If You Give a Patient a Cookie

Mully

If you give a patient a cookie, they'll want a glass of milk.

If you give them a glass of milk, they'll probably need to go to the bathroom.

They'll be too weak to get out of bed so you'll have them use the bedpan, but they won't be able to go in that.

So you'll bladder scan them and see they have 900ml's of urine in their bladder, which you will promptly proceed to straight cath.

When you stick the catheter in, you'll probably meet resistance, but with a little elbow grease, you'll soon strike gold. However, it will only be later when the patient has a temp of 38.5 that you realize you accidentally contaminated the catheter and caused a UTI.

For this you'll certainly hang some antibiotics. Unfortunately this will probably cause the patient to have some major diarrhea. By the third complete bed change you'll realize that this patient would benefit from a rectal tube for which you'll get an order and go to place. However, the patient will probably vasovagal when your padded finger penetrates his rectum a little too forcefully, which you'll then report to the doctor.

The doctor will then consult neurology, cardiology, endocrinology, PT, OT, ST, and a chaplain for good measure. They'll likely all take turns calling your mobile phone while you're elbows deep in doodoo. You'll answer their every wild question from memory, phone sandwiched between cheek and shoulder.

By now though, the patient will be in pain, which the doctor will kindly order acetaminophen 81 mg Q Day for. You'll be forced to try to remember those non-pharmacological interventions for pain that they taught you in nursing school. You'll try showing the patient the beautiful landscapes on the screensaver to your portable computer, attempting to sooth him with guided imagery. His pain will probably rise to a 10 out of 10 with this intervention, so you'll have him close his eyes for some progressive muscle relaxation.

When you tell him to open his eyes again, he won't. The bedside monitor will then start dinging that his O2 sat is 82% and rapidly declining. You'll sternal rub him and shout "Mr. Velasquez! Emilio!!! Abre los ojos!!!!!" to which he will not respond. You'll call a staff assist which will bring 60 people to the room. The patient will be intubated, sedated, and paralyzed. His new diagnosis will be urosepsis and he'll need a central line and an art line placed.

However, when the intern overconfidently attempts the central line, he'll accidentally puncture the lung and cause a pneumothorax, adding a needle decompression and chest tube insertion to the impressive roster of procedures he's done now that he's finally a doctor.

While turning your patient every 2 hours in attempt to prevent him from getting bedsores, the shift in intrathoracic pressures will probably compress his vena cava to the point of cardiac arrest. You will promptly begin high quality chest compressions, advise someone nearby to activate the emergency response system, and apply an AED, but to no avail. The code will be called and the patient will be dead.

After finishing his post mortem care, you'll sit down to mount the heart rhythm strips to his chart. Another nurse will proceed from your other room to say, "I answered Mr. Jones' call light while you were in that code. Can he have a cookie?" You'll look up at the clock and realize that the next shift comes in in 10 minutes. "Yeah, sure," you'll reply, "but he'll probably want a glass of milk with it too..."

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If You Give a Patient a Cookie

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