"My doctor told me..."

adventure_rn, MSN, NP · Oct 27, 2018

Oh geez, those are wild. I don't have anything that exciting, although I will have the occasional family member who doesn't trust anything I say because I'm "just a nurse," and will repeat every single question I just answered to the provider (spoiler alert, they're going to tell you the exact same thing, lol). :rolleyes:

I did once have a newborn with idiopathic thrombocytopenia and the mom (who was pretty granola) just could not get on board with the treatment plan. Every time we tried to educate her on the risk of hemorrhage, she'd respond with, "Well, my naturopath said it was ok for her to have a platelet count of 32." She also didn't trust us so for several weeks, she had different family members stationed awake and at the bedside for shifts 24/7; the baby was literally never unattended. After trying for days without getting through to her, we finally just had to say, "Even if you don't agree with the plan of care, we aren't discharging your baby until it is medically safe to do so." We recommend that all NICU grads are seen by a pediatrician or PNP rather than a family practice doctor or FNP due to their unique medical needs, but despite her coag issues mom insisted that the naturopath would be her primary care provider. Can't help but shake my head.

MunoRN, RN · Oct 27, 2018

I've have a weird week this week with some weird information that patients have said their doctors told them. It cracks me up because they either have the worst doctors I've ever known or they completely misunderstood what their doctor told them.
Example: Pt with a large abscess that's open and swelling. Abscesses don't usually swell more once open, so I was curious.
ME: How have you been treating it?
Pt: My doctor told me to clean with dawn dish soap and bleach. (He cut it open with a bleached knife and washed it with more bleach and dish soap)
What the doctor probably said: Clean with soap and water.
(Hey, bleach cleans stuff, right?)

That's actually not a particularly unusual MD instruction, when used for wounds it's more commonly called "Dakin's solution", but it's still just diluted sodium hypochlorite, or what is commonly called "bleach".

Surfactants are also not unusual for MD's to recommend for wounds, preferably a highly biocompatible surfactant, a common one being dawn dish soap.

Kooky Korky, BSN, RN · Oct 27, 2018

Oh geez, those are wild. I don't have anything that exciting, although I will have the occasional family member who doesn't trust anything I say because I'm "just a nurse," and will repeat every single question I just answered to the provider (spoiler alert, they're going to tell you the exact same thing, lol).
I did once have a newborn with idiopathic thrombocytopenia and the mom (who was pretty granola) just could not get on board with the treatment plan. Every time we tried to educate her on the risk of hemorrhage, she'd respond with, "Well, my naturopath said it was ok for her to have a platelet count of 32." She also didn't trust us so for several weeks, she had different family members stationed awake and at the bedside for shifts 24/7; the baby was literally never unattended. After trying for days without getting through to her, we finally just had to say, "Even if you don't agree with the plan of care, we aren't discharging your baby until it is medically safe to do so." We recommend that all NICU grads are seen by a pediatrician or PNP rather than a family practice doctor or FNP due to their unique medical needs, but despite her coag issues mom insisted that the naturopath would be her primary care provider. Can't help but shake my head.

How is the wee one doing?

Davey Do · Oct 27, 2018

My doctor told me...

Let's put it to music!

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applewhitern, BSN, RN · Oct 27, 2018

Munro is right about the Dakin's solution. Used it many times. In fact, some patients are instructed to put a little bleach in a bathtub filled with water and soak. This is why education for patients while in the hospital has become such a big deal. We discuss, give handouts, and chart their response to education daily. I have no idea if any type of education is done by outpatient clinics, urgent care, etc.

K+MgSO4, BSN · Oct 27, 2018

I recently had one but more of "well the doctor didn't say".

We had been educating the patient on a low salt diet as he has Child Pugh C cirrhosis. Use herbs, spices instead to bring out the flavour of the food. Pt back in a month later and the chronic liver disease nurse is checking with him about his diet, "not using salt, using herbs" etc. Further digging into what herbs he has been using - chicken salt!!!!

On questioning why he was using that when we said no salt he told us that "you never said no chicken salt". Slap my head!

angeloublue22, BSN, RN · Oct 27, 2018

That's actually not a particularly unusual MD instruction, when used for wounds it's more commonly called "Dakin's solution", but it's still just diluted sodium hypochlorite, or what is commonly called "bleach".
Surfactants are also not unusual for MD's to recommend for wounds, preferably a highly biocompatible surfactant, a common one being dawn dish soap.

He was using pure household bleach. I have heard little bit about using a diluted bleach and soap although I'm not terribly familiar with the method, and thank you for going more in-depth for me. The dawn dish soap was not the problem because at least it's soap. I think the look of the wound proved he was not doing it right. It was swollen to the size of a soft ball.

Home Health Columnist / Guide · Oct 27, 2018

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Home Health Columnist / Guide · Oct 27, 2018

Dakins solution used frequently in home care nursing for infected wounds - recipe for normal saline, dakins, acetic acid below.... created many batches for my home care patients, still in use today.

https://www.vnhcsb.org/media/data/papers/pdf/073_4.12.3.pdf

missmollie, ADN, BSN, RN · Oct 27, 2018

Patient: My doctor told me everything would be done for my pain.

Me: Yes, you've had your Fiorcet, which is all you can have because you have a head injury and we have to make sure your brain is okay.

Patient: But he said everything would be done for my pain!

Me: And everything is being done. You just had brain surgery, you will have some pain.

Patient: But My doctor...

Me: I forgot the most important part. We need to turn you every two hours. Did Dr. X talk about how beneficial the turn schedule is for pain?

Patient: I'd really like some oxycodone

Me: Doesn't even treat brain pain. Turning...I can't believe I forgot that. Right side or left?

angeloublue22, BSN, RN · Oct 27, 2018

I don't think I'm making it clear. He was using straight bleach, not diluted in any way, right out of the bottle onto his wound not the actual Dakin's solution.