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?
We used to give our patients a pink enema that was called "Pink Lady Enema" and that's how the MD's would order it. The pharmacy would make it up with a mixture of things, like mineral oil, but I don't know what made it pink!
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.
How about taking drainage from illeostomy (stool), STRAIN it, and administer over 12 hrs via jejuneostomy, every 12 hrs. Yuck. Had to put pillow case over TF bag because I could not stand looking at it. I have also seen an MD make a pt DRINK small intestine drainage because they absolutely refused NGT/GT.
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.
How about taking drainage from illeostomy (stool), STRAIN it, and administer over 12 hrs via jejuneostomy, every 12 hrs. Yuck. Had to put pillow case over TF bag because I could not stand looking at it. I have also seen an MD make a pt DRINK small intestine drainage because they absolutely refused NGT/GT.
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.
One phone call to Doctor X on that one, "uh, excuse me, but I really don't want to dehydrate this lady as she has already had multiple BM's today, can we d/c this order please?"
Ya know, I've also felt insulted by that order when I've gotten it!
I used to dread getting this one surgeon's gastric bypass patients who he'd send to our med-surg floor, fresh post-op, with continuous epidural fentanyl (which was rarely adequate for pain relief and we'd spend half our time paging Anesthesia for orders) and he'd send them WITHOUT FOLEY CATHETERS!!! and orders to insert a foley if no void in 8 hours. Well, invariably they couldn't void due to the epidural fentanyl's tendency to cause urinary retention. And because of their extreme obesity it would be painful and extremely difficult to try to get female patients on one of our tiny fracture bedpans, and then it would be really challenging to cath them due also to the obesity.
Fortunately, his gastric bypass patients now spend their first night in ICU and come to med-surg the 2nd day, and usually have a foley in, or, were able to somehow void in ICU.
"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.
We were taught in school that "until clear" means until no solid feces came out, not until clear as spring water.
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.
I'll be dreaming of rectal bags tonight, I have never seen one but they sound lovely!
Why is it that people find it a need to make fun of their pt's? It must be human nature I kinda find it sad
Most dreaded in this order:
1)Nurse, set this patient up for a pelvic! (350 pound scanky woman with abdominal pain)
2)Nurse, get a cath specimen on this patient (same 350 pound scanky woman with abdominal pain..on her period!)
3)Nurse, irrigate this patient's ear with saline until you get the earwax out (scanky woman's significant other who hasn't had a bath since Moby Dick was a minnow)
4)Nurse, do a hemocult on this patient (same patient as noted above, oh look, the bottom set of dentures stuck where the sun don't shine and what IS that stuck between the teeth!)
Oh well, just another day in paradise...oops....ER!:chuckle
Don't mean to be dumb :imbar but.... what does dx fos & via DHT mean?? I am starting my second semester and trying to learn. Thanks!
FOS=Full of Stool or Full of SH&%...depends if you are talking about a patient or
an administrator/physician...just kidding!
DHT is a Dobhoff tube. Small bore feeding tube. Clogs easy, pulls out easy and is very easy to sink into a patient's lungs.
Good luck with your nursing courses! Besides, there is no such thing as a dumb question...we all are in learning mode, no matter how long we have been slinging bedpans!
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.
Oh..... I've gotten the unenviable nickname of "Priapism Princess" in my ER. How 'bout this one.... had a 30ish year old diabetic who had a priapism for 3 days come into the ER. ER doc calls in urology. After urologist injects member with Neo-Synephrine and it doesn't come down (that in itself freaked me out!) he has me "assist" him in IRRIGATING the corpora cavernosa. Oh... but it gets better.
Now... this happened on a busy day. I had 3 other rooms but they were more treat and street. The urologist, whom I had never met, proceeds to take an 18 guage needle and spear this poor guys swollen member. He then aspirates about 3cc's and then switches off syringes handing me the one with blood. Trying not to look like some new ER nurse I start to put it in the biohazard bin when he says,"Can you send that for blood gases?"
!!!!?????!!!!!! So I go to the ward clerk and ask her,"Can you send this for blood gases?"(thinking the all knowing ward clerk is going to know exactly what he wants) when she says... no.... respiratory runs their own ABG's. Having little time to explain that this wasn't that, I got my charge nurse in on it to handle because I had to run back in to assist Dr. "LANCE-ALOT".
By the time I get back in there he has ANOTHER 18 gauge speared in to the other side of this guys member and he's starting to inject sterile saline in when he asks me to take the other syringe and aspirate as he injects!!!
Now I'm starting to wig out just a little because I'm quite sure that nowhere in my nursing education did I ever learn how to aspirate a member, and I've since scanned the ENA stuff and it isn't in there either!
So.... given my druthers I would have much rather have applied pressure!
). 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 kinda find it sad 
JJRN
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