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?
Specializes in LTC, assisted living, med-surg, psych.
Before we got new beds at my hospital, I most dreaded "daily weights".......seemed like it was ALWAYS ordered for our 300+ pounders who had to be hoisted like beached whales on an old-style Hoyer scale, or the poor old souls who needed 2-3 people to get them onto the chair scale. Talk about the bad old days.......
Titrating pain meds to level Dr thinks is approiate while patient, who is terminal ca, is crying and c/o severe pain.
Wound packing on a 350 lb man/woman who has a open wound on their abdomen, buttocks, knee, or where ever, that has been draining green/yellow drainage for weeks. Oh, by the way, do some cultures and let me know what that show so we can start antibiotics.
Walk this partially paralysised patient down the length of the hall so I can decide if physical therapy is really needed. ( I swear this happened)
You can do the paracentesis, just make sure to send the specimens to the lab, the nurses where I come from do it all of the time. ( Needed to explain that state law says DR performs this procedure even if it is close to dinner time)
What do you mean that the H & H has dropped 2 grams in the last 8 hours? Why did you not give PRBC's? Oh, yes, I did leave an order for it, someone just forgot to write it. DO IT NOW!!!!
Oh, I could go on and on but these are just a few of the things that happened on my last job in the last week I worked there.
I hate suctioning coma patients....I have a hard time with sputum and snot anyway, but these guys always seem to have dried-up-hangy-downy-massive hunk of it hanging from the roof of their mouth, and it won't suction out NO MATTER how much you try, so then you gotta "retreive it".....ick ick ick!!!
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by Big Bab's
I hate suctioning coma patients....I have a hard time with sputum and snot anyway, but these guys always seem to have dried-up-hangy-downy-massive hunk of it hanging from the roof of their mouth, and it won't suction out NO MATTER how much you try, so then you gotta "retreive it".....ick ick ick!!!
Double ick if they have those big flaky things in their mouths from mouth-breathing!
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by EmeraldNYL
Rectal pouches are your friends!!!! :roll
Yeah, if your pt will stay still long enough to keep it on. This guy was all over the bed. Then as soon as his ammonia levels started to decrease, he became oriented enough to ask for the bedpan. I would have loved to have been able to put a rectal bag on him, believe me.
OMG! How about an order that comes out of left field?
We had an old man who was third spacing in his member and scrotum. The doc didn't know what to do, so he called urology. I got an order to apply firm pressure to affected area q30minutes, beginning at the top of the member and working down to the scrotum. Thinking being I could push the excess fluid out of the extremity.
The second time I went in there, he began to talk to me. Apologized for not being circumcized, for some reason...then talked about how long it had been since he had been touched there....then how long it had been since he had "got some"
OK, if I had not had an order to do this once, I would say you're crazy.
HOWEVER... while I was working on my BSN, we actually had a MD order this. Everyone thought that it would be good for a student to do this and that a male would prefer a male student.
SO, here I am Nurse Eager Beaver and they tell me what I gotta do. Hold pressure at the tip, push firmly downwards. (I swear I don't think it was a fluid issue, circulation is what is stuck in my mind.) Anyway, do this for 15min q20min, with warm compress during the q20 off time.
Took everyone a good ten minutes to convince me I wasn't on candid camera.
Ended up doing it, with my INSTRUCTOR WATCHING :imbar
Bout the middle way through, Urologist comes in and says "You two busy, should I leave you alone?"
Dave got a reallllllyyyy red face and excused himself, to see if he excused himself into a CVA.
). 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?
VivaLasViejas, ASN, RN
22 Articles; 9,996 Posts
Before we got new beds at my hospital, I most dreaded "daily weights".......seemed like it was ALWAYS ordered for our 300+ pounders who had to be hoisted like beached whales on an old-style Hoyer scale, or the poor old souls who needed 2-3 people to get them onto the chair scale. Talk about the bad old days.......