Does this order make sense to you?

[kimmicoobug]

This morning I called an MD, who was mightily irritated with me for calling. This is a Ca patient of unknown origin. She had very little output on eve, and then on my shift, she had none. Bladder scan showed very little. So, I get a little worried because her IV fluids are going somewhere if not to her bladder. I listen to her lungs and heart, she has developed crackles (were clear on admission as well as for me at the beginning of the shift). Heartbeat was getting pretty loud and BP was starting to climb a bit. Well, this MD was not on call, though he didn't bother to sign out this patient to another doc (which is something they are supposed to do on this unit). He chewed me out for this and then told me to straight cath her.

"you want me to straight cath her with only a 100 in her bladder".

"yeah, you know the catheter that just goes in and then out?"

I told him I knew what a straight cath was and that I wasn't aware another MD was covering for him.

Does this order make sense to you?

[stevierae]

Originally posted by kimmicoobug

This morning I called an MD, who was mightily irritated with me for calling. This is a Ca patient of unknown origin. She had very little output on eve, and then on my shift, she had none. Bladder scan showed very little. So, I get a little worried because her IV fluids are going somewhere if not to her bladder. I listen to her lungs and heart, she has developed crackles (were clear on admission as well as for me at the beginning of the shift). Heartbeat was getting pretty loud and BP was starting to climb a bit.

Dang, she could be going into pulmonary edema and need Lasix, not a straight cath. What a jerk that MD was. Was he a resident? Well, did you straight cath her and how much WAS in there? What happened after her own doc took over?

[EastCoast]

If you gave him all of this info then i think he must have been still sleeping. How could he reasonably not acknowledge the rales, HTN, and heart sounds??

The only thing is if the patient had lung CA or pleural effusions than your lung sounds might be a red herring until you get a CXR. But jeez doc, wake up and at least act like you are interested !!

Hopefully he at ordered a u/a on that straight cath so he could act marginally interested in the case.

[Tweety, BSN, RN]

So you straight cath her, get the 100 cc out. Then immediately call back with the information. Let the doc get irritated, you need to do what you need to do to take care of the patient.

Nope doesn't make sense, except that maybe he/she wanted an accurate output.

[kimmicoobug]

A UA had previously been ordered, but since she wasn't producing urine...I couldn't get it. I was expecting to get some Lasix..not an order for a straight cath.

[EastCoast]

What was her 'admitting diagnosis'? Just curious. Did she havve a cxr or lab work done on admission.

[mother/babyRN, RN]

Sounds like one of those situations where you say something like, "So, you aren't interested in addressing her breath sounds or the rest of her assessment?" I will certainly document same.....

[mother/babyRN, RN]

I have also mentioned that after I straight cath her and her symptoms persist, he should be expecting more calls from me unless he wanted to address her other symptomology now..I don't think he was asleep. I think he was doing the old power play, I am a jerk deal. Stick to your guns , call the supervisor and write down exactly what was said. In similar situations, I have had other nurses listening on another phone for witness purposes....If he is willing to punish a patient and take it out on the person because he is irritated at a simple phone call, then he has more issues that should be addressed either in writing or via a professional written complaint....