Kansas_RN

Help me out here. I posted this in General Forums without any response. ++++++++++++++++++++++++++++++++++++++++++++++++++++++ I have a question for all of you. I had a patient last week. She had TAH with vertical abdominal incision. She did very well, but had one problem. Hypoxia. I personally don't like hypoxia in my patients. It makes me nervous. Anyway she could get up and walk without sats dropping, (at least not that we documented it seemed she was breathing deeper) but in her room and especially at rest she would desat to mid 80's and become symptomatic. (Nausea, sob, lightheaded). The surgeon did PE tests (EKG, CXR, US Bilat lower extrem for clot, and d-dimer) and consulted her PCP. All tests were neg, even the d-dimer two days after surgery, which was a surprise to me. Most of us thought it was her epidural, but even 24hrs after turning it off she was having symptomatic episodes. Nurses were concerned. Lungs clear. CXR (port) showed mild ataletesis with clearing the next day. (post-op day 3). Her doctor almost seemed to be annoyed that he was bothered to be consulted by this. The first time in her room he took a pulse ox in and found her sitting up eating without oxygen on and sats were 87% and she was starting to become SOB. They dropped as low as 84% was documented more than once on several shifts. He commemted he would like a "sleep study on her after she's out of the hosptial....maybe she has sleep apnea and she might run low." But all of these time she ran low she was awake and sometimes talking to staff and visitors for over 30min before checking her sats. The next day the doc stated if you check her sats and they are normal just don't check them again. And that same day stated that she could go home if the surgeon dismissed her...which he did. My patient in question is a nurse and a friend and was insulted at the way the physician treated her, acting like this was "just an annoyance" in her words. She left post-op day 3 and continued to have these episodes for 3 more days as home. After that time she hasn't had any problems with the symptoms. My question...have you had a patient go home with these symptoms. I'm not saying she had a PE, because the d-dimer was neg....but something was going on. Can you give me your opinions on this?

It is a policy where I am from too. But in a small hospital with doctors that have been there 25 years, or Ortho staff with "g*d complexes" good luck. Management says to the floor nurses, "page them until they clarify", but when a doc gets ticked off and starts to hang up on the nurses that is going to affect the working relationship. If management wants it rectified then THEY need to continue addressing it with the docs. Just my two cents.

If the doctor writes continue home meds..that is what I write on the discharge instructions. How many times have you seen that the patient's home list is different than the H&P, and they are both different that the PCP office list. Sorry, I am NOT going to write it down wrong and get in trouble for prescribing without an order. If the docs want it written out then they write it out or write "continue current meds" or "home meds listed on H&P". I want documentation that I am writing what the doctor has ordered....not trying to guess what the patient is on or what the doctor thinks the patient is taking at home. Besides have you seen some of the home lists from the elderly patients? Crossed out meds, "Now I take a half a pill of that one" Who knows if it is the same dose or not. I have had a patient tell me that that lasix 40 she has listed isn't right. She only takes half a pill. After looking at her BOX OF PILLS she happened to bring with her the Lasix is actually and 80mg tab, but half a pill. H-E-L-L-O same dose....See what I mean? CYOB - Cover Your Own But!!!! Learn it! Live it!!!

Okay....my questions is what else was going on with the patient. I mean I had my thyroid out and the next day I was sent home. Up in my room the same day as surgery. Was there an imobilizer on? Precautions written on the chart? Was the patient given these precautions? Did hemove his neck more than you did during your exam? I've just never heard of this without some sort of other worries regarding the patient. Just my two cents. Without more info I would say that you didn't do anything wrong.

--I posted this another place, but had about the same answer as I would give you. ------------------------------------------------------------------------------ My kids were 1, 2, and 4 1/2 when I went back to school. They are now 8,9 and 12. They hardly remember anything about me being in school, and now my hubby and I can afford to do some fun things with the kids that we wouldn't have been able to otherwise. They were too young to play the "why is your school more important than me" card. It is hard, but if you want it bad enough you can do it and if you love to help people you won't regret it. It is hard....but school won't last forever! YOU CAN DO IT!!!!

My kids were 1, 2, and 4 1/2 when I went back to school. They are now 8,9 and 12. They hardly remember anything about me being in school, and now my hubby and I can afford to do some fun things with the kids that we wouldn't have been able to otherwise. They were too young to play the "why is your school more important than me" card. It is hard, but if you want it bad enough you can do it and if you love to help people you won't regret it.:) I hope that helps.

I have a question for all of you. I had a patient last week. She had TAH with vertical abdominal incision. She did very well, but had one problem. Hypoxia. I personally don't like hypoxia in my patients. It makes me nervous. Anyway she could get up and walk without sats dropping, (at least not that we documented it seemed she was breathing deeper) but in her room and especially at rest she would desat to mid 80's and become symptomatic. (Nausea, sob, lightheaded). The surgeon did PE tests (EKG, CXR, US Bilat lower extrem for clot, and d-dimer) and consulted her PCP. All tests were neg, even the d-dimer two days after surgery, which was a surprise to me. Most of us thought it was her epidural, but even 24hrs after turning it off she was having symptomatic episodes. Nurses were concerned. Lungs clear. CXR (port) showed mild ataletesis with clearing the next day. (post-op day 3). Her doctor almost seemed to be annoyed that he was bothered to be consulted by this. The first time in her room he took a pulse ox in and found her sitting up eating without oxygen on and sats were 87% and she was starting to become SOB. They dropped as low as 84% was documented more than once on several shifts. He commemted he would like a "sleep study on her after she's out of the hosptial....maybe she has sleep apnea and she might run low." But all of these time she ran low she was awake and sometimes talking to staff and visitors for over 30min before checking her sats. The next day the doc stated if you check her sats and they are normal just don't check them again. And that same day stated that she could go home if the surgeon dismissed her...which he did. My patient in question is a nurse and a friend and was insulted at the way the physician treated her, acting like this was "just an annoyance" in her words. She left post-op day 3 and continued to have these episodes for 3 more days as home. After that time she hasn't had any problems with the symptoms. My question...have you had a patient go home with these symptoms. I'm not saying she had a PE, because the d-dimer was neg....but something was going on. Can you give me your opinions on this?

Our unit clerk is a super anal retentive person. Sometimes we rearrage her rows of pens (black, red and highlighters when she leaves her desk, just to see how long it takes her to see it....or mix her small paperclips in with her large ones. It's all done out of love... Anyway she called admitting because a dx: of "rectal fissure" was heard incorrectly and typed up on paperwork as "rectal seizure". She asked, what's a rectal seizure....."I told her it's what happens to you when we rearrage your pens!" :chuckle

Usually we hang a 250cc bag of NS with 40mEq of KCL with 100mg of lidocaine. Works like a charm most of the time. Our standard order for _____mEq KCL ryder IVPB over 3-4 hrs.

let me start by saying...(doesn't sound like a short post does it???)....that i have been a med/surg nurse for 3 1/2yrs. i am still green around the edges by some standards and experienced by others. i mainly work medical floor in an approx 50 bed hospital. i have personally never been yelled at. that doesn't mean that a dr. has not been a bit peeved at me or at least to me at times. i am lucky in that our physicians are mostly even tempered and when certain docs get pi**ed off they will calmly tell you to your face exactly what it is they would like changed. an ordinary statement in an extrodinarily demeaning tone is much more likely to upset me than a screaming doc. we have only one doc that likes to scream. he is an ortho surgeon...(i know you are all just surprised by that one. )....and when he decides to yell at me, as i'm sure it will happen i just hope i am able to keep my wits about me enough to walk away and keep my job, rather than recipricate. he doesn't yell over one particular thing....just lets er rip every once in a while on whoever is there when it all boils over. (whatever) anyway, now on to your double standard question. we have only 2 male nurses. i don't see any favoritism, but i can tell you that patients are more likely to assume that men are docs. our new female doc has had alot of pts tell her that she is a wonderful assistant to the doc....she straightens them out very politely......but you see where i am going with this. my problem is with our male cna's. generally the ones i have known have not liked the "working" part of having a job. now i am not generalizing. the male nurses i work with are absolutely wonderful and definitly pull their own weight. i get more upset with the way the docs treat our male cnas. they always know their names, talk sports....ask personal interest questions. now the best cnas we have on the floor have been there a year and if you talk about her by name you have to describe who she is and then the docs say something like..."oh, yeah, i think i know who you are talking about...is she an aide?" puulllleeaazzzzeeee. i had a doc, one of my favorites, come up to me and say..."what is his name again?" and let's call him ray. so after being told his name the doc goes up and says, "hey, so ray how's it going......i heard blah, blah , blah" :angryfire did i mention the pts loved ray because he sat in the rooms and talked all shift with them...and doesn't do any of his work. (he got fired) another male cna was like that too. these are docs i like and respect and i even socialize with some outside of work....but hellooooo. if that isn't a double standard what is? i think that generally males get more initial attention, esp in nursing where there are mostly females. but i haven't found a situation where males could slack on the job more without getting called on the carpet all the same. all you have to do is find a job you love and do it well. bi*chy pts come and go. your self respect is what you have. you can't control how other people react to you....but you can control how you use it and react in similar situations. good luck, work hard, and have fun! j

When I started the nurses wore white or Caribien Blue, the cna's another, respiratory therapists another and so on. I was a pt at that hospital when I had two of my babies and for 2 minor surgerys. Guess what....When I was hired on I had NO IDEA that the nurses and CNA could be identified by their uniforms. Unless the pt is told on admission then how are they to know. Trust me...a pt in pain is not going to distinquish between colors of uniforms...."oh that's the same blue the other nurse wore....all nurses must wear it!" My big peeve is that managment wanted to keep it that way so pt could tell staff apart. But on our name badge we have our last name printed ( I don't lik that. and on an approx 2 1/2 inch by 4inch name badge my title (RN) is not bigger than the type in this post. HELLO!!!!!Wouldn't it help if someone with 20/20 would be able to read my title, let alone the 85 yo lady that forgot her glasses. We have our policy changed. Now any scrubs that are clean, "look nice". Except for black?????Duh...someone suggested maybe it looked morbid. I think that Black scrub pants look nice with a print shirt. I think Managment walking around in a black dress or skirt with heels look more like a funeral procession than a nurse with black scrub pants. ....but whatever.

Your right about addicts in for surgery. I found out from an experience on our med floor. Pt was constantly complaining of pain and finding it hard to get pain meds. She was a chronic abuser to the point you could easily see the track marks and she could tell you exatctly where to get an iv stick. I was never personally her nurse, but if you work on a floor with 20 beds (max) you know what is going on. Anyway they finally after a couple of days found out what was going on. I know that the nurses who doubted her felt bad. Now in the ER....that's a whole 'nother ballgame. Thanks for all your great posts and points of view. That's why I came here!

Okay don't hate me...but no I did not grow up wearing those "horrible caps". I put that in quotes because that is what I have heard them called time after time by nurses who wore them before they had a choice. If the question came down to white uniform or cap....well please let me wear the cap but keep my colored scubs. I usually wear solid colors with, maybe, a print jacket. I would rather keep that on my head than be forced to wear white uniform or even worse.....white dress with hose. Isn't that where we are headed if hopitals go to whites for "professionalism" Hey I would where the cap for a chance to keep my personality in the clothes I wear.

i work part time in a family practice office. i work for all providers at one time or another. we have a doc (lets call hime smith) that is famous for giving pain meds. he'll switch them from lortab, to percocet, to methadone, to dilaudid, to whatever. we have a pt that filled her methadone then 2 days later siad they weren't working and he gave dilaudid. orders demerol 150mg im for obvious drug seekers. the nurses know if the pt complains of pain in the hosp, he doesn't think twice about putting them on a pca. (even had a lap chole on a ms pca. 45 min after d/c of drugs pt felt good enough to leave. go figure!) we had a surgeon admit a pt under dr. smith's care d/t lortab/percocet abuse post-op with dx of narc. addiction, even though we are not a rehab facility. the pt left with a script for lortab. she had been getting percocet #300 previous to surg. my question for all of you is.....when does this become an ethical question for me? working in the hospital and/or working in the office. i have told the doc repeatedly my opinion that these are drug seekers and they need help. i have said......"they walked in here and joked around....then needed 150mg of demerol????????" he disagrees, and when he does defend the pt he simply says pain is subjective. uh, yeah, but can't you think for yourself? i like the doc as person. very interesting company and good conversation, but don't i have a line where i am enabling these drug seeker too???? i might add no nurse at the hospital would let him be their doc. he is scary most of the time...and in difficult cases we know the pt would have a much better chance with another doc. i have recently heard talk around the office that i might soon be offered a job working full time for this provider..(i'm full time right now med-surg) ethical delima or not....i know it sounds like i've made up my mind....but i would like your imput.

wow!!!! where was that and what kind of office. H*ll, I don't make that on the floor.