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?

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

Lets please remember that nurses come here to vent their frustrations to people who understand what the problem is. I too am overweight but I can tell you that I understand where the poster is coming from I wouldn't want to work on a "skanky" person either but I would do and then hope that I would have someone to vent to.

Now to get back to the levity, please more stories I am learning a lot. One question though does it take you guys a while to be able to drink milk and eat pancakes again after giving the milk and molasses(sp?) enema?

Specializes in pediatric neuro/neurosurg/rehab.

-miralax with tube fed patients

-peak and troughs b/c lab isn't allowed to do them (peds)

-iv placement on pts that don't need ivs for any reason whatsoever

-timed cbgs

-tap water enemas

-calorie counts on patients that eat everything in sight

i dont work in an icu so my patients usually dont have easy blood access i.e. art lines

#1 order: MRI This is a pain in the butt task when my patient has vasoactive drips running, but it makes me really appreciate how nurses did things back in the day.

Boy oh boy.

I can clearly remember throwing kelly clamps, scissors, wallet, jewelry, etc. on the floor, running into a scanner which was actively scanning, and starting to bag a patient while an MD, RN, and two techs stood watching the pt's vitals go down the tubes on the monitor.

"WILL YOU GET IN HERE?????"

"I've got metal stuff on me. Look, his sat's going up now."

:angryfire:angryfire:angryfire

Mark Hammerschmidt wrote something on codes in the scanner ... I think he used the phrase "not any kind of fun."

Well, Mark, it wasn't for me either.

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

I'm sorry that people take thing personally and get thier feeling hurt because I'm sure that no one here intends to hurt anyone else. This is humorous, a look at the lighter side of nursing. I certainly haven't taken anything personally. Enema's have been joked about quite heavily in here, but that doesn't mean that I should say " Oh! I had to have an enema once and I don't think it's funny at all!"

If a patients physical traits are mentioned, and it somehow adds to the humor, then so be it. No one has said " I hate fat people" and I'm pretty sure that no one here feels that way. But I can see how a patients size can sometimes make certain tasks very difficult.

Specializes in M/S, OB, Ortho, ICU, Diabetes, QA/PI.

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But seriously...the absolute worst order is to "reinfuse duodenal drainage via NG tube". This tends to be a necrotic pancreas with a duodenal drain...the contents of which are reinfused into the stomach. I can feel the bile at the back of my throat as I "re-feed" this swill. Yeah, definitely put that on the list of horrible things to do to me if I'm ever a pt.

oooohhhh - I had to do this on a patient when I was first out of school - that was waaaayyyyyy nasty.........

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 think that as nurses, we need a release. Joking around about various pt conditions or even a death is a wonderful release.

I once had a pt who died not once but twice on me. She was unresponsive for several days and she was a DNR. Staff found her trying to get OOB. They returned her to bed and she died..several of my colleagues confirmed this fact. I went in, listened and very clearly heard heart sounds. I thought they were playing a joke on me. Either way, I monitored her very closely for the next couple of hours. Eventually, I went back into her room and found her trying to get OOB once again. While the aide and I were struggling to get this previously unresponsive woman back into the bed.....the pt punched the aide in his face while she kicked me. Once we finally got her returned to the bed.......she died immediately...we're talking in less than one minute. Needless to say, I didn't call it for another 5-6 minutes because I didn't want to call the doc and tell him that she died and then have to call him back 10 mins later and explain to him that she wasn't dead after all. The family of course took her death very hard. However, given the circumstances of her death and the fact that she broke the aide's nose, we all busted a gut laughing for the rest of the noc.

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

Of course........I forgot to add but should go w/out saying.......we never make fun/light of pts in their presence.

Specializes in OB, M/S, HH, Medical Imaging RN.

My most dreaded order is "Insert NG tube". I'm really good at dropping an NG so I always get volunteered to do everyone's who gets that order. I hate putting the patient through dropping a NG.

I'll take enemas over inserting an NG any day.

Specializes in Inpatient Acute Rehab.

OOOOH--- the worst is yogurt enemas!!!! (for c-diff)

Specializes in MICU, SICU, PACU, Travel nursing.
Accuchecks Q1 with sliding scale Insulin (usually because there are no beds on the floors where the pt can get an Insulin gtt.). These poor pts get sooo tired of being stuck twice an hr, too.

the mds at the hospital i work at are saying that we are going to have to do q1 bgs automatically on any pt whose bg is greater than 120 starting soon.

other nurses and i didn't believe this at first, but it is true. apparently "the literature"shows 25 % better outcomes in an icu setting due to better healing because of the controlled bg's. can you imagine finding the time to poke people who are sick of having their fingers stuck every hour for a bg of 121? this sounds crazy to me because our sliding scale doesn't even tx unless the bg is at least 150.

Specializes in ICU, psych, corrections.

I had to help with a milk and molasses enema a few weeks ago. The patient hadn't pooped in over a week and had been having abdominal pain for a few days. She had been given lactulose, colace, and a myriad of other meds to try and get her "to go" but alas, none worked. So I overhear this order for a milk and molasses enema and ask what that is......big mistake...LOL. Being a student nurse working as an Apprentice Nurse, they jump on the chance to have me do such "fun" procedures as disimpaction (got to do that for over 30 min. on a patient and pulled out at least 12 undigested pills....hmmm...this patient had been NPO for over a week....BLECHH). So they offer me up to help the nurse give it. Oh boy, did that patient EVER go....all over the bed and down onto the floor. Never did I think some milk and molasses would be that effective. And the smell....hmmmm...yeah, it was pretty bad. The entire pod smelled like crap for hours.

Another order I HATE is dropping NG's into alert patients. I've almost been knocked out by patients while trying to get one in. I hate putting NG's in, period! A few weeks ago, I almost got punched in the face when putting in a foley in a 24 year old male. Hell, he whined about the temp. probe in his butt and that thing is TINY. He flipped out hours later, asking if "that thing was still in my butt" and then we had to inform him he needed a foley. He was screaming so loudly that the pods on either side of us came running because they thought something was horribly wrong. I've never seen a patient react like that. He was cussing up a storm and swinging his arms around, kicking his legs, etc. Very much the drama queen. Then again, I'm female AND I've never had a foley, so I can't really judge how much those things hurt.

I definitely know a busy night is ahead when stuff like lactulose is ordered for a patient who hasn't pooped in days!!!

Melanie :p

I use nursing judgement and hold laxative and enema orders on a patient who's already pooping just fine. It's perfectly appropriate.

And I do my darndest not to give lactulose for any reason but liver failure with high ammonia. It's a nasty, nasty laxative that causes bad cramping and runny, yellow, foul-smelling stool for days. This is why God made senna, dulcolax and milk of mag.

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