Inquiring Minds Want To Know: Outrageous Orders!

Nurses General Nursing

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nurse kratchet

12 Posts

we have a chf pt on aspiration precautions with no gag reflex that nurses must supervise with all meals. order ,lasix 40 mg if pt eats more than 50% which she barely eats at all. dnr but needless to say she's out to the hospital q week in chf and pneumonia. he's our med director and will not change it!

Curlytop

34 Posts

Originally posted by micro

what troubles me is when pt. has definitively indicated and all legal paperwork is in place......that they are a dnr/dni........but yet everything i mean everything is done.........why...........

also when you know what the patient wants done and not done.....but procedures are done anyway......

sorry for the somber response........but sometimes in nursing this is what we see...............

:( Couldn't agree more- in ICU I see that too often- especially when the family is has decided on a DNR and the stupid, paternalistic md gives them a shread of hope to grab a hold to.

And what's up with "Chemical Code Only" orders as opposed to DNR??? We're going to ONLY give the ACLS MEDS and NOT do chest compressions or ambu with oxygen- I've never witnessed that to work. I say either Full Code or No Code.

Oh Yeah-- How about "Up to chair QID" for a total-lift patient who is half comatose. YEAH RIGHT!!

fedupnurse

790 Posts

Couldn't agree more Curlytop! We just went from a Level sytem of DNR (dirt nap request) to code or no code. BUT, you knew there ahd to be a but, that only means for an arrest situation. If their BP is low we have to treat it, they still get blood products, they are still aggressively treated until they go apnic or pulseless.

And the false hope!!! OMG!! Don't even get me started on THAT one! I have gotten to the point where I tell families that "unfortunately, Dr._____, tends to paint a very rosy picture. Here is what I have seen in 10 years of doing this..." Most families are grateful for the truth.

mattsmom81

4,516 Posts

How about "Get correct insurance info from patient". I informed him politely this was NOT my job nor a good idea; he persisted in writing it as an ORDER. :(

This one I sent directly to risk management, and my boss...as it creates a conflict of interest and is not good PR.:(.

nursedawn67, LPN

1,046 Posts

Specializes in Geriatrics, LTC.
Originally posted by RN2bNC

I did some time as a unit secretary, and can't remember all the crazy orders I saw, but there are a couple that stick out in my mind.

"Please make clear liquid diet more appealing" - The nurse wanted to know if we should put a picture of a T-bone at the bottom of the cup of broth, hehe!

ROFLMAO!!!:roll :D

nursedawn67, LPN

1,046 Posts

Specializes in Geriatrics, LTC.

I found this one funny/ sad.........

Doc ordered I&O on a resident at the LTC facility I worked at.....I asked Doc, "how long would you like her on I&O?" He replied, "until she dies". He could have just said indefinately. :stone

Curlytop said "Oh Yeah-- How about "Up to chair QID" for a total-lift patient who is half comatose. YEAH RIGHT!!" I can see why we do it, and I did it for a long time, it really is good for the comatose patients, and we had special chairs for people who were OOB but couldn't really sit in a chair! The unit got beds that adjusted more than the usual bed. So that "counted" as being OOB in a chair. Never got around to getting them for the floor!

Love

Dennie

RNinICU

235 Posts

We have a doc who is a real jerk, writes "turn pt q 2 hours." He once wrote to ambulate a patient in the hall who was a bilateral amputee. The same doc wrote in a pt's H&P that there were no testicular lumps or penile discharge. The patient was a 72 year old woman.

MollyJ

648 Posts

Originally posted by nurse kratchet

we have a chf pt on aspiration precautions with no gag reflex that nurses must supervise with all meals. order ,lasix 40 mg if pt eats more than 50% which she barely eats at all. dnr but needless to say she's out to the hospital q week in chf and pneumonia. he's our med director and will not change it!

I know that docs in certain situations have a lot of power, but have you considered pulling in a speech therapist as an ally? A patient with no gag reflex should not be getting oral feedings. Period. Family needs to be consulted PEG tube vs something else or what the patient wants but to IATROGENICALLY cause aspiration because of this order. That borders/lands on cruelty. I know you know this. The SLP just may give you another voice.

MollyJ

648 Posts

Well all of these postings reminded me of so many squirrelly orders through the years, but the one that incensed me the most was written on an elderly, alcoholic woman who had fallen on ice in mid winter and laid there for a while. She was a popsicle on arrival to the ED, but we thawed her and sent her from ICU to the floor for a long convalescence. She sustained frost bite to her finger tips. Her doc was a fossil and was treating her with some sort of magnesium solution (it turned her fingers purple) and we bandaged her hands. Well, that meant she couldn't SMOKE!! Doc wrote an order said:

Nurses to hold cigarette for patient so that she can smoke.

There was never a day that that order would have fit into my schedule. Like she needed the vasoconstrictive effects of smoking to slow the healing to fingers...

okihusker

26 Posts

Admit ICU: DX Physical Exhaustion

(Guess I should have been admitted on some days too)

Transfer to Inpatient Mental Health Unit: DX: Major Depressive Episode, Partner Relational Distress, Suicide Gesture, and Bilateral Ingroing Toe Nail.

Admit General Medical Ward: DX: Social Admission

Admit ICU: DX Rule Out MI (the patient's symptom were electrical shock feelings that started in the chest and rushed to hear head. Three to four of these 1-2 second episodes in 24 hours) Should have read Admit to Inpatient Psychiatric Unit: Axis II, Conversion Disorder.

Admit ICU: Palpatations, Rule Out Dysrhythmias (yes she was having frequent unifocal PVCs. After further enquiry by this RN, we discovered that she consumed 15-16 Mountain Dews a day and 2 to 3 liters of ice tea a day as well).

Brita01

350 Posts

'Notify me if any pussy drainage occurs.'

We know what he meant, it just looked funny in writing. :chuckle

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