Words You Hear In The Wonderful World of Nursing

[43RN20]

words you hear in the wonderful world of [color=maroon][color=gray]hospital nursing

part i [color=gray]words patients say

by: jane delveaux, rn

“i came to the er because i need an enema.”

what happened

it was the night of the biggest snowstorm of the year in our rural wisconsin community. an elderly gentleman and his wife, both dressed in their sunday best had just driven twenty-two miles to the hospital. he was satisfied that he felt much better after receiving the attention for the emergency that he had come for. the patient was discharged and he left with his wife the same way that he had arrived. incidentally because of the heavy snow, i had to call the sheriff’s department to transport our nurses to work in the morning.

“i usually just hold my breath and push and it goes away all by itself.”

what happened

this came from a completely relaxed, composed, eight year old with psvt during an ambulance transfer to another hospital. this little boy was trying to reassure me ‘cause he didn’t want me to worry. he was being transferred in stable condition to a specialty unit since his psvt could not be converted in our community hospital.

“what did you do that for?”

what happened

an alert, elderly, white male in stable condition was admitted to er. he complained of a “pounding heart”. cardiac monitoring indicated svt and he was put on oxygen. as his blood pressure was being checked, his level of consciousness was deteriorating. an iv was started. verapamil was drawn up and delivered ivp. he responded by going into another dysrhythmia and went unconscious. cardioversion restored him to normal sinus rhythm immediately. this is where he sat bolt upright and, with surprised eyes wide open, he made that accusation. fortunately, he calmed down with a little explanation.

“i really should tell you that i always pass out when i see needles.”

what happened

this was in the er. the young man needed an iv and lab work. i told him, “pass out if you want to. you’re already lying down.” he then passed out. a few seconds later we were both laughing about it.

“don’t worry! i didn’t have anything to eat or drink after midnight.”

what happened

this was a twenty-four year old male being admitted in the am for major surgery. when i asked him what he did before midnight, he stated that he had been careful and had finished drinking his case of beer in plenty of time. surgery cancelled !

“i don’t know. i think i’m lost.”

what happened

an older post-op patient was found tottering unsteadily out of his room. his wandering was a little aimless because he had flipped his only covering, his hospital gown, over his head. he was carefully returned to his bed, assessed, and watched closely during the rest of the night. with a little investigation into his medical history and collaboration with his doctor, it was decided that his confusion could probably be cured with a daily can of beer. and so it was.

“i just don’t understand why my chest is so sore today.”

what happened

the night before this statement was made, i had been walking hospital rounds to check on my assigned patients. as was my habit, i always made a quick bed check of all of the patients who were near my assigned patients, as well. even from a distance, it was quite evident that this little lady was not breathing and i called a code blue. the interventions turned out to be successful. when i returned to work the next night, she was recovering in icu and had an incidental diagnosis of fractured ribs. if you have ever done it, you do not forget the feel of cracking ribs. i did not want to go to her room to confess that her chest was sore because i had cracked her ribs. so, i didn’t.

“it sure was a nice day.”---“how nice to see all of you.”---“i’m not s-----.”

what happened

this was a patient on a med/surg unit who was on telemetry. when her monitor pattern began to show short bursts of pvcs which quickly increased in frequency, a team was brought to her bedside and the crash cart opened. the er doctor tried all of the appropriate protocols to break the vt that followed. it was sad to see that it took several shocks with the defibrillator to determine that she could not be converted out of it for more than a few seconds. each shock brought her wide awake and she continued to talk as though she were just continuing a conversation until the code was discontinued. not all stories have happy endings

[43RN20]

words you hear in the wonderful world of [color=gray]hospital nursing

part ii[color=maroon] words [color=maroon]doctors say

by: jane delveaux, rn

"i see. ah ------ what would you like to do?"

what happened

as a new grad just finishing orientation on a night shift, i made my first call to an attending physician to report a change in his patient's condition. my report to the doctor was, at first, met with silence. but, i was taken back when he asked me what i would like to do. since i hadn't anticipated that question, my first thought and my response was, "doctor, that is why i called you". it wasn't long before i found out that he was very young and just as new as i was to this hospital. the lesson learned --- be prepared with answers because you never know what the questions might be.

"just wait a minute. it looks like we're not done, yet."

what happened

a young mom was all smiles. as she was looking on her infant son for the first time the doctor made a somewhat startled statement. "we have another baby here ---- and the foot is already delivering." the mom looked alarmed and asked is that a good thing? no one that i ever met could surpass this doctor's bedside manner. with a big grin on his face, he beamed back, " oh yes, this is the way we like to see them!" however, just in case, i made sure to call for back-up and for an extra isolette. the delivery was a little tricky, but the second foot was found and another healthy baby boy was born. hopefully, this double blessing did not turn into double trouble for this surprised mom.

"hello, what's happening?"

what happened

the doctor with the great bedside manner always sounded wide awake when i had to call him in the middle of the night. but, it didn't take me long to find out that he had a delayed reaction and i couldn't trust his first response. from then on, i knew i had better ask him at least twice if he was really awake before accepting phone orders.

"hello," --------------------------------------------------------------silence

what happened

late night phone calls to mds produce more surprises than any direct daytime face-to-face meetings. my question this time was, 'what happened to the call that i had just placed to one of our most prominent doctors.' after finally getting a call through to him, he sheepishly admitted that he had placed the phone in his shoe while half asleep.

"where did you get this order from? --- i never talked to you during the night."

what happened

here is another interesting response from a doctor who gave phone orders for one of his patients during the night. he couldn't remember the phone call or the phone orders. i guess he liked the orders, as written, because he dropped the matter without anymore complaining. *the next time that a similar incident happened it appeared that he did not like the orders, as written, because i saw him pull the orders out of the chart and rip them up. this was such a flagrant legal error in judgment that i was not about to confront him. i just saved the documents and turned them over to the director of nurses. fortunately, an intact copy had been sent to pharmacy, earlier. i needed the orders to cover my nursing interventions during the night. but, never heard how the matter was handled.

"give morphine to patient per family request."

what happened

one of the staff nurses called me to say that this was a written medical order for one of her patients and she was having a problem with the way it was written. the orders were for iv morphine on a patient with terminal cancer. the patient's family was at her bedside making repeated requests for the morphine despite nursing assessments that found the patient to be unresponsive with no signs of pain or unrest. the implications of this order were disturbing. potentially, the order gave the family the power to order the nurse to euthanize the patient at their will. the doctor was contacted for an amendment to this

order.

"i said, don't call me again. i heard you the first time"

what happened

another staff nurse, after a thorough assessment, was trying to get a response from the attending physician for middle-aged, anxious, female patient. this matron's condition was deteriorating and the physician had ignored three phone calls. the patient's family was with her and becoming alarmed. after another assessment of the patient, i contacted the physician to let him know that the patient's family was preparing to transfer her out of the hospital. he arrived at the hospital seven minutes after i told him he could still get there, before the patient's attorney, if he hurried.

"admit the patient to icu."

what happened

the patient was a forty-two year old nurse who had just come from the airport. she had no significant health problems by history, but was dyspnic and anxious. the er physician wanted the patient in icu to rule out pulmonary emboli and after his initial assessment and review of all labs and monitors, he left the er. i received a call from the er nurse asking me to come to er because she didn't feel comfortable transferring the patient who was de-stabilizing. the patient's o2 sats were low, despite being on o2. her blood pressure was dropping and telemetry showed tachycardia. a call was placed to the physician to update him on these changes and he returned to er to initiate enough interventions to allow for a transfer to icu. because the transfer involved an elevator ride, the physician was asked to accompany the transfer and it was accomplished safely. the next day the nursing staff was particularly saddened to see that this nurse couldn't be saved. not all stories have happy endings.

[43RN20]

words you hear in the wonderful world of [color=maroon][color=gray]hospital nursing

part iii [color=gray]more words

by: jane delveaux, rn

nurse: "i can't get to work tonight because i hit another deer."

what happened

roving deer comprise one of the hazards posed in country living for those who commute to their jobs. this determined nurse said that she hits about two deer annually. she has been working in the same hospital for twenty-six years. do the math. her auto insurance carrier is not happy with her. however, she had no injuries and had to consider herself lucky. we had a couple of other nurses who didn't get to work because they received serious injuries in their encounters with deer.

nurse: "i can't get to work today because i got hit by a toilet."

what happened

highways present deadly challenges to drivers. but, this was a phone call that was so outrageous that it took a while to stop laughing and determine that it wasn't a joke. we were short one nurse that day because of the damage caused by a porcelain toilet that had slid off the back of a truck and landed on the hood of this nurse's pickup. we get call-ins for roll-overs on icy roads, and various major and minor traffic accidents, but there has never been another as unique as this one.

nurse: "we need help here."

what happened

a call for help went out when a diabetic patient became hypoglycemic and combative. his nurse had been trying to get him to drink the orange juice cocktail that she had prepared to reverse the hypoglycemia. he was a strong two-hundred-sixty pounder, sitting in a recliner when he became all flaying arms and legs. it probably wasn't the best plan, but three nurses responded to give aid. the patient actually drank the cocktail, but only after bouncing two nurses off the wall and kicking the third in a sudden burst of energy. fortunately the violence stopped as quickly as it had started and there were no serious injuries.

nurse: "call a manpower code."

what happened

a twenty-four year old, with a history of alcoholism, was admitted to the hospital with a diagnosis of acute pancreatitis. he was transferred to icu as he was going into dt's. manpower was immediately called as the patient became paranoid and combative. with no time to waste, an iv site needed to be established before the patient went into uncontrolled, life-threatening seizures. we found out what tremendous strength a twenty-four year old can muster when in an altered mental state. with no time to waste, in order to get a patent iv site, it took the entire twelve-person team, using their own bodies in unorthodox measures to wrestle and restrain him. i have never again seen so many on one bed at one time. the patient received the iv meds and recovered solely due to the extraordinary interventions by the manpower team.

emt: "this will be a cinch. my mom's diabetic. i've been doing this for years at home."

what happened

our community hospital was served by seven ambulance services. none of these services had paramedics at that time. as the er coordinator, i had been working with the emts toward getting them certified emt-es so that they could administer epinephrine out in the field. after the classes were finished, the day came that they had successfully completed the written testing and were ready to practice the technique for sq injections. the first practices were on oranges and they were ready for return demonstrations, on each other, using ns. i almost believed the emt who did that little bit of bragging. but, he had to eat his words when the injection that he was supposed to give sq was a through and through injection. he pinched up a little tuft of skin and his aim was so bad that the tip of the needle came out the other side. --- my dad always said, "never believe anything that you hear and only half of what you see." lesson learned

family of patient: "we don't know what to do."

what happened

an eighty-nine year old admitted to er, was diagnosed with a bowel obstruction, by the surgeon. during the exam, the surgeon also found a five centimeter superficial tumor on the patient's chest wall. he spoke to the patient's children to tell them that their mother needed surgery. as he explained the need for the bowel surgery, he let them know that he would like to remove the tumor at the same time. they were having a problem understanding the need for the removal of the tumor since their mother had it for several years. the surgeon left orders to admit for an am surgery. it was apparent that the family was uneasy and not in agreement with the plan when they made that statement and asked me what i would do in this situation. they were encouraged to seek an outside opinion. when asked if they knew of someone who might help them, they remembered an uncle who had a medical practice just thirty miles away. by morning, they had made arrangements to transfer their mom and place her under the care of their uncle. i am not sure what the reaction of the surgeon was when he got that message.

my mom: "i need to have gall bladder surgery. i am thinking of going to dr._____. what do you think?"

what happened

that was a simple question for me. since i loved my mom and knew this surgeon well, i gave mom my opinion. "there is no way on earth that i would recommend him." next thing i knew, she was scheduled for surgery with dr. _____. --- that is not so uncommon a reaction. it often happens when family or friends ask for an opinion related to health issues.

so much for my opinion !

[cucciolla22]

those were really cool

[cucciolla22]

hey , i have experienced the morphine by family request for a palliative care patient as well, oh needless to say i wasnt very popular with that family, but i wasnt going to give 5mg morph( it was subcut) every hour when family wants

[peridotgirl]

How is that possible? isn't it illegal for thr pt's family to request Morphine(or any med) for the pt and the nurse gives it. Doesn't that require a dr's order (unlees it is a standing order)? Plus the nurse can't always give the pt pain meds just becuase the family wants them to. The nurse has to decided that upon his/her judgement.

[43RN20]

Thanks for taking the time to comment.

Physicians can have moments when they make errors or use poor judgment, just like the rest of us. RNs have a legal responsibility to be knowledgeable in order to recognize inappropriate orders. The proper response is to bring this to the attention of the physician for correction. The RN will be held liable for following an order that was written in error. Moral & ethical situations present complex dilemas. Following this episode, the situation was brought before the Hospital Ethics Committee for action.

[Magda_PatagoniaNurse]

From Chile, in the ER in one of the crowdest ER of the country, sometimes we must accept patients who must wait in the floor, in a chair, or even just waiting standing (with apendicitis....no comments)

Complaint postuled for the patient:

"i have cerebral-ache"....

"i have body-ache"

"i have cardiac in the heart...

"I came because the pediatric nurse told me that my baby is "euthrophic".....

Nurse: Do you take any meds usually?

Patient: Yes, "filipino" (nifedipino), the green pill, the big red pill, and the sweet pill.

These was real situations...jajaj

[Magda_PatagoniaNurse]

Hello

I gonna tell you some "funny" thing that happen in some hospitals in Chile...from the doctors jajaja

"The patient is ok, prepare the discharge"

what happened: The patient, minutes before....jumped from the 5 th floor of the PSYCHIATRIC unit....

"baby's ok, mother to the house"

what happened: that was the final asessment of a pediatrician awarded like the best of the hospital, and educated in harvard.

"This woman is confused and no time or space oriented"

what happened: the older woman didn't hear what doctor said because he was talking to patient from 3 meters.

"Please, don't call me for "nothing".

what happened: nothing is, from that young doctor's perspective: a patient with renal failure and a potassium of 8. The patient coded. Of course.

[EmmaG, RN]

How is that possible? isn't it illegal for thr pt's family to request Morphine(or any med) for the pt and the nurse gives it. Doesn't that require a dr's order (unlees it is a standing order)? Plus the nurse can't always give the pt pain meds just becuase the family wants them to. The nurse has to decided that upon his/her judgement.

This can be a bit complicated. It's not illegal if there is an order for pain medicine. Of course, the nurse has to rely on his or her own judgment but sometimes that means relying on family members to clue you in that their loved one is uncomfortable. They know the patient better than we do; they often will pick up on signals the patient is in pain that might not be apparent to us.

[43RN20]

Quick question:

Were these patient's bi-lingual and trying to describe their symptoms in English?

That can be hard enough to do in any language. It sure adds a bit of a challenge to the nurses' duties!

[Magda_PatagoniaNurse]

Quick question:

Were these patient's bi-lingual and trying to describe their symptoms in English?

That can be hard enough to do in any language. It sure adds a bit of a challenge to the nurses' duties!

No...i translated, word by word, the patients complaints....The patients spoke spanish because we're chilean...

And the hidden message is that the patients haven't physiology or anathomy classes and the folk ways to speak about their complaints is, at least, very funny sometimes.