you know you are in for trouble when..... - page 5
I was just thinking about the family of a recent admission.We knew we were in trouble when we met the adult children. The #1 contact had tardive dyskinesia and it quickly became clear that... Read More
May 16, '09Message on the PA system is "Dr XYZ on line ___."
This particular doctor had the personality of a loose cannon, English not his first language, and we made sure not to call him unless really really necessary. He would respond (loudly) to almost anything we said with "I am a medical doctor! Do you know what this means?!? Blah blah." As we would try to explain why we actually needed to talk to a "medical" doctor he would get louder and louder, drowning out most of the explanation. We all speculated on how much he must be paying his nurses for them to be willing to work for him, and thought he must just take out his frustrations on medical personnel around him.
Later I learned from talking with our LTC residents that he treats them in much the same way.
May 16, '09You try to do initial assessment and ask family to step out of room. "No, I think I'll stay and watch." EEWW.
Husband/daughter/son/PIA tells you "They can only swallow one pill at a time, and can't take more than two pills within 20minutes." Yeah, and they are on 15meds in the morning.
May 16, '09LPN1313 -- that's when I give them 1 pill with "applesauce" -- which has the rest of the pills crushed up in it....
I have a new one from last night.
When the COPD/CHF/dementia pt with 10% EF and a continuous pulse ox that you can't get above 87 has 8 children, 7 of which are okay with NH placement, and the one who's home living off dad's check is threatening to sue anyone who tries to place him (this guy also has some kind of mental retardation, and I'm not sure he's even capable of looking after himself, much less dad, but he knows to threaten a lawsuit...). The dad had been just left in his own urine/fecal so long, he has no skin on his bottom and half way up his back. I left a message on the chart that if he doesn't go to a NH, I'm calling adult protective services.
May 16, '09We used to have a brother and sister in our nursing home. The sister is still living. Brother, God love him, finally got to die. But sister used to call for him to come down to her room, and "oh, by the way, Bub, stop at the nurses' station and get my monistat."!!!! He'd stop to get it, we'd remind him he no longer had to do that, and we'd go hand it to her to do it herself. She expected him to rub her vaginal cream on, insert vaginal suppositories, give her enemas, or just look to make sure all way okay, apparently like he'd done for yrs at home. He was never allowed to date or marry. The mother, who was a nut case, told him his job in life was to "take care of" his sister. He was an intelligent man, but a quiet shadow on the wall, afraid to move without sister's permission. Was unreal!
May 16, '09when the old chart is more than three volumes . . .
when the admitting orders say "bathe before seen by md."
when the allergy list is more than 10 items, and five of them are nsaids or psych meds
when the family insists that they're "close personal friends" of one of the suits at your facility, one of the physicians on your service or your manager.
when your manager's new in-law is admitted with an etoh level of .24 and they admit to drinking "a few beers" almost every day.
when the family member is carrying a handgun, machete, sword or leading an attack dog.
May 16, '09When the new admission has several men fighting out in the hall about who is the "baby daddy," when the pt can't pay the small copay for her child's inhaler but has plenty of money for acrylics with rhinestones and designs and cell phones that could run a NASA launch, and when you smell something not quite so fresh from the hall when entering the room to break down the bed for a pelvic.
May 16, '09Quote from travel50This is almost the saddest thing I've ever read. So happy he passed away to something better.We used to have a brother and sister in our nursing home. The sister is still living. Brother, God love him, finally got to die. But sister used to call for him to come down to her room, and "oh, by the way, Bub, stop at the nurses' station and get my monistat."!!!! He'd stop to get it, we'd remind him he no longer had to do that, and we'd go hand it to her to do it herself. She expected him to rub her vaginal cream on, insert vaginal suppositories, give her enemas, or just look to make sure all way okay, apparently like he'd done for yrs at home. He was never allowed to date or marry. The mother, who was a nut case, told him his job in life was to "take care of" his sister. He was an intelligent man, but a quiet shadow on the wall, afraid to move without sister's permission. Was unreal!
May 16, '09* You hear that distinctive, high pitched, irregular, whiny squeak of a child in acute respiratory distress from across the noisy ER and you just know without turning your head that you're going to be in for a BIG one.
* 8 burly cops bring in a 460 lbs built-like-a-mountain-solid-as-a-tank drunk who is also high on meth and PCP, who is spittin', cussin', screamin', kickin', punchin' and naked as a jaybird in -30 degree weather. Who proceeds to break free of said 8 cops and fling a stretcher onto it's side (with one hand, as if it were made of matchwood) and use it as a barricade - challenging one and all to "come and get me!" [I worship at the altar of Haldol since that shift!]
* Central calls with a code "45 year old c/o discomfort and general malaise. 5 minutes out"... and the medics come wheeling in with an intubated patient with CPR in progress with a tearful wife and frightened kids in tow... Apparently patient crashed and had a massive coronary on the way in.
* MICU wheels in a patient and the first thing you notice is the blood. Blood everywhere... nose, ears, mouth, base of neck, eyes... spurting up with each chest compression and dripping down and leaving a bloody, messy trail behind the stretcher. You look down at the patient and you realise with horror that it's one of your staff (very sad, tragic case).
* You're on Divert and MICU brings in two patients almost simultaneously: One with a stroke and another who keeps going in and out of V-tach. Hmmm, who is to be assessed first...
* You're walking by another patient's room on the way to take a pee break when you notice the pt. doesn't quite "look alright". You glance up at the monitor and the BP reading says "75/30". Hmm, that can't be right. Maybe the cuff is on incorrectly. So you walk into the room to try and readjust the cuff. You notice that the patient is breathing "kinda shallow" and looks a little pale. At that very moment, your feet feel distinctly Warm N Wet. Thinking that you perhaps forgot and pee'd on yourself, you glance down only to see that it's not pee but blood. Blood that's been coming out of the pts. rectum and is now spilling over the stretcher onto your shiny shoes...
* Whenever you hear a colleague yell/shout "I Need Some Help In Here!"... or if you see a colleague running...
* It's the holiday weekend and everyone and their grandparents are down in the ER. You're short staffed because of call outs. You have no techs because they are all on suicide watch precautions. Besides your two intubated ICU patients (no room in ICU) and three Telemetry patients (no room in Tele) you have a poor sweet lady out in the hallway with an acute attack of C-diff.... [Solution? Wheel the stretcher into the Doc on-call room and use a portable screen to cover the door. Presto! Instant room!! We've done everything from pelvics to foleys in that room in a pinch Adapt! Improvise! Overcome! ]
* Weather forcasts "lots of ice/snow/rain/fog". Get the backboards and x-rays ready: it's gonna be "MVA Day".
* The frequent flier drunk is parked in the corner hallway and a new EMS crew brings in frequent flier coke addict and unknowingly/unwittingly parks the stretcher in the hallway bed next to her. New EMS crew not aware of pts. past histories and intense animosity toward each other. You see what's about to happen but even before you can say "Oh poop!", Drunk sees coke addict - coke addict sees drunk. Lips curl, snarls rent the air and a full on melee is in progress in the hallway. You just turn to the shocked EMS crew and
* When every portable oxygen tank in your ER is empty because of high patient volume... :stone
* You walk into work and see 4 ambulances, all with medic units in tow parked outside. Walk in and see that the average waiting time in the waiting room is 3.5 hours (add another hour at least till they're seen by a Doc) and two codes are in progress while they're calling the third one [4th one has already been pronounced].
* The patient who was just coded and pronounced is found to have the wrong identifying information on the label/chart.... when the sister with the name/info of the patient shows up.
* The wrong patient is transferred to the wrong nursing home.
May 16, '09Quote from Roy FokkerLMAO I so totally love this!! I am rather fond of Haldol myself!![I worship at the altar of Haldol since that shift!]
Thanks for that! (and thank Neptune for Haldol!)
May 16, '09When their paperwork looks bad, they roll in looking worse, and there's no DNR form in sight. (Back to the hospital with you)
When said patient is assigned to the one doc who's notorious for not answering pages. Or calls to his cell phone. Or calls to the office.
When families don't see the need for 95yo end stage CA patients to have DNR forms.
When you hear 'everyone's fine. It's been a quiet night.'
May 16, '09...you walk into the unit with a smile and before you can even say "good morning" a usually friendly co-worker snarls at you.
May 17, '09Report at the start of your shift is, patient was a nursing home patient with CVA. Admitted to us from hospital with a recent history of change of mental status. According to the family she hasn't had a good BM in over a week. She was disimpacted on admission yesterday and given a dulcolox without results. She got a triple H enema a few hours ago and and again checked. Manually removed very large amt of stool. Flood gates were opened folks! Code Brown anybody?
May 17, '09Quote from LiveToLearnThe first instance is easy to deal with. Tell them the court officer will be right along to register the daddy so the state can make sure to collect the child support.When the new admission has several men fighting out in the hall about who is the "baby daddy," when the pt can't pay the small copay for her child's inhaler but has plenty of money for acrylics with rhinestones and designs and cell phones that could run a NASA launch, and when you smell something not quite so fresh from the hall when entering the room to break down the bed for a pelvic.
The fighting will instantly change to finger-pointing, each saying another is the daddy, assuming they're not bright enough to scatter, and they're likely not.