Things Change, People Change ;=)

[CaLLaCoDe, BSN, RN]

Please don't get me wrong, the nurse I got report from yesterday morning is a darn good one. Described a patient of mine to a tee. The epidural, the dilauded 0.2 for threshold pain (that he called way to often for, besides it was ordered every 15 minutes, he thought it to be every 2 (thank God!); The below the knee amputation with an incision that was resolving, that he had refused to be painted with betadine; the SCDs to the other leg to prevent another BKA; His refusal to be moved in bed saying "I hurt way too much!", "perhaps you could order a Trapeze for him to allow him to move himsef; the temperature brought down lower with IS and pulmonary toiletting. "He's wanting coffee, I said no, he's on a clear liquid diet, the coffee's acidic, don't let him manipulate you into giving him coffee!" All of this hit my ears in the morning and I thought to myself, you've got a busy day ahead of you!

Well, things were entirely better. Once again, I reiterate, the night nurse is excellent. He got out of bed with some assist from me to a chair holding a pad to his wound to his abdomin: asked for dilauded 7 times during my shift, mainly during transfers, tolerated the removal of his compression sock to his amputation and application of betadine, overall a pleasant patient. Even shaved himself! Had received Asterix SC yesterday, but I wasn't too overly concerned for him bleeding. I know that things can change rapidly with a post op patient and it makes the one giving report seem like a liar.

Ever have this happen. Where you get report on a patient and think to yourself: OMG, I won't have a chance to help my other patients and turns out to be a goodie? The painting you receive in the morning can be entirely different from the one you paint during the day?

[Tait, MSN, RN]

Absolutely. Which is why, when someone gets on a tirade about how difficult/needy/psycho a patient is I just wipe my mental slate clean, ask them to focus on the care details do the best I can.

Tait

[chicookie, BSN, RN]

Yup. This is true. It reminds me especially of pts that have sundowners. During the day they are awesome and the coolest patient ever. Once 5pm rolls around they go berserk and take follies and IVs out, they throw bed pans at you.

Then of course are the patients that are a pain in the rear the first day you take care of them, then they love you and are a pleasure to take care of for the next shift or two.

Which why during report I pay heed to what I was told but don't let it influence me in how I treat a patient.

[Flare, ASN, BSN]

Sure - I take report of difficult patients with a grain of salt. Don't get me wrong, it's nice to have the heads up and sometimes that assessment is spot on but sometimes that PITA patient starts feeling a bit better and their attitude improves greatly. I try not to go into the room with my mind made up that this is going to be a difficult patient.

[tvccrn, ASN, RN]

:offtopic:

Why can't he have coffee if it's black? Here that is part of the clear liquid diet.

[Aneroo, LPN]

:offtopic:

Why can't he have coffee if it's black? Here that is part of the clear liquid diet.

I always understood it to be very literal- clear liquids (to me) means if I can't see through it, it isn't considered a clear liquid.

[morte, LPN, LVN]

I always understood it to be very literal- clear liquids (to me) means if I can't see through it, it isn't considered a clear liquid.

you can see thru black coffee......

[chicookie, BSN, RN]

Coffee is a clear liquid.

Because the internet said so:

http://www.gastromd.com/diets/clearliquid.html

http://cancer.about.com/od/treatmentoptions/p/clearliquiddiet.htm

http://www.mayoclinic.com/health/clear-liquid-diet/DG00060

[Virgo_RN, BSN, RN]

People can change their behavior on a dime. I've received report on difficult patients only to have them be very pleasant, and I've reported off on pleasant patients that have turned into nightmares.

And here, coffee is a clear liquid also.

[heron, ASN, RN]

Sure - I take report of difficult patients with a grain of salt. Don't get me wrong, it's nice to have the heads up and sometimes that assessment is spot on but sometimes that PITA patient starts feeling a bit better and their attitude improves greatly. I try not to go into the room with my mind made up that this is going to be a difficult patient.

Besides that, PITA is often in the eye of the beholder. I personally like curmudgeons and families who ask a lot of questions, whereas another nurse may interpret this behavior as hostile, non-compliant or whatever, and react accordingly.

[CaLLaCoDe, BSN, RN]

http://www.buzzle.com/articles/bariatric-surgery-why-coffee-must-be-avoided.html

"...Caffeine increases gastric acids, which causes heartburn and gastro esophageal reflux. Caffeine also increases urine production, which can lead to dehydration of the body."

This article addresses concerns for a bariatric post surgical patient. My patient had a tumor removed from his colon, so this might also apply. Thanks posters! Yes, coffee is considered a clear liquid! Only, sometimes it might be contraindicated: heart patient, GI bypass patient...etc etc.

[Ruby Vee, BSN]

everyplace i've worked, coffee is considered a full liquid as opposed to a clear liquid. that said, our cardiac surgery patients don't really need to be caffienated!

[color=#483d8b]

[color=#483d8b]i've had more experience with patients who have been reported as being wonderful patients with supportive, wonderful families being the opposite when i get them. in fact, as soon as someone starts giving me report about what a wonderful patient this is, i can feel my gut start to clench. invariably, they're sundowning or psychotic by the time i get into the room . . . sometimes i think my co-workers report the manipulative, demanding psychotics as "so sweet and friendly" just to mess with me.