When working as a labor and delivery nurse one never feels that all the things
When working as a labor and delivery nurse one never feels that all the things you watch out for for your patients could ever happen to you. The "rules" of pregnancy, drinking sufficient water, eating healthy, kick counts, etc... all the things done that most of the patients we see rarely do and yet even in doing all these things as one is supposed to the unthinkable still can happen.
At work on a Wed, laboring a 36 week ruptured anorexic teenager with only one other nurse available due to staffing shortage, the day continues to get more and more stressful. The patient reports " I don't eat because I can't get fat and I want to nurse so I can lose as much weight as possible." This sets a poor tone with our staff because at no point does this patient seem to worry about the baby's condition or what could occur. Finally my coworker decides it's a good idea to take my blood pressure in the middle of all this since over the last several days my lower extremities have swelled. At this point I am 31 weeks 3 days. Of course the readings are 140s/90s and my norm is 110s/70s so she calls to report this finding behind my back and (probably should be thanked for) to my OB doctor who will also be delivering this patient I am laboring.
At this point going home "sick" is not an option as we are short handed already so she tells me to take off Thursday to do a 24 urine and see her at my appointment on Friday and she will decide based on the appointment whether I can work the weekend or if bed rest is in my future. I started the 24 hour and the patient delivered without a problem. I went home with my jug of pee in hand to await the results. I didn't work that weekend.
Thursday at 24 hours, finished the 24 hr urine and went home to "rest" and await a call on the results. Thursday being my doctor's day off, I assume she will just let me know what they were when I see her on Friday but as we return home to find a geyser spraying out of the ground on our farm and as those living the farm life know you can't just call the plumber to fix that, so my husband Josh and I are using a trencher and digging up the lines, meanwhile I am bucketing water out of the hole so that I can keep him updated on where to dig. This of course is not what I or the doctor had in mind in regards to "rest". Of course the phone rings and it is the doctor who as stated above should be off today so for her to call me the results doesn't make me feel good. The cut off level is around 300 so when she told me it was over 600 and then asked "what are you doing today, resting I hope?" I was very reluctant to tell the truth about fixing a water leak. When I finally got up the guts to tell her, I promised to "go rest" as soon as possible. She informed me that I was on bed rest until further notice and to have labs drawn to review right before my appointment the next day. Finally after some reinforcements showed up the leak was fixed and I went to the couch. Little did I know that within 24 hrs I would nearly be unrecognizable to my own mom and sister due to the swelling.
At this point I don't really have much as far as symptoms that I would have gone to be seen over. Yes I do have lower ext swelling but who doesn't? Yes a couple high BP readings but what's more stressful than a young anorexic labor patient the day before? I'm a labor nurse I'll know what's right and what's not.....right? Friday I am just laying around waiting to go to my appointment, which of course I drive myself to since the animals have to be fed around the farm, nothing stops just because you're on "bed rest". I have noticed that this morning my rings are very tight and my face looks puffy. On the way there granted this is Friday Feb 29th and NOT hot out, I am starting to soak through my t-shirt and I have the A.C. running. Suddenly I am so hot and sweaty and feeling like I am getting the flu. During the night my right lower back was really bothering me but when I got up and repositioned it finally went away. I show up to the lab and have soaked my shirt. How embarrassing. The lab tech draws the labs and tells me to tell doctor that they are really backed up and that it will take awhile to get the results to her. I walk across the street from the hospital to the clinic and wait to see her. As soon as I walk in her nurse takes my weight and says "Hmm that's weird, lets double check that." After another weight check she tells me that I have gained 9 lbs. Not what I wanted to hear. I sit on the exam table and she takes my blood pressure. 180s/110s. Double check. Same. I lay on my left side for a few minutes and the nurse goes to get my doctor. The doctor comes in, checks the BP for herself and says the same. She gets on the phone with the lab and tells them, "No we can't wait for the results upgrade the request to stat." Five minutes later she answers a call from the lab, platelets are 70. AST/ALT are elevated and uric acid is sky high. 3 beat clonus and pitting edema. How did this happen so fast? She informs me that she is calling Josh and that driving myself was probably not a good idea and that she is admitting me to the hospital and calling a high risk specialist that she recommends due to the early gestation at this point. I talk to Josh about this and he is obviously very confused so I try to quickly explain in layman's terms preeclampsia and HELLP syndrome. More confused. Doctor tells us that she will let me go from the clinic to the hospital myself for foley, mag bolus, betamethasone, nst, etc and then will go by ambulance from our hospital to Kansas City which is about an hour and half away. I take myself to the OB that I work in and am admitted. 6 sticks later an IV is started and mag 6gm bolus is started, to be followed by 3gm basal. Steroids given, foley in, now contracting every 2 but cervix closed. After several well wishes and tears from co-workers I am not being told my BP at this point because "it's better I don't know." I am given IV labetalol and taken to ambulance and on the way from our unit to the ambulance the EMT says "what is H E L L P syndrome?" Oh my. I just say to him at this point, "just make sure you can help me if I seize and lets get there asap."
We arrive at the hospital and go through all the admissions process again. Josh arrives and we meet the specialist. He explains everything to Josh, as I had chose to leave out some of the details and informs us that we will wait until 24 hrs so we can get the 2nd steroid shot and then start an induction process. NPO from 1st hospital with ice chips privileges (literally 4 cubes on a spoon) every so many hrs. By the next day I am sure I will starve to death. Finally given some jell-o and it never tasted so good. Platelets now are in 60s. At 2pm the 2nd dose of steroids given and 1st dose of prepidil gel. 2nd dose at 6pm and pit induction started at midnight. Balloon catheter inserted and pressure applied against cervix at 1cm. The nurse checked the balloon catheter which should come out when pulled on at 3 cm and it does so she checks and now 5cm. Aroma at this point. Back pain is getting much much worse and unable to reposition much but I had to try hands and knees to take some of the pain away, after only a few minutes of this I suddenly can't breathe, the pain is the worse I have ever experienced. I am panting because it is the only way I can breathe. This does not help dry mouth and the ice chip nazis are not flexible. The specialist comes in and checks, still 5cm. He orders 5mg morphine IV now and the nurse gives it before I realize what he even said. Now I am panicked that the mag running for 2 days plus morphine and general sedation there is no way the baby will be able to breathe if they call a stat section. He tells me "you may have dislocated a rib, sometimes that happens when you're shifting around." Stat labs tell us that the platelets are now only 22 and the "dislocated rib" is actually my liver swelling and the liver enzymes have gone through the roof. He orders 10mg IV now and I refuse because I can't help but think that the baby won't breathe if they do it. The anesthesiologist comes in to talk about general sedation and I think I can hear Josh throwing up in the bathroom. I say goodbyes to my mom, dad, sister and Josh and wheel across the hall to the OR suite. I am begging for ice at this time because dry mouth is an understatement now. I am told no and they start a second IV and hang platelets. Suddenly I am counting backwards and can remember saying 7.
I wake up in the recovery room where I will be kept for over 24 hrs due to continuing 3 more bags of platelets and o2 sats in the 80's with o2 on. We had not found out the sex of the baby so when I opened my eyes I could see the nurse standing over me and Josh and my mom and sister standing in the corner of the recovery room. "What did we have a boy or girl?" is the first thing I asked. I am told a beautiful 3lb 14oz baby girl. On o2 but needed very little to get started. This is the best news yet. I am hooked to 2 IV's, the mag is still running, platelets are infusing, a pca pump and o2 and with sats in the 80s they are not letting me go anywhere at this time. 9 hours later I begged long enough that 4 nurses came in and maneuvered all my tubes, wires and mess and the bed out of the recovery room and to the NICU. I am allowed to do skin to skin for the 1st time and tears overflow. They only allow a short time because she needs to be in the incubator and my BP is still very high. Finally 24 hours later I am taken to an in-between room for monitoring and 24 hours after that taken to a real patient room. I am finally to the point of being able to go to NICU by wheelchair and slowly losing some of the IV's and foley and o2. They dc the pca because I refuse to use it other than the basal rate. YEAH finally a real shower is allowed. Slowly but surely, day by day things are getting better and after 8 days in the hospital I am released. In ten days I lost 29 lbs. Baby Joslyn spent 17 days in the NICU getting phototherapy and learning to nurse. She is beating all the other babies and completing her "goals" much quicker than anticipated. Originally they told us to plan on 2 months! 17 days sounded much better to her and us. We went home without monitors at 4lbs 7ozs and never looked back.
She is meeting milestones long before due for her "corrected age" and still before expected for her "real age". Although petite still she is full of life and very outgoing. This experience was a real eye opener but hindsight there were more noticeable symptoms than I let myself be aware of and I try to make sure that any of our preeclampsia patients are well aware of the fact that it can be blatantly obvious or sneak up on you overnight. I hope the stories on this website help those going through this condition feel like they are not alone because time stands still once you start putting the pieces together. Good luck to anyone else with preeclampsia and or HELLP and God bless.