Most dreaded Dr.'s orders

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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?

Specializes in Med-Surg, Tele, ER, Psych.

I was just guessing that he was third spacing because that is what the area resembled.

But I am soooo glad someone else can verify it happens!

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

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? ;)

My most dreaded orders from MD's are ones written in the emergency room. Example: Feed patient, clean pt.'s feet and then do trial ambulation while recording O2 sat's, and then send patient home with x-ray's and make appt for CT scan in one week....send home with 2 pre-packs......Orthostatics prior to discharge.

Specializes in Med-Surg.
Originally posted by mjlrn97

Any order mentioning the word "Golytely".........:eek:

Exactly what I was going to say.

Specializes in Hospice, Critical Care.
Originally posted by MD Terminator

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.

Actually, we did have a patient in the Unit that we had to do this for q15min for a priapism. We tried using a pediatric blood pressure cuff but it didn't work. 35-year-old man who was most definitely alert & oriented -- he was also on a fentanyl drip and could have morphine IV push every 10 minutes. He told me, during one of our "sessions," to go home and tell my husband "he's got a good woman." LOL. Unfortunately, even after a couple of surgeries, this man did lose erectile function.

EmeraldNYL -- I love rectal pouches (or fecal bags, as we call them). Unfortunately they don't work on all butts. Hee-hee, you know you're a nurse when you roll some person over, look at their butt and say "Hey, look at this! He's got a *perfect* fecal-bag butt!"

Yea.. what gets me about the golytely and the enema's is that 1/2 the time it is ordered on this little old lady who has already done her business twice on your shift, but tells the doc that she hasn't gone in several days, so now we have to give it and it's bedpan every other minute.

or a major lasix order on a demented nursing home patient and no foley ordered..

or the same order on a patient who is on strict bed rest post procedure and no foley

Or for a patient who hasn't been out of bed in over a year.. 'up to chair bid and for meals.' HUH?

Or restricted diets on terminal patients.. YOU going to tell him he can't have salt or caffine or sugar or whatever he wants after telling him he only has a few weeks or months?

I'm sure I could think of some more.. but it's my bed time!! Nite all!!

Rachael

Originally posted by MD Terminator

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.

-Dave, who will NEVER ORDER THAT FOR ANY PATIENT!

OKayyyyyy, now why couldn't he do it himself?

Specializes in Nurse Scientist-Research.
Originally posted by Zee_RN

Hee-hee, you know you're a nurse when you roll some person over, look at their butt and say "Hey, look at this! He's got a *perfect* fecal-bag butt!" [/b]

I know exactly what you mean. It's almost a weird kind of pleasure to get a fecal bag stuck on well to a patient who will have Golytely infusing through a feeding pump to a G-tube. Pumping in one end, draining out the other.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by TiffyRN

I know exactly what you mean. It's almost a weird kind of pleasure to get a fecal bag stuck on well to a patient who will have Golytely infusing through a feeding pump to a G-tube. Pumping in one end, draining out the other.

Lol...and it's also a sad, sad thing when your spending half your shift wistfully wishing, "If only that fecal bag would stick," and trying to figure out more creative ways to make sure it stays in place the next time.

Originally posted by Zee_RN

EmeraldNYL -- I love rectal pouches (or fecal bags, as we call them). Unfortunately they don't work on all butts. Hee-hee, you know you're a nurse when you roll some person over, look at their butt and say "Hey, look at this! He's got a *perfect* fecal-bag butt!"

:roll Lol, very true. Maybe we should all get together and invent the perfect rectal pouch that always sticks!! Prepping first with Benzoin seems to help a little though. I really hate it when the doo doo is just thick enough that it won't fit through the pouch!!

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by EmeraldNYL

:roll Lol, very true. Maybe we should all get together and invent the perfect rectal pouch that always sticks!! Prepping first with Benzoin seems to help a little though.

Yes, but it has to be the Tincture of Benzoin in the little plastic capsules. The spray or the pads just don't seem to work as well. I have been known to hoard the unused capsules from colostomy kits in my locker for such purposes. :D

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Originally posted by mjlrn97

Any order mentioning the word "Golytely".........:eek:

That stuff should have been called "Go Often".

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