mellomom

Interesting thread. I appreciate the many atriculate and thoughtful comments. I absolutely do not think we should pander to our patients and their biases. I've had patients who are racist, too - and I ignore their comments just as I would ignore any ignorant comments about my appearance. I've had patients who have refused to be cared for by a man, "a foreigner," a woman; who think their caregiver is incompetent because s/he is too young or old, and on and on. Patients often ask me the nationality of my coworkers, and I smile and say, "I am fortunate to work with such outstanding people." The message is received. The question is not usually asked again. I aim to deal with people politely and professionally. I expect that in return. Ultimately, what other people think of me is of much less interest to me than what I think about myself.

Same problems here in rural Washington state - I work at a public hospital, where all the addicts go when 1) they can't score any more drugs and realize they are sick and/or 2) they try to kill themselves/OD and/or 3) they come in with amazing wounds and infections and we get to detox them. Then we release them, and they come back... sick and addicted. Of course we never get reimbursed b/c these people aren't even functional enough to get Medicaid. AND they bring in their homeless friends/dealers/fellow addicts to eat and sleep while they are in the hospital. I agree you can't be judgemental and let your frustration affect your care, but...sometimes I wish just one of them cleaned up after their brushes with death. Usually they just leave AMA when they are ambulatory, so they can go out...and use. The strain on their loved ones and families is tremendous and heartbreaking. guess what? I had one of these patients today...

In my facility, we don't always have aides if the census is low, so we to total patient care alone on those days. I had a patient just this week assume I was an aide becuase I was changing her bed and wiping her behind. She was quite startled when I came in with her meds and hung an IV, and fell all over herself apollogizing for "insulting" me by calling me an aide. I do think as our delegates the aides are performing MY responsibility, and I am fortunate to have outstanding aides who are a great team. They are very good at reporting things I don't see because I am away from the bedside. On the other hand, I know that with the ever-increasing amount of paperwork, there isn't time for me to have five, six, nine patients and have time to wash bums, so to speak.

This is such an interesting thread. I have seen these end-of-life pts die a long agonizing death like most of you. The worst was a 90 + yo with multiple medical prob who developed an ileus with end stage dementia, they ended up doing surgery but there wasn't enough viable tissue left to close her so they sent her back OPEN to the floor, where she lost massive amounts of fluid, went into CHF and RF, and was in horrible pain every time we tried to turn her or reposition her...of course we couldn't give her enough morphine due to her Bp being in the toilet...this went on for weeks with her as a full code! Finally even the family figured out she wasn't going to get better and she was converted to a DNR...and finally died comfortably. The upshot of this and similar experiences is that I look for opportunities to talk to the families about what to expect at end of life, what the prognosis is after hip fx, how dementia affects the dying process, etc. There is so much ignorance. And yes, I signed a living will & MPOA - everyone knows my wishes!

I've read my own chart too... while in the room, waiting for the ARNP who was called out for an emergency. While she was "suprised" I didn't feel she was angry. I discovered she had a horrible transcriptionist! Once I read my son's chart and found a significant transcription error related to a steroid dosage...they would have been toast if he had had an adverse outcome because it looked like he'd been prescribed a 10-fold increase over normal.... I think since it's your info, you should be able to see it. I take the patient's chart in their room with me if they request it so they can see labs, etc. It really defuses upset/concerned POA/s and patients...

Just FYI if you have a high instep, Dansko's aren't for you. Try Zappo's online for free returns up to 1 year after purchase...good luck!

Well, I'm (sort of) glad to know the same crap happens someplace other than my facility.... The pain thing makes me crazy, we have alot of orthos and I can't count the times I have started the shift with a furious, painful patient and phone calls from (equally upset) family members. It's a good thing the nurse who had the pt previously is gone by then! I'm glad you vented and I hope it helped! It sounds like you did awesome with lots stacked against you!

We also have the lopresor 5 mg q 5 min x 3 protocol at our hospital, but I've learned to watch those vitals carefully (in addition to having tele on)... The drop in BP can be very rapid, so i do vitals before i start and before each dose to be sure the pt can tolerate it - often I only end up giving one dose because the heart rate and bp are affected so fast. When in doubt...wait! You can always give more later lol!

So does narcan always cause the delirium I saw? It seems when we've given it before, it just wakes folks up (and increases their pain...) but this was so violent... we were wondering if psych hx or anesthesia reaction played a part as well... and it turned out she did have a seizure disorder (found when family brought in all of the pill bottles, not in pmh)... I guess I want to know what to expect next time (God forbid, but there will be one, I'm sure). I'm on a medsurg floor, so I don't usually get the od's until er is through with them; my pts who need narcan are usually othro postops, and they all have narc use/dependency for pain prior to coming in for surgery. This is the first one who went bats on me!

clee, I had to laugh at your post. I've noticed I can tell the addicts by how they respond to ivp narcs - the addicts looove the rush, and everyone else is mad and wants the next dose slower!! lol

Thank you so much! For awhile I thought I'd killed her! Apparently she told the doc/her family that she was "weaning off everything" when in reality she was not only taking her own med but her dead husband's meds too!!

Hello everyone! I am new to this site, and wanted to get feedback on narcan use from other people. Gave some ivp the other day for post surgery respiratory depression (RR