Most dreaded Dr.'s orders

Nurses General Nursing

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What are your most dreaded Dr.'s orders to hear- you know, the ones that tell you that you're in for one heck of a night? For the past couple of nights, I had a patient with ammonia levels in the 260s, who had an order for a Lactulose drip (at first, it was full-strength via DHT- yeah, THAT worked out well ;) ). Needless to say, it went how I had envisioned it: the DHT kept occluding, until I finally got new orders for 1/2 strength via NGT, the pt was out of it, and was code-browning the whole time. Man, I hope I never see orders like that again! What are some of your dreaded orders?

ok, help me out here, why would this be ordered?????????

gross me out!!!!

but seriously, why?

les

drainage from the duodenum is very alkaline so if it is drained and disposed, the pt becomes acidotic. according to the docs, it needs to be re-fed so pt doesn't suffer from an acid/base imbalance. seems like there should be a better way though.... it wouldn't even be so bad if it weren't for the chunks. :)

Thanks PJ Mommy!!

mmmm... chunks hunh? I've got alot to look forward to here. Can't wait to get acquainted with rectal bags.

Les ;)

Specializes in Rodeo Nursing (Neuro).
Uh, I think you guys win the prize so far for worst orders. :chuckle

I hope to never, ever have to do that one! (Come to think of it, Lactulose Guy DID have scrotal edema. I can imagine trying to hold him down for that treatment.) Can't they make an SCD type device for situations such as these? ;)

There's got to be a market for these...

That is one reason I quit working as a tech/nurse aide and went into allied health. After six months, I finally got burned out on shoveling S*#$ for a living(certainly not putting anyone down who is a tech/aide). :rotfl: :rotfl: :rotfl: :rotfl: :p

I think I would have to say flatus bag BID and PRN for obstructive bowel. This lady is a TF who gets sorbitol every night so the consistency of her bowels is liquid. However, I am proud of myself because now I can do her flatus bag without making a mess! Her belly will deflate like a popped balloon.

Specializes in floor to ICU.

One doc continually insists on writing the order "continue home meds" 

I HATE that order. Usually, they'll tell you that they take "a blue pill in the a.m. followed by the big white pill at noon", etc...or "call my doctor, he knows what I take" or I love it when the family actually brings the meds into the ER, but the nurse doesn't take the time to write down the names and DOSAGES of the meds so the family takes the big bag back home... :angryfire

Specializes in Education, Acute, Med/Surg, Tele, etc.

Continue home meds! Oh I love that one too! I work in an assisted living, and my pharamacy will not honor that request from the MD (or the 90 day orders), so I have to write down all that patients orders and have them re-sign! What a total waste of time for both me and the doc! I even copy the MAR's for anyone going to the ER or MD office so they can check out what they are on, and write notes and sign for any changes..guess that is a big ol waste of time and paper if they don't even notice (but it is very helpful for the paramedics so I keep on doing it!).

I just got a fun order today...FILL OUT POLST WITH FAMILY (a polst is a DNR). Okay well an RN signature doesn't do much on those...it needs the MD signature (and since it is a 'physicians order for life sustaining treatment' I really think it should be a DOC thing ;). This one patient just got diagnosed with CHF and liver failure today..and now I am supose to fill out a MD order for a DNR??? No way...I defered back to the Doc on that one (since the doc didn't tell us anything about the patient, and I had to pull the new Dx out of them in the first place! Nope, won't talk to patients and their family for the first time about a DNR unless I know why all the sudden they need to change their status on a DNR order...kinda helpful to know why before the tears start falling by the question!).

Why is it that people find it a need to make fun of their pt's? It must be human nature :nono: I kinda find it sad :o

I agree. I am an overweight woman, and find it insulting for a professional to be using those types of terms to describe their patient. Glad I won't ever have her for a nurse. :angryfire

Oh..... I've gotten the unenviable nickname of "Priapism Princess" in my ER. How 'bout this one.... had a 30ish year old diabetic who had a priapism for 3 days come into the ER. ER doc calls in urology. After urologist injects member with Neo-Synephrine and it doesn't come down (that in itself freaked me out!) he has me "assist" him in IRRIGATING the corpora cavernosa. Oh... but it gets better.

Now... this happened on a busy day. I had 3 other rooms but they were more treat and street. The urologist, whom I had never met, proceeds to take an 18 guage needle and spear this poor guys swollen member. He then aspirates about 3cc's and then switches off syringes handing me the one with blood. Trying not to look like some new ER nurse I start to put it in the biohazard bin when he says,"Can you send that for blood gases?"

!!!!?????!!!!!! So I go to the ward clerk and ask her,"Can you send this for blood gases?"(thinking the all knowing ward clerk is going to know exactly what he wants) when she says... no.... respiratory runs their own ABG's. Having little time to explain that this wasn't that, I got my charge nurse in on it to handle because I had to run back in to assist Dr. "LANCE-ALOT".

By the time I get back in there he has ANOTHER 18 gauge speared in to the other side of this guys member and he's starting to inject sterile saline in when he asks me to take the other syringe and aspirate as he injects!!!

Now I'm starting to wig out just a little because I'm quite sure that nowhere in my nursing education did I ever learn how to aspirate a member, and I've since scanned the ENA stuff and it isn't in there either!

So.... given my druthers I would have much rather have applied pressure! :rolleyes:

I had a guy with priapism once. Urology came in and did the same thing - speared the patient's swollen member. He then just let the blood flow out of the needle onto the bed. Nice.

Once he let the patient bleed out a couple hundred cc's, he ASKED FOR A TRANSDUCER SETUP to hook up to this guy's member.

Yes, that's right. We obtained a CPP on this patient. Central member Pressure.

"Give him whatever the hell he wants".

Anything order with the words enema or bowel prep in it....

Specializes in Me Surge.

Now that is grosser than gross. I almost lost it when I read that.

How about taking drainage from illeostomy (stool), STRAIN it, and administer over 12 hrs via jejuneostomy, every 12 hrs. Yuck. Had to put pillow case over TF bag because I could not stand looking at it. I have also seen an MD make a pt DRINK small intestine drainage because they absolutely refused NGT/GT.
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