Just a vent: why snooker a pt who needs to get up? (and other thoughts)

[HappyNurse2005, RN]

warning-long rambly vent.

OK, a few things to vent about today. Had a pt who is post op day 3 from CABG. Per our regular schedule of things, she should be up and walking in the halls, getting a 2view cxr, moving, using IS, etc.

This particular pt had been reported as sensitive to her medicines. Had a morphine pca (standard for cabg pt's, dc'd on day 2 usually). had to be narcan'ed out of it. woke up mad, then fell back asleep. sleepy after reglan. (reglan d/c'd) was told this pt had just been really really sleepy for the whole post op period up til this point.

She NEEDS to be awake so we can ambulate her, get her to do her IS, etc.

But, she's complained of some nausea. Has Phenergan and Zofran prn. Now, i'd think for a person so sensitive to sedatives, you'd give zofran. Nope. at 645am, she was given 12.5 of phenergan. (NOT by me)

said nurse told me in report that "she'll be snookered til three o clock!" (i get off at 7pm, so it wasn't implying it'd be for my whole shift). i dont think she snookered her on purpose, but i don't see it as thinking things through very well.

she slept. most of the day. she couldn't get her pa and lat cxr b/c she couldn't stand up! she would fall asleep while transferring from the bed to the potty chair. couldn't wake up to eat. well,she'd wake up easily but not stay awake. this lasted for HOURS. pt ended up with a neuro consult, ct of head(no cva), echo, eeg, kub, lft's, etc.

So I made it known to the PA about pt recieving the med so when he did rounds he would know why she was out like a light. he and the doc were upset that she was given the sedating med that made her unable to work on getting well esp when she already had zofran they could have given her.

so it negatively affects her, makes me look bad b/c i can't get her up and oob. (she finally began to wake up more, and me and 1 other managed to get her to walk a whole 20 feet with great difficulty.)

just having given her some darned zofran instead would have worked. would have saved us all some trouble.

[McGyverRN]

Seems like the doc or PA should have d/c'ed that phenergan after it was determined that she was very sensitive to meds. Nevertheless, I agree with you. I would have been irritated with the previous shift as well for not thinking that one through. There's probably a good chance that her hosp. stay will be prolonged a day or so.

[HappyNurse2005, RN]

honestly, it'd be nice if no one got phenergan and they all got zofran prn.

i've had phenergan 12.5mg iv once, when in labor. i hated it so bad, i'd rather vomit.

[anne74]

I agree - if the doc or PA were so upset, then why was there an order for phen at all - or why was it not DC'd sooner? Seems like it was their fault as well. Obviously the nurse should have given Zofran, but perhaps some new or inexperienced nurses may not know that phen had a sedating effect. Thanks for the example - I'm a new nurse and I learned a lot from this scenario. I will always chose Zofran now if the Pt is drowsy. (Although, our docs will usually order only one or the other - not both.)

[sharann, BSN, RN]

Zofran costs alot more and it seems like some are influenced by this. I think that sedating agents have their place in patient care when it will HELP the patient. Giving a sedating drug when an alternate(and better drug) is available is not great thinking is it. This nurse may have thought she was doing you a favor by snokering the patient for you. If this is true then that's lousy.