What have other nurses done that have freaked you out? - page 66

What has other peers done intentional/unintentional to freak you out? Good or bad. Happy or sad. On my FIRST day as a LVN, (LTC) a res was screaming in her room as I was walking out to leave. I... Read More

  1. by   TJMICHAEL
    I am a student, still early in my nursing education. At my clinical site, my patient was found having a hypoglycemic episode. Diaphoretic, lethargic, very thirsty. She was soaking wet from head to toe. I notified her nurse, who was not concerned. Thankfully my clinical instructor & I checked her blood glucose because she was barely above 30, & going downhill quickly right before our eyes. We gave her orange juice, & when her nurse came to the room, she had insulin with her. It really freaked me out as I watched her inject insulin into my patient whose blood glucose was already so low! I am still not clear on why this was done, but my patient is still alive & kicking, so I'm sure there is logic to this that I am just too new to the game to have caught on to.
  2. by   CrazierThanYou
    Quote from TJMICHAEL
    I am a student, still early in my nursing education. At my clinical site, my patient was found having a hypoglycemic episode. Diaphoretic, lethargic, very thirsty. She was soaking wet from head to toe. I notified her nurse, who was not concerned. Thankfully my clinical instructor & I checked her blood glucose because she was barely above 30, & going downhill quickly right before our eyes. We gave her orange juice, & when her nurse came to the room, she had insulin with her. It really freaked me out as I watched her inject insulin into my patient whose blood glucose was already so low! I am still not clear on why this was done, but my patient is still alive & kicking, so I'm sure there is logic to this that I am just too new to the game to have caught on to.
    I'm halfway finished with nursing school and I can't see any logic to that.

    One day, we were talking about diabetes and this genius in my class says "Okaaaaaaaaay, so, like if a person is hyperglycemic, you would never, like, give them insulin, right?" So, I said "Hello, insulin is what brings it down". Her response: "I'm soooooooo confused".

    Clearly.
  3. by   ElvishDNP
    Quote from TJMICHAEL
    I am a student, still early in my nursing education. At my clinical site, my patient was found having a hypoglycemic episode. Diaphoretic, lethargic, very thirsty. She was soaking wet from head to toe. I notified her nurse, who was not concerned. Thankfully my clinical instructor & I checked her blood glucose because she was barely above 30, & going downhill quickly right before our eyes. We gave her orange juice, & when her nurse came to the room, she had insulin with her. It really freaked me out as I watched her inject insulin into my patient whose blood glucose was already so low! I am still not clear on why this was done, but my patient is still alive & kicking, so I'm sure there is logic to this that I am just too new to the game to have caught on to.
    It does depend on what kind of insulin she would have been giving. Rapid-onset, rapid-peak insulin (such as regular or humalog) is of course not indicated and you'd be right to be concerned; however, there are plenty of folks with diabetes who have to take much longer-acting insulins (such as Lantus or NPH) whose onset of action is several hours and peak is not for 8, 12, or even 18 hours after injection. Now, if the low blood glucose consistently occurs at a certain time of day/night, it might be prudent to consider tweaking the insulin regimen in terms of dose or timing, or consider a diet-appropriate snack to keep it from occurring.
  4. by   talaxandra
    It also depends on the type of diabetes - you almost never withhold insulin from someone with T1DM, even if their sugar's low, though in this case I'd wait a bit, and also consult with the endo reg first.

    What often happens is that the patient hypo's, insulin's withheld, the patient starts to trend higher, and the team spend the next two-plus days trying to restabilise the sugar. There was a case at my hsopital (though not my ward) recently where a patient with almost resolved DKA had insulin withheld for a low BSL; insulin wasn't given when the hypo resolved, the unit wasn't contacted, and for some reason the next dose was also withheld (even though the pre-meal BSL was high normal) - by midnight the patient was trending back toward DKA, had a two-day extension of admission, and an increased risk of lifetime complications of diabetes.
  5. by   Christy1019
    i agree w/the last two posters, the nurse was likely giving Lantus which is long acting which has a delayed onset and peak time, HOWEVER, regardless if it was long or short acting, the nurse should have been checking the pt's blood sugar herself prior to administering it, as well as assessing the patients symptoms. Not to mention, if it was my patient, i would've been giving an amp or half-amp of D50 for a glucose in the low 30s.. but thats just me..
    one other thing... did your instructor say anything at all to the nurse? or ask what type of insulin she was giving? or just stood by and assumed this nurse knew what she was doing? or at the very least, explained it all to you, assuming she had more information? if not, i'd say she isn't setting a good example for her students.. i don't care if someone's a student, a housekeeper, or the chief of medicine, if you notice someone ignoring troubling symptoms, or appearing to be acting negligent to a patient in any way, say something.. it might pis* that person off, but i know i personally wouldn't be able to have a clear conscience if i was right and that person was affected negatively...
    when in doubt.. ask questions
  6. by   RHIA, RN
    Quote from texas_lvn
    First off I am no longer a "neophyte" and at that time I did not want to work anywhere but in longterm care. I can honestly say that I learned just as much there as I have in a hospital setting.

    Secondly, the only way to get to the xanax, or ANY meds for that matter is thru a closed, LOCKED door that only the nurse on duty has. I was going out the door. The LVN that relieved me had just come on duty. Why are you being so judgemental of me? I didnt do anything to you, and I ACTUALLY KNOW HOW TO DO MY JOB.

    Lastly, this incident was several years ago. I made this thread up for laughs.
    That was my first thought, you already said you were leaving and, of course, xanax is locked up. Geeze.
  7. by   optimist
    As a brand new nurse, I was holding an agitated pts arm while another nurse was trying to draw stat labs on her. The nurse blew out the first attempt pulled out and stuck again inches below it (same needle no alchohol)!!!. I watched dumbfounded (I know I should have spoke up) as she attempted 5 sticks on that same arm with that same needle with no success.
  8. by   LouisVRN
    Holding all of a patients meds for an hour period of time because they didn't have time
  9. by   RNJill
    Hemodialysis patient came up to my floor-had been admitted through the ED w/1 wk hx of fevers of unknown cause. I was doing my exam and realized that her vascath was covered by a BANDAID with a small piece of what looked like clear tegaderm over that! I asked her what had happened to the dressing that was on it before (thinking that at some point, somewhere, somehow-at least at her dialysis clinic-someone had done a proper central line dressing). Nope-she said that she'd been told at her dialysis clinic that "just a bandaid" covering this central line was okay. When she came through our ED, she complained to the nurse that this bandaid was "itching" her, and told me that in response, the ED nurse had replaced the bandaid (!!) I quickly educated the patient and her mother about the importance of dressing the vascath like a central line and did the dressing change myself, but the two of them seemed pretty annoyed with me actually. Oh well, hopefully I scared them enough that these bandaid happy nurses stay away from that site.

    Makes you wonder where those fevers were coming from, right? (I'm sure you can sense my sarcasm!)
  10. by   Jenni811
    I was working a night shift and was getting report from the nurse who worked before me. After i had left, i went into my patients rooms, doing my assessments. I can kind of be a neat freak with things (Not OBSESSED) i just don't like clutter...and he is a slob. So i'm straitening up the rooms and i notice a medicine cup full of pills. the patient saw me looking at it kind of puzzled and she said "Oh no i forgot to take those this morning." I replied "What do you mean you forgot to take them? Didn't your nurse give them to you?"
    She replies "No. they were sitting on my table when i woke up. I asked him what they were and he told me they were my morning pills and to take them whenever i'm ready"
    ....he just LEFT the pills at the bedside table for her to take on her own at her "own time."
    Through talking to CNLs and charge nurse, this has not been the first time this has happened.found out this nurse does this ALL THE TIME!!!
    what he does in the morning.....puts his patients pills in a medicine cup, leaves them at the bedside and tells the patients to take them when they are ready.

    So i had to consult one of our CNL's to figure out what each pill was, what pills this patient had missed. It ended up being some things like a Lasix, 1 narcotic, some BP medications, things the patient needed.

    He is the laziest nurse i have EVER met.
  11. by   joanna73
    I've known of some nurses to leave pills at the bedside. I don't think its good practice, ESPECIALLY narcotics. Who knows who might wander in and take the pills?
  12. by   RNJill
    I never leave ANYTHING at the bedside anymore (well, unless it's like a colace with a pt who is AAOx3 when I'm super busy). Had an experience where I *thought* a pt was taking all of their pills (including calcium-which was important in their case b/c they were admitted with severe hypocalcemia) until I made their bed one day and several pills that I'm almost positive were calcium popped onto the floor. I'd been in the room to *watch* pt take the pills but apparently I was not watching closely enough and she managed to avoid taking them! Long story short-unless you see that the pt took the pills, you never really know what happened to them!
  13. by   Smartone86
    Quote from jlcole45
    after 20+ years, this is the first time i've ever heard of this .... a new grad hired in a long term care facility reported that during orientation that her 'preceptor' another nurse, told her that if the residents refused to take their oral medication - to give it rectally!!!

    oh my god that is wrong is so many ways. wrong route, the fact that some meds are engineered to change once they reach the gut to the usable form of the med (specifically the liver), the wrong ph, the fact that it might not be absorbed at all, or absorbed all at once, etc....

    has anyone ever heard of that? i told the new grad to report it immediately to her don. (i didn't work with her, but if i had i would have reported it - and i'm not one to run to the boss but that is soooo wrong).

    when i was still in nursing school i had one of my instructors tell my entire class that every drug that you can give po you can give pr. (i'm not about to test that theory)

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