I am venting my pet peeves. I had one of each of these yesterday, 1 patient w/ 3 of these. Share with me yours.
I hate:
1. Giving enemas - I have never not caused a huge mess even before I get the solution INTO the patient.
2. Taking accuchecks - The accucheck needs a calibration or quality check, or has the wrong code card for the strips, or I don't stick the patient hard enough so there's not enough blood and then have to go run for another finger stick thingie because the second one I grabbed is faulty
3. Sitz bath - see #1
4. Simply having a patient in isolation - putting on and taking off the PPE can suck your time, and if the patient has the temp in their room up I get all hot and sweaty within 5 minutes
5. Putting in a foley - this is never as easy as it should be. Either the A&O patient is unhelpful "Please keep your knees up and apart Ms X" or the anatomy is unhelpful.
Finding out "call the doctor"--worthy lab or radiology results at 0300....when it was resulted at 3 PM....which is why I now come in early to check my charts for "surprises"
Labels on IV tubes...
DKA protocol!!! Q2h FSBS and when you've got someone on an insulin drip/DKA protocol, you end up with a constellation of bags hanging, and every 2 hours, you're swapping D5 1/2ns for NS to D10 back to D5....
I don't have a problem with sputum or blood or puke or stool, but projectile vomiting of BRB from dissecting varices....makes me want to go in dressed like an astronaut...at least NASA puts air conditioners in the things...You're hot, sweaty, and you end the shift smelling like a slaughterhouse.
DKA protocol!!! Q2h FSBS and when you've got someone on an insulin drip/DKA protocol, you end up with a constellation of bags hanging, and every 2 hours, you're swapping D5 1/2ns for NS to D10 back to D5....
Well that's ridicuous!
Our DKA's are on hourly BSL's while they've got insulin running, but the only thing that changes is the rate of the Actrapid/Novorapid, which titrates to the BSL: eg 1unit/hr for 5 - 10mmol/L, 2units/he for 10.1 - 15mmol/L... We run N/saline 6-8/24 (depending on the level of dehydration) and concurrent 5% dextrose 8/24 once the BSL drops under 15mmol/L +/- K+.
That swapping business reminds me a little of the old days here when heparin infusions - they all ran at 21ml/hr and we changed the amount of heparin in each bag based on the APTT. I cheered when someone came up with the bright idea of having a universal concentration and varying the rateto titrate to APTT!
I know a great way to get TED stockings on. Get a plastic bag (the longest one u can get) and put it over the patient's foot, roll up the stocking as much as you can, and it should slip over the bag - it does take some practice but u can take some TED stockings home & practice there. I wondered why when I did my clinical in theatre, everyone had plastic bags in their pockets! But it does work, trust me!
Can you explain this further? I'm having trouble picturing it. I always strain my neck when putting TEDs on people so I'd love a technique that makes it easier.
Passing pills! The more pills they have, the pickier they are! The patient has to identify each of their 20+ pills, then take each one individually with applesauce, and a glass of water between each pill. Then they have to pee in the middle of it all, because they drank so much water.
Or they want their pills with Sprite, or ice cream (in a flavor we don't have), or they want them in 20 minutes because they're in the middle of a long-distance call. Or you have to hand them the pill one at a time because they drop the pills if they try to pick them up. I had patients who literally took 10 minutes to take their meds. Multiply it by 17, and you can see why I hated LTC.
The plastic bag trick involved slipping a bag over the foot, then gliding the stocking on over the bag, which is removed through the foot hole.
I find an easier way is to turn the stocking partly inside out; leave the foot part and pull that over the toes and foot like a sock, then grasp either side of the top of the stocking and pull up. It's easier if the patient's able to straighten their legs and push a little but is still straight forward on a hemiplegic limb
ETA: or you could just watch
:) I haven't found a YouTube clip showing the plastic bag technique but I'm sure there's one out there
The only thing I hate about my job is the question, "When is the doctor coming in"?
Oh, I could write missives about the angst ThAT particular problem has caused!
I HATE that question too! I work as a nurse tech in the ER, and although I understand that the wait to be evaluated, reevaluated, or discharged by the residents can be AWFUL, I have noooo idea when the docs will have time to see them. Each doc can have like 20 patients each (while priority patients are always changing)! Even after I tell them this, they still are pushy and ask "well, can you find him/her?" Yeah, sure I can find and ask all 40 something residents on the unit if they happen to have YOU as a patient, and completely disregard my other ten patients, in this fast environment. While I'm at it, I'll be sure to tell them that your ride is outside waiting for you so they should stop trying to stabilize the lady with the MI so you can get home in a "timely" manner to watch the game. *eyeroll*
The plastic bag trick involved slipping a bag over the foot, then gliding the stocking on over the bag, which is removed through the foot hole.
I find an easier way is to turn the stocking partly inside out; leave the foot part and pull that over the toes and foot like a sock, then grasp either side of the top of the stocking and pull up. It's easier if the patient's able to straighten their legs and push a little but is still straight forward on a hemiplegic limb
ETA: or you could just watch
:) I haven't found a YouTube clip showing the plastic bag technique but I'm sure there's one out there
Talaxandra, you explained that very well. We used to get the plastic bag over the foot, tape it with micropore, then roll up the TED as much as possible, standing at the foot of the patient (so u dont hurt ur neck). Push the stocking up as much as you can, then I go round the patient's side & pull it up from there. It should just glide up after that, but like I said it does take practice & a bit of sweating on big patients (or patients with big limbs).
I've even seen some nurses even tape plastic nearly all over the patient's leg, then after the stocking is on, u just rip the bag off. To do this you have to roll the stocking back up on itself (as talaxandra said above) but it saves sooo much time.
Also whoever said they get a sore neck, try to get the patient to help pull up the inner part of the stocking (so you're not leaning over as much and straining), and get them to PUSH really hard. Like I said with practice it does get easier (but it won't be easy on every patient, depending on their status, ie: dementias).
nerdtonurse?, BSN, RN
1 Article; 2,043 Posts
Finding out "call the doctor"--worthy lab or radiology results at 0300....when it was resulted at 3 PM....which is why I now come in early to check my charts for "surprises"
Labels on IV tubes...
DKA protocol!!! Q2h FSBS and when you've got someone on an insulin drip/DKA protocol, you end up with a constellation of bags hanging, and every 2 hours, you're swapping D5 1/2ns for NS to D10 back to D5....
I don't have a problem with sputum or blood or puke or stool, but projectile vomiting of BRB from dissecting varices....makes me want to go in dressed like an astronaut...at least NASA puts air conditioners in the things...You're hot, sweaty, and you end the shift smelling like a slaughterhouse.