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?
I had a gal in August that came into our office saying she had a moth in her ear, and sure enough, when I looked in there the thing was hanging on her tympanic membrane!!...It actually turned its head to look at me!!!....eeek!.....So we put some colace in there and washed it out.....That poor woman had had it in there for like 18 hours!!!.....She thought she was gonna go nuts from the noise!!
Originally posted by athomas91
i really hate - nurse - irrigate this man's ear to see if the cockroach will come out on it's own....
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.
Ok, if the guy was A&O wouldn't this be a perfect time for a little patient teaching? "The Dr. has ordered this, here is how you do it, it is very important to do this b/c.......... it should be done q3o mins. Do you feel comfortable doing this? If you have questions or need anything at all just put your light on."
That's what I wouldn've done, and then made sure I brought the warm compresses in q30 mins.
Specializes in LTC, assisted living, med-surg, psych.
Another order I dread is for an NG tube to be put down and a digital disimpaction to be done on a demented, combative NH patient with suspected bowel obstruction...........
Ok, if the guy was A&O wouldn't this be a perfect time for a little patient teaching? "The Dr. has ordered this, here is how you do it, it is very important to do this b/c.......... it should be done q3o mins. Do you feel comfortable doing this? If you have questions or need anything at all just put your light on."
That's what I wouldn've done, and then made sure I brought the warm compresses in q30 mins.
It is hard to explain but you know how an old person can be alert but just lies there? It is like a patient who is pleasantly confused, AAO X 3, but confused nonetheless. I can guarantee he would not have done it himself.
My favorite was a pt who had just returned from the cath lab. The orders were for four stat IV antibiotics, a Protonix gtt, an Integrilin gtt, routine IV fluids, and start peri-dialysis @ 2100. It was now 2045. Couldn't use the left arm for IVs because of graft. One of the two IV's in her right arm was infiltrated and there were no other veins to be seen. Sheesh! Talk about stress. Needless to say, the antibiotics weren't exactly given stat.
How about when you have a pt circling the big drain in the sky and the doctor writes the order to "transfer to ICU/SDU when bed available", and leaves the floor. hello?????
Lactulose is the worst, followed closely by Golytley. Gave Phosphosoda to an A&OX3 fully ambulatory pt and still had a HUGE mess. :chuckle
How could I forget? In addition to all the IVs and the peridialysis there was an order to pull the sheath and hold pressure for 30 min. Oh yes. I can do it all! I am so darn good.
Combative patient with ETT on vent" "Do NOT sedate or give analgesics in any event".
Only thing worse than this is same patient with femoral sheaths in place, and because patient will not lay flat, they bleed. Especially if they are obese.
The combative pt. whom the doctor absolutely refuses to prescribe and antipsychotics or sedatives for because "he's for nursing home placement" and they "will not accept him if he's on those meds" because then that would mean "obviously he has problems". Great, leave ppl in the dark.
Something tells me when they got him that they had no idea about this person.
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Originally posted by LPN2Be2004
And how could i forget.
The combative pt. whom the doctor absolutely refuses to prescribe and antipsychotics or sedatives for because "he's for nursing home placement" and they "will not accept him if he's on those meds" because then that would mean "obviously he has problems". Great, leave ppl in the dark.
Something tells me when they got him that they had no idea about this person.
Oh, yeah!!! How could I forget the dreaded "awaiting nursing home placement" patients! 9:10 they are cunfused wanderers with new hip replacements or C-spine injuries, 0 psych meds, 0 restraints, and 0 sitter. :stone
). 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?
TraumaQueen
88 Posts
Or more appropriately, Go Heavily :)
But yeah, the most feared orders usually include, Go Heavily, x-prep, rectal suppositories, colace, etc.... all on ONE patient.