Why did the Dr order this???

[nursekara513]

Unsure if i am in the right category or not but here it goes:


I work at a facility for the developmental and intellectually disabled.

I have a resident lets call her Barb, that was seen yesterday at the clinic for URI s/s. She was seen by a temporary doctor there (one of the doctors left and the clinic is constantly busy and they hired a temp doctor until they hire a new one.) This was the first time this doctor had seen Barb.

Barb had been seen 2-3weeks ago for the same URI s/s. She was placed on Omnicef for x 10days. She has been off this antibiotic for a week and a half when I brought her in again as things werent getting better.

She has history of pancreatitis and dysfunction of Oddi. I relayed to this new Dr. that the omnicef had caused a little diarrhea and a few of her stools were gray, and that I had called pharmacy about these symptoms and they contributed them to the antibiotic. I also let her primary doctor know. Her primary doctor said to let her know if the issue with gray colored stools persisted after the antibiotic was done. There has been no gray colored stools since off the antibiotic. (I relayed this to the doctor we seen yesterday).

This new doctor diagnosed an URI again. Orders for Nasal Saline Wash and Levequin and she also wanted a lipase done. (Last time lipase was checked it was between 800-900). Blood drawn and left clinic.

I relayed to my supervisor for the Nasal Saline Wash order. She did not think this was a good idea since Barb is NPO with a Jtube due to aspiration. I called the doctor back and relayed this to her about our concerns with aspiration if the liquid would go down throat. She still wanted it ordered. Relayed this to my supervisor. My supervisor called her primary doctor and got the order d/ced as the Primary doctor also left the risks were not worth it.

Today I get a call from Pharmacy in regards to Barb and new order for Magnesium. I had NO idea what they were talking about. I have no new order for magnesium or understand why she is getting it!! Called to clinic to figure this out. Talked with new doctor. She says that Barb was low in magnesium. I asked how she new as the only lab ran yesterday was a lipase. She said she has s/s of it. I asked what they were, never got a straight answer. She said that magnesium will also help with her bowels. (The only bowel issue I relayed that was Barb had a little diarrhea and gray stools but that was contributed from the Omnicef Barb was on.) I told her we called the primary about this and she thought it was Omnicef also and to contact her if it happened after the antibiotic and we would do lipase and stool culture. It has not happened since. I told the new doctor that Barb wasn't having bowel problems, that stools are usually formed (soft) or pudding consistency. She also stated that the magnesium can help relax that muscle of the spincter of oddi (cause Barb had spincter of Oddi Dysfunction). I relayed the lipase was only 78 and no cause for concern, she sees a GI specilist for this, and a ERCP was done. She still wants in ordered. I relayed that I have no order for the magnesium I only had an order for a Nasal Sinus Wash and Levequin antibiotic from yesterday. She says "no I wrote it right at top". I recheck P.O. nothing there. I relayed that to this new doctor. She yes she "knew she wrote it there because we d/ced a bunch of other medications". I asked if she was thinking of the wrong patient cause we did not D/C any medications yesterday. She said it was the right patient cause we irrigated her ears (which we did). Makes no sense to me why it would be order if she isn't having problems!! Completely frustrated.



Called my supervisor. She asked me to get dictation from yesterday and get all labs done yesterday (maybe something else was drawn other than just a lipse??) Went to clinic and got both. No dictation done as of 11:40am today. Lipase was the only lab drawn yesterday(which was normal at 78).


I checked s/s for low magnesium: weakness, dizziness, irregular heartbeat, shaking, twitching, and seizures.


NONE AT ALL WHICH MY PATIENT WAS HAVING!


The doctor still wants it ordered. She is supposed to be faxing me the order. No order received yet.


Does this make sense to anyone???
I am thinking I am just going to call her primary doctor and relay this information. I just hate to go over another doctors head.

[netglow, ASN, RN]

What is the Magnesium dose? Is it to be permanent?

Some docs put patients who are on long term PPIs on magnesium -- don't know if this is something that that doctor was thinking of?

http://www.drugs.com/fda/proton-pump-inhibitor-ppis-safety-communication-low-magnesium-levels-can-associated-long-term-12913.html

[nursekara513]

I am so sorry the post above was so mess, I am unsure what happened!

Back to the magnesium.

It was ordered for Magnesium Citrate 5cc per J tube daily and to call dr if diarrhea developes (DUH ITS MAG CITRATE!). My boss, myself, and the rest of the nursing team all thought this was an inappropriate order as there was no issues. Why add another med??

She got the magnesium order for 2 days. Diarrhea developed (probably from the antibiotic she was on since the mag citrate dose was so low) but still called her PRIMARY doctor (not the one that ordered the mag) and got it d/ced :)

[nurseprnRN, BSN, RN]

mag citrate is not ordered as a magnesium supplement generally, but as a laxative. it is remotely possible that the physician thought that getting the antibiotic out of her gut would make her feel better and if she absorbed a little of the magnesium, bonus. however, i think your idea that she was thinking about another patient could be right. sounds pretty confusing.