01.05 Live Bedside Report OB and PACU

All right guys. In this lesson we're going to focus on the live bedside report for the OB unit and the post-anesthesia care unit or PACU. Now the way this works is we're going to show you some scenarios. So we want you to watch the scenario from start to finish. Then we're going to break it down and go over some key points. And then finally we want you to go back and either watch that one again or watch the next scenario so that you can try to figure out what you need for a report.

This is chance he's going to be taking care of you tonight. So I'm just going to tell him about your plan of care. Okay, so Ms. Hernandez is a 27-year-old patient and she has no known allergies and no known history. She delivered vaginally at 36 weeks earlier today at 1116. She's a G 1 P 1. So first baby, a positive GBS negative rubella immune, Hep negative, RPR negative and HIV negative. Her fundus right now is firm at U. Her bleeding is scant. She did have a first-degree perinatal laceration and has applied ice packs to that. Has that been helping? Yeah. Okay. Her paranium is a little bit bruised and edematous, but the ice is helping that. So she had a baby boy who's currently in the nursery. His name is Aiden. He weighed six pounds, one ounce.

He's breastfeeding and doing well with that. He last ate at 1700 for about 30 minutes and he is having blood sugar checks for being 36 weeks before feeds. So we have one more left to do. His last one was 55 for me. So he'll have the next one do the next feeding around 2000. She might just need a reminder to call for that. Okay. Do you have anything to add? Should I be concerned about his blood sugars going forward? No, just because he's preterm, so we just make sure in the beginning that they're able to stabilize their blood sugars. So after this last one, he won't get checked again unless he is symptomatic. Okay. All right. I do have a couple more patients and then I'll be back to check on you. Good. Alright, thanks. Okay, guys. So let's break this scenario down.

This is Chance he's going to be taking care of you tonight. So I'm just going to tell him about your plan of care. So Ms. Hernandez is a 27-year-old patient and she has no known allergies and no known history.

So for these types of patients, what you want to do is review the history, the demographics and any allergies they may have. 

She delivered vaginally at 36 weeks earlier today at 1116. She's a G! P!. So first baby, A positive, GBS negative, rubella immune, hep B negative, RPR, negative and HIV negative.

And you're going to want to give birth history information. So vaginal or C-section, what time they delivered and their GP history. Other history includes blood type, GBS status, rebuild immunity, hepatitis, RPR and HIV status. 

Her fundus right now is firm at U. Her bleeding is scant. She did have a first-degree perennial laceration and has been applying ice packs to that. Has that been helping? Yeah. Okay. Her parenting was a little bit bruised and a dominance, but the ice is helping that.

All right. So at this point, what you're going to want to do is focus on the assessment for the new mom. We're looking at everything involved with the process. So any lacerations that were involved, an episiotomy, the location of the fundus and how firm or if it's boggy, any sort of discharge has been going on. This is that time that you're going to want to convey that information to the oncoming nurse or make sure that you receive it.

So she had a baby boy who's currently in the nursery. His name is Aiden. He weighed six pounds, one ounce. He's breastfeeding and doing well with that. Um, he last ate at 1700 for about 30 minutes and he is having blood sugar checks for being 36 weeks. So the check before feed. So we have one more left to do. His last one was 55 for me, so he'll have the next one do the next feeding around 2000. Okay.

At this point in the report, you're going to want to discuss the newborn assessments who are talking birth weight feeding. So what if they're on formula or breast milk, how often they're feeding with the last feeding one is how long they've, they were actually feeding for whether they were latching. And then the last thing you want to talk about is any information about the interventions that the newborn needs such as blood sugar checks for this patient.

She might just need a reminder to call for that. Okay. Do you have anything to add?

This part is really important. Make sure you take the time to ask your patients if they have any questions that will allow you and the offgoing nurse to clear up any areas of confusion. 

No, just because he's preterm, so we just make sure in the beginning that they are able to stabilize their blood sugars. So after this last one, he won't get checked again unless he is symptomatic. Okay. 

All right. Do you have a couple of more patients to go check on and then we'll be back to check on you? Sounds good. All right. Thanks.Ms Andy, this is Miriam. She's going to be a nurse for today. I'm just going to go over everything that's gone on today and then if you have any questions we can go over all this stuff. Okay. All right, so this is Mrs Andy. She's a 32-year-old female, no known allergy. She has a full code and the doctor is Busto. She presented today for a laparoscopic appendectomy and she's got a couple of incisions we'll talk about in a minute. Her main concern is that after the surgery and post op she became febrile. So we gave her Tylenol for that and we're going to continue to monitor it. They did start her on some antibiotics. Neuro wise she is alert and oriented times four.

She does follow commands. Her, all of her vital signs have been great except for her temp is spiked but it's now come down and has not recurred. She has a left 20 gauge to the forearm. She's receiving Ancef every 24 hours. She's getting one gram. In terms of all of our other systems are fine. The other big concern is that she's got the three, uh, incisions to the abdomen. Those are all Derma bonded. In terms of her pain, she is controlled with oral. She's getting Norco 5/325. Okay.the plan is for her is to get discharged tomorrow. Do you have any questions? Do you have any questions? Perfect. All right. Do you need anything?

Okay guys, so let's break this scenario down. 

I'm just going to go over everything that's gone on today and then if you have any questions we can go over all this stuff. Okay. All right. So this is Mrs Andy. She's a 32 year old female, no known allergy. She has a full code and the doctor is Busto.

The main thing here with PACU patients is that you want to give the demographics, the history overall and the code status allergies. And the patient presented today for a laparoscopic appendectomy and she's got a couple of incisions we'll talk about in a minute. Okay. Her main concern is that after the surgery and post-op she became febrile. So we gave her Tylenol for that and we're going to continue to monitor it. They did start her on some antibiotics with PACU patients. You want to focus on a couple of things. First off, why they're here, what surgery did they have, what were the results of it? The second thing that you want to think about with these types of patients is why are they still here? If these are routine procedures, they should be able to go to PACU and then go home. But in some cases, you have to admit them to the hospital so you have to give a good reason to why they're here. In this case, the patient became febrile after surgery, so we needed to continue to monitor because there's a suspicion of infection, which is also included in their plan of care.

Neuro wise she is alert and oriented times four. She does follow commands. Her, all of her vital signs have been great except for um, her temp that spiked, but it's now come down and has not recurred. She has a left 20 gauge to the forearm. She's receiving Ancef every 24 hours. She's getting one gram here. At this point you're going to want to do there the general review of systems, neuro cardio, respiratory gig, you skin and musculoskeletal. One thing that you may want to hold off on are the skin needs because sometimes those patients have dressings that need to be pointed out and demonstrated and you need to talk about dressings a little bit more in depth. But at this point you're going to do a general review of systems, any medications, and be sure to follow the appropriate report. You can actually use the report sheets that are attached to this lesson and also the ones that we use in our cheat sheets that help you to know which system and what order and what information is important in all of those. 

In terms of all of our other systems are fine. The other big concern is that she's got the three incisions to the abdomen. Those are all Derma bonded. In terms of her pain, she is controlled with oral. She's getting Norco 5/325. Okay. the plan is for her is to get discharged tomorrow. Don't forget to discuss your patient's pain management plan, especially for surgical patients and also their plan for discharge. The idea is that our surgical patients come in, they get the surgery that they need, and then they go home. There's really no need for them to be in the hospital unless their surgery is specific and it requires some certain type of hospitalization. Do you have any questions? Do you have any questions? Perfect. All right. Do you need anything? Just some water. Okay. I'll bring someone. I come back.