- Shadowing Journal -

Kailyn Larson
Time: 9:00 am - 4:00 pm

Date: October 21st, 2023

Place: Prairie Lakes Hospital (OB)

Total Hours Spent Shadowing: 7 hours

Observations
Today, we started with being shown around the OB part of the hospital. The nurse I was shadowing
showed me the main nurse's office, the nursery, the kitchen/break room, the washroom, and the rooms where the
patients would ultimately deliver their baby in. OB is such a hit or miss, you never know if you’re going to have
12 patients or 1 patient. The day I was there, they had two moms waiting to get discharged. Therefore, they both
had already had their baby so I didn’t get to see a delivery. Both of the babies were put in the nursery to be under
bilirubin lights. Neither of them had a terrible case of jaundice, but the nurses wanted to keep them under the
lights for as long as they could while they were at the hospital just so that they could get the jaundice down as
much as possible before sending the mom home with her baby that way, the mom shouldn’t have to worry about
it as much while being at home with her newborn. About every 2-3 hours, we would swaddle the babies up and
bring them back to their moms to be fed. Each time the baby enters the mom's room from being out of her room,
you have to check the number on the baby's ankle bracelet with the number on the mom's wrist bracelet, just to
ensure you’re giving the right baby to the right mother. When we weren’t in the patient's room, I wasn’t very
busy doing anything. However, the nurses always had something to do whether that was cleaning up the nursery,
organizing the office, but mainly charting things. I learned charting is a huge part of the medical field and they
say “If you didn’t chart it, you didn’t do it”. You do have to make sure you chart everything you do even if it’s
something as small as giving a patient some ibuprofen. Every little detail needs to be written down and charted,
no matter what. About halfway through my shadowing day, one of the mothers started to complain about having
a terrible headache. She couldn't even sit up to feed her baby, as well as she could hardly move her head lying
down because of all the pressure and pain she felt. The nurses talked over what they thought could be causing
her this amount of pressure and pain and they decided that it was a spinal headache and a blood patch should
relieve this pressure almost immediately. Of course, before performing a blood patch, they called up a CRNA
(Certified Registered Nurse Anesthetist), to talk it over with her and just make sure this is what they think is best
for her. Fortunately, the CRNA agreed so they started to prepare for what they called an epidural blood patch.
An EBP is a surgical procedure that uses autologous blood to close one or many holes in the dura mater of the
spinal cord, usually as a result of a previous lumbar puncture or epidural. The procedure is most commonly used
to relieve orthostatic headaches. The nurse had the mother sit up on the edge of the bed. As soon as the mom was
comfortable and ready to start, the CRNA slowly started putting the “epidural needle” into the mother's back. I
would say the needle was about 6 inches and was being fully inserted into the mother's back. While the CRNA
inserted the needle, the nurse was taking blood from the mother's arm. It took a while and a couple of tries for the
nurse to find a vein that would give her blood back. Therefore, the mother was poked many times with the
needle, as well as the needle being inserted into her back. The nurse finally had 20 mm of blood and handed her
syringe back to the CRNA. The CRNA put that syringe on the needle in the mom's back and slowly started
inserting her blood into her back. As soon as there was about 2mm left to be inserted into the back through the
needle, the mother sighed and said she had just felt complete relief and her headache was completely gone. The
CRNA slowly pulled the large needle out of her back and she was done. You could just tell the mom was so
relieved and thankful that she could finally sit up and function normally without immense pressure. It was cool
to see how the nurses and CRNA chose a blood patch, went ahead and did it and told the mom she should feel
immediate relief. And that is exactly what happened. During my shadowing, I also got to see a circumcision be
performed. There wasn’t a whole lot of detail about what the doctor was doing while she was performing
because she was focused, but afterward, she gave me the rundown of what she was doing as well as the risks of
not circumcising a male. Shortly after the circumcision, a mother called that she was on her way in because she
thought she could be in labor. The mother got there and she was immediately hooked up so that we could see her
heart rate, her baby's heart rate, as well as the timing of her contractions. They checked her cervix and she was at
a 3, almost 4. The mother was only 37 weeks pregnant, so the nurses didn’t want to do anything to speed up the
process of labor because she still had just a little less than a month before she was considered full-term. After
that, it was my time to go so I am unsure if the mother ever did have her baby or if she was sent back home.

Reflection
Looking back on today, I thought I learned a lot of information. Though I didn’t expect to see a
blood patch and circumcision, I’m glad I got the opportunity to experience both of those. My nurse was
wonderful at giving me information and making sure I understood what they were doing, and why they were
doing it. If we weren’t busy with a patient, my mentor would talk and explain other things that we weren’t
actually dealing with at the moment, but things that might have happened any other day working in OB. This
showed me that my nurse really did value me and cared about my learning experience, which I am very thankful
for. One significant part of my day was just being able to be there and have this opportunity to shadow a person
who is doing what I would like to do someday. It was really cool how I got to go into the patient’s room and be
engaged and retain information about what was happening. I’m really hoping in my next couple of times of
shadowing, I get lucky enough to see the actual labor and delivery part but like I said, you just never know.
Overall, my first shadowing experience went great and I am so excited to go back to learn more, and hopefully be
able to be there for the labor and delivery part!
 - Shadowing Journal -
Kailyn Larson
Time: 9:00 am - 4:00 pm

Date: October 28th, 2023

Place: Prairie Lakes Hospital (OB)

Total Hours Spent Shadowing: 7 hours

Observations
Today was a rather boring day up in OB. When I first got there, there were 5 babies in the nursery so I
was pretty excited because I thought that meant we were busy with things to do! Unfortunately, that was not the
case. All the babies were just finishing getting assessed by the doctor, and then they were ready to go home. For a
little while in the morning, I just sat in the nursery and rocked different babies, which I enjoyed. Before 10:30,
all the babies were back in their mother's room just waiting to be discharged from the hospital. Therefore, that
left me with not much to do, but the nurses still had things to do. They were busy charting things and making
sure all information about each baby was written down. I watched a nurse chart for a while and she was just
writing down that the baby passed his/her hearing test at the time they did pass, that the baby was fed at a
certain time, and had his/her diaper changed. The nurses expressed to me that paperwork/charting things is the
worst part about nursing, but is very necessary and has to be done carefully. My mentor showed me a monitor
sheet and explained how you could see the mother's heartbeat, the baby's heartbeat, as well as the mother's
contractions. It was pretty cool to see that you could hook someone in labor up to that machine (called a
tocodynamometer) and receive all that very important information right there on the paper. As moms were
being cleared to go home, the nurse and I would go into the mom's room one last time and read off some
directions for discharge. It was just a packet with helpful information, things to worry about/things not to worry
about, etc. As soon as the family was ready to go home, a nurse would walk them downstairs and make sure that
their baby had a car seat and that it was properly put in the vehicle correctly, as well as the baby being strapped
in how he/she should be.

Reflection
Although today was not a very interesting day, I still enjoyed my time shadowing in OB. I felt as if the
nurses tried their best to make it somewhat beneficial for me, even with not much going on. I’m glad I still had
the opportunity to be there and to learn about the tocodynamometer, something I didn’t have very much
knowledge about. One significant part of my day was definitely just being in the nursery holding all the newborn
babies! I could have done that all day, but unfortunately, the babies had to go back with their moms to head home
;). I'm really looking forward to my next shadowing experience because my mentor helped me schedule when a
mom has her appointment to be induced. My mentor made no promises that she would deliver when I was there
because you just never know, but she did her best to help me get scheduled to see labor. The nurses/my mentor
really do show that they care for you and value your learning experience, which as a student, I appreciate.
Overall, my second shadowing experience was the best it could have been with how little of things there were to
be doing.
 - Shadowing Journal -
Kailyn Larson
Time: 9:00 am - 3: 00 pm

Date: November 6th, 2023

Place: Prairie Lakes Hospital (OB)

Total Hours Spent Shadowing: 6 hours

Observations
Today was supposed to be the day I was going to see someone deliver their baby! Unfortunately, it didn’t
all go as planned so I ended up not seeing the delivery. However, I was there for the whole laboring part and just
barely missed the delivery as I had to get back to Castlewood for practice. Otherwise, I would have loved to stay
and experience labor! Even though I didn’t get to see the part I wanted to see the most, it was still a great learning
experience to be able to see what labor looks like. When I got there, the mother was dilated at a 6, but her water
hadn’t broken yet. She was having pretty good contractions but wasn’t sure if she wanted to get the epidural or
not because she had a bad experience with her first epidural. We let her know that of course it was an option and
would definitely help her contractions, but it was up to her if she wanted to get it or go unmedicated. The nurse
checked her again and she was now about 7-8 cm dilated. They decided that now was a good time to break her
water so they called up the doctor to do so. The doctor used what is called an amnihook to break her water. An
amnihook is about 12 inches long, with a curved hook at the top of it. To break her water, the doctor just inserted
it and tore a hole in the amniotic sac which allows the fluid to escape. After about another hour, she was still
having contractions that were getting worse over time. The nurse had explained to her that she had to make her
choice soon, otherwise, it’d be too late for the epidural. She decided that she was going to get the epidural so the
nurse called the anesthesiologist to come up and give an epidural. The epidural went smoothly and the mother
was feeling lots better, with less pain and pressure. During the epidural, the anesthesiologist was already sterile
and he had to re-insert the needle because he accidentally got off to the right a little bit. Since he was already
sterile, he couldn’t touch anything that wasn’t sterile, otherwise, he would have to restart the whole procedure.
He needed more numbing medication, and the nurse couldn’t grab it for him because she had to keep a hand on
the mother's stomach to keep track of the baby's heartbeat, so the anesthesiologist had me grab his vial so I could
hold it while he drew up the medicine. I thought it was cool that I got to be helpful and be a part of something,
even if it was something as simple as that. When getting an epidural, a catheter is also put into your back by a
needle. The needle comes out, but the catheter stays in the back. After giving her the epidural, we gave her time
to just get comfortable and hopefully dilate fully. Later on, we went back to check on her and she was still only at
an 8. The nurse couldn’t feel the baby's head as much as she thought she should be able to while dilated at an 8.
The nurse upped her pit, which is oxytocin which stimulates the muscles of the uterus. Doing that, we were
hoping it’d make her contractions stronger and really push the baby’s head down so that she would dilate to a 10
and be 100% effaced, which is essential to start pushing. With the epidural, the mother was pretty much numb
from the hips down. Therefore, she couldn’t feel any of her most powerful contractions, which is a good thing for
her. With an epidural, you have to empty the catheter every 2 hours. It had been about 2 hours since she got it, so
we went in and emptied her catheter. It was now about 2:30 so we gave her a half hour with the upped pit,
hoping that when we went in at 3 she’d be dilated to a 10 and the baby's head would be down at the cervix. We
went to check on her, she was at a 9 now, so making progress, but the baby's head still wasn’t down as far as it
should be when dilated to a 9. My nurse upped her pit once more just to really contract her uterus and help get
her dilated and push the baby's head down into her cervix. Unfortunately, it was now 3:00 and my time to go.
They figured she’d have the baby by 4 so I just barely missed it!

Reflection
Looking back on my shadowing experience today, I feel really grateful that I got to have that experience,
even though I didn’t get to see the most exciting part. I thought I learned a lot of information just by following the
nurse around, and being able to be in the room while the nurse was doing things, while the doctor was accessing
the patient, as well as the anesthesiologist. One thing I learned is that a catheter is put in after getting the
epidural. I thought it was just a shot that goes right into the back to numb you and that was all so it was
interesting to be able to see that whole process be done. Even if they weren’t explaining exactly what was
happening because they were focused and worried about other things, I still got a good feel for what they were
doing, and afterwards they’d explain what they just did, which was very beneficial. One significant part of my
day was just being lucky enough to experience everything that I got to. While sitting in the patient's room, I just
was thinking about how cool it is that I’m allowed to be here and learn new information about the job I would
like to pursue in my upcoming future. Overall, I am bummed I barely missed the delivery, but still thankful for
the great experience I had throughout the day.