stroked, sneezing, sucking, turning in the direction of a stroked cheek, and flailing when startled should all be present. The lack of any of these gets noted--some things can be signs of anomalies (spina bifida = non-intact spinal column; low-set ears is common in people with Down syndrome); some are signs of maturity (creases on the palms & soles of feet develop as the baby matures, so preemies have smooth palms); some are signs of adaptation (extended/splayed posture, blue hands and feet = lack of oxygen).
We haven't really seen any babies who were not 'normal' nearly-full term babies. For some of us in the group who don't have children, it was as much about simply getting comfortable with the babies as anything else! There are 3 mothers in our group, so of course they were a little more experienced in this regard.
In lecture for OB, we learned about the Stages of labor, which my group has already done in Clinical. We learned more about what happens in each stage (the movements the baby's head goes through, etc...) and also types of pain management in each stage. We also learned about fetal heart monitoring, and how to interpret signs of distress vs. normal reactions.
In Mental Health we had our 2nd exam, and then on Friday we learned about personality disorders. One of our Clinical requirements is that we go to 2 community-based support groups and write about our experience. So, this morning I went to a nearby (open) AA meeting. (Many meetings are closed--they are for alcoholics only. This area has meetings at just about every hour of the day, though, so it's not hart to find an open meeting somewhere.) I'm not sure what type of meeting I will go to next.
I'm going to try to be good and get my homework all done early this weekend so that I can start getting the house ready for Thanksgiving week. We don't have any more exams until after break--hooray!
