Feel traumatized - page 2
The other day the doctor ordered a pt.'s Foley changed out. I didn't feel good about it going in, because the last time the Foley was placed the urologist had to do it. Also, the pt. had been... Read More
Feb 19, '10Joined: Feb '09; Posts: 7,635; Likes: 26,320Quote from firstyearstudentFirst, I apologize if I sounded as if I "blamed" you. Didn't mean to; I was just expressing what action I would have taken. Your initial post didn't aska specific question so I assumed you wanted our opinions. If it were me, I would have at least talked to the MD to make him/her aware of the patient's history of a constriction or whatever it was that required a urologist in the past. If a month has passed by, it's entirely possible that the MD had forgotten the previous situation, if they ever even knew about it.I don't know. I guess my rationale was that a month had passed since the last Foley was placed and the previous problems were probably due to trauma/inflammation from pulling the Foley out. Do you think I should have refused? I feel like you're blaming me. Doesn't the MD who ordered this have any responsibility? This is the first time I had this patient.
In terms of the MD having any "responsibility" in this situation.....of course they do. But so do you. You have two things to protect: your patient's best interests and your license. Don't get me wrong - I'm not remotely trying to imply that loss of license could result from a situation like this. What I want to impress upon you is that you must learn to question orders that are grossly wrong, in your professional opinion. The days are long gone where a nurse blindly follows MD orders. We assess our own patients and advocate for them, in addition to carrying out medical orders. That's why we also carry a license. If you don't speak up because the doctor is a jerk (you said that you would have said something to another, nicer MD), then you are not advocating for your patient.
Feb 19, '10Joined: Nov '05; Posts: 893; Likes: 260I don't think I would have hesitated to confront the MD if I felt the order was grossly wrong. This was definitely a gray area (at least in my opinion) and I would have liked to confer with the doctor. This MD does not "confer" with nurses. He gives orders and nurses fill them.
Feb 19, '10Joined: Feb '10; Posts: 4,326; Likes: 6,283
Is the patient alright now? Dwell on that. Was any lasting harm done? Why can't you look at his chart or check up on how he's doing?
Feb 19, '10Specialty: ICU, Cardiac ; Joined: Oct '05; Posts: 75; Likes: 210Quote from firstyearstudentI am not sure who that comment was directed at, but either way I don't understand it. Was something deleted?What's so funny? You're a creep.
As for replacing it, with the additional information you provided, I would definitely have not done the replacing and would have asked for a urologist to do so. He had a history of recent trauma to the area, the first catheter had to be placed by a specialist and he had a platelet count of 30.
I am sorry if the doc is and was being a jerk, but if you have a concern over an order that you have been given, you have to be able to talk with him about it. If he doesn't listen, go up your the chain of command.
If this MD is a jerk to all, administration should be doing something about it as he is could be jeopardizing the care of a patient if people are afraid to ask a question or question one of his orders.
Feb 19, '10Joined: Feb '09; Posts: 7,635; Likes: 26,320"I am not sure who that comment was directed at, but either way I don't understand it. Was something deleted?"
Yes, something was deleted. It was a really bizarre post that I reported.
Feb 19, '10Joined: Nov '05; Posts: 893; Likes: 260Yeah, well, I guess I learned my lesson. I'm definitely not doing any more procedures like this with platelets that low. Because it is a heme unit, just about everyone has low platelets and we are always doing procedures with platelets that low. (Most nurses would do a Foley unless platelets were below like 20.)
I actually spoke to the charge nurse and the nurse supervisor about putting this cath in and they thought it was okay. But I'll just refuse next time and let the charge nurse or some other chump take the responsibility.
And there is no way they would get a urologist to put in a catheter unless the RN had tried first.Last edit by firstyearstudent on Feb 19, '10
Feb 19, '10Occupation: RN LTC Specialty: 25 year(s) of experience ; From: US ; Joined: Jan '03; Posts: 3,766; Likes: 1,820We change caths every 30 days or prn. I've dealt with some difficult pts (enlarged prostates, ones who spasm). I might have tried once then if it didn't go in easy, I'd be calling the doc. This is in LTC too. I've had my share of bleedeers too.
Feb 19, '10Occupation: Registered Nurse Specialty: Med/Surg ; From: US ; Joined: Sep '08; Posts: 1,577; Likes: 2,726
Feb 19, '10Specialty: 3 year(s) of experience in Army Medic ; From: US ; Joined: Jan '08; Posts: 244; Likes: 219Do you feel that you did any permanent damage?
I've had these things happen as well when I was still in the military - and I always felt horrible about it, I think partially because of the area that the damage was done.
On the other hand, if it's not changed out they run a risk of infection - which I think would be a lot worse than some bleeding.
I think the nature of the area makes it seem worse than it is when you do some damage, but if it's nothing permanent you should not beat yourself up too much about it. Procedures like this are in place for a reason.
Feb 20, '10Occupation: "Exploring my options" ;) Specialty: 30 year(s) of experience in Alzheimer's, Geriatrics, Chem. Dep. ; From: US ; Joined: Apr '03; Posts: 11,245; Likes: 8,515
Feb 21, '10Occupation: PACU Critical Care Specialty: 3 year(s) of experience in PACU, Surgery, Acute Medicine ; From: US ; Joined: Jul '08; Posts: 291; Likes: 244Quote from michelle126I agree with this. Especially if I had clearance from my charge, I would have given it a try. But when it was clear that it wasn't going in okay for whatever reason, I would have stopped and tried to get the urologist involved. Just because it required the urologist 30 days ago doesn't mean the pt's condition was the same and it would still be problematic. It might have gone in just fine. But when it didn't, then maybe stop and go higher up the food chain (can I say that without getting flamed? )We change caths every 30 days or prn. I've dealt with some difficult pts (enlarged prostates, ones who spasm). I might have tried once then if it didn't go in easy, I'd be calling the doc. This is in LTC too. I've had my share of bleedeers too.