Most dreaded Dr.'s orders

[BBFRN]

What are your most dreaded Dr.'s orders to hear- you know, the ones that tell you that you're in for one heck of a night? For the past couple of nights, I had a patient with ammonia levels in the 260s, who had an order for a Lactulose drip (at first, it was full-strength via DHT- yeah, THAT worked out well ). Needless to say, it went how I had envisioned it: the DHT kept occluding, until I finally got new orders for 1/2 strength via NGT, the pt was out of it, and was code-browning the whole time. Man, I hope I never see orders like that again! What are some of your dreaded orders?

[RN-PA, RN]

My most dreaded order is "Insert NG tube". I'm really good at dropping an NG so I always get volunteered to do everyone's who gets that order. I hate putting the patient through dropping a NG.

I'll take enemas over inserting an NG any day.

I'm with YOU! I pray like mad--before and during-- NG tube insertion. I always get a helper to hold the patient's hand and to help them sip water so the tube advances. It's so hard to see tears rolling down their faces, not necessarily from crying, but from the discomfort of it all. And of course, we all know how much fun it is to drop an NGT on a confused patient. :stone

If I ever need an NG tube, I will request sedation first. Either that, or the poor nurse who has to insert it in me will need sedation!

[DutchgirlRN, ASN, RN]

Up until yesterday it was dropping an NGT. Not that I mind doing it I just hate putting a patient through it. I have a new most dreaded order........admitted a 4 year old yesterday......IV Fluids, ok I understand that, I got through it, UA & C&S , cathed specimen. It was awful. I got a small feeding tube from the nursery, I don't think the procedure was particularly painful for her but if you can imagine adults holding this little girl down, she's screaming her head off, were prying her legs apart, cleaning her.....you get the picture. I realize I had to follow orders but I hated like hell doing that to her. I think at 4 years she's old enough to get a clean catch with Mom's help. If I had been the mother I would have refused the cath. Her diagnosis had nothing to do with her urinary tract. Opinions? (This is one Dr. who could not be persuaded otherwise and would have called administration if I had questioned his orders).

[RN-PA, RN]

Up until yesterday it was dropping an NGT. Not that I mind doing it I just hate putting a patient through it. I have a new most dreaded order........admitted a 4 year old yesterday......IV Fluids, ok I understand that, I got through it, UA & C&S , cathed specimen. It was awful. I got a small feeding tube from the nursery, I don't think the procedure was particularly painful for her but if you can imagine adults holding this little girl down, she's screaming her head off, were prying her legs apart, cleaning her.....you get the picture. I realize I had to follow orders but I hated like hell doing that to her. I think at 4 years she's old enough to get a clean catch with Mom's help. If I had been the mother I would have refused the cath. Her diagnosis had nothing to do with her urinary tract. Opinions? (This is one Dr. who could not be persuaded otherwise and would have called administration if I had questioned his orders).

I don't know who to feel sorriest for-- You or that poor little girl! I had a 14 year old who'd had her foley D/C'd post-op and because of various issues, I was afraid I was going to have to cath her. (I ended up transferring her elsewhere before she was due to void, so didn't have to deal with it.) But I remember praying that she'd be able to void.

I probably would've taken the Mother aside and told her about the procedure and the alternative clean catch method. I would tell her inserting a catheter would likely be traumatic for her daughter and that she as the parent is allowed to refuse any procedures. If she refused, I'd then call that tyrant doctor and get a different order. :angryfire

[RN-PA, RN]

Getting back to the topic of milk and molases enemas, I came in to work last Sunday to find the chart of a newly admitted patient with a bowel obstruction. And the orders that caused me to get weak-kneed and short-of-breath, break into a cold sweat, and begin whimpering like a two-year-old: "Milk and molasses enemas x 2".

My co-workers whispered amongst themselves, and glanced at me with facial expressions of pity mixed with relief that it wasn't their patient.

I taught the patient about what was ahead and he decided he could probably hold the enema contents until the bathroom, but I had a bedside commode close by just in case. Unfortunately (and stupidly), I thought I'd have time to unhook and clamp his NG tube before he'd need to evacuate. As the last inch was draining from the enema bag, the patient said he thought he couldn't hold anymore. So I began to unhook the NG tube as he was scrambling to the edge of the bed which was in the high position. I yelled, "WAIT! WAIT! I NEED TO GET THE BED DOWN!" But he rolled over the edge of the bed, straight to the bedside commode, and proceeded to spray the wall, the floor, commode, and bedside table with milk and molasses, and not much else.

OH THE HUMANITY!!!

I helped housekeeping clean up the mess (boy, does it ever get sticky quickly!), and later on, one of my beloved co-workers, whom I will never be able to repay, insisted on administering the second M&M enema since she was down to two patients. She had him use a large bedpan this time and the patient had excellent results, we're all happy to report.

[RNKPCE]

Never heard of this kind of enema thank god and hope I never do. Is the doc who ordered it older? Anyone ever hand an alcohol IV bag. Did that once about 15-18 years ago.

Getting back to the topic of milk and molases enemas, I came in to work last Sunday to find the chart of a newly admitted patient with a bowel obstruction. And the orders that caused me to get weak-kneed and short-of-breath, break into a cold sweat, and begin whimpering like a two-year-old: "Milk and molasses enemas x 2".

My co-workers whispered amongst themselves, and glanced at me with facial expressions of pity mixed with relief that it wasn't their patient.

I taught the patient about what was ahead and he decided he could probably hold the enema contents until the bathroom, but I had a bedside commode close by just in case. Unfortunately (and stupidly), I thought I'd have time to unhook and clamp his NG tube before he'd need to evacuate. As the last inch was draining from the enema bag, the patient said he thought he couldn't hold anymore. So I began to unhook the NG tube as he was scrambling to the edge of the bed which was in the high position. I yelled, "WAIT! WAIT! I NEED TO GET THE BED DOWN!" But he rolled over the edge of the bed, straight to the bedside commode, and proceeded to spray the wall, the floor, commode, and bedside table with milk and molasses, and not much else.

OH THE HUMANITY!!!

I helped housekeeping clean up the mess (boy, does it ever get sticky quickly!), and later on, one of my beloved co-workers, whom I will never be able to repay, insisted on administering the second M&M enema since she was down to two patients. She had him use a large bedpan this time and the patient had excellent results, we're all happy to report.

[Mommy2Katiebaby]

Some orders MUST be given solely for the amusement of the docs...

[RN-PA, RN]

Never heard of this kind of enema thank god and hope I never do. Is the doc who ordered it older?

I guess he's in his late 40's early 50's and is a surgeon. The patient did get good results from the second milk and molasses enema, but I wonder if he'd have had similar results from other types of enemas without putting nurses and patients off of ginger cookies and shoofly pie forever.

Some orders MUST be given solely for the amusement of the docs...

It sure seems that way sometimes, doesn't it?

[Mommy2Katiebaby]

Well, you know GOOD and well they'd be highly unlikely to write for such a thing if they had to do it themselves. Probably foist it off on some unsuspecting med student...

[Nurseferatu]

..admitted a 4 year old yesterday......IV Fluids, ok I understand that, I got through it, UA & C&S , cathed specimen. It was awful....holding this little girl down, she's screaming her head off, were prying her legs apart, cleaning her.....you get the picture. I realize I had to follow orders but I hated like hell doing that to her. I think at 4 years she's old enough to get a clean catch with Mom's help. If I had been the mother I would have refused the cath. Her diagnosis had nothing to do with her urinary tract. Opinions? (This is one Dr. who could not be persuaded otherwise and would have called administration if I had questioned his orders).

Here's something we ca me up with at my hospital a loooong time ago -- it's not a cath specimen, but it is a sterile sample -- take a medium-sized tegaderm, place a few sterile 2x2's in the center, place it on the child and let nature take its course - the kids never complained, and we were able to squeeze the enough of the urine into a sample bottle

[Labrys]

Originally Posted by hippienurse

I agree. I am an overweight woman, and find it insulting for a professional to be using those types of terms to describe their patient. Glad I won't ever have her for a nurse.

I'm pretty sure when the poster said "skanky"...they meant dirty. The pt just happened to be overweight also. :)

[melzan]

The other night I had a continuous cbi wide open along with my other 8 patients on a medsurg floor. I was in that room every 20 minutes, plus the times when he clotted off. To make matters worse the man was A&Otimes 3 but had a hole in the roof of his mouth so he spoke jibberish, this man would also strain against the catheter it was a horrible night, especially since a few of my other patients were"needy". It was the first time in a while that I broke down and cried when I got home.