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?
In the past two weeks, I have seen more orders for Milk and Molasses enemas than I have in the past two years!
Fortunately for me, the poor day shift nurses administered them for my patients before my 3-11 shift. My one patient said she'd never eat Shoofly pie again, and it used to be her favorite pie!
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
"Enemas until clear" means that you keep giving them enemas until their BMs are clear like water. Depending on the patient, this can mean a few enemas, and the pt will have lots of BMs to get there. Fun for both parties.
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
My favorite Neurosurgeon ordered that we get a 300+ lb patient out of bed and ambulate him. Mind you, he just had a crani for a tumor that returned, he had been using a wheelchair for the past two years, and didn't have the strength to walk, let alone turn himself over to assist in hygeine. God bless this Doc!
Then there is the well intentioned but stupid resident who is covering. We called for palliative orders for an end stage patient. Give the resident the current medications. Mention that the patient is having poor pain control, and needs more aggressive pain control. The resident cuts the pain medications down by 1/2, but adds tylenol for breakthrough pain...I was going to strangle him, but one of the nurses held me back. The resident couldn't understand why I wanted to kill him. If you are getting 10 mg of morphine every 2 hours, and are still writhing in pain, tylenol is just not going to cut it...I don't care about a synergistic affect...just not going to do it. I was fortunate to be able to get hold of one of the oncologists, who spoke to the resident, and quickly clarified what the term palliative care was defined as, and how that works.
Gotta love them, or find a hole big enough to hide the bodies!
I can handle most things...even the worst code brown. But just say "Mucomyst" and the thought of that horrible, rotten-egg smell makes me start dry heaving. When I have to administer it, I truly try not to breathe the entire time...it's a wonder I don't pass out because I'm hypoxic.
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.
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"
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"
Oh man, I would definitely have had to delegate that one... to a male aide...
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.
ok, help me out here, why would this be ordered?????????
The dreaded orders...I'd have to divide that one up into a few different areas.
In family practice, on an 8 year old immigrant child who doesn't have any of the required immunizations for school: "Nurse, he will need a DPT shot, an MMR, AND please draw a varicella titer. Then he calmly goes into his office and shuts the door.
In the med-surg ward: You open up a chart with fresh new orders on it at 11:30pm, after some night-owl doctor has done his rounds, only to find "Obtain consent for colonoscopy in AM" with an order for Golytely or Fleet Phospho soda. The patient has severe dementia, won't drink the bowel prep, and needs their power-of-attorney to sign the consent form for them.
Long term care: "Antifungal lady partsl cream qhs x 7 days" Your resident is obese and combative.
#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.
#2 order: lactulose around the clock, enemas or anything to do with helping a patient poop.
). 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?
RN-PA, RN
626 Posts
In the past two weeks, I have seen more orders for Milk and Molasses enemas than I have in the past two years!
Fortunately for me, the poor day shift nurses administered them for my patients before my 3-11 shift. My one patient said she'd never eat Shoofly pie again, and it used to be her favorite pie!