What have other nurses done that have freaked you out? - page 54

What have other peers done intentional/unintentional to freak you out? Good or bad. Happy or sad. On my FIRST day as an LVN, (LTC) a res was screaming in her room as I was walking out to leave. I... Read More

  1. by   JulieCVICURN
    Quote from cardiacmadeline
    Coreg is a nonselective beta-alpha blocker given in HF to block SNS effects like increased heart rate, contractility, and peripheral constriction, all of which increase oxygen needs and increases the workload on the heart. Coreg is part of the core treatment of HF, with the goal being to decrease the workload on the heart and to maximize the ability of the heart. Coreg decreases heart rate to increase filling time and decreases afterload. So if a CHF'er has SBP in the 90's and this is their baseline while on coreg, I will give it. If it is a huge change from their baseline or they are symptomatic with the low BP, I would call the MD. A lot of CHF'ers have and are tolerant of low BP's and as long as they are tolerating it (have no s/s hypoperfusion or hypovolemia), they should receive their core CHF medications (diuretics, B-blockers, ACE inhibitors). You have to ask yourself if holding the medication would actually benefit the patient, and you can't base that decision on blood pressure alone, you have to look at the whole clinical picture. Also, I have always been taught that coreg therapy should never be interrupted or discontinued abruptly, so I will always call the MD before holding it unless there are parameters written.
    I work in cardiac ICU, and I agree with this. In fact, it's one of the only drugs that our cardiologists get mad if we hold unless they've given parameters. We can hold Lopressor 'til the cows come home, they trust us with that one, but Coreg is important. FWIW, I have given Coreg to hypotensive patients and actually seen the SBP come up because it helped the heart pump more efficiently. Also, I think Coreg has something to do with remodeling in the heart, although off the top of my head I can't remember exactly what.
  2. by   tri-rn
    Wondering why phenergan has to be diluted? My drug guide says nothing about diluting it. I'm not sure I've ever given this drug. Thanks!
  3. by   fiveofpeep
    Quote from tri-rn
    Wondering why phenergan has to be diluted? My drug guide says nothing about diluting it. I'm not sure I've ever given this drug. Thanks!
    yeah what freaked me out was I looked it up on micromedix at a hospital I worked at, and it didnt say it either under administration or on the med order.
  4. by   Simba&NalasMom
    Quote from maggiofliore
    yeah what freaked me out was I looked it up on micromedix at a hospital I worked at, and it didnt say it either under administration or on the med order.
    Apparently it increases risk for phlebitis, based on another thread:

    https://allnurses.com/infusion-nursi...554-page2.html

    Also found this link which recommends a 10 Ml dilution:

    http://www.adaweb.net/Portals/0/Para...omethazine.pdf
  5. by   fiveofpeep
    yeah I heard that it causes some gnarly extravasation as well.
  6. by   diane227
    Phenergan is an agent that is very hard on the veins. It must be diluted before administration, to ease the discomfort of the injection. If you have ever had phenergan IM it is an experience that you will never forget. If it gets out into the tissue you will have tissue destruction so make sure you check your IV site carefully before you give it. You can expect that phlebitis will occur so check the vein. If you feel it getting even a little bit firm, remove that IV and restart in another location. Give it slow.
  7. by   diane227
    You know, this has been a long post full of horrible incidents. We laugh but when you really look at these issues they are sad. It is no wonder that the public does not trust health care when they see and hear things like this. I believe that it is imperative that all of us, as professionals and as people who obviously care about the well-being of our patients we MUST do what ever we can to weed these incompetent people out of our profession. When I see stuff like this I document it for the manager and then I nag her until she takes action on the situation. When I have students on my floor I tell them that if they see something strange or see anyone doing something that is contrary to their training to tell me so we can discuss it. We have to get rid of these incompetent, unsafe people. They may be taking care of us or one of our loved ones one of these days.
  8. by   NicuRN73
    In the middle of report of a baby in an oxygen hood, Off going nurse stated that they baby was crying all night long so she taped the pacifier to the baby's mouth.. I was like "what????!!!!" She stated it again.. I was floored. In a state of disbelief that she stated it twice. I was like "Hold please" and in the middle of report, I removed the tape. Four side tape job on the pacifier to mouth!.

    I explain to the foreign nurse that this isn't allowed here in the states, that it is a risk for aspiration (esp since this baby had projectile vomiting episodes). She then told me I could do what I wanted on my shift, and that she would do what she wanted for her shift.

    I reported her to my charge nurse. I was treated like cowdung for the rest of the assignment ( since I was a traveler at the time and she was staff) But I didn't care. My babies come first!!!

    Kathy
  9. by   diane227
    I would have made a formal written complaint to the manager of the unit with a copy to your agency. This is sooooo unsafe. I cannot believe that someone would do such a stupid thing to a baby. What nursing school did she go to?
  10. by   Cthebigguy
    Worse thing I have ever seen done... one of our nurses (who's name shall remain in my book of shame) left a nice 21 gauge needle in a residents room. This kindly demented lady then proceeds to jab it at me (needle first) asking me to take it away, I can tell you that even a 20 gauge needle looks like a 7 gauge when you know it really has the power to change your life (did I mention that our facility doesn't do an STD panel on new residents?). I told the DON and was informed that it was a mistake and it wouldn't happen again. 2-weeks later the nurse got busted with stolen pills.
  11. by   GoalsInTransition
    So, I'll take the opportunity to vent!

    While working as a brand-new CNA at an understaffed SNF, I found a resident (with dementia, of course) loudly cursing, gown soaked from the waist down, and smelling of emesis.

    Her mouth and nose were free of emesis, and there was no actual vomit (just gastic secretions)-- of course, her feeding tube was not secured! But (at least at the time) I was not allowed to touch this, so I found a nurse and asked her to fix it. She came into the room, barely looked at the patient, glared at me and said, "She just threw up on herself, duh. Clean her up and change the bed".

    Sigh... I did as told, assuming that I had to be wrong (this was my first week post-orientation). Well, after an exhausting total bed change (with patient in bed) and gown change/mini-bath of a very combative lady, OF COURSE she was again forund to be soaked from the waist down.

    Again, I called the RN, and was AGAIN told that she had just thrown up on herself, and to re-do the gown and bed change, wash-up, etc. I did this, with tears in my eyes, only to find the SAME THING a third time later on my shift.

    Finally, the nurse checked the feed tube, fixed it-- and left the room without even looking at me- no apology, no nothing. AND I had to clean up again. (BTW, this was not a facility where CNAs helped each other, and I didn't dare ask for what I knew I wouldn't get)

    Lessons- I need to be more assertive, and nurses aren't perfect. Since I'll be a nurse soon, I hope I keep this in mind when a CNA or other co-worker wants my help.

    Stacy
  12. by   CASTLEGATES
    Quote from diane227
    1. Lick his finger before he scanned his finger on the Pyxis machine to get medication out. He never took a bath and smelled horrible. He was a horrible nurse. Our manager fired him after his patient pulled out all of her post op drains and was bleeding out. Two of the other nurses where in there holding pressure and the others were trying to find him. They were paging him over and over and he was asleep in the family room
    2. Administer medication without a physician order to a patient that was not even her patient telling the patients nurse that this was a "nursing dose". She almost killed the patient. I fired her.
    3. In the Pedi ICU, drawing up IVF from one patients bag to flush the line of another patient. I fired her too. (We had worked and worked with this girl to try to get her on track without success).
    4. Break a patients arm while trying to draw blood. She was high on cocaine and instead of restraining her as was protocol, he got into a struggle with her and in the process broke her humerus. He was a good nurse but he had no tolerance for drunks or people on drugs. I had no choice but to terminate him.
    5. Go for an entire 12 hour shift and not chart one word on any of the 5 patients the nurse had.
    6. Leaving medications at the bedside (I HATE this).
    7. Telling the patient to just go ahead and pee on herself (she had a pad under her) and she would clean her up later. (This REALLY made me mad.)
    8. Physically picking up a patient and throwing him out of the ED and throwing his walker after him. (this was a very well known frequent flyer pt who was a real pain in the butt). The director fired the nurse and of course reported him to the board for disciplinary action.
    9. Refusing to do CPR because "my card expired".
    10. Running the tube feeding through the IV line (caught this before it went into the vein).
    11. I became the director of a mid size ED and there was a nurse on nights who worked in no other area of the ED expect triage. I met with the staff and told the staff that everyone was expected to be proficient in all areas of the ED and everyone had to rotate in all areas. She quit shortly after. Then I found out that she was drunk every day she came to work and her thermos was full of liquor which she drank throughout the shift. This was apparently a well known fact that no one had done anything about.

    Amazing but true. And so do you wonder why errors occur?
    "Nursing dose" Cool! I like that one!
    I can bring a thermos to work with some gin fizz? wow!
  13. by   JessicRN
    Quote from tri-rn
    Wondering why phenergan has to be diluted? My drug guide says nothing about diluting it. I'm not sure I've ever given this drug. Thanks!

    Promethazine is buffered with acetic acid-sodium acetate and has a pH between 4.0 and 5.5. That is stronger then some chemotherapy medication. Because of this too many accidents just like shooting acid into a vein. This drug has been banned by ours and every facity I know of due to the danger.

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