Scariest thing you have found

healingtouchRN · Jun 6, 2003

con-graduations! I noticed that you grad today! I hope you day goes well!!!! :biggringi :balloons: :nurse:

Pediatric Critical Care Columnist · Jun 7, 2003

Here in the Great White North, when we talk about 2/3-1/3, we're referring to 3.3% Dextrose, 0.3% Sodium. It isn't really "two thirds-one thirds", but more like two threes-one three. Comes commercially prepared, we use it for mixing our morphine gtts.

Pediatric Critical Care Columnist · Jun 7, 2003

Now that I've got that out of the way...

A few years back, I came on a night shift and got report from a very senior nurse who had worked neonatal forever, a meticulous nurse, one who paid great attention to detail. I'm assessing my patient, a little 1100 gm 30-weeker with NEC. Oops, there's blood almost the entire length of the silastic CVC her TPN is running into. :confused: Come to find out that the IV tubing had been put into the pump upside down and instead of pushing the TPN into the pt, it was pulling blood out of her. She was fine.

Then there was the newbee nurse only about 8 months into her career who put a peds pt's p.o. meds into the balloon port on the foley we were temporarily using as a GT until the stoma matured and we could place a button. "A one-way med port on a GT! How cool is that?" she says. :eek:

I think the scariest thing I've seen so far is the 11 year old trauma with the shredded gut who became hypotensive after a small dose of fentanyl during rounds. She was a little antsy while I was trying to give report, so the attending said to give her 50 of fentanyl. Since she had already had two arrests, I gave it very slowly over a good five minutes. :saint: Within minutes her BP was 40/20. The attending then walked over to the pump tree and turned up (and UP) the epi. :devil: Next time I look her BP was now 240/120!! With all the vascular damage she had in her gut, I was afraid she was going to blow a gasket! :chair: In the end we didn't save her, but thank TPTB that we didn't "kill" her.:wink2:

nrw350 · Jun 7, 2003

what is "TPTB "?

Thanks.

Pediatric Critical Care Columnist · Jun 7, 2003

The Powers That Be... you're welcome.

nrw350 · Jun 7, 2003

Personally I find it hard to believe than anyone with a bp of 40/20 could be stable. I also understand how dangerous 240/120 is bad since I have hypertension. I think I would be dead if ever my bp was that high.

NurseAngie · Jun 7, 2003

Originally posted by night owl
Not the scariest, but certainly the most cruelest. Worked psych one night. The next morning, a pt c/o his feet were hurting so bad and would it be ok for him to have breakfast in his room. (He had gout). Charge nurse said, "NO, it's not allowed!" So the pt ever so slowly and in a great deal of pain shuffled to the dinning room. The kitchen aid went to hand him his tray and the charge nurse said, "'Oops, breakfast is over" and made the kitchen aid put his tray back. I asked her what was that all about, and she said, "He took too long." Oh really? I gave him his tray when she left the room. Explained what happened to the Unit manager when she arrived, wrote her up and the ***** was suspended for three days! Thought she should have been admitted to the psych ward for that little stunt...

This one really bothered me. It was deliberate. I hope this "nurse" found a different line of work.

~Angie

NurseAngie · Jun 7, 2003

I like your siggy line :) I had a nsg. supervisor in the ER tell me this.... A dumb nurse will ask questions and won't be dumb for long. A sorry nurse won't ask questions and WILL ALWAYS be sorry! I remember that each time I ask something that I don't know.

~Angie

mattsmom81 · Jun 7, 2003

Jan, I have found IV tubing backwards too and pulling blood!! Seems to me there should be a failsafe on the tubing or pumps!

'specially with our smallest patients this could be fatal.

It scares me too when I see a health care worker being deliberately mean to patients. Wonder what worse they are doing when nobody is watching...

suzannasue · Jun 7, 2003

Was working Peds one evening. had a floater nurse coming on at 2300, so I decided to stay late and help her become a little more oriented with the unit/routine...well...I had my purse over my shoulder and was ready to leave, feeling a bit,umm, tired, but also very anxious about leaving this gal with "my kids"...so, I put my purse on the desk and found her in a pts room pushing liquid Tylenol into the IV line...I literally jumped to the bedside and clamped the IV tubing, called the other night nurse, DC'd the IV site and called the MD...had to work a double...it was a "gut " feeling we get, you know...no harm done but the potential was there...I asked her why she was giving Tylenol IV and she said "the kid is NPO" I informed her that he child had tylenol suppositories ordered, until able to take po's...she just said, lackadaisically "oh well"...

Another situation that scared me to death was when working med/surg, we admitted a male and a female s/p MVA...both were highly positive for cannabis,cocaine, ETOH,amphetamines....the male was less injured than the female so he asked to keep her purse in his room...no problem with that...he requested and was given his pain med and drifted off to sleep...she woke up and although a bit dreary from concussion, she asked about her purse. We told her that her male friend had it in his room, and she firmly yet politely asked for us to bring it to her...I got her purse for her, but on the way to her room, stopped at the desk.

You see, her purse must have weighed 10 lbs or more...I just opened the top and looked in, expecting to see bricks or just a lot of make up or something benign that we women just have to have...LO and BEHOLD... the very first thing I saw was the hand grip of the biggest pistol I had ever seen !!!! I called the supervisor who immediately got angry at me for violating this woman's privacy...OK....beat me, spank me, whip me....we went to the female's room and I confessed what I had done and she said " that's OK...I wanted my purse because I know HE was going to use it on me for wrecking that car we were stealing, I mean taking to New Jersey"...we had to get the police involved, the pistol was locked up in the hospital safe and the supervisor remained furious with me for a long while...I guess she never expected a "shoot-out " on the floor...both pts were arrested upon discharge for possession of illegal substances with intenet to sell, grand theft auto, and possession of an unregistered firearm...and you know, this was not the last time I found a weapon amongst a pts belongings... I am a firm believer in metal detectors at every hospital entrance...

nrw350 · Jun 7, 2003

I support you suzannasue!!! You did well. I don't believe you should have been punished for that action in that case. Basically for the most part if you are a patient in a hospital, you can expect to loose much of your privacy. But so long as this is done correctly, there should not be any harm done. JOB WELL DONE!!!

Pediatric Critical Care Columnist · Jun 7, 2003

Originally posted by nrw350
Personally I find it hard to believe than anyone with a bp of 40/20 could be stable.

Of course she wasn't stable with a BP like that. I don't think in the six weeks we kept her alive that she was ever truly stable. Her BP never went above 70/40 (the epi incident nothwithstanding...) and she was on dopamine and vasopressin for most of her stay. She went back to the OR numerous times to have perforations of her small bowel repaired and never had her abdomen closed, she had five sumps inserted, the surgeon came in daily to change her dressing, we weren't able to extubate her... all in all a very sad case. She was conscious and aware until the moment she died.