*Original post 1/7/2022
It’s no secret that ICU nursing over the past two years has gotten a lot more complicated, especially since Covid infections haven’t gone away. At the end of August 2021, my husband and I found out the incredible news that we were pregnant! Amidst all the excitement, there was also a little apprehension knowing that I work in the ICU setting where there’s always a possibility of being exposed to or taking care of a Covid patient. For those of you who aren’t aware, pregnancy increases the woman’s blood volume and viscosity, predisposing her to the potential development of blood clots. For me, I also have two additional factors against me in regard to the risk of blood clots and their complications — Covid nursing and Factor V Leiden thrombophilia. We’ll talk about how I’m handling this high risk pregnancy as a nurse in next week’s article though! In this week’s article, I want to discuss some of safety and health measures I’ve been encouraged to take as well tips I’ve learned along the way during these past four and a half months.
As far as safety and health measures are concerned, my high risk fetal maternal specialist encouraged me to restrict lifting to no more than 20 pounds. If you’re a nurse, you know that this is a nearly impossible task…let alone in the ICU setting. I’ve had to get used to requesting more assistance when lifting, turning, and ambulating patients. Another measure I’ve employed is being overly cautious and aware of infection exposure and precautions. When I’m alerted about a new admission to the ICU, regardless of the originating unit (ED, medsurg, tele, etc.), I check to make sure they have had a recent Covid test and the results are available. Many times the ED tries to get patients in and out as quickly as possible, especially when they have a high acuity, so there have been times where the patient’s labs aren’t yet resulted before I’m asked to admit them. This is a hard stop for me. Wearing an N95 and extensive handwashing (versus the use of alcohol based rubs) as much as possible is also a necessary evil.
A side note to make here as well would be that I’ve increased my awareness of working with certain teratogenic drugs. In an ICU setting, patients often have a high acuity and multiple comorbidities that result in the need for anticoagulation or chemotherapeutic, antipsychotic, and anticonvulsant use. In these cases, drugs like Warfarin, Phenytoin, tetracyclines, hormonal drugs, and anti-cancer medications are some that should be avoided while pregnant.
Now let’s move on to tips I’ve picked up on either through the advice of other moms or on my own while working as a nurse. Naturally, I have been more hungry and thirsty as the pregnancy has progressed. My goals with nutrition and hydration have been to eat every 2-3 hours minimum and aim for at least 64 oz water daily. To help with this, each shift I work I pack at least 6-8 snack size portions in my lunchbox along with my actual lunch meal. I’ve opted for a flip top 64 oz water jug to keep on the unit when able so I can see my progress throughout the shift. Plus, the flip top makes it easy to take quick sips here and there. Staying hydrated is crucial, especially since we’re expecting twins, because dehydration can increase the pregnant woman’s risk for contractions and pre-term labor. Along with hydration comes the consequence of micturition. In case you didn’t know, that’s a fancy term for peeing! At a minimum, at five and a half months pregnant, I find myself running to the restroom every 1-2 hours while working.
Pregnancy related fatigue is also NO JOKE! Many of us nurses live off of caffeine as sustenance, especially those of us working night shift. Unfortunately, during pregnancy it’s encouraged to limit caffeine intake. I discussed the use of caffeinated products with my OB and we set a limit of no more than 200 mg daily. As an example, that’s approximately 2 cups of coffee or 3-4 12 oz cans of Mountain Dew (my caffeine of choice). Know your caffeine limits and plan ahead for your shift so you can get that caffeine in when you need it most! I’ve also increased the amount of “breaks” I take throughout my shift, aiming for a 15 minute rest every 2-4 hours. I try to group my tasks together (AKA: clustering care) so that I can conserve more of my energy. I’ve also had to learn to accept and request help when needed and delegate tasks as able. This was a concept that’s been truly difficult for me to learn and employ in my nursing habits.
Lastly, I’ll address some of those all-too-common pregnancy discomforts such as leg swelling, foot pain, and abdominal pain. As the circulating blood volume increases and time spent standing increases, so does the foot pain and leg swelling. Compression socks are no longer a suggestion or nice thought; they’ve become a necessity. I noticed some small superficial bulging veins early on, and compression socks have helped delay that progression to varicose veins tremendously. Whenever there’s an option to sit and elevate my feet at work, usually while charting, I take advantage of the opportunity. As soon as I get home, the feet are elevated too! As for the abdominal pain, it’s also referred to as round ligament pain which occurs as the pelvis expands to make room for the baby as it grows. With two little ones in my womb, this pain started early on in pregnancy! Purchasing and using a belly band has been an invaluable investment.
In short, pregnancy hasn’t really altered how I provide nursing care to my ICU patients, but it has adjusted my night shift routine a little. I have to make time to eat, go to the bathroom, and rest more often…which means making wiser use of the same amount of time to prevent staying late each shift to catch up on charting. Keeping precautions and exposure in mind are things that nurses need to be doing already, so there wasn’t much change in routine there. I simply acknowledge that being a little “lax” with any of those measures isn’t placing only myself at risk anymore and avoid those lax behaviors as much as possible. Being pregnant as a ICU nurse isn’t something that needs to be avoided, even now with Covid ever present, so long as you take care of yourself and implement the necessary measures for infection control.
In next week’s article, I’ll take the time to outline why my OB has chosen to consider my pregnancy “high risk” aside from the fact that I’m carrying more than one baby. I’ll break down each aspect of our high risk pregnancy and how we’re coping with it. Until next time, happy studying!