Had a patient that just had abdominal surgery, was doing fine with pain, but began having a huge amount of abdominal pain a couple days after surgery. Like he wasn’t requiring much in the way of opioids for pain control, then suddenly started needing full PRN doses on schedule.
I worked nights at the time and the surgeons rounded early in the morning. I expressed my concern about this increased pain that didn’t seem to match up with the situation, incision was looking great, no drainage, and no other s/s of sepsis, although I was concerned the extreme pain was trouble brewing for an infection.
The senior surgical resident looks right at me and goes, “well he just had major surgery...” I couldn’t help myself, I said, “oh wow I did not know that, that must be the cause!” Like really dude? I know! I’m concerned something bad is happening in there!
Specializes in OR, Nursing Professional Development.
On 4/9/2021 at 9:27 AM, klone said:
A doctor is to give a speech at the local AMA dinner. He jots down notes for his speech. Unfortunately, when he stands in front of his colleagues later that night, he finds that he can't read his notes. So he asks, "Is there a pharmacist in the house?"
When talk of the Covid pandemic hit in earnest and people started really freaking out, I made a passing comment to one of our doctors that I predicted rates of vaccination for flu were going to go way up— because everyone was suddenly hyper-aware of illnesses and super concerned about viruses. He said, “Well you know, Covid is a coronavirus, which is different from influenza.” I... I know that. Thank you, doctor.
So, this past week I’ve learned quite a bit at work. I’ve really been impressed with how wise some of our doctors are.
Some Words of Wisdom that they have offered:
1. If a patient is having loose stools, you should hold their bowel meds
2. A patient with a skin tear on their arm should try not to bump their arm as this could lead to reopening of the wound
3. A patient with a broken hip should avoid falling on that hip to prevent further injury
4. Antihypertensives should be held for low blood pressures
5. Patients at risk for aspiration/choking should eat slowly, eat small bites and be supervised during meals
The intelligence and thought that went into each of these orders is incredible. So insightful are these recommendations.
Who else has any Words of Wisdom to share from wise providers?
C'mon. These are within the scope of nursing practice. You don't need MD orders for these things, including #1 (there are reasons to continue to give these bowel meds however even with loose stools) and #4.
C'mon. These are within the scope of nursing practice. You don't need MD orders for these things, including #1 (there are reasons to continue to give these bowel meds however even with loose stools) and #4.
Hence the words "wise." Post was written with an intended sarcastic tone LOL. But yes, you are right about 1 and 4
Specializes in mental health / psychiatic nursing.
On 4/9/2021 at 5:42 AM, Davey Do said:
I overheard Dr. G, a psychiatrist on the phone with the intake center, say this regarding a possible admission:
"You can't admit someone for just being weird."
He's not wrong. People are allowed to be stupid. People are allowed to be eccentric. Being either of those things does not automatically mean a ticket to an inpatient psych bed. Sometimes people are just weird and there is nothing pathological about it.
Specializes in mental health / psychiatic nursing.
On 4/8/2021 at 9:42 PM, SilverBells said:
So, this past week I’ve learned quite a bit at work. I’ve really been impressed with how wise some of our doctors are.
Some Words of Wisdom that they have offered:
1. If a patient is having loose stools, you should hold their bowel meds
2. A patient with a skin tear on their arm should try not to bump their arm as this could lead to reopening of the wound
3. A patient with a broken hip should avoid falling on that hip to prevent further injury
4. Antihypertensives should be held for low blood pressures
5. Patients at risk for aspiration/choking should eat slowly, eat small bites and be supervised during meals
The intelligence and thought that went into each of these orders is incredible. So insightful are these recommendations.
Who else has any Words of Wisdom to share from wise providers?
Unfortunately coming from the other side of things as an NP all of these sound completely reasonable orders or at least recommendations (Which sometimes turn into orders when no one follows them) to me. These things come about because people are either extremely literal and will only do exactly as ordered, don't realize scope of nursing practice, or because actual harm relating to something "oh so obvious" has actually occurred. Or because sometimes no matter how clear I think my order is - I somehow end up with 5 different RNs calling me to clarify it over and over again by adding stuff like this to it.
All of those wise 'orders' look like they're pretty much interventions to be written into a pt care plan. Routine stuff from what I see for care plans.
0.9%NormalSarah, BSN, RN
266 Posts
Had a patient that just had abdominal surgery, was doing fine with pain, but began having a huge amount of abdominal pain a couple days after surgery. Like he wasn’t requiring much in the way of opioids for pain control, then suddenly started needing full PRN doses on schedule.
I worked nights at the time and the surgeons rounded early in the morning. I expressed my concern about this increased pain that didn’t seem to match up with the situation, incision was looking great, no drainage, and no other s/s of sepsis, although I was concerned the extreme pain was trouble brewing for an infection.
The senior surgical resident looks right at me and goes, “well he just had major surgery...” I couldn’t help myself, I said, “oh wow I did not know that, that must be the cause!” Like really dude? I know! I’m concerned something bad is happening in there!