Really, Doctor?!

[OrganizedChaos]

So I had my first code called on my my patient last night. Without going into a lot of details, a strike code was called but basically the patient had too much pain medication (she was on Q2H dilaudid).

Her doctor previously rounded before shift change, saw she was very lethargic & had pin-point pupils. Didn't order anything but changed a few other things.

When shift change came we did bedside report & she was acting different from her usual self so a code was called. When I called the doctor he was upset that the shift coordinator wanted to transfer her to the ICU & ordered Narcan.

*I* was pissed because HE saw her & could've order Narcan when he SAW her! I saw the doctor today & he said not to call a code. It took all of me not to say anything back at him.

The patient wasn't transferred, the Narcan helped her & she is fine today.

[OrganizedChaos, LVN]

I realized after that my message might have sounded rude, so I apologize if it came off that way.

I think this is just a good learning experience and example of us being the ultimate first line when it comes to our patients. If you don't mind, I want to give you a few pieces of advice that I gained with experience on a super busy floor with less-than-proactive resident doctors.

Don't be afraid to clarify things with the doctors. I've gotten to the point where I don't care how dumb or aloof I seem to them, but (depending on a lot of things, I know) I'd like to clarify with the doc what he thought and maybe even pull him back in that room with me. Then with a change that you observed, you and him would both be on the same page about what is different and when it changed. I've had a couple sticky situations where it came down to needing to know almost exactly when symptoms started, and I couldn't give a great answer. I've needed to keep the closest eyes on those kinds of patients for the stroke stuff, which of course I learned afterwards.

Also, try not to describe doses of meds as volume - you described her med dose as 1.5ml every two hours. For covering your butt and just generally, the strength is what you should refer to.

I don't mean to be critical in a negative way, I just know how hard floor nursing can be. Keep up the good work!!!

I don't think you ever sounded harsh. I know I have a lot to learn when it comes to floor nursing, that's why I came on here & I love all of the advice I received. Thank you! :)

[CardiacDork, MSN, RN]

Okay so for once and for all I am trying to understand the timeline.

You see patient and she looks okay and you give her the dose or hydromorphone.

Doctor sees patient, she doesn't look quite right. He doesn't order Narcan but he does order Toradol.

Shift change arrives and you and the night nurse note the patient is even more aletered WITH left sided weakness, so a stroke code is called?

IF SO. Narcan was not necessary. Unless she was displaying symptoms such as hypotension (which I would ask for fluids first) or respiratory depression, then you'd give Narcan

If she was having left sided weakness what she needed was a STAT CT.

[UnicoRN93]

The nurse has to Assess whether that patient can stand to receive that much medication and remain stable. Just like you would with any other medication. the patient isnt required to receive them every 2 hours if it isnt safe and might cause her to code, etc. And its the nurses responsibility to communicate to the doctor if there are any changes in mentation or alertness. if the doctor should have seen it then that nurse should also have noticed

[OrganizedChaos, LVN]

Okay so for once and for all I am trying to understand the timeline.

You see patient and she looks okay and you give her the dose or hydromorphone.

Doctor sees patient, she doesn't look quite right. He doesn't order Narcan but he does order Toradol.

Shift change arrives and you and the night nurse note the patient is even more aletered WITH left sided weakness, so a stroke code is called?

IF SO. Narcan was not necessary. Unless she was displaying symptoms such as hypotension (which I would ask for fluids first) or respiratory depression, then you'd give Narcan

If she was having left sided weakness what she needed was a STAT CT.

Yes, that is all correct.

[OrganizedChaos, LVN]

The nurse has to Assess whether that patient can stand to receive that much medication and remain stable. Just like you would with any other medication. the patient isnt required to receive them every 2 hours if it isnt safe and might cause her to code, etc. And its the nurses responsibility to communicate to the doctor if there are any changes in mentation or alertness. if the doctor should have seen it then that nurse should also have noticed

The patient was fine before she got the Dilaudid, the patient's normal self. The doctor noticed the change before I did as I was rather busy (I'm new to the floor & my floor is one of the busier floors). He did not mention any stroke symptoms, just over medication symptoms. He is a doctor & did not seem too concerned that she was too sedated. It wasn't until shift change (not much later) that we all noticed the possible stroke symptoms.

[allnurses Admin Team]

This thread has been reported multiple times.

Many posts removed.

99.99% of the time a thread derails (just like this thread) ... when we make it personal.

Please do not bring it down to a one-on-one personal level ... please stay on topic. That way, the thread is readable, makes sense, and everyone can benefit.

Thank you for staying on topic and being respectful.

[OrganizedChaos, LVN]

This thread has been reported multiple times.

Many posts removed.

99.99% of the time a thread derails (just like this thread) ... when we make it personal.

Please do not bring it down to a one-on-one personal level ... please stay on topic. That way, the thread is readable, makes sense, and everyone can benefit.

Thank you for staying on topic and being respectful.

Thank you so much! :)