Scary scary thing on my FIRST day!!!

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Specializes in NICU, Peds, Med-Surg.

Patient had a hgb of 9, wheezing and crackles. We start infusing blood. A doc that doesn't know a THING about this patient comes in to tell him he'll be doing his colonoscopy tomorrow. Tells my preceptor to "run the blood as fast as possible" so that he can start his Go-Lytely. Did he NOT notice how tachypneic the pt. was? Did he NOT hear the audible wheezing???

My preceptor tells me NO WAY is she running the blood fast, and consults w/ a specialty nurse AND our nurse manager, who both agree with her. The specialty nurse even said "if you run the blood FAST, he won't need a colonoscopy, 'cuz he'll be intubated and in the unit!".........This is SCARY stuff-------and this explains my user name--(nervous nurse)---LOL!

This situation just reminded me again that people have NO IDEA how much responsibilty we have!!!!!!!!!!!! I'm glad I got to see this as a BRAND NEW RN (former LPN),

because I learned a lot from it! I HATE it when other doctors come in and don't know ANYTHING about the patient, then give stupid orders that could really harm the patient. :angryfire

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ok, so would the doctor's order of run the blood as fast as possible" be only as fast as the patient's condition will allow anyways?? It sounds to me like you would only run the blood as fast as you could for that particular patient.

However, I am still a nursing student and only hang out here to try and learn more. I would love to see other comments on this...

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Specializes in Travel Nursing, ICU, tele, etc.

It sounds to me like you have the GI guy coming in and only being concerned about his little piece of the patient, I would bet that doing that colonoscopy tomorrow fit nicely into the Docs schedule and that was all he was considering. Did he even look at the chart or the patient??? I'll bet he never listens to lungs anyway, if he does even carry a stethoscope.

After awhile, you just look at those guys and laugh!! There are actually a few specialists that actually consider the whole patient and what is best for them, but not many.

Running blood into a guy with crackles can be very risky. Obviously you did the right thing. Don't let it freak you out too much, it will happen again!

That brings me back to the point of what actually makes nursing a profession. We do not blindly follow anyone's orders, we are there to protect our patients, we are their advocates. We have the responsibility to question anything that we think may harm them.

We are independent thinkers, not Dr's servants!

;) Good job!

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Did you have Lasix ordered in between doses? if so, maybe that was his rationale?

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Good job, sounds like your're doing some critical thinking. Now think about what the other nurses have said here. Was there an order for lasix etc... But, none the less, good job thinking it through. At the very least it sounds like that pt was in good hands and you knew that particular attention was needed for his/her status. Yes, your right, we take a lot of responsability in our jobs can be very scary, but sounds like your on your way to doing what a good nurse does best. :wink2: I have full confidence that some day we will see your log - on to CRITICALCARERN !!!

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

Sometimes the only thing you can say to a doc like that is, "Okay, we'll run it in as fast as the patient's condition will allow." Don't let him ruffle your feathers--you did the right thing by not cranking up the rate on the infusion. Sounds like the patient could have used a little lasix between units.

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Specializes in ER, Occupational Health, Cardiology.

Lesson learned: just because an MD orders something does not mean that it should be done. If you are concerned about an order of any kind, for any reason, run it by a co-worker and/or your Charge Nurse and Manager. Don't let them blow you off, if you are really concerned, without a reasonable explanation. It is not our job to regulate MDs, but it IS our job to be good pt advocates!

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Good job for noticing all that!! I'd have pointed out to Mr. Colonoscopy Doc that the patient was having a rapid HR and breathing difficulties - he may want to check back tomorrow before he plans on that procedure.

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Specializes in med-surg,sa,breast & cervical ca.

Geez, agreed you did good. Was patient alert and aware of what was going on?

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Specializes in Oncology.

Some people just need lasix with blood.

Bear in mind the rationale for running blood over a certain amount of time isn't just about fluid overload- you also risk a reaction to the blood (which is always a risk anyways, but at least you can catch it in time this way, and not as likely to happen at a slower rate). Unless the patient is already intubated (and even then, in very rare situations), I never run blood faster than 175ml/hr.

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Wow! Yes, I work with alot of geriatrics...seen some pretty disiterested doctors throw orders around and the floor nurses simply disregard some of the flippant and erroneous ones.

Thanks goodness for nurses like you.:yeah:

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