Need to vent. Had a terminal, TERMINAL brain CA pt. Family states, "she doesnt want any more surgery, she just wants to go home and die". We don't do chemo/radiation on our floor. Gave her 2mg mgso4 at MN and 100mg iv DPH at 0130.
She is old, tired, dying and slow. Slow to follow commands. Call the resident at 0400, notify that she is not following commands. 5 minutes later she does. I call back, tell him not to come, but he is aware she is slow. 0600 another resident comes along and for lack of a better term freaks out and orders a stat CT. I tell him she is just slow and he needs to be more gentle and give her more time. He insists on a stat EEG. I remind him the family wants no more treatment. He gets upset that she received 2mg morphine....She had pain, i 'm not with holding pain meds from a dying cancer pt. I remind him that she had DPH at 0130 and that she never stopped following. Doesn't matter...we drag this poor woman to CT, she vomints all over herself on the CT table...we bring her back, hook her up to a stat EEG...all very traumatic for her and her family.
Suprise, the CT is unchanged, EEG negative. By this time the senior res and all the other residents are re rounding as a group. They stop at my room and by thsi time the pt is more awake. DPH wearing off...she is talking, following briskly.
The senior wants to know why she was lethargic and what I had given her.
Again I tell them 2mg mgso4 and DPH. Again, no one seems to hear DPH they are so caught up on the 2 mg of morphine (2mg, mind you). She didnt even get drowsy until after the DPH...an hour and half after the morphine. I was getting frustrated...so I say...she had a throbbing headache in the back of her head that she is rating an 8/10, her BP was 160 and she normally runs 94...she was in pain...the tears in her eyes made it even more obvious.
He says: that is a pressure HA and we shouldnt be "SEDATING" for a pressure HA. She is on dexamethasone and that should help.
Well it didnt help her HA. Shes dysphagic so no PO. They tell me to give her no more pain medication. I wonder if she cares if her pain is pressure related? I wasn't aware that I was sedating her, I thought I was treating her pain. She didnt have a neuro change after the morphine. She was drowsy from the DPH. NO one listens. If you dont want me to give morhpine, dont order it. The next night, same thing...she doesnt have a lot of pain, just once here and there she needs treated in 12 hrs...I chase down a resident...walking backward, begging for something for her...Order me Fentanyl which I asked for, nope...he says "i dont want the chief to get upset"...UGH!!!!!!!!!!!!!!!! Lucky it was time for her next dose of DPH and she fell asleep...UGHHHHHHHHHHHH. Tks for listening. Oh and I went to my NM.
Amen. Same thing happened to me recently when a brand new FELLOW (who should know better) told me a baby wasn't suffering and "can't cry because he has an ETT." I lost it.
"BS! I'd like to see YOU with an ETT down YOUR throat and see whether or not you can cry!" came immediately to mind, and was relayed in a rather nasty tone of voice to said fellow. I'm such a mild-mannered person, but start messing with my babies, and you will get an earful. I think I'm secretly a mama bear or something.
"BS! I'd like to see YOU with an ETT down YOUR throat and see whether or not you can cry!" came immediately to mind, and was relayed in a rather nasty tone of voice to said fellow. I'm such a mild-mannered person, but start messing with my babies, and you will get an earful. I think I'm secretly a mama bear or something.
LOL. I guess thats really why they say nursing is all about being a pt. advocate.
Your doc should have ordered the pain meds q1hr, or an infusion. No PRN. One of my docs calls PRN doses "per RN." He says too often patients are at the mercy of nurses who don't "like" pain meds or don't think they need them.
I love that name. It should NOT be subjective. The patient either needs pain meds or not - and some of them who do won't ask for them. I really believe in keeping the pain level as close to zero as possible, so the patient doesn't even NEED to ask. That shouldn't be their responsibility. And I really don't want pain to get to 10 and then try to get it back down with, what? A Vicodin?
LOL. I guess thats really why they say nursing is all about being a pt. advocate.
I have a friend who works somehow for a health insurance company. He just told me that they had an inservice where they explained to them about how nurses are patient advocates and just what that means! Not sure why it was necessary, but I thought that was pretty cool.
GrnHonu99, RN
1,459 Posts
Seriously. I don't even know what to say to that.