I'm very curious. I'm sure we've all been there. We've dealt with doctors from all spectrum and mindsets. Most are very good at their jobs and have sound ideas!
But sometimes docs just say and do the craziest things
My example: at my last LTC facility I had one doctor seriously outright refuse/fight giving and prescribing pain meds (for patients who really, really needed it/were on vents/dying) because he honestly believed that these residents who had been stuck in a bed for years were going to get better and go out to buy/smoke crack cocaine.
According to him "prescribing narcotics leads to methadone and crack usage." These poor residents have been here for years taking the same medications and pain meds for years...just WHAT?
It might have helped for sure. I was on a cardiac step down unit (no vents) and it was night with no hospitalist around sooooo if we had coded him he would have gotten a tube by the ER Doc. BiPap sufficed thankfully!
Yup... Helped by pushing all those lovely bacteria pods deeper into the lungs 🙄
Specializes in Mental Health, Gerontology, Palliative.
Charting 2.5mg morphine TDS for a patient in end stage CA with bony mets.
To make it worse when the patient awoke in the early hours of the morning in screaming agony there was no after hours contact for this doctor and I had to ring the after hours
I saw a resident googling on a computer different types of NG tubes and something about intubation. Yeah, please don't come at me with any tubes near my throat if you have to google it! 🙄
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
I had a baby doc(resident) question a comfort patients pain meds order. She was getting 2mg Dilaudid Q1h. He was afraid it would kill her. It didn't, the fluid build up in her lungs did.
I had another doc ask me why I was bothering him with petty stuff(not his actual word) when I called to get a nurse may assess order on a pt whose death was imminent. I asked if he would rather come down and assess for death. He shut up.
Then there was the doc go into the wrong room to assess for death (she refused to give us the NMA order), and came up to the primary nurse and I and told us that we obviously didn't know what we were doing. The patient was still alive. She then went to tell the family that their loved one was still alive. We realized that she had gone into the wrong room and had to have one of her partners come assess for death. The patient that she assessed was also a comfort patient, with no family at the bedside. I finally asked her if she didn't find it odd that there was no family at the bedside. She told me that no, she just assumed they had left. Head desk moment!
I work on a palliative care unit (Onc and Palliative) at a teaching hospital, so I get a lot of question that make me scratch my head. Most of them dealing with pain management of my palliative patients.
Pt was immediate post-op for unstable mandibular fx, bilat. 2 plates, 10 pins, wires, the whole shebang. We'd been struggling with htn the whole pre-op period, and when I recv'd pt back from PACU pt's BP was 190/100 and climbing, despite the IV metoprolol and labetalol had during the surgery and in recovery. Pt reported worsening headache, then started vomiting beautiful coffee ground emesis through the new wires. Paged the attending, who'd been in a bad mood all day. The genius ordered her to restart her daily coreg, which was 3.125 MG qday PO.
PO low dose carvedilol for a vomiting pt with a wired shut mouth and urgent htn. Brilliance in action.
There was the intern who ordered 80 mg IVP Lasix on my HHNS pt... his attending looked at him w the most withering look and asked "Do you want to be a doctor or a murderer?"
We had a resident order a bag of chips STAT for a pt with low sodium. Really? At 0600 I'll get right on that. How about 2% or 3% NaCl?
I had a pt who went into SVT (I am rapid response) and the MD ordered po lopressor after the adenosine didn't work (BP was completely stable, and pt was sitting in bed talking away) and his HR stayed down at his base of 120 for a while. Later it was back up to the 160 range, and ordered po lopressor again. This time I had the RN page cardiology who was on and got him some cardizem, and boom, he was back in SR. I asked for cardizem and was denied!
I also had a patient who was in AF w/RVR, and on cardizem, not working, dropping pressure, HR hitting 190-200, asked about amiodarone, and denied. Asked all night and was denied. (I was working ICU at that time), and I come in the next day, and he was on amiodarone. WTH?
It is funny that this is a thread for dumb things doc's say (granted sometimes they do) but often RN's don't have the answers. There would be absolutely no way I would give 2% or 3% to hyponatemia. Granted I don't know all the details but correcting someones hyponatremia rapidly (unless they are seizing) is a recipe for disaster. I will take the bag of chips over hypertonic saline (unless you want CPL).
PO Metoprolol is not a bad treatment for SVT that is stable. Once the patient gets off their Dilt drip they will be transitioned to it anyways. Dilt drips will just prolong length of stay.
Amio for A-fib with RVR is controversial. Some believe in it some don't. I have yet to ever start someone with A-fib with RVR on amio since it is really slow to take effect. If they are truly dropping their pressures and are already on a Dilt drip its time to introduce electricity.
I saw a resident googling on a computer different types of NG tubes and something about intubation. Yeah, please don't come at me with any tubes near my throat if you have to google it! ������
In my first year of residency I had a patient with a spontaneous pneumo. My attending told me to put in a toravent. I had never done one before. What was I supposed to do? So I youtubed thoravent and found out how to put one in. As a resident that is the name of the game. if you don't know something look it up while you have an attending looking over your shoulder. Granted my attending was "looking over my shoulder" from a floor away but still.
It is funny that this is a thread for dumb things doc's say (granted sometimes they do) but often RN's don't have the answers. There would be absolutely no way I would give 2% or 3% to hyponatemia. Granted I don't know all the details but correcting someones hyponatremia rapidly (unless they are seizing) is a recipe for disaster. I will take the bag of chips over hypertonic saline (unless you want CPL).
PO Metoprolol is not a bad treatment for SVT that is stable. Once the patient gets off their Dilt drip they will be transitioned to it anyways. Dilt drips will just prolong length of stay.
Amio for A-fib with RVR is controversial. Some believe in it some don't. I have yet to ever start someone with A-fib with RVR on amio since it is really slow to take effect. If they are truly dropping their pressures and are already on a Dilt drip its time to introduce electricity.
Sorry to pick on one post. Anyways carry on.
Well apparently you need to school the attendings on my floor, as I have seen 3% saline given for hyponatremia. In fact, I double signed the MAR with his primary nurse. I believe I read that the key is slow correction with extremely close monitoring.
Well apparently you need to school the attendings on my floor, as I have seen 3% saline given for hyponatremia. In fact, I double signed the MAR with his primary nurse. I believe I read that the key is slow correction with extremely close monitoring.
Hypertonic saline in hyponatremia has one role and that is to correct seizures. Other than that fast correction can lead to central pontine myelinolysis or other debilitating CNS problems. You can give 3% but you really shouldn't correct hyponatremia over 10 points per 24 hours.
Lol. Guys oxygenation was a bit more important in the moment so we went with it.
I know, it's just super frustrating as an ICU nurse when people need intubation asap, and the team is still ******* around with bipap. Your case was probably different , but in my experience we are usually delaying the inevitable with pneumonia + respiratory distress. Usually the bipap gives them a little burst of respiratory energy and then they completely crash and then things get really ugly
OhioCCRN, MSN, NP
572 Posts
Yup... Helped by pushing all those lovely bacteria pods deeper into the lungs 🙄