Orders from hell...

3ringnursing, BSN · Apr 12, 2017

Security found him over 12 hours later when they made their midnight rounds. He did not make a full recovery. His family blamed the nursing staff for not taking him outside to smoke.

Oooooh man! How sad. I feel terrible he was trapped for so long - I bet he was burned and dehydrated, and in fierce nicotine withdrawal. How horrible!

Remember when patients could smoke in their rooms?

twss2323 · Apr 12, 2017

Temp/BP/HR/RR Ht Wt q1h

How much ya think he's gonna grow or shrink every hour doc?

blondy2061h, MSN, RN · Apr 12, 2017

Novorapid 10u SQ PRN for BGL>20.0
So . . . if I check the res 15 minutes later and they're still high, I can give it again? And every 15 minutes after that?
Asked multiple times, always refused to add a frequency for this very brittle diabetic.

Then the order should just be discontinued because it's not valid. Not sure what country you're in, though, since those aren't US terms.

notanumber · Apr 12, 2017

Then the order should just be discontinued because it's not valid. Not sure what country you're in, though, since those aren't US terms.

I agree, but pharmacy put it through. I'm in Canada. No one else seems as concerned about it as me so it's difficult to combat.

Orca, ADN, ASN, RN · Apr 12, 2017

I'm sorry, but what is a "tappered" dose?

Infused with a mallet. :)

Skippingtowork · Apr 13, 2017

Levaquin 750 g = 750,000 mg. Levaquin is typically supplied in 250 mg, 500 mg, and 750 mg. Assuming the pharmacy has the 750 mg stocked, then it would be 1,000 pills to be given every two days (48 hours) for two more days. Sounds legit.

But very expensive:roflmao:

queenjulie, RN · Apr 13, 2017

"No sodium diet" (I can get "no salt", but "no sodium"?)

I got a new admission one time of a CHF patient, and the family was furious when they asked what diet he had ordered, and I told them it was our low-sodium cardiac diet. They insisted, "He doesn't eat ANY salt! He has heart disease! He is on a NO SALT AT ALL diet!" I tried to explain as gently as possible that eating no salt at all would lead to death fairly quickly, and they were absolutely enraged. I have no idea what they actually fed the guy at home.

Kooky Korky, BSN, RN · Apr 15, 2017

I worked with a CT surgeon who always whipped out his own nasty looking scissors to remove chest tubes. I'd always pad down the bed and the floor with chucks, and lay a sterile suture removal kit next to it. When he was ready I'd peel back the top and leave it near him â€¦ he'd always ignore it, pull out his funk covered scissors from his lab coat pocket, snip, snip - yank out the chest tube (insert patient screaming here) blood flying, and fling it to a section of floor without any chucks. Zip - he'd pull the sutures closed like purse strings (the patient still yelling in agony, trying desperately to find themselves through the haze of pain) spin on his heel and walk out - leaving me to comfort a writhing patient, and a nasty mess to clean up while cursing under my breath.
One day he left his fancy surgery telescope glasses sitting on the counter and left â€¦ I tried them on, played with them a bit, then ran a saliva covered finger down each lenses before putting them snuggly back into the padded case. Let him chew on that for a while as he obsessively polished them while wondering what happened to them.

I think I would have to either be sedated myself to work with this a** or I'd have to have a little talk with him.

I would say something like, "You really are a sadist, aren't you? You really enjoy inflicting pain on patients, don't you, and making a mess for the nurses".

And then I'd have to hie myself to the boss and tell him or her that I would not be picking up any more messes after this SOB or working with him on any more chest tube removals because he was seriously hurting the patients and intentionally causing more work for the nurses and that he needed to come into the 21st century with regard to properly medicating patients and not causing blood to fly about unnecessarily.

I might include the Chief of Service or Staff in my communique and try to get other nurses who were witnesses/victims of his complete lack of respect for living beings to speak up, too.

Have you ever tried guiding his hand and telling him to "Just put it right here on this Chux that I laid out for you"?

"And, Doctor Schmuck, you've probably never had a CT removed and you probably are so tired that you don't really hear your patients screaming in agony, but please be aware that you can order some pain Rx about an hour before you plan to do the removal. To do otherwise is really cruel."

Maybe you should have put something other than just saliva on his loopes - like some blood from a flung about chest tube.

Kooky Korky, BSN, RN · Apr 15, 2017

"Do not call me again tonight unless the patient is actively coding!!" (pediatric patient no reason to believe they would code but had many changing medical needs throughout the shift that needed doctor's orders/intervention, and doctor just didn't want to deal with them anymore.) Yikes.

If the child had a need, tough you-know-what. Doc is getting awakened.

jobellestarr · Apr 15, 2017

I had a surgeon write an order that the nursing staff had to go and sing happy birthday to a patient :)

KatieMI, BSN, MSN, RN · Apr 15, 2017

I got a new admission one time of a CHF patient, and the family was furious when they asked what diet he had ordered, and I told them it was our low-sodium cardiac diet. They insisted, "He doesn't eat ANY salt! He has heart disease! He is on a NO SALT AT ALL diet!" I tried to explain as gently as possible that eating no salt at all would lead to death fairly quickly, and they were absolutely enraged. I have no idea what they actually fed the guy at home.

I once broke up a case which mystified everyone else. Elderly lady, preterminal congestive CHF, LTC came in large teaching hospital ER every Monday, Wednesday, Friday somewhere between 8 PM and midnight clearly decompensated, only to be given Lasix and d/c back into her LTC 24 hours later. After it happened a few dozens of times, I started to get kind of bored of it all. I was not in nursing capacity at that time, so I just spoke with ER chief MD and went into that LTC. As it happened, since the facility was Catholic, the clients were given both meat and non-meat options on M, W, F. The pious old lady in question faithfully chose to abstain from meat, which meant canned tomato soup with saltines, among other things, and her favorite V8 juice. Nobody seemed to understand that the stuff had almost deadly dose of sodium for her.

80 mg of Lasix at 6 PM on Lord's days solved the problem for quite a while.

KatieMI, BSN, MSN, RN · Apr 16, 2017

I had a surgeon write an order that the nursing staff had to go and sing happy birthday to a patient :)

A VIP status family made a huge mess and almost took a very sick child home AMA because someone wished the kid happy birthday. The parents were die-hard Jenovah' Witnesses, and so saw the good wish as a bad thing according to their faith. After that, one of authomatic "nursing communication" admission orders became "ask parents/guardians about birthday celebration wishes" and a special form must be signed and witnessed by second RN, even if the patient was clearly not in unit around his or her birthday time.