thehipcrip

The OP never said anything about not feeling safe. In fact, she never gave her rationale for pushing the Benedryl 30m after the Dilaudid. Are there factual reasons for giving the two meds separately [e.g. the patient snows out when the two are pushed together or she has concerns about it affecting his respiration], OP?

Some folks are able to control evacuation using irrigation -- essentially giving themselves an enema through their stoma. One friend has had such success with irrigation that he covers his stoma with a large bandaid between the times he does his scheduled bowel care.

If this had happened recently, this is definitely good advice. But since the OP said she's resisted posting about this for months, re-opening the matter with her manager by requesting a sit-down this long after the fact is a really bad idea. OP -- if the accusations were really that serious, you'd have been written up or worse. Listen to your peers' wise words, take a deep breath, and find a way to let it go.

The OP states that the second nurse asked the first nurse for *her* birthday, the drug and the dose, not for a patient's birthday, drug and dose. Seems clear to me that the first nurse needed a refill of a personal prescription, and asked another nurse to call it in using the name of a doctor who works that unit -- a doctor who had not been present that day to prescribe a refill. As to your obligations, I'm inclined to say there may be an ethical obligation to let the DON know of this transaction if the script that was called in was for a controlled substance *and* was a med not typically prescribed by physicians practicing in the same specialty as the doctor on the unit whose name was used.

Many urologists treating people with spinal cord injury consider collecting the first urine emitted immediately after a new sterile catheter is placed to be the best practice. This ensures that the only bacteria sent for C&S are those actually present [as opposed to bacteria colonized in the indwelling catheter, tubing, and/or bag].

Ack! Forgot my link. The NIH funded study that recommended using the 10 percent bleach solution and found that pseudomonas thrived in bags cleaned with vinegar can be found at: http://www.ncbi.nlm.nih.gov/pubmed/8466427

He should be on some anticholinergic medications to both prevent painful bladder spasms and to help prevent bladder shrinkage. Just because the ditropan didn't work doesn't mean others shouldn't be tried -- some people may need a combination of meds to prevent spasms, control leaking, etc. NEVER clean a collection bag with vinegar. Studies have shown that pseudomonas thrives in bags cleaned with vinegar. Instead, use a 10 percent bleach solution. Do two tap water rinses, swishing the water around for 15 seconds each. Then fill the bag 1/3 full with the 10 percent bleach solution and swish it around for 30 seconds. Drain and air dry without rinsing. Why is he on antibiotics full time? The presence of bacteria in his urine alone is considered colonization and should not be treated with antibiotics. Only symptomatic UTIs should be treated -- i.e. bacteria and fever, flank pain, malaise, blood in the urine, elevated white count. Run a C&S on the first urine collected immediately after a new catheter has been put in so you're certain you're treating the bacteria that's present in his bladder and not just the bacteria colonized in the old catheter. I'd really appreciate it if someone would post a link to the 'evidence-based research' advocating not changing indwelling catheters on a regular basis. ETA: Are you sure the research you're talking about didn't show that there was no benefit to changing catheters at arbitrary fixed intervals -- i.e. every four weeks -- but should instead be changed as needed based on clinical symptoms [encrustations, leakage, etc.] and tailored to an individual's needs rather than actually advocating *no* cath changes? Someone who only skimmed this article might read the bullet point about no arbitrary cath changes and interpret it incorrectly to mean no changes at all.

I'm not a nurse and I found both the correct name of the ABX and the answer to the question! This doesn't fill me with confidence about the competency of some of the new grads entrusted with keeping me alive.

If I discovered a nurse had unilaterally decided to 'stretch out' the time before I received pain medication that was ordered by my physician, I'd file complaints with everyone from her employer to the BON.

There are a number of people I know who manage their bladders with catheterization [indwelling and intermittent] using instillations of a wound-care product called Microcyn to prevent urinary tract colonization and infection. Several dozen people with indwelling caths [urethral and suprapubic] have remained free from even colonization, verified through C&S, for over a year by instilling up to 60ccs of the product for 20-30 minutes q24 hours or BID. I'm having similar off-label success treating chronic bronchiectasis-related lung infections by nebulizing the more affordable and more potent veterinary version of the product, available under the brand name Vetericyn VF. [same formula and quality production standards as Microcyn.] And while it's an FDA-approved use and therefore not a home remedy, Microcyn/Vetericyn/Puracyn is far and away the best wound care product on the market. Works ten times better and faster than any OTC triple antibiotic cream available, and better than several prescription topical ABX, too. There's an insanely long thread about using Microcyn/Vetericyn to prevent/treat UTIs and bladder colonization at the CareCure site if anyone's interested.

Riiiiiggght. And right now, your counterpart is posting a similar rant over at AllTeachers.com about how they should become a nurse because it's a high status profession, they're well-paid, and all they really do anyway is pass out pills. :) Sorry things are so frustrating. Burnout is a horrible place to be.

The problem with software like this is that the geeks [and I use that term with the utmost respect ] who develop it have almost zero input from the actual end users, so they don't know about features like this that would make a world of difference when it come to patient care -- and enabling nurses to do their jobs more efficiently. Have every nurse and doctor send this suggestion to the hospital's risk management folks and directly to the software manufacturer. In the age of Twitter, it should be no problem at all for the company that designed the software to build in a feature that automatically sends a text message to the nurse assigned to a patient for whom a STAT order has been submitted. If enough of these suggestions [customer demands] are received, the feature will be included in the next software update and will soon replicate across products and become an industry standard.

Sorry, I had to come back to this thread and address the fact that a nurse thinks that cleaning urinary collection bags is "ridiculous". Urinary tract infections (UTIs) are the most common type of nosocomial infections, accounting for 40% of all infections in hospitals per year (Burke and Zavasky 1999). In addition, several studies have reported that about 80% of nosocomial UTIs occur following instrumentation, primarily catheterization (Asher, Oliver and Fry 1986). Further, retrograde contamination [the transfer of bacteria from the urine collection bag into the bladder] is the cause of 15-20 percent of UTIs in patients who use indwelling catheters. [source] So the proper cleaning of all urine collection bags is a critical element in preventing UTIs in those who manage their bladders using either indwelling catheters. There are two reasons that are likely responsible for your facility's policy about not using leg bags during the day - [1] it will help reduce the chance of infection because the collection system remains closed, and [2] it's less work for the staff. However, as a previous poster has noted, requiring patients to haul around an overnight collection bag negatively affects both their dignity and mobility. The use of leg or belly bags that can be discreetly concealed under clothing enables those of us who use catheters to move about freely and feel like people, not patients by respecting our dignity and privacy [i.e. it's no one's business how we manage our bladders]. I apologize for the curt tone of this post. I do my best to be positive when replying, but this subject hits home in a big way and the original post has been eating at me all day.

A study funded by NIH and done at the University of Utah recommends cleaning all urinary leg bags with a solution of 10% bleach. The procedure should be two rinses with tap water, sloshed vigorously for at least 10 seconds, then filled 1/3 full with the bleach solution, and slosh for another 30 seconds. Do not rinse. Never use vinegar. It can foster the growth of pseudomonas, a common pathogen in SCI UTIs. You should always use aseptic technique when connecting/disconnecting collection bags. Just a bit of advice from one of those meddlesome patients and Foley users who insist on butting into a *nursing* discussion.

From the meds alone, it sounds like the 20-something is living with central pain, a specific type of chronic pain that occurs as a result of damage to the central nervous system. I've been living with central pain for 33 years, and have had way too many experiences with HCP who don't believe I'm in pain or pass judgment on me and withhold pain medications because of lack of knowledge and personal bias: I've had quite a few doctors and nurses tell me that I couldn't possibly be in pain because I'm an incomplete tetraplegic and use a wheelchair. "You can't feel me touch you, so you can't possibly have unbearable burning, shooting and stabbing pains. Therefore, you're a drug-seeker." Certain areas of my body are affected by severe hyperpathia [increased response to painful stimuli] and allodynia [things that wouldn't usually hurt, like wearing shoes, trigger significant pain]. When I broke into tears after a nurse put a non-slip sock on me despite my repeated explanations about why I couldn't have that foot covered, she told me to 'quit being such a baby.' An ER doctor on duty when I came in for a tib/fib fracture in leg affected by hyperpathia and allodynia refused to give me any pain medication. The doctor told me to my face that I was a drug seeker and had likely deliberately injured myself to get a 'fix' because I told the triage nurse that I had central pain and take 80mg of Oxycontin BID plus oxycodone for breakthrough pain. I've recently had to switch from Oxycontin to a more affordable pain medication because the cost, even with insurance, was bankrupting me. The more affordable pain medication I'm on now is Dolophine, which is the brand name for methadone. Even though the script from my pain management doctor specifically states 'for pain', the pharmacist who's filled my prescriptions for opioid pain meds from this same doctor for the last seven years told me that it was 'illegal for him to dispense methadone to manage addiction, so I needed to go to the clinic'. Seeing so many nurses who are already well-educated about chronic pain, pseudoaddiction, etc. and even more who are eager to learn to better help their patients is a beautiful thing.

It's evident from your efforts to better understand your opioid-tolerant patient's actions and concerns about the potentially dangerous side effects narcotic drugs can have on bowel function that you're a very caring nurse. However, I'm troubled by some of your methodology. Requiring a patient to do laps in order to get the pain meds that they've been prescribed and withholding phenergan until a patient is suffering from nausea crosses the line from caring into, and I don't use these words lightly, controlling and abusive. No matter how noble or well-intended your reasons, 'finding ways to deny requests' for pain relief is not your responsibility, it's the doctor's.

Something no one mentioned here is the use of Lidocaine 2% gel to make insertion less uncomfortable. Apply a liberal amount of lidocaine gel to the patient's meatus and leave it to start working while prepping your insertion tray. You can also mix the Lidocaine gel in with the Surgilube. It doesn't necessarily make the insertion more comfortable but does eliminate irritation/discomfort shortly after. Question -- why do hospitals/clinics all seem to use the insertion trays with the cotton balls and tongs instead of the prepackaged antiseptic swabs? For women, it's so much easier to ensure the swabs get into the labial folds than using those clumsy tongs and drippy cotton balls.

I never worked as a nurse, but this is what I told people in my line of work: I need you for the long haul, not just the short term. If you take on too much now, you'll burn yourself out. For your own good, and for the good of what we're trying to do, pace yourself so you will be able to do this work, do it well and without resentment for a long time.

As someone who uses an indwelling urethral catheter for bladder management, I'm exceedingly frustrated by how few nurses (and doctors who are not urologists, for that matter) know the proper procedure for collecting a urine specimen from someone with an indwelling catheter. I've had five orders for a UA written during recent visits to the ED and an admission for abdominal surgery. Not one of the four nurses or the ED doctor who came to collect the specimen knew the correct procedure, and only one (a marvelous RN) listened to me when I explained why the way she planned to take the sample would not yield accurate results and what needed to be done to collect a valid specimen. So I'm curious. As a nurse, were you ever specifically taught how to collect a urine sample from patients who rely on indwelling catheters? If so, what were you taught? Did this teaching occur as this part of your nursing school curriculum or did you learn on the job from another nurse, doctor, or (gasp!) a patient?

This is more than a little overdramatic, don't you think? It might not be a comfortable existence, but I speak from experience when I tell you that thrush and yeast infections resulting from extended tx with antibiotics are hardly terminal conditions. Have a little more faith in your own strength and ability to survive hardship -- we humans are remarkable creatures when it comes to enduring the inconceivable.

One night in my local ED, a nurse started the process of emptying my bedside urine collection bag without putting on gloves or using hand sanitizer. As a FT Foley user at high risk for UTIs, I ask her to please use either the gloves or the Purell before handling my bag. Her response: "You better have some hand lotion for me because that stuff dries out my hands too much." I responded that she could simply put on some gloves if she didn't want to use the hand sanitizer, but because I was highly susceptible to infections, I insisted that anyone who emptied my bag do one or the other. I also told her that I did have some lotion in my backpack that I would be happy to let her use. She became irate! She raised her voice and went off on a rant about how I had no idea how hard washing and sanitizing her hands multiple times a day was on her skin, and what was I so worried about anyway because she was far more likely to get diseases from me than I was from her, and on and on and on. Pointing out that what I asked of her was hospital policy, as evidenced by the poster over the sink, did nothing but make her angrier. Fortunately, I was in a room directly across from the nurses' station and the charge nurse heard the commotion and came to investigate. You'd better believe I filed a formal complaint against her.

Having no one to help a patient bathe or having an inaccessible tub/shower at home may, in fact, be the reason that some patient seek help with bathing just before being discharged. There have been a number of times when I was released from a hospital stay without being able to step into the tub/shower combo I had at home. The assistance of a CNA or nurse with using the hospital's walk/roll-in bathroom right before being discharged enabled me to take one last real shower and wash my hair before heading home to bed baths and no rinse shampoo. Being able to go home with a clean body and hair was a godsend, and I've never forgotten the nurses who made that possible.

I already carry a wallet card about AD, which I presented to both the nurse who checked me in and took vitals, and the triage nurse. The Medic Alert bracelet is a great idea.

While my resting heart rate during triage was 25+ beats per minute slower than my very high baseline, I was still WNL and not obviously bradycardic. @NeoPediRN and Leslie -- That the nurses at my small local hospital didn't recognize the AD is one thing. But hearing from you both that anyone with a BP that high, regardless of a history of AD, should have been assessed immediately tells me there are bigger problems at hand.

What is the best way for a patient to alert you to and educate you about autonomic dysreflexia (AD), an emergent, potentially life-threatening medical condition most doctors and nurses have never heard of? Autonomic dysreflexia (AD) is a condition that can occur in anyone who has a spinal cord injury at or above the T6 level which causes the blood pressure to rise to potentially dangerous levels. The primary risk of Autonomic dysreflexia is stroke. It is a potentially life-threatening condition. If Autonomic dysreflexia is left untreated, the body's attempt to control blood pressure will severely decrease the heart rate. This, combined with uncontrolled high blood pressure, can be fatal. For this reason, it is very important to treat this condition as soon as possible. However, getting doctors and nurses, especially ED triage nurses, to recognize and respond to autonomic dysreflexia is an ongoing challenge for people with spinal cord injury/damage (SCI/D). It happened to me during a recent trip to the ED for a gallbladder infection, the pain from which triggered AD. When I arrived at the hospital, my BP had spiked to 215/119. I was sweaty and had a severe headache, blurry vision, and anxiety, all of which are symptoms of AD. Yet despite alerting both the nurse who took my vitals and the triage nurse that I was having autonomic dysreflexia and showing them the wallet card I carry about AD, neither recognized my condition as potentially life-threatening -- I was actually taken back for treatment after a pre-teen boy with an ankle injury who was in no apparent distress. Luckily, I made it through this bout of AD without incident (except for the pounding headache). I wish I could say that my experience was the exception, but it's not. Almost everyone I know who is prone to AD has had problems at one point or another with getting health care professionals to recognize and treat autonomic dysreflexia, even when we bring educational materials about the condition with us. While there are a lot of nurses out there who listen to what we're telling them, there are still too many who dismiss us as demanding patients who have self-diagnosed off of the Internet and are trying to tell them how to do their job. So I'm coming to those of you who work the front lines of medicine for advice. What's the best way for someone suffering from AD to help you recognize the condition and help get us the immediate treatment we need?