you know you are in for trouble when.....

[ktwlpn]

I was just thinking about the family of a recent admission.We knew we were in trouble when we met the adult children. The #1 contact had tardive dyskinesia and it quickly became clear that reasoning with this person would not be possible. We were taken aback a when we saw the list of meds which he provided. Narcotics,benzos galore. It seems that if his mom couldn't sleep he would just pop her a second ambien and if that failed another klonopin was given. If her back pain did not respond to "vikadin" he had plenty of ms contin handy. A days worth of thorazine was her regular bedtime routine.

It was also apparent that the full time care giver/crack ho was under the influence of something-possibly some of her patient's meds? A few days ago the social worker received a call from the same son-seems mom's social security check did not arrive.He just could not understand that it goes to the home now.

What kinds of things strike fear into your heart when you first encounter a new admission or their significant others?

[EarthChild1130]

[i worship at the altar of Haldol since that shift!]

LMAO I so totally love this!! I am rather fond of Haldol myself!!

Thanks for that! (and thank Neptune for Haldol!)

[lpn1313]

When their paperwork looks bad, they roll in looking worse, and there's no DNR form in sight. (Back to the hospital with you)

When said patient is assigned to the one doc who's notorious for not answering pages. Or calls to his cell phone. Or calls to the office.

When families don't see the need for 95yo end stage CA patients to have DNR forms.

When you hear 'everyone's fine. It's been a quiet night.'

[Valerie Salva, BSN, RN]

...you walk into the unit with a smile and before you can even say "good morning" a usually friendly co-worker snarls at you.

[ShayRN]

Report at the start of your shift is, patient was a nursing home patient with CVA. Admitted to us from hospital with a recent history of change of mental status. According to the family she hasn't had a good BM in over a week. She was disimpacted on admission yesterday and given a dulcolox without results. She got a triple H enema a few hours ago and and again checked. Manually removed very large amt of stool. Flood gates were opened folks! Code Brown anybody?

[rngolfer53]

When the new admission has several men fighting out in the hall about who is the "baby daddy," when the pt can't pay the small copay for her child's inhaler but has plenty of money for acrylics with rhinestones and designs and cell phones that could run a NASA launch, and when you smell something not quite so fresh from the hall when entering the room to break down the bed for a pelvic.

The first instance is easy to deal with. Tell them the court officer will be right along to register the daddy so the state can make sure to collect the child support.

The fighting will instantly change to finger-pointing, each saying another is the daddy, assuming they're not bright enough to scatter, and they're likely not.

[rngolfer53]

Your inbox contains a memo from management that begins:

To improve Client satisfaction..............................

[rph3664]

You know you are in trouble when the patient comes on to the unit with shopping bags full of meds. Some with expiry dates that go back to before you were born.

Got to love it.

We once had a psych patient who came in with a huge gym bag with over 200 bottles of meds, most from various mail order facilities and most of them were untouched.

No wonder she was in the psych unit! The pharmacist on duty that day at the psych facility, which at our hospital is in a separate building, has been a pharmacist for over 40 years and he said it was by far the weirdest thing he had ever seen - and he once owned a pharmacy that serviced a nursing home.

[bagladyrn, RN]

On OB:

When you've received 4 phone calls and 2 in person visitors asking about the status of the pt. before you've even heard from, much less seen the pt. (Find yourself hoping they stopped at the other hospital in town.)

When the labor room door is shut and the off going nurse hands you a mask and a jar of Vicks as you walk into the unit.

When your phone rings at 5:30 and you hear the voice saying "Could you come in a little early - Like now?"

When you receive in report that both the husband AND the father of the baby are in the room...

And of course, when the birthing plan is longer than 3 pages!

[nerdtonurse?, BSN, RN]

When the brand new butt kissing idiot the NM hired is following all the LPNs around to "verify our clinical skills" but charts good pedal pulses bilaterally on a double AKA.

When said wonder nurse tapes -- yup, you heard me, TAPES -- a bag over a illeostomy stoma -- and it's the kind of wafer that has the plastic storage container lid closure...can you say "Code brown?"

[travel50]

Hey, jnrsmommy, yes, actually that was not at all funny. We were horrified. The sister decided that she and the brother were going to go back home one day. Tired of being in the nursing home. She was tired of not getting her "needs" met. I told the adm that if she left and took him, I was calling adult protective services. It was nothing less than abuse as far as I was concerned. She did not take him home, by the way.

[Mommy_of_3_in_AL..RN]

Oh goodness..in only my 8 weeks as a nurse in MICU i can list a hundred of these...here are a couple:

*If i ever get a nurse calling report from the EAU (express admit unit), i go into automatic panic mode..especially when they say, "the patient is really fine. their labs were a little off, and they are having some respiratory problems and hip pain, but otherwise they are fine..and afebrile." First, if that is the case, they wouldnt be the one tossed into the unit when we are on divert. Second, as i learned the hard way, if you are ever told the labs were a little off, clarify WHICH labs..In mycase, said patient came to us very grey, obviusly difficulty breathing. The "off" labs were their ABGs...sever respiratory acidosis. NO line whatsoever, no BP (at least not that we could hear or palpate), and no orders at all other than to transfer to the unit. Oh, and that afebrile status...patient had fever of 105.2. All of a sudden, we are full blown coding her, emergent CVL placement, ART line, intubation, the works.. every consulting doc showed up at this time. MRI from previousphysician visit showed extreme left hip imflammation extnding through the muscle. Sent to emegency surgery where it was determined that her hip pain was a result of necrotizing fasciatis. Entire evacuation of left hip area, down to the muscle. Wound vac in place. Came back from surgery with nothing more than dilaudid 0.5 mg every 4 hrs PRN. Oh yeah, and two weeks later, we find out she is severely schizophrenic to top it off..But, good news is, we discharged said patient to LTC last week..looks like she will be ok after lots of rehab.

*If a report is ever called on a patient coming to bed X i will always do a double take. This specific bed is where previous patient was admitted to, the SAME DAY we discharged another patient from that room after a three month long admission for the same thing!

*if you get to work and you are given report saying "we discharged 4 patints yesterday so we put two staff on call, leaving you with two nurses" you can bet your paycheck that by 9 am you will have admitted four patients, leaving two nurses for 8 ICU patients until said coworkers, both of which live at least 90 minutes away, can get there...

*and my fav so far, which happened my second week on the unit, as a new grad. "we had two call ins, andonly one float staff available, so you will have to make do with two nurses, one orientee (myself) and a full house (8 beds). We have two VIP patients as well, and one going downhill fast. Oh, and by the way, Joint commission will be here this morning" YIKES!!!!!!! (all turned out well..patient didnt die on us, and joint comm chose the other unit instead..God was looking down on us that day!!!!)