Once you see a heartbeat on the ultrasound, you don't need to follow HCG Quants
If some one is miscarrying and they have never had an ultrasound that proves an intrauterine pregnancy, you DO need to follow HCG quants to less than 5 to make sure you don't have molar pregnancy
HCG Quants will start to decrease around 10 weeks, and this is NORMAL - it does not indicate an impending miscarriage
If a patient doesn't have insurance and wants a postpartum tubal (After SVD), it is not covered and they will need money up front ($2000 up front, and there may be other charges later - they are able to start installments of the $2000 long before hospital admission) - can still sign the consent in case they end up getting a section, but talk to them about their other (more affordable) options
Free Nexplanon at Lafayette Medical Center; cheap or free IUD at NHC
If someone has newly diagnosed or poorly controlled diabetes, see them back in a week (not in 2-4 weeks); if not able to see them back that soon, plan for a phone encounter to adjust meds as needed
MAKE SURE YOU'RE OFFERING GENETICS AND MFM REFERRAL TO ALLLLLLLLLL WOMEN WHO WILL BE 35 OR OLDER AT DELIVERY!!! We HAVE to document we are offering the referral. They will offer them the NIPT/cell-free-DNA screening test which we cannot offer at NHC - other than that we are able to do everything in our clinic. If they don't have insurance, it will be a pay-out-of-pocket visit (plus labs and maybe ultrasound), so do not make the patients feel like the HAVE to go. Can do quad with us too and if high-risk then re-offer MFM.
Anyone who is Rh negative should have an Antibody Screening test with their 28 week labs to make sure they NEED the rhogam!
Please make sure you're putting in a diagnosis for all the triage patients (ie. abdominal pain, decreased fetal movement, etc). If you don't, then I get a delightful slip of paper about 8-10 weeks later and I have to go in and put them in. Please don't make me do this. I hate doing this.
Signs of a NOT-OA baby - coupleting, back labor/pain, longer/protracted labor, persistent "lip" (anterior/L/R - the lip is often where the forehead is)
If a patient is admitted for more than three days, you need to repeat her type and screen - for PPROM or prolonged admission patients, please make sure set for Q3D type and screens
Please do not blast preeclampsia patients with IV fluids...could get you into trouble later!
For prolonged ROM (>18 hours), start the same antibiotics as you would for GBS prophylaxis
When using an interpreter, remember that many of our patients read at an average of a second grade level; you need to use terminology that they will understand, and not medical words (or at least give them context of the medical words) - for example, talking about the "jaundice level...which is a thing called bilirubin...this is what can make the baby yellow."
DOL#0 is the birth day (not DOL#1)
To prevent readmission, babies discharged <48 hours old should be seen within 48 hours. If >48 hours, should still be seen within 72 hours (ideal) to 96 hours (https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=139978717&bookid=1626)
To find the hearing screen, CCHD screen, go to the results review, and look at the "Assessments - Provider View"
If a baby is Coombs positive, it goes up in neurotoxic risk (to medium if baby is 38+ weeks, high risk if baby is <38 weeks)
All babies who are exposed to opiates (illegal or prescribed) or illicit substances other than THC should be kept for a total of three to five days for NAS observation (5 days if on methadone or subutex). Parents should be able to "room-in" with baby as long as there is room (and as long as appropriate to have baby unsupervised), and shouldn't be discharged until cleared by Social Services. For rooming in protocols and "rules"/guidelines, ask Dr. Turner!
Once a baby has been on phototherapy, you CANNOT USE TRANSCUTANEOUS BILI UNLESS LIGHTS HAVE BEEN OFF FOR AT LEAST 24 HOURS! The lights decrease the bili at the skin so you can have falsely low bili. You MUST follow serum once they're being treated. If you have someone doing TcB, please teach them otherwise! Or tell me and I will!
**IF BABY GETS DISCHARGED, IT CANNOT STAY WITH IT'S MOTHER UNLESS THERE IS ANOTHER ADULT WITH THEM 24 HOURS A DAY!!! A PATIENT CANNOT BE CARING FOR A MINOR WHILE ADMITTED. BABIES CAN ALMOST ALWAYS REMAIN A PATIENT AS LONG AS MOM IS (ASK NURSING ADMIN ABOUT THE TIME LIMIT)***
You should usually wait for a baby to pee before doing a circumcision if you can
We do not have Car Seats to give you willy nilly - patients should be getting these prior to admission, and only in the cases where they literally cannot afford to buy them should they be provided by the hospital (this should be determined through nursing assessments and social work, not your questioning alone)