What have other nurses done that have freaked you out?

[texas_lvn]

What have other peers done intentional/unintentional to freak you out? Good or bad. Happy or sad.

On my FIRST day as an LVN, (LTC) a res was screaming in her room as I was walking out to leave. I went in to see what was going on. She was having an anxiety attack and severe pain (post stroke). I pulled the call light, and no one came. Uggg.

So I peeked out the door and saw my CNA walking down the hall, and told him to come sit with res. I went down to get her a Xanax and a pain pill, well relief nurse was in the restroom, and relief CNA (with call light still going off) was sitting behind nurses station reading a newspaper. I told CNA to tell the nurse to get a Xanax and pain pill for res. She said OK. I go to relieve my CNA. Said goodbye to him, and stayed with res. after 10 minutes, CNA COMES INTO ROOM WITH XANAX AND MORPHINE PILL. She is soooooo shocked to see me still there, she hands me the pills and RUNS to the relief nurse. I could NOT BELIEVE WHAT I JUST SAW!!!!

(I did immediately call DON and tell what happened. Luckily, my CNA was still checking on another res, and saw the whole thing.--------they got a slap on the wrist! that was it!!!) :madface: :madface:

[fiveofpeep]

ouch!

[Simba&NalasMom, LPN]

Didn't really "freak me out" so much as grossed me out: I showed up to work an agency shift at a medical group home and did rounds with the day shift staff nurse. One of the residents had a boil on his shoulder and she popped it with her bare hands and didn't wash up afterwards.

[Simba&NalasMom, LPN]

When I was a student an RN one of my classmates was shadowing drew up an IM injection with a blunt and then forgot to switch needles. She somehow managed to force the thing through the patient's skin to give the injection. She then blamed the student for not catching her and in the interest of "maintaining the school's relationship with the hospital" the student received three demerits. I might add it was only our third week of clinicals.

Oooooooooooooo that reminds me of one of MY clinicals: a classmate's patient went hypoglycemic (I think he was in the 60's) so we tried to give him some OJ but he started choking on it. He became symptomatic shortly thereafter; diaphoretic and yelling. While he sat in the dining room sweating and yelling out, the charge nurse continued to pass her meds; she stopped once and gave us a piece of a Hershey bar to give the patient. She finally stopped her med pass to search for glucose frosting and squirted it all over his tongue instead of placing it in the buccal space. It didn't work at that point; his BS continued to drop. Put him back in his room and the charge nurse (who always bragged about being a nurse for 30 years) paged the NP who was in the building. NP ordered glucagon STAT. Guess what? Nobody could find an IM needle. The NP also mentioned to the charge nurse that the glucose should have been administered buccally and the charge nurse made the excuse that the pt was thrashing so badly she couldn't get it in right. They finally found an IM needle at the other end of the building and gave the shot.

On top of that, some of the staff overheard me complaining about this nurse so she gave me a talking to about how I'm a student and don't know the patients, nursing is more than values that we read about in books, she knew better, blah blah blah. I was lucky she didn't complain to my school, although to this day I know I was in the right.

[cardiacmadeline, RN]

I do hold coreg for this reason all the time, I dont see the problem. I think holding it is a better option than letting the pt bp bottom out. Unless the pt is tachy, I don't see the problem with holding it. Beta blockers used to be contraindicated in chf, this one is used for tachy arrythmias. I hold it and then notify the md when I get around to it, chances are they will get it again later anyway. :redbeathe If you know otherwise, please enlighten me.

Coreg is a nonselective beta-alpha blocker given in HF to block SNS effects like increased heart rate, contractility, and peripheral constriction, all of which increase oxygen needs and increases the workload on the heart. Coreg is part of the core treatment of HF, with the goal being to decrease the workload on the heart and to maximize the ability of the heart. Coreg decreases heart rate to increase filling time and decreases afterload. So if a CHF'er has SBP in the 90's and this is their baseline while on coreg, I will give it. If it is a huge change from their baseline or they are symptomatic with the low BP, I would call the MD. A lot of CHF'ers have and are tolerant of low BP's and as long as they are tolerating it (have no s/s hypoperfusion or hypovolemia), they should receive their core CHF medications (diuretics, B-blockers, ACE inhibitors). You have to ask yourself if holding the medication would actually benefit the patient, and you can't base that decision on blood pressure alone, you have to look at the whole clinical picture. Also, I have always been taught that coreg therapy should never be interrupted or discontinued abruptly, so I will always call the MD before holding it unless there are parameters written.

[MNRN2009]

Watched in horror as a nurse fast pushed UNDILUTED Phenergan through a peripheral IV. They did it so fast that by the time I said STOP, it was already done.

That reminds me of a story my preceptor told me back when I was on orientation. This happened quite a few years ago. She said that at change of shift, the nurse reporting off to her told her she had just pushed Phenergan for a patient. When my preceptor went in the room to check on the patient she was not breathing, she called a code and ended up riding on the bed doing chest compression while the patient was being wheeled to the ICU. When she called the previous nurse at home, she stated that she hadn't diluted the Phenergan and didn't remember how fast she pushed it. Shortly after that, the facility stopped using Phenergan all together.

[JulieCVICURN, BSN, RN]

Coreg is a nonselective beta-alpha blocker given in HF to block SNS effects like increased heart rate, contractility, and peripheral constriction, all of which increase oxygen needs and increases the workload on the heart. Coreg is part of the core treatment of HF, with the goal being to decrease the workload on the heart and to maximize the ability of the heart. Coreg decreases heart rate to increase filling time and decreases afterload. So if a CHF'er has SBP in the 90's and this is their baseline while on coreg, I will give it. If it is a huge change from their baseline or they are symptomatic with the low BP, I would call the MD. A lot of CHF'ers have and are tolerant of low BP's and as long as they are tolerating it (have no s/s hypoperfusion or hypovolemia), they should receive their core CHF medications (diuretics, B-blockers, ACE inhibitors). You have to ask yourself if holding the medication would actually benefit the patient, and you can't base that decision on blood pressure alone, you have to look at the whole clinical picture. Also, I have always been taught that coreg therapy should never be interrupted or discontinued abruptly, so I will always call the MD before holding it unless there are parameters written.

I work in cardiac ICU, and I agree with this. In fact, it's one of the only drugs that our cardiologists get mad if we hold unless they've given parameters. We can hold Lopressor 'til the cows come home, they trust us with that one, but Coreg is important. FWIW, I have given Coreg to hypotensive patients and actually seen the SBP come up because it helped the heart pump more efficiently. Also, I think Coreg has something to do with remodeling in the heart, although off the top of my head I can't remember exactly what.

[tri-rn]

Wondering why phenergan has to be diluted? My drug guide says nothing about diluting it. I'm not sure I've ever given this drug. Thanks!

[fiveofpeep]

Wondering why phenergan has to be diluted? My drug guide says nothing about diluting it. I'm not sure I've ever given this drug. Thanks!

yeah what freaked me out was I looked it up on micromedix at a hospital I worked at, and it didnt say it either under administration or on the med order.

[Simba&NalasMom, LPN]

yeah what freaked me out was I looked it up on micromedix at a hospital I worked at, and it didnt say it either under administration or on the med order.

Apparently it increases risk for phlebitis, based on another thread:

https://allnurses.com/infusion-nursing-intravenous/protocol-admin-iv-23554-page2.html

Also found this link which recommends a 10 Ml dilution:

http://www.adaweb.net/Portals/0/Paramedics/documents/promethazine.pdf

[fiveofpeep]

yeah I heard that it causes some gnarly extravasation as well.

[diane227, LPN, RN]

Phenergan is an agent that is very hard on the veins. It must be diluted before administration, to ease the discomfort of the injection. If you have ever had phenergan IM it is an experience that you will never forget. If it gets out into the tissue you will have tissue destruction so make sure you check your IV site carefully before you give it. You can expect that phlebitis will occur so check the vein. If you feel it getting even a little bit firm, remove that IV and restart in another location. Give it slow.

[diane227, LPN, RN]

You know, this has been a long post full of horrible incidents. We laugh but when you really look at these issues they are sad. It is no wonder that the public does not trust health care when they see and hear things like this. I believe that it is imperative that all of us, as professionals and as people who obviously care about the well-being of our patients we MUST do what ever we can to weed these incompetent people out of our profession. When I see stuff like this I document it for the manager and then I nag her until she takes action on the situation. When I have students on my floor I tell them that if they see something strange or see anyone doing something that is contrary to their training to tell me so we can discuss it. We have to get rid of these incompetent, unsafe people. They may be taking care of us or one of our loved ones one of these days.