I have a two nursing degrees, going for a third and have a whole lotta common sense. When I see stupid or hear stupid orders I may or may not carry them out..here are my all time favorites:
1) Male patient with active lower GI bleed...HGB of 5...Hypotensive and tachycardic..has 2 large bore IVs running with NS wide open as fast as it will go...blood bank working as fast as possible to get me my units of PRBCs ASAP...BP barely 90 systolic.
Order from resident: "We need orthostatic vitals on this patient"
Psych patient going wild in the ER, multiple attempts of calming the patient failed secondary to his schizophrenia and paranoid delusions. Security was already in the room physically restraining him.
Expecting some Halodol and Ativan orders, got:
"attempt to verbally de escalate the patient"
I would have told him...YOU talk to the patient and "de-escalate" him!!!!
"I think I would have told the person who wrote that order that "this is a no-kill shelter we don't do that here."
Great comeback!! Would love to see the face if that was said :chuckle
Had a good one a couple of weeks ago *NOT* -- pt is left side flaccid, on a peg, can't communicate except for nodding his head "yes" -- which he does to everything. This "yes to everything" is charted all over the place, including a sign over the freakin' bed, and pt tends to run hypotensive...
Can you see what's coming?
Nurse brainless on dayshift sails in, gets report, including me saying, "HE NODS YES TO EVERYTHING." She goes and asks my pt I've had all night if he's in pain -- he nods -- there goes 4mg morphine IV push, didn't look at his BP, and WHAMO, hypotensive crisis.....
as for the 2 units for sugar over 150, it depends on the patient's condition. If they have a nasty infected wound it is going to take longer for it to heal if their sugar is over 150.
I'm still in my first year and I don't work with residents that much but I liked this one for a guy admitted with intractable back pain (average size person). 8mg. morphine iv q 1 hr x 5 hours prn pain. Call if pain is greater than 5/10 after 5 hours. We might be calling you and respiratory if we actually give that 40mg of morphine.
In the ICU where I work, according to our protocol if the blood glucose is 110-150, we give two units of regular insulin. It doesn't matter if the patient is NPO. They get insulin coverage no matter what. Tighter glycemic control leads to less infect and better wound healing.
We have an MD that frequently orders urine Hcg's to R/O pregnancy on abd pains and before getting back or abd. films. That's fine, but on our hysterectomy patients?? Also he will order a urine hcg and beta hcg at the same time. I understand maybe urine first then blood to confirm approx. gestation, but really! I often wonder what these patients insurance companies have to say...or how much of these test cost we have to eat.
These docs are like freakin robots--mark the same boxes over and over and over. Just look at the trige sheets, please. Save me some busy work!!
What's the "hmm" for? Are you judging me because I didn't know what that meant? I've been a nurse for three years too and have never seen that as an order before.
Saw this order a lot on the ortho floor post knee/hip replacements.
Anything written in ancient egyptian letters....oh wait, that's supposed to be English. How about you take an extra 30 seconds out of the 2.5 hours you spent tying up my ED bed while you write admitting orders and bother writing a little bit slower so that they are decipherable. Anything less is just rude. And if you think I will spend any more time than 10 sec, approaching every nurse in the unit to see what they think an order says, you are mistaken. Your speed and sloppiness is going to cost you a phone call to me to explain your order. I don't have time or the inclination to guess what it says and if it annoys you that I've bothered to interrupt you to ask in order to prevent an erorr, I guess in the future you'll write it more clearly.....If only we would all stick together and do this...
Dolce, RN
861 Posts
That is priceless.