What made your jaw drop

Nurses General Nursing

Published

  1. Have you ever had a family member/friend press PCA button?

    • 17
      No.
    • 22
      Yes but the patient was not harmed.
    • 11
      Yes and the patient was affected and/or needed reversal.

50 members have participated

Pt had moderate sedation and was brought to recovery drowsy but arousable. PCA started but no other drugs administered by nursing. Pt begins snoring and becomes completely unaroausable. Friend at bedside asked how frequently the pt was pressing PCA button. Friend was indeed pressing the button for the patient q6mins.

Pt received over 7mg Dilaudid and had to be reversed.

:no:

What's something that made your jaw drop?

Specializes in Care Coordination, MDS, med-surg, Peds.
I am going to tell you why we use so many narcotics, particularly Dilaudid. HCAP scores. The biggest downturn in scores is "pain isn't adequately controlled" Adequately to patients means "NO PAIN". So since reimbursements depends on scores and surveys, then if you aren't bringing out the big guns on pain control then you aren't getting paid. Thanks Joint Commission for making pain a vital sign. Patients will tell you that their pain is a 10, right before they respiratory arrest. I have worked PACU for 15 years! Patients aren't educated enough on what to expect from pain after a surgery. If doctors tell patients that they are going to have pain after surgery, if it is an elected surgery, they won't have it. We are a give me society and a no pain society. I will tell you this, the new laws that they have enacted in Tennessee about narcotic dispensing should be a crack down on all this pill mill crap. If you ask for a 2nd pain pill prescription after the original supply given after surgery, then you have to enroll in a pain clinic contract. All patients getting more than a 3 day supply of narcotics have to sign a contract with the facility that they are aware of the side affects and potential problems and that they don't have multiple narcotic prescriptions already. The doctors can look in a data base prior to giving a narcotic prescription to see if the patient has had a recent prescription. If they have, hopefully they won't give another. It is a big problem and everyone suffers. Boy do I have a book of stories that would cover this topic.

where does this leave patients with legitament pain control needs, like TKR which can be crazy painful for weeks, they have to get scripts from surgeon every three days? Or chronic pain like Rheumatoid arthritis or other ongoing chronic pain? Not talking about the ones who say 20/10 pain while playing on the phone etc.

its a huge disservice to the patients who truly require pain meds. They are treated like drug abuses. I don't know the answers, but there has to be a better way.

Please don't say pain management doctors/clinics.

In my town and my state- the pain managent folks are few and far between. The wait to see a pain management group is greater than 6 months. How is that going to help your post op TKR with crazy pain?

This actually happened to me. After my hysterectomy. The nurse told my husband I could press my Morphine PCA button every 15 min, so he proceeded to do it for me. I had 4 really good hours of sleep until I woke up and asked him to please not do that anymore.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
What made my jaw drop, since you asked, (unless we're still beating the PCA example to death), were the nurses telling each other in report that the patient slept all shift. Different nurses each shift, no continuity of care. Slept all day. Slept all night. For 2 days. One nurse finally did an actual assessment, patient had stroked.

That made my jaw drop.

Years ago, I walked into work to start my 7am shift and there was a code in progress. Physician yelled out the door to get the vital signs board and check the 2am and 6am vital signs. Normal vital signs at 2 and 6. The patient was wearing a Holter monitor, and that showed V fib at midnight. Normal vital signs on a dead patient.

Then there was the student who gave 30cc of MOM "in the butt" because the patient was NPO. MOM enema? No, she gave it IM.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I am going to tell you why we use so many narcotics, particularly Dilaudid. HCAP scores. The biggest downturn in scores is "pain isn't adequately controlled" Adequately to patients means "NO PAIN". So since reimbursements depends on scores and surveys, then if you aren't bringing out the big guns on pain control then you aren't getting paid. Thanks Joint Commission for making pain a vital sign. Patients will tell you that their pain is a 10, right before they respiratory arrest. I have worked PACU for 15 years! Patients aren't educated enough on what to expect from pain after a surgery. If doctors tell patients that they are going to have pain after surgery, if it is an elected surgery, they won't have it. We are a give me society and a no pain society. I will tell you this, the new laws that they have enacted in Tennessee about narcotic dispensing should be a crack down on all this pill mill crap. If you ask for a 2nd pain pill prescription after the original supply given after surgery, then you have to enroll in a pain clinic contract. All patients getting more than a 3 day supply of narcotics have to sign a contract with the facility that they are aware of the side affects and potential problems and that they don't have multiple narcotic prescriptions already. The doctors can look in a data base prior to giving a narcotic prescription to see if the patient has had a recent prescription. If they have, hopefully they won't give another. It is a big problem and everyone suffers. Boy do I have a book of stories that would cover this topic.

We've had two generations of physicians now who have been educating patients that they won't have any pain after surgery "because the nurses will take care of it." Therein lies the problem. I've been in the room and nearly had to swallow my tongue to keep from ripping them a new one right in front of the patient. I've also been "educated" that way when I've had my own surgeries.

Specializes in 911 critical care ambulance nurse.

I work as a critical care nurse on a 911 ambulance. In addition to transfers, I also go on 911 emergency calls. We got called on the freeway for a Honda CRV versus a motorhome head-on with each vehicle doing about 50 mph at time of collision. I recognized the driver of the CRV as being a known chronic 10-personality schizophrenic local lady who was awake. She said she went out driving in an attempt to find something big to run into to kill herself. Her pelvis was crushed and lower extremities were smushed. Airbag sheltered her torso. We got her out of the car, quick splinted the legs, and into the back of the ambulance to resuscitate her. I volunteered to do the IV's because I know how to get a line on her. Her veins are normally ******, but she allows me to summon her Michael persona and, since he's bodybuilder, he can get her veins to stand out. I summoned Michael and he appeared in about 30 seconds. I explained I needed to start two IVs and that I needed her to get me some big veins. Within a couple seconds, the veins popped right up and I got two 16 gauges started. I looked to see my partners giving me the look like I was a voodoo doctor. Then I notice lady partsl bleeding. External exam showed porcelain fragments. When asked, the patient said she placed a teacup in her lady parts before going driving. The teacup broke in the crash and lacerated her lady parts. I chose to wait for the ER to address that problem further. She recovered, but, for some reason her schizophrenia is now under better control.

Specializes in NICU/Mother-Baby/Peds/Mgmt.
It's a bit complicated, but I'll try to explain how the system works. Yes, we do have very generous paid parental leave. It's 480 days paid leave (=15 months), but the law says that you have a right to stay at home for 18 months with each child. So either you get paid for all of the 15 months or if you choose to stay at home for the full 18 months, it will be at a slightly lower pay level. (You basically stretch the 15 months pay to last for 18). After the 18 months are up you have a right to return to your old job/position.

Out of the 480 paid days, 90 days are exclusive to the mother and 90 days are only for the use of the father. It's a "use them or lose them" type of thing. If one of the parents chooses not to use the 90 days that are exclusive to them, they lose the pay for that time. They don't lose the time though. The parent who stays at home with the child still has a right to be home for the full 18 months. They'll just get paid less.

The mother also has a right to stop working seven weeks prior to the expected delivery (with pay). Earlier of course, with sick pay, if a doctor says it's medically necessary. After the child's birth both parents have a right to stay at home for ten work days (two weeks) together. The remaining 480 paid days of parental leave is taken by one parent at a time.

The most recent statistics I could find are from 2013 and then 75% of paid parental leave was used by mothers and 25% was used by fathers. The percentage of paternal leave has increased somewhat since then, by I don't have the exact figures.

You also have right to have shorter workdays until your youngest child turns eight. You can choose to work 80% of fulltime = six-hours days. That however isn't paid, but an employer can't discriminate against you when it comes to promotions etc. if you choose to utilize this option.

If your child is sick (short-term cold/flu etc. or longer periods for more serious conditions), you can also stay at home to care for them. In this scenario you receive your full pay. Not from the employer, but from one of the social safety programs.

What crummy luck to be hit by a car when vacationing. I hope the son made a full recovery!

I'm happy to hear that the care he received inspired the daughter to go into the medical field :) I am actually quite proud of our healthcare. Like virtually all Swedes, I fully support the idea that healthcare is a human right and that it should be available to all citizens at an affordable cost.

Healthcare here is different from the U.S. Most facilities and hospitals aren't as nicely decorated as the U.S. hospitals I've been in. If you visit a hospital here that was built in for example the 1950s, it shows :lol2: The equipment is state of the art and the staff are highly trained, but no one really feels it's a priority to make the facilities look like "hotels". The decor is very basic, they slap on a fresh coat of paint when needed, but that's about it.

So how does it work when someone is out for 18 months, do they get temporary workers in? I've done scheduling and I know it's been hard to cover sometimes when someone is out for 3 months maternity leave, while trying to give everyone else their vacations, medical leave etc.

Specializes in NICU/Mother-Baby/Peds/Mgmt.
I work as a critical care nurse on a 911 ambulance. In addition to transfers, I also go on 911 emergency calls. We got called on the freeway for a Honda CRV versus a motorhome head-on with each vehicle doing about 50 mph at time of collision. I recognized the driver of the CRV as being a known chronic 10-personality schizophrenic local lady who was awake. She said she went out driving in an attempt to find something big to run into to kill herself. Her pelvis was crushed and lower extremities were smushed. Airbag sheltered her torso. We got her out of the car, quick splinted the legs, and into the back of the ambulance to resuscitate her. I volunteered to do the IV's because I know how to get a line on her. Her veins are normally ******, but she allows me to summon her Michael persona and, since he's bodybuilder, he can get her veins to stand out. I summoned Michael and he appeared in about 30 seconds. I explained I needed to start two IVs and that I needed her to get me some big veins. Within a couple seconds, the veins popped right up and I got two 16 gauges started. I looked to see my partners giving me the look like I was a voodoo doctor. Then I notice lady partsl bleeding. External exam showed porcelain fragments. When asked, the patient said she placed a teacup in her lady parts before going driving. The teacup broke in the crash and lacerated her lady parts. I chose to wait for the ER to address that problem further. She recovered, but, for some reason her schizophrenia is now under better control.

My jaw dropped the whole time I read that-twice. If I didn't know better I'd say you made that up. So sad. For her and the people in the motorhome.

It's a bit complicated, but I'll try to explain how the system works. Yes, we do have very generous paid parental leave. It's 480 days paid leave (=15 months), but the law says that you have a right to stay at home for 18 months with each child. So either you get paid for all of the 15 months or if you choose to stay at home for the full 18 months, it will be at a slightly lower pay level. (You basically stretch the 15 months pay to last for 18). After the 18 months are up you have a right to return to your old job/position.

Out of the 480 paid days, 90 days are exclusive to the mother and 90 days are only for the use of the father. It's a "use them or lose them" type of thing. If one of the parents chooses not to use the 90 days that are exclusive to them, they lose the pay for that time. They don't lose the time though. The parent who stays at home with the child still has a right to be home for the full 18 months. They'll just get paid less.

The mother also has a right to stop working seven weeks prior to the expected delivery (with pay). Earlier of course, with sick pay, if a doctor says it's medically necessary. After the child's birth both parents have a right to stay at home for ten work days (two weeks) together. The remaining 480 paid days of parental leave is taken by one parent at a time.

The most recent statistics I could find are from 2013 and then 75% of paid parental leave was used by mothers and 25% was used by fathers. The percentage of paternal leave has increased somewhat since then, by I don't have the exact figures.

You also have right to have shorter workdays until your youngest child turns eight. You can choose to work 80% of fulltime = six-hours days. That however isn't paid, but an employer can't discriminate against you when it comes to promotions etc. if you choose to utilize this option.

If your child is sick (short-term cold/flu etc. or longer periods for more serious conditions), you can also stay at home to care for them. In this scenario you receive your full pay. Not from the employer, but from one of the social safety programs.

What crummy luck to be hit by a car when vacationing. I hope the son made a full recovery!

I'm happy to hear that the care he received inspired the daughter to go into the medical field :) I am actually quite proud of our healthcare. Like virtually all Swedes, I fully support the idea that healthcare is a human right and that it should be available to all citizens at an affordable cost.

Healthcare here is different from the U.S. Most facilities and hospitals aren't as nicely decorated as the U.S. hospitals I've been in. If you visit a hospital here that was built in for example the 1950s, it shows :lol2: The equipment is state of the art and the staff are highly trained, but no one really feels it's a priority to make the facilities look like "hotels". The decor is very basic, they slap on a fresh coat of paint when needed, but that's about it.

I would really appreciate if you could give me an idea of how this leave policy is funded. I'm not a financial person, so I get confused how different countries handle there healthcare. My hospital (US) swears they are " going broke" giving us three weeks of combined sick/ vacation time per year.

I had a patient, COPD retainer. Limited code, noninvasive ventiltion. The patient came off Bipap and one of the family members put the patient on 15 liters of O2. I was wondering why the oxygen level was maintaining at 94-97% on the central monitor off the Bipap when this patient usually desatted 🤦🏼*♀️🤦🏼*♀️ I went in immediately and explained why the patient can't be on O2 that high (PCO2 levels sky high already) and this patient did not want to be ventilated!!

Specializes in Surgical, quality,management.
So how does it work when someone is out for 18 months, do they get temporary workers in? I've done scheduling and I know it's been hard to cover sometimes when someone is out for 3 months maternity leave, while trying to give everyone else their vacations, medical leave etc.

Yes, well here in Australia anyway. The manager gets a statement of maternity leave as the employee has to fill out forms and they are sent via HR and generates a fixed term backfill position that is advertised or otherwise recruited into.

Specializes in nurseline,med surg, PD.
I work as a critical care nurse on a 911 ambulance. In addition to transfers, I also go on 911 emergency calls. We got called on the freeway for a Honda CRV versus a motorhome head-on with each vehicle doing about 50 mph at time of collision. I recognized the driver of the CRV as being a known chronic 10-personality schizophrenic local lady who was awake. She said she went out driving in an attempt to find something big to run into to kill herself. Her pelvis was crushed and lower extremities were smushed. Airbag sheltered her torso. We got her out of the car, quick splinted the legs, and into the back of the ambulance to resuscitate her. I volunteered to do the IV's because I know how to get a line on her. Her veins are normally ******, but she allows me to summon her Michael persona and, since he's bodybuilder, he can get her veins to stand out. I summoned Michael and he appeared in about 30 seconds. I explained I needed to start two IVs and that I needed her to get me some big veins. Within a couple seconds, the veins popped right up and I got two 16 gauges started. I looked to see my partners giving me the look like I was a voodoo doctor. Then I notice lady partsl bleeding. External exam showed porcelain fragments. When asked, the patient said she placed a teacup in her lady parts before going driving. The teacup broke in the crash and lacerated her lady parts. I chose to wait for the ER to address that problem further. She recovered, but, for some reason her schizophrenia is now under better control.

OMG!!!!

I don't know where this qualifies, but when I was a student there was an elderly who kept asking for help. There was a foreign device in her pelvic area and could not recall how it got there. Now apart from the confusion this patient had and calling for help in a bird like voice... laboratory values were not abnormal either or outrageous. Initial treatment was for possible UTI and further exploration led to a big surprise. Here is the kicker... you know what was the " irregular shaped foreign body"? It was a vibrator that somehow got stuck up there and how long it was there... no idea.It was surgically removed and I have no idea if the family was fully aware what brought their loved one to the hospital.

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