Admit I dread"generalized weekness a/o Dialysis pt, had dialysis today, Full code:"

[Sirapples]

Ya you know it. Your day is doing ok, you have your patients settled, and everything is going great. Hell you might even say "its such a good night tonight" tempting the gods of nursing.

my god I spelt Weakness wrong typing to fast.

Then you get that admission call.

Mike you are up for admission... No big deal, my shift is going smooth.

Then you find out its an alert oriented dialysis patient who was dialized today.. patient felt week after dialysis and is now unable to ambulate, or they have a fever, or they suddenly had blood pressure drop... then the kicker... Full code.

Man these are the only patients that get me cringeing. You know there is a very good chance that the rest of your shift is about to suck.

Anyone else have a particular admit diagnosis that scares them?

[blondy2061h, MSN, RN]

The newly diagnosed leukemics coming in with a WBC of like 400,00 or so and they're going to get leukophoresis, a line placed, a bone marrow biopsy, and chemo started, all within a few hours.

Sometimes the diagnosis doesn't matter, but the name of the patient does. There's some names I just cringe to see.

[cookienay]

And his wife doesnt know why all these MEAN nurses are doing this to him!

And he was tasered before they got him in the four points. help me.

[AngelfireRN, MSN, RN, APRN]

God bless those poor renal patients. Even on a good day, they're a train wreck.

[XingtheBBB, BSN, RN]

And his wife doesnt know why all these MEAN nurses are doing this to him!

Maybe she should look in in the mirror at her bruised cheek and try to guess? Sorry. But I hate when we have spouses who think that just because they "don't mind" being hit "very rarely, when things are very bad for him and he can't help it" that I shouldn't mind either. The drunk is tied to a bed. We'll hold him for a couple days. For the love of common sense and self respect, take this phone number, call them, and go home and start packing!

[chicookie, BSN, RN]

Sometimes the diagnosis doesn't matter, but the name of the patient does. There's some names I just cringe to see.

Agree. A couple days ago there were 3 nurses that could have admits. We saw the name and the three of us were no way we can't get that patient and tried to think of any excuse not to get him. So the charge nurse made us literally play paper rock scissors for this patient. I lost. I was so screwed. One of the worst shifts ever!

[BluegrassRN]

We saw the name and the three of us were no way we can't get that patient and tried to think of any excuse not to get him. So the charge nurse made us literally play paper rock scissors for this patient. I lost. I was so screwed. One of the worst shifts ever!

It's the certain pts more than the certain diagnosis that I dread. I charge sometimes, and I am totally doing the rock, paper, scissors the next time this comes up, if it's no one's particular turn to take the admit! That's hilarious!

On the flip side, give me the detoxer any day. I seriously love them. We have great detox orders, if they're an ETOHer they're familiar with the routine, and I just honestly do my best to keep them comfortable. I don't know why these people don't push my buttons like some other types of patients, but they just don't. If given a choice, I'll take a detoxer over a lot of other diagnoses any day. Say hello to my little friend, Ativan.

I agree about the renal pts. Even on a good day, those poor folks can be so fragile.

[Ruby Vee, BSN]

"makes me wonder what is happening in that dialysis facility. "

i'll bite.

"patient felt week after dialysis and is now unable to ambulate, or they have a fever, or they suddenly had blood pressure drop... then the kicker... full code."

1) pt felt weak after dialysis. pt came into dialysis with 3 kg of fluid on. fluid was removed. heart was unable to compensate for decrease in blood volume, fluid shifted slowly from interstitial and intracellular space to vascular system... you'd feel weak too. and pt's co is probably 30%...

2) fever. pt was uremic prior to dialysis, maybe only slightly, which inhibited the inflammatory response of the immune system. blood was cleaned, fever subsequently spiked. sick renal pts often don't spike temps until after dialysis.

3) blood pressure drop. duh. see #1. dialysis pts love to go hypotensive. you try pumping 5 extra kilos of fluid, then have it removed (out of necessity) and see how you do.

4) full code. you mean that's their code status? or the pt is arresting? probably potassium here. you know kidneys excrete extra potassium and dialysis pt's kidneys aren't functioning... and surely you also know that what is even more important than the actual level of potassium is the speed in which the potassium level is altered. my pt comes in with a potassium of 7.5 and i put him on a k1 bath... well... it happens that some will arrest.

it strikes me that this is probably a vent thread, and the original poster is just venting about some of the patients he dreads to see coming through the doors. i doubt he needs to be educated about dialysis. he's just venting and inviting the rest of us to do the same. good vent threads are cathartic and often funny. it is rude to step on a vent thread by attempting to educate the posters who probably know more about it than you do. it would be nice if all vent threads were labeled as such for those who don't get it, but there you are.

the patient i personally hate to see coming is the frequent flier with an infected ventricular assist device who is coming in because they overdosed on street drugs, got too drunk to remember to change their batteries or attempted suicide by removing their batteries. i keep thinking that they got their second chance, they ought to be grateful! maybe it's just our particular patient population, but it seems the same few vad patients make up 80% of our readmits . . . . and none of them are pleasant people!

[VivaLasViejas, ASN, RN]

When I worked Med/Surg, I absolutely hated getting a direct admit from the clinic. Most of the time they didn't even bring a complete set of admission orders, let alone an IV, a Foley, an NG or any of the other devices that patients admitted through the ER usually came with.

I also dreaded the ubiquitous "altered LOC/confusion" and "weakness" patients. These were nearly always elderly, extremely anxious, and unaccompanied by anyone who could give a decent history. In addition, 95% of them weighed at least 200 lbs and needed 2-3 people to transfer them safely from bed to commode, usually every 30 minutes or so..:icon_roll In the nursing home, I don't mind these folks in the least; in the acute care setting, they are a nightmare to deal with.

The ETOH'ers, however, were the worst by far. You just never knew what you were going to get, you only knew that you were in for a baaaaaaaad shift. So glad those days are far behind me. ((((((shudder))))))