MO3BB

you should look in your med/surg textbook under each diagnosis/surgery. They always have a boatload of care plans. After all, that's what nursing school was full of--care plans, care plans, and more care plans!

I don't remember her exact words but she was begging me to call the doctor to give her something for her "craziness". All the night shift nurses the night before and day shift had repeatedly called the doctor to ask for ativan or xanax or anything else that might help her become less restless so I knew that a phone call on my part (especially to the particular doctor on call that night) was going to be futile. I reassured her that it was most certainly related to her lack of sleep and that she needed to relax and try to sleep. She kept saying that she couldn't and I told her I'd try to help her sleep. It was at that point that I got her back into bed after starting her IV. (btw, the ambien was something that had been originally ordered on admission, not something she took normally at home, and it had been dc'd at some point during her stay--not completely sure why as I never got it in report and couldn't find anything in the notes about it). As I was flushing her IV she thanked me for me trying to help her sleep (which is how I figured she must have thought it was a med). I stayed and talked quietly with her and fluffed her pillows, brought her a fan (she said she was hot), fixed her blankets, gave her ice water, etc.--that was my idea of "helping her sleep" but her idea was a medication I gathered. But like I said, I didn't confirm or deny it. Then in the morning when she asked for "that great medicine" again I guess I shouldn't say "without a word I flushed her IV" because I didn't just walk in, flush it, and leave. I meant without a word about it being or not being a medication. I took the flush in, scanned her band, scanned the flush, flushed it, asked her if she slept well earlier to which she said, "Oh yes! Thank you so much!" I asked her if the fan helped, if she was too hot or too cold right now, etc. I guess I worked it in my mind that her asking for "that great medicine" again meant to me that she was asking for the flush again even though in her mind it wasn't just a flush. In the end, I am seeing your individual points which is why I asked the question in the first place. I wanted a different perspective other than my own. I always try to treat patients like I would treat a family member. If that had been my mom and she was suddenly better after a mysterious injection I would have asked what it was (had I been asked I would have been completely honest). If the nurse said, "nothing actually, just saline" then I would be happy to know that we needed to look in a different direction for what the problem really was. Not a GI problem but more of a psychological problem. She had been making comments all along about being lonely and alone. Her family would visit her, she would be just fine, then they would leave and she would say, "I'm just an old discarded shoe, lying in the corner...." Which was another clue to me that her nausea was more than just nausea. I began to feel like it was a reason for her to be on her call light. She needed attention. Which is why I stayed and talked for a while with her and tried to make her as comfortable as possible without medication because I didn't think it was what she really needed even if she thought otherwise.

I had a patient last night that had continuously complained of "24/7" nausea since she had been admitted. She was not sleeping well, was anxious and restless. The nurses before me had asked the doctor for an antianxiety med and for some unknown reason her ambien was dc'd so that wasn't an option either. This patient had pulled her IV out and didn't recall pulling it out. While I was restarting it I talked to her about how she was feeling. She was having difficulty expressing herself. I knew she hadn't slept the night before more than an hour, nor had she slept during the day and now it was almost midnight again. I let her sit up in the bedside chair while I restarted the IV but then after I got it in I told her a lot of her anxiety and "feeling crazy" (as she called it) was most likely due to lack of sleep. I got her back in bed and told her it was time to relax and close her eyes, turn off her TV and attempt to sleep. I flushed her IV with saline (since it was a new IV). She thought I was giving her some sort of medicine. I did not confirm or deny it. I just said, "it's time to relax now". She ended up sleeping the rest of the night. At 0530 she woke up to void and asked if she could have "some of that same great medicine". Again, I didn't confirm or deny it and our saline flushes are due at 0600, 1400, and 2200. Since it was 0530, without a word, I flushed her IV again. She said thanks and went back to sleep. In my report to the oncoming shift I mentioned her thinking the saline was a med and said, "it seemed to work great". Well, the nurses (after I left of course because heaven forbid someone actually say something to your face) all gathered at the nurses' station and were talking about the legal ramifications of what I had done, giving a placebo without consent, etc. I heard about it from one of the night shift nurses who stayed late to chart. She said, "I hope you didn't chart it anywhere". I had charted that the patient had complained of nausea all night but stated it was gone after I flushed her IV with saline. I also charted that the patient asked for the "same great medicine" meaning the saline but didn't mention that when she asked for it like that I gave it to her. I charted it simply because i thought it spoke to her mental status. Personally if I were a doctor or NP I would want to know that the patient felt better even though she was given nothing. My concern is, did I truly do something wrong here?