Caffeine_IV, BSN, RN 16,393 Views
Joined: Dec 14, '06;
Posts: 1,221 (48% Liked)
; Likes: 2,002
I WANT to believe something this ridiculous could not be real.
Dealing drugs from their child's PICU room (caught on video EEG), having sex on a couch in the waiting room.
My personal fave was the daughter of a hospice patient who passed who 1) went back to sleep after the body was removed 2) was irate that she could not order room service (after mom was deceased and gone) and 3) dangled her car keys in front of me and said "You can put these in my.car and bring it around" pointing to her SEVEN pieces of luggage.
I was once directly exposed and one more time "ordered" to be exposed, through management, to the stuff I am very much allergic to by visitors AFTER I told that to them in clear English. Both later named their actions "just some practical joke". The first time I ended up in ICU in the same hospital after Rapid Response with all its bells and whistles.
A visitor brought in the room where her relative was lying comatose on vent her very frail, pleasantly demented and terribly disheveled 90+++ years old grandmother in wheelchair "so she could visit him" and abandoned her there. After some following administrative adventures, the poor sweet old lady ended up as "ward of the State" and a local SNF resident, as she only knew her name and the only one contact was that granddaughter who did not take phone calls. The second and third contacts provided happened to be fake. The granddaughter came back in about 2 weeks after enjoying a cruise and was beyond irate after finding that the unit did not provide free meals, housing and care for her grandmother all that time and even did not collect her SSI check.
I don't think it really matters if you want to check the EMR before you get report.
However, once you receive report and assume care, you need to lay eyes on your patients before you start/continue your chart check.
Never delay your first visit.
That depends, almost entirely, on who I'm getting report from.
I think it's unusual you got hired to not work weekends when all your coworkers do. Do you work in a hospital setting?
Who cares if the primary physician is mad at you? The way I see it, we are all colleagues. He isn't your boss. He's calling the shots, but you're assessing and implementing, and your input is vital to patient advocacy. You absolutely did the right thing in an awkward situation!
For the record, when I say "who cares if the physician is mad at you"---well, I'm still trying to ingrain that in my brain as well. I don't mean that we should go around being rude or anything like that, but just that providers are not gods. We shouldn't feel weird about discussing patient health with a doctor.
This case is just an extreme example of our hope that medicine will save us from life's imperfections and from our own mortality. And even in the obviousness of the futility of it, the religious people are wringing their hands and having a gnashing of teeth over it.
True spirituality, in my opinion, is finding inner peace in the face of adversity. I don't think it is clinging to life, through technology, at taxpayer expense, while children are wanting for a bowl of rice and other parts of the world.
Unfortunately, this is a first world problem as a result of advanced medical technologies. Not too many years ago this child may have lasted less than a week and there would be no ethical debate . Now we have the technology to prolong the "life" of infants with machines when there is literally a human doll in the bed. Unless the medical issues overwhelm modern medicine's ability to stabilize the patient, the patient's body can be held in limbo by machines indefinitely. There are some babies that have way too many genetic or congenital issues to survive and prolonging the life via machines is just delaying the inevitable.
I do think you were wrong in this situation, but I also do understand your concerns and point of view. In this case you spoke with the provider, he explained that he was not concerned by the dosing and that you should follow the orders. So, I would have followed the orders, end of story. I would have documented your concerns, given her the meds, and closely monitored vitals. I also would have taken another approach with the provider when you spoke with them. Rather than trying to argue your point with them after they said to follow the orders (with your statements re: her BP, etc), I would have simply requested additional monitoring for her and also an order for narcan just in case. Specifically I would have asked for her to be on continuous end tidal CO2 monitoring- a simple solution to assessing whether her airway was impacted by the meds. Tele wouldn't hurt either.
I do completely understand where you were coming from with your reluctance, but the doctor said to carry out an order and you refused. You mention the legal side of nursing, and from that perspective you were wrong here.
Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.
Do not crucify yourself. End stage renal patients routinely have BPs that would horrify a nurse in any other area of practices.
Reasonably happy with Nursing.
But my real preference would be to be born with a silver spoon in my mouth, be royalty, have a trust fund, do whatever I like, whenever. You know - win the Lottery.
No I don't regret it. I was a useless, homeless bum in my teens and had a rough start to life, so my wake up call was a serious motorcycle accident that left me in hospital for a while, where I realized that nursing and medicine really interested me so I applied for nursing school once I had recovered. It has afforded me direction, a feeling of self-worth and an ambition I didn't know I had. It's moved me across countries and continents and given me a lifestyle I never thought I'd have. 25 years later I'm in NP school and grateful for every chance I've been given. Nursing saved my life and is one of the best things that ever happened to me. In return I've given it half of my life. You get out what you put in.
Why would you waste in the Pyxis but not actually the meds? That's the confusing part for me. Is the cactus not right beside the Pyxis?
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