The Respiratory System

My physiology class is systematically taking me through every system of the body and relearning the entire system from a cellular physiological standpoint. Can you say TEDIOUS?

I just finished up 4 days of studying the physiological aspects of the respiratory system. Why is this important to a future midwife you may be asking? Well, I kinda did too, when I began my monumentous journey through all of the material including 2 APA papers on the subject. Well, I am always pleased when I am able to apply the learning I am doing on a practical level for my practice now as a nurse and later as a midwife.

The gem of knowledge I will take away with me from this lecture involves the physiological response to excess interstitial fluid leading to peripheral and pulmonary edema. As a nurse in a high-risk obstetrics department I often take care of patients with PIH and pre-ecclampsia. And, I always knew the importance of assessing for pulmonary edema vigilantly. However, I never knew the complicated and intertwined physiological processes that must happen in a cascade effect in order to produce pulmonary edema.

In a very short form, if interested, please read on:
When the renal system malfunctions by failing to filter sodium and water appropriately, fluid overload occurs. This can result in peripheral and pulmonary edema. Excess fluid volume increases hydrostatic pressure and pushes fluid into the tissues. And, when renal disease is present, there is a decreased production of plasma proteins which results in decreased oncotic pressure of the blood. In the absence of sufficient onconic pressure, the venous system is unable to facilitate enough reabsorption. This can lead to increased peripheral vascular resistance, creating an opposing force to left ventricular output. The result is pulmonary edema (Black & Hawks, 2005, p. 214). Additionally, the lymphatic system is altered as it usually helps to compensate by removing residual fluid from the tissues.

Really, very interesting...

Black, J. M. & Hawks, J. H. (2005). Medical-Surgical nursing: Clinical management for positive outcomes (7^th ed.). St. Louis, MI: Elsevier/Saunders

Week of Certifications

While working in OB, you need to maintain various certifications... Most of which you don't use on a daily basis.. some of which I've thankfully never had to put into practice... However, this past week I had to use my most recently obtained certification - TWICE...

A couple months ago I went to an ALSO conference and became ALSO certified. ALSO stands for Advanced Life Support in Obstetrics. and it covers various OB emergencies that arise occasionally that require additional training. Some topics covered include CPR in the pregnant woman (different than basic CPR), Perimortum C-Sections, Breech births, Postpartum hemorrhages, Shoulder dystocia, etc. Things you never want to have to deal with... But need to know how.

It was great to have the certifications "In my pocket" so to speak and know exactly what to expect/do when the situations arose. Not all of the nurses on our unit are ALSO certified, so not all of them knew exactly what steps to take... and it was reassuring to me that I did and was able to help others through the situations...

Everything went well with both situations and I wouldn't want to have to have them happen again... But, I'm glad I was there when they did happen, so that I could have the hands on experience under my belt and learn from them. I was in on a postpartum hemorrhage and a true shoulder dystocia.

In the postpartum hemorrhage situation, I was lucky enough to have a doctor there who is interested in my continued learning. He included me in the process the whole time... Took my suggestions and input and used it. And, afterward, he sat with me to process the situation so when I am there alone one day, I will be able to move quickly to the necessary steps.

All in all, certifications are a pain the butt to get and keep up on.. But in the rare cases they are needed... It feels good to kind of be on "automatic pilot" in an emergency and know exactly what steps are needed.

Today was a struggle

There were a few things adding up to make a difficult day today... The one thing that is hindering me the most at this point is my circadian rhythm. In working night shift half of the week and being off half of the week, my body just gets adjusted to working when all of a sudden I stop and expect my body to readjust to "normal" life. The result is a mess. Even when I'm off, I wake up at 1am and am ready to eat "lunch." I was awake from 1am-4am last night... and could. not. sleep. Then, I cannot stay awake during the day. It just sucks.

So, today, I got up for the day at 7am, after just a couple hours of sleep and had a specific list of things I had to get done for school and my family. Then, what happens? I get a full blown migraine --- Because I didn't sleep! So, I HAD to take time out and take a pill and lay down... So, what happens? I go to sleep! What a mess.

It was about 1pm and I literally said to myself, "If I do not get up, push forward through this headache and do my studying, I will NOT become a midwife." So, with that in my mind, I did it.

I ticked off one thing after another on my "to do" list. I read 2 chapters of bio-statistics... Listened to all of the lectures to go with it. Did the review sheet for the module. And, took the bio-statistics exam and got a 100%.

Then, I went on to make a healthy, good tasting dinner of chicken Parmesan for my family. And, after dinner, I took my daughter out for some needed mother-daughter time.

It may sound like I'm patting myself on the back... But, darn it... It was a hard day, and I struggled through every part of it...

I have to just thank God for the strength and determination he gave me to get off that couch and take the next step. Each step counts. I'm glad that this step is out of the way.

On to tomorrow. and the next day... for the next 2.5 years... Ummm... we'll see.