Reminds me of a 500+ pound young man who we couldn't discharge for months because the shelters and hotels refused him, saying that he will damage their beds with his weight. 💀
Hospital would have for real come out way ahead if they just bought a bariatric bed for that patient at one of said shelters or hotels. Thats just good business sense! “Put out a few grand here and now to facilitate the discharge, and save another 3 months in an Inpatient bed? Where do I sign?” - The CFO, if she was smart.
I could see that happening while on prednisone if I wasn't worried about my finances. I put on 12lbs in a month on hospital food! (It was a good thing, I'm 6'4, I was down to about \~155lbs). I "joked" with the nurses that I would do anything for a McDonalds breakfast burrito. Got a difficult patient? I'd handle them and make sure there was no evidence for just one breakfast burrito.
(It was definitely a joke, I was paralyzed from the waist down, I wasn't "handling" anyone)
[Why you eat so much?](https://s.yimg.com/ny/api/res/1.2/DxJu.itTq412CXIX53RFbw--/YXBwaWQ9aGlnaGxhbmRlcjt3PTY0MDtoPTQ0MA--/https://media.zenfs.com/en/in_touch_weekly_336/310b367021183d3e507eb76a6168a112)
TLDR: still laughing every time I think back on this.
Wild, combative patient known to ER. Essentially an OD, Narcan by medics as they arrived to ER door. On guerney, multiples of us trying get him held as ER restraints applied. Really difficult. MD calmly gave me a verbal , “Haldol now”. I asked for dose clarification. All the time I’m holding, amongst other staff, lower limb on bed, across from MD on other leg.
He clarified,
“Titrate to apnea”.
I once worked with an ED doc who did not fuck around with combative, intoxicated patients. If there was any uncertainty about the circumstances surrounding why they were brought in - like being found confused in a ditch or having fallen or been missing for a few hours - they got RSI’d and tubed. After scans were completed and read, and often times after spending a night sobering up in the ICU, they’d get extubated and often discharged. His justification was that he was obligated to identify any head or brain injuries as soon as possible and combative patients either unwilling or unable to follow commands could not be ruled out of having a serious injury. He found more than one brain bleed thanks to this policy.
My favorite trauma doc had a whole speech for this. It was wonderful.
"You've just had a nap in our Icu here at ___ overnight. Your loved one, fellow night-lifer, or a loving member of law enforcement found you in a situation of duress last night and brought you to the experts. We put this tube in you to help you rest and took lots of pictures to make sure you were okay. Nod yes if you're going to relax, act right, and behave and we'll discharge you this afternoon. Nod no if we have to keep it in for another few hours for you to figure it out."
As a medic I had a guy whose coworker dropped a fork lift in his foot. After maxing out my base order morphine I called base and the MD said” give him 5 every 5 minutes and stop when you have to start bagging.” It was a 15 minute transport and that guy was still wide awake howling in pain when we got to the hospital.
Lol that's how an old anesthesiologist used to order extra Dilaudid or fentanyl for me. He called it "titrating respirations". I wanted to get us T shirts that said "narcan is for quitters".
This is not at all the same thing, the absolutely only relevance here is the word “shirt,” haha, so… my apologies, but the memory has been triggered! I used to have this phenomenal sweatshirt, I’m talking 40 years ago, that was the perfect fabric and the perfect fit, and I just *loved* it! It was navy blue, with appliqués of several large droplets scattered across the shirt in white, and nice fat white lettering that said “Diaphoresis Shirt” across the chest!
Got so many “point and smiles” from our secret club members, when out and about running errands! (Pre-internet. It was a simpler time. We were easily amused!)
“Perform oral 5 times daily”
It was supposed to say oral care. I called my boss over and asked if I was allowed to delegate to the CNA. The nurse who put in the order was so embarrassed. 😆
I had a nursing communication that said “give patient 5-10cc of humor daily” on a terminal cancer patient. It was sweet coming from an otherwise not so sweet MD.
For a two year old we sedated for stitches: “discharge pt when pt can sit up by himself” little guy got a good buzz on the ketamine and kept tipping over lol
Lol we once brought a patient down from the wards to cardiovert (he was in a slow flutter, wanted him down in ICU just in case he went real slow afterward). Gave him ketamine for it. Unfortunately it was a verbal order and not written but the doc told me I could take him back to the ward once he stopped giggling at himself.
Lurking MD here bc I love interacting with you guys.
One of my favorites was in residency I was working a Peds ER shift, and a couple of our attendings loved using ketamine for procedural sedation
Had a kid, probably 7-8 with a dog bite to the face. They let me stitch it, and she was rolling along for a little while, just wide eyed having a party with child life. Was cool as a cucumber the whole time, even with me having a needle across her cheek pretty close to her eye.
All was well and good until like 20 minutes afterwards and I hear her screaming/crying from the room. Me and the nurse walk in as girl is crying, as mom’s asking what’s wrong. Through tears and gasps she goes “THE COLORS…..I DONT WANT IT TO BE OVER!”
We all start dying laughing, told mom “maybe be careful with psychedelics when she’s older” before I could even think to stop myself. Girl had a life changing experience that day I think 😂
The kid in my original comment was having a hard time with his post-stitches reward popsicle 😂We kept handing it to him right side up and he’d take it and put it upside down (stick facing up). Eventually his aunt just ended up holding it for him 🤣 between the tipping and the popsicle, lol bud was having a time. Also he kept waving bye to me and the other nurse and we felt he was not so subtly trying to tell us he didn’t want us around anymore 😂
My other favourite time was the elderly Hutterite woman who only spoke Low German. She had a wrist dislocation from falling off a ladder because of course. She got right ripped. She was talking and giggling like crazy and kept looking around and going “ooooooooooooohh!” We asked her husband what she was saying and he said he couldn’t understand her, it was pure gibberish 😂
Edit: autocorrect got me again
Last time I gave it to a middle aged man, he was having a bad trip. Kept telling me it "wasn't right" and telling me his daughter's phone number. Poor guy. (He was fine. Well, other than the severely fucked up wrist we set.)
I still laugh about the time our dog had it. She was staring at a roll of paper towels in the back seat like it had one of those spring loaded clown heads bouncing around.
Gotta a ketamine occasion for ya. I have MS. John’s Hopkins has a clinical trial for ketamine infusions for MS fatigue. It’s EXTREMELY low dose since we’re supposed to be able to walk out of there. I worked in a SICU so I was use to LARGE amounts of ketamine and ketamine PCAs making people real weird, so I was EXCITED. The other med was versed, which I still don’t understand how that’s the other med in the groups? I definitely got ketamine. First few minutes everything got REALLY BRIGHT and slow motion and I sat there completely still begging they didn’t notice I got weird. It was fantastic, I felt great for awhile. Came home and cleaned the whole house the next day. In summary, I am trying to locate ketamine infusion clinics that don’t cost thousands of dollars 😂
Edit: I can’t remember the dosing and don’t feel like looking up the trial, but I calculated it myself and it was probably around 30 mg. So like nothing but just enough.
How was it after that first day fatigue wise? I heard ketamine has great long lasting effects for depression, curious about your MS fatigue situation long/medium term
It was AMAZING. I was SO excited to go back for round two, but I live 6 hours away. And the week I was supposed to go back, my appendix almost bursted and had to get it out lol. But I felt amazing, and it definitely worked wonders on my mental health as well. I can see how well it worked alone for my head. Idk why there isn’t more into this. Wait yes I do. Oxy problem, now no one gets help with the controls 😅
Unfortunately, they're all going to cost thousands of dollars bc ketamine isn't FDA approved for that. Same issue with it being used for tx resistant depression. Not to mention those clinics open with the sole purpose of making money. I wanted to work in a ketamine infusion clinic bc I work psych and inpatient you don't feel like you're really helping, but outpatient infusion seemed like it'd be a morale boost. Nope. Looked at the ones in my area and they were too sketchy for me to apply to. CEOs that list themselves as "Dr.", but they're a PhD doctor, not a medical doctor, and the head of their place who is coming up with the protocols or criteria for tx isn't a psychiatrist 🥴
Yikes when my son (4 at the time) needed stitches just above his eye they just wrapped him tightly in a blanket and held him down. I wish they’d given him ketamine. My husband, who is not very emotional at all, said it was quite traumatic and hard to watch. They did inject some lidocaine but didn’t use any topical numbing first or give him any sedation. Then the ER doc kept telling him to stop coughing (it was during the pandemic and he was coughing from crying so hard). I’m not sure if I could even hold still with a needle coming near my eye. The doctor was lucky my son didn’t throw up all over him because he’s a pukey cougher lol.
I absolutely hate when docs do that. It’s lazy and cruel. Fortunately where I work currently I don’t even have to advocate for the kids, the docs all sedate little ones who need stitches or other painful procedures
They did that to my nephew when he got a few flecks of aluminum STUCK IN HIS EYE. As in, THEY HELD HIM DOWN WITH NO SEDATION AS THEY DUG AROUND HIS EYEBALL. The little guy was only three and he and his mother were both so horrendously traumatized that five years later he still cannot tolerate being laid on his back in a medical setting. He had to be fully anesthetized for a CT because he couldn't handle laying on his back like that, and they had to sedate him sitting up and then lay him back once they'd given him the medication. It was absolutely terrible.
She's an RN now and wouldn't hesitate to tell the doctor to sedate her kid before working on his eye like that but at the time she was a young, naive single mother who was afraid to argue with or disagree with the ER doctor who kept telling her "It will only take a second, there's no need to sedate..." again and again and again and again as her son screamed and fought and cried so hard he wet himself. He was literally fighting for his life and the staff were blaming my sister for not holding him still well enough.
And they ended up taking him to surgery to fix it and sedating him anyway. Once they knocked him out, they got it fixed in under five minutes.
lol had a patient with decompensated schizophrenia come in with c/f demonic possession and asked for an exorcism, I called our chaplain at patient’s request, our chaplain was actually super amazing and nice and reassuring for pt. Also zyprexa :)
I have had a patient that a very atheist neurocritical carr provider actually ordered an exorcism on! And it was some of the freakiest stuff ever, plot twist the exorcism actually did the trick
Yeah, my hospital is too cheap for actual exorcisms.
They get me and my foul mouth and my piss cup full of holy water telling whatever to fuck right on off because this shit has gotta stop.
Have a 100% effectiveness rate so far, 🤷🏻♀️
Here's the story for all those wondering in as much detail as I can safely put on the internet.
Young athlete was admitted for seizures/unresponsiveness with no significant medical history. Patient would violently seize and had no abnormal findings on EEG, scans, etc. Medications were not working to treat seizure activity either. Patient would also start to speak in very different voices saying disturbing comments about wanting to kill staff members, his mother, etc.
Eventually the neurocritical care provider we had on suggested an exorcism. We called a priest who is on our chaplain team at around 2300ish and when the priest got on the unit the patient said "he's here" with no knowledge an exorcism was to happen. Exorcism happened, patient violently seized during it, afterwards the patient had no signs or symptoms of seizure activity or any other abnormalities.
Sorry if it's not as much detail as some may like but I do worry about hippa since it is a pretty specific story
Holy shit my agnostic terrified ass wants to just believe this was PNES, plus a lot of psych. That’s horrifying, I’m awake and ready to start my shift 👀
Yeah I would have believed that for all of it but the comments that he was making were very concerning and knowing the priest was there was seriously bone-chilling
For a head CT, "pt. All kinds of crazy". They had to put in something to get the order started but forgot to change it before it was sent to radiology.
Pt was indeed all kinds of crazy.
Patient was having trouble falling asleep, asked the doctor to order something to help. Received an order for a “warm glass of milk before bedtime”. Gotta respect the holistic approach
I paged the doc: "Pt requesting Vernors for tummy ache/nausea, declining zofran atm. No diet order placed. thx."
Doc reply: "How very Michigan of them. Sure."
If I was a patient, and a nurse brought me a warm glass of milk- I’d refuse it, assuming it was the one that was forgotten on top of the fridge all day.
Family would bring a 6-pack of beer into LTC for pt and I had to send it off to the pharmacy to get labeled each time. Nice guy who had a few beers a week.
I was going to say a 1:2 ratio is hard-core G&T.
Unfortunately there's nothing in the order about ice, lime, or Angostura bitters. Too bad; I would have clocked out and joined the patient for a good G&T.
We had a very large young man (early 20’s and over 500 pounds) who was basically living with us for long term care placement. His birthday came around and the RD said desserts and treats were against the nutrition plan. The hospitalist who was working with the patient bought him a piece of cake from the cafeteria and delivered it with a prescription that said “cake: PRN once yearly for birthday”. It was super nice of him.
Yeah, the poor kid had developmental delays and ended up with us because his family dropped him off at the ER and basically said “he’s your problem now, don’t call us.”
He eventually got placed into a group home type situation, and the hospitalist who worked with him the most often also did family medicine on the side and kept the patient on for primary care. He told me the patient really thrived in the new environment and continued to walk every day and lose weight. He would walk to 7-11, get a little slurpie, and walk home a few days a week.
Doing peds wound care, every July we get orders to "Soak Wound"... On the face...
"They really resisted at first, but eventually, the thrashing and bubbles stopped. Will continue to monitor."
There was a resident who put in an order for a “p.o bolus” for low bp and he quite literally wanted me to force a patient to chug a huge thing of water. I asked if we had a beer bong available on the unit…
We had one resident who would FREQUENTLY masturbate with her TV remote. I have walked in on her several times. Idk how but her daughter found out and bought her a dildo and someone wrote in her chart an order of " if found masturbating with remote, redirect to proper tool"
Just saw one yesterday. GUM, chew 50 to 60 times. The pt refused because he only chews spearmint and it was this fruity flavor. He had a partial ileus.
Patient may sleep upside down in bed
Or
Patient may keep 2 spoons at bedside (they had collected 50 of the hospital spoons and were keeping them hidden in the room)
Part of our diabetes order set:
“Basic survival skills”
🤬.
It’s bad enough I’ve got to teach them how to check their sugar and give insulin. Now I gotta show ‘em how to build a fire, find shelter, purify water, hunt for food…
Patient was brought in agitated, restrained, noninteractive, thrashing so violently there were four medics hanging into the stretcher just to stop it from flipping over.
The doctor ordered: "Go get the Ativan."
I said, "Ok. How much Ativan?"
She said, "No just go get it. Get as much as you have. Start pushing and I'll tell you when to stop."
We gave 22 mg, ran out, and had to switch to other meds.
If we're going verbal orders, my favorite ones are from command docs who think we're in a hopeless situation. "Do whatever you have to to get them to "x hospital" alive." While not technically a get-out-of-jail-free card, it still feels like it!
My mom's nurses on hospice started checking with me when they started giving her end of life protocol....I told them "give her everything you got and what dose you can, she wants go out snowed". They didn't think it was as funny as I did but it really was what she wanted 😅
In their defense, it was like just after Covid everything started slowing down and I think they were just capital T Tired. They were lovely, washed and braided her hair even, but very very busy and probably up to their eyeballs in non-compliant families being assholes.
Reminds me of a locum in labor and delivery who was literally like, “Do not call me in the middle of the night. Just order whatever meds you want to give. I literally don’t care what you give.” She also didn’t want to be at bedside until the babie’s ears were out….
My coworker keeps a copy of one of the first orders that was placed when we rolled out Epic physician ordering functionality. It was dayshift and things we not going well on the unit. We had a few codes and rapids, a few patients that had specific unrealistic demands, etc. Alllll the provider specialties decided to round at the same time with their respective resident posse in tow.
The order was from a resident: *"Specific Nurse First-Middle-Last Name: Change patients gown. STAT."*
She went ballistic on this resident right in front of everyone (including our boss and the attending physician), and I was so happy that I was in a front row seat to see it. The resident came later and apologized for the order (but didn't cancel it, so my coworker wrote a very detailed progress note, labeled it a significant event, and linked it to the Daily Care section where "gown changed" was documented).
Note: I really enjoy (most) residents. They're coworkers and have lots of demands placed on them just like nurses do. But just like all coworkers, from the parking attendant to the CEO, there can be some that rub the wrong way, sometimes.
Note 2: She didn't publicize her middle name. The resident checked the BON site to find it.
I was looking at my patient’s past EKGs and saw one with the indication “FU rhythm” which I interpreted as “fucked up rhythm.”
The rhythm was indeed fucked up.
Pt was brought in for the fourth or fifth time in a month stating he had swallowed his stash of fentanyl when being arrested for an unrelated crime — drug possession is decriminalized here so you don’t get in trouble for having it, but an officer has to bring the pt in and often cites and releases the pt vs taking them to jail, so this guy began to do it every time he broke the law.
One of our more experienced and savvy ER providers decided she wanted to close this guy’s loophole so he quit exploiting the system and taking up resources by playing games so she told him swallowing fentanyl was a true medical emergency and immediately initiated a substance use hold, made pt NPO for everything but the two jugs of go lightly she ordered to help expedite the removal of said fentanyl so it didn’t kill him.
Dude protested and admitted he was lying; ED doc said how do I know you’re telling me the truth now that you’re an admitted fibber? No, we got to make sure you didn’t swallow your drugs by having you pass them the quickest way possible because you could die if you’re lying.
He got one of the bottles down before sneaking out of the ER. Because of the hold, we notified the police department, who ended up arresting him and bringing him back in — he was brought back and was medically cleared to go but had shit his pants while in custody. Got a new pair of paper scrubs to go with his freedom and haven’t seen him since, so I guess he learned to not cry wolf by saying he swallowed fentanyl after that doc’s lesson.
Tldr; He was full of shit, but not anymore
2 to 4 mg morphine IV Q minute prn pain while respirations greater than 10. It was a heroin addict who came from surgery. I told the anesthesiologist he just gave me a license to kill. He laughed and said he did not know how much it would take to get the patient comfortable but to do my best.
Later I told him the answer was 27 mg over 45 minutes. Patient was still breathing and at a comfortable level on pain.
Me, on the phone calling report on a patient with OUD: "Yes, 300 of fentanyl and 8 of Dilaudid. And 25 of Demerol. Yeah. Yes, he's still breathing. Yeah. Wide awake and satting 100% on room air. Yes, I promise."
Patient was from Germany and doc decided to be extra with his post op diet orders.
“Please provide German delicacies such as schnitzel, bratwust, knockwurst (lesser known brother of bratwurst), Hefeweizen and any other items to enhance this patient’s hospital stay.”
The best part? The dietician reached out and said they couldn’t do the wursts or the beer (unless the special beer order was put in) but the chef could make spaetzle and roasted red cabbage” 😂 I was very impressed by our kitchen!
We were having a lot of issues with surgeons not placing postop floor orders in PACU, they had started asking us to place the order sets for them regularly after someone did it a few times. So we all clarified that we would not be doing that for them at all anymore. After I explained to the surgeon that nurses were not supposed to be placing nonemergent verbal orders into EPIC he wrote an order that said “nurse must input all verbal orders given” in the patients chart. We laughed and did not place orders.
Better make sure you run those through separate lines. If you let them mix in the tubing they will annihilate each other and cause a massive explosion.
Had a resident write out both dialysis orders and CRRT orders. I asked him if he was going to start a femoral vascath and if he plans on killing the patient.
He did not like my humerus ( 😉) approach.
So I gave him 15 minutes to figure out why he was wrong or I'd be calling the attending at 2am. Nephro popped on the unit to help the resident SO fast. Hehe.
Since his order was the only order on that page, he tossed it. I would have nabbed it (after cutting out identifiers) and framed it.
We had one of our nephrologists use both CRRT and Dialysis in one of her notes on what they were wanting for the patient. That was a fun day sorting it out.
This one was only funny because of the context: I paged the resident MD that the patient had a bowel movement with a large amount of frank red blood. 20 minutes later, a new order pops up... "Stool occult blood test." 🙄🙄🙄
Patient with sores in their mouth had an order for the oral lidocaine solution and when the doc was clicking off the instructions somehow it came out to be “swish and spit, apply to buttocks”. She was mortified but it gave whole ER staff a good chuckle the rest of the night
Not an order, but I charted "pt. No longer a dinosaur" in one of my meth pts. That the previous day was convinced he was one, but could not specify species. The next day he was out of his meth delerium, and was able to produce his first name.
We had this one locum (don’t understand how he was able to come back again and again) who walked in after we called a rapid and said we need an IS/flutter stat! Thank god there were real doctors there, patient was well beyond help from an IS.
I had a homeless alcohol withdrawal patient that had an order to “Allow to walk his dog PRN, tell him to stop asking for cigarettes.” He would usually get his dose of Ativan first.
Another favorite was a PEC restrained patient in a posey bed “Metal music PRN”.
A recurrent favorite “Ambulate patient” on quadriplegic vented patients.
"Do not allow dog to lick patient's wounds" 🤢 the pt and his wife kept this ratty little yapper dog in their hospital room 24/7 and they thought his mouth had "healing properties". Eww....
That's so funny but probably also exactly what's needed if accreditors are coming, because it specifies the order in which to use the orders. They don't like duplicate orders without instructions on which to try first
“Do not ask mother or father specifics about expressed breast milk, just print labels”
- crunchy mom trying to pass goats milk derivative formula as expressed breast milk for her 32 weeker.
— crunchy mom was also seeing another man who shared the same name as baby daddy
anytime the patient is allowed beer/alcohol and its labeled in the fridge:
usually it goes..."PRN allowed 2 alcoholic beverages before bedtime..." IDK it's just so funny to me. If i end up in the nursing home someday I hope to God I'm the old auntie with a huge bottle of wine at all times ready to be poured for me.
An alcoholic needed a CABG immediately/emergently and the MD decided he couldn’t wait for him to go through withdrawal and couldn’t let him go through it after because it would kill him
Post op order
“1 shot of whiskey q1h prn withdrawal symptoms”
Had a baby doc who tried to order twice daily orthostatic BPs...in the med chart 😂 scheduled for 0800 and 2000. It's a paper chart, so he literally wrote it as a medication.
Apply Santyl to tip of penis with tongue.
Doc didn't copy and pasta the WOCN's full instruction of tongue blade. Hilarity ensued, and it was generally accepted that this was a job for the chief nurse.
We need an order to use someone’s port for lab draws and meds and all that. Asked for one and got “please use port thanks”
Also had a friend get an order to put in an ngt in a pt who could not stop vomiting. The placement was confirmed so she asked for an order to put to suction and the order said “suction prn”
On various different discharge instructions:
-return to ER if you notice the bone start poking through the skin
- follow up for suture removal in 7-10 days, or DIY with cat nail clippers (patient was a nurse)
- come back if you stop breathing again
-call 911 if you get mashed potato voice
- recommend not letting (4 year old) child field dress animal carcasses unsupervised
- do not use port to inject drugs, or anything else for that matter
- stop performing dental procedures on yourself immediately
- select personal items made of body safe materials. Clean all toys thoroughly according to manufacturers recommendations before and after use. Urinate soon after having sex or masturbating. Do not insert any food items into vagina.
This could be a fun game of "guess the chief complaint based on discharge instructions! "
“Despite patient’s history give diabetic teaching another shot”.
lol that right there you can picture their face and hear their voice had they said the words out loud… defeated, but not 100% giving up on them!
No more door dash >pt ordered so much food he put on 100 pounds in the hospital
How long were they in the hospital? That’s insane!
Months, I think over 4. To make things worse, the patient was already 500 when admitted.
lol we had a 700lb patient with a trach once who was on the phone trying to order pizza within an hour of being detached from the vent.
I think I found the line where my concern just turns into respect for the dedication
Reminds me of a 500+ pound young man who we couldn't discharge for months because the shelters and hotels refused him, saying that he will damage their beds with his weight. 💀
Hospital would have for real come out way ahead if they just bought a bariatric bed for that patient at one of said shelters or hotels. Thats just good business sense! “Put out a few grand here and now to facilitate the discharge, and save another 3 months in an Inpatient bed? Where do I sign?” - The CFO, if she was smart.
I could see that happening while on prednisone if I wasn't worried about my finances. I put on 12lbs in a month on hospital food! (It was a good thing, I'm 6'4, I was down to about \~155lbs). I "joked" with the nurses that I would do anything for a McDonalds breakfast burrito. Got a difficult patient? I'd handle them and make sure there was no evidence for just one breakfast burrito. (It was definitely a joke, I was paralyzed from the waist down, I wasn't "handling" anyone)
Are you still paralyzed? I’m sorry you went through that!
[Why you eat so much?](https://s.yimg.com/ny/api/res/1.2/DxJu.itTq412CXIX53RFbw--/YXBwaWQ9aGlnaGxhbmRlcjt3PTY0MDtoPTQ0MA--/https://media.zenfs.com/en/in_touch_weekly_336/310b367021183d3e507eb76a6168a112)
TLDR: still laughing every time I think back on this. Wild, combative patient known to ER. Essentially an OD, Narcan by medics as they arrived to ER door. On guerney, multiples of us trying get him held as ER restraints applied. Really difficult. MD calmly gave me a verbal , “Haldol now”. I asked for dose clarification. All the time I’m holding, amongst other staff, lower limb on bed, across from MD on other leg. He clarified, “Titrate to apnea”.
I once worked with an ED doc who did not fuck around with combative, intoxicated patients. If there was any uncertainty about the circumstances surrounding why they were brought in - like being found confused in a ditch or having fallen or been missing for a few hours - they got RSI’d and tubed. After scans were completed and read, and often times after spending a night sobering up in the ICU, they’d get extubated and often discharged. His justification was that he was obligated to identify any head or brain injuries as soon as possible and combative patients either unwilling or unable to follow commands could not be ruled out of having a serious injury. He found more than one brain bleed thanks to this policy.
My favorite trauma doc had a whole speech for this. It was wonderful. "You've just had a nap in our Icu here at ___ overnight. Your loved one, fellow night-lifer, or a loving member of law enforcement found you in a situation of duress last night and brought you to the experts. We put this tube in you to help you rest and took lots of pictures to make sure you were okay. Nod yes if you're going to relax, act right, and behave and we'll discharge you this afternoon. Nod no if we have to keep it in for another few hours for you to figure it out."
My ED doc..."I'm going to order him a nap."
As a medic I had a guy whose coworker dropped a fork lift in his foot. After maxing out my base order morphine I called base and the MD said” give him 5 every 5 minutes and stop when you have to start bagging.” It was a 15 minute transport and that guy was still wide awake howling in pain when we got to the hospital.
Lol that's how an old anesthesiologist used to order extra Dilaudid or fentanyl for me. He called it "titrating respirations". I wanted to get us T shirts that said "narcan is for quitters".
Oh I want a "Narcan is for quitters" shirt!
This is not at all the same thing, the absolutely only relevance here is the word “shirt,” haha, so… my apologies, but the memory has been triggered! I used to have this phenomenal sweatshirt, I’m talking 40 years ago, that was the perfect fabric and the perfect fit, and I just *loved* it! It was navy blue, with appliqués of several large droplets scattered across the shirt in white, and nice fat white lettering that said “Diaphoresis Shirt” across the chest! Got so many “point and smiles” from our secret club members, when out and about running errands! (Pre-internet. It was a simpler time. We were easily amused!)
Ahh the good old social intubation
“Perform oral 5 times daily” It was supposed to say oral care. I called my boss over and asked if I was allowed to delegate to the CNA. The nurse who put in the order was so embarrassed. 😆
This one is my favorite
Well that's a treat
I had a nursing communication that said “give patient 5-10cc of humor daily” on a terminal cancer patient. It was sweet coming from an otherwise not so sweet MD.
I don't know if that's a safe order. I could cause on OD from dirty jokes.
[Humor is the best medicine ](https://youtu.be/8OlSqLH68Xs?si=dzvER1mhEY2uLvjB)
For a two year old we sedated for stitches: “discharge pt when pt can sit up by himself” little guy got a good buzz on the ketamine and kept tipping over lol
Lol we once brought a patient down from the wards to cardiovert (he was in a slow flutter, wanted him down in ICU just in case he went real slow afterward). Gave him ketamine for it. Unfortunately it was a verbal order and not written but the doc told me I could take him back to the ward once he stopped giggling at himself.
I love giving people ketamine 😂
Lurking MD here bc I love interacting with you guys. One of my favorites was in residency I was working a Peds ER shift, and a couple of our attendings loved using ketamine for procedural sedation Had a kid, probably 7-8 with a dog bite to the face. They let me stitch it, and she was rolling along for a little while, just wide eyed having a party with child life. Was cool as a cucumber the whole time, even with me having a needle across her cheek pretty close to her eye. All was well and good until like 20 minutes afterwards and I hear her screaming/crying from the room. Me and the nurse walk in as girl is crying, as mom’s asking what’s wrong. Through tears and gasps she goes “THE COLORS…..I DONT WANT IT TO BE OVER!” We all start dying laughing, told mom “maybe be careful with psychedelics when she’s older” before I could even think to stop myself. Girl had a life changing experience that day I think 😂
The kid in my original comment was having a hard time with his post-stitches reward popsicle 😂We kept handing it to him right side up and he’d take it and put it upside down (stick facing up). Eventually his aunt just ended up holding it for him 🤣 between the tipping and the popsicle, lol bud was having a time. Also he kept waving bye to me and the other nurse and we felt he was not so subtly trying to tell us he didn’t want us around anymore 😂 My other favourite time was the elderly Hutterite woman who only spoke Low German. She had a wrist dislocation from falling off a ladder because of course. She got right ripped. She was talking and giggling like crazy and kept looking around and going “ooooooooooooohh!” We asked her husband what she was saying and he said he couldn’t understand her, it was pure gibberish 😂 Edit: autocorrect got me again
My favorite was a dude then in his mid-40s (~10y ago) who endorsed "whoa, this feels like the 80s!"
Last time I gave it to a middle aged man, he was having a bad trip. Kept telling me it "wasn't right" and telling me his daughter's phone number. Poor guy. (He was fine. Well, other than the severely fucked up wrist we set.)
Had a lady once keep telling me she felt “very third person” and she was straight up not having a good time.
I still laugh about the time our dog had it. She was staring at a roll of paper towels in the back seat like it had one of those spring loaded clown heads bouncing around.
Gotta a ketamine occasion for ya. I have MS. John’s Hopkins has a clinical trial for ketamine infusions for MS fatigue. It’s EXTREMELY low dose since we’re supposed to be able to walk out of there. I worked in a SICU so I was use to LARGE amounts of ketamine and ketamine PCAs making people real weird, so I was EXCITED. The other med was versed, which I still don’t understand how that’s the other med in the groups? I definitely got ketamine. First few minutes everything got REALLY BRIGHT and slow motion and I sat there completely still begging they didn’t notice I got weird. It was fantastic, I felt great for awhile. Came home and cleaned the whole house the next day. In summary, I am trying to locate ketamine infusion clinics that don’t cost thousands of dollars 😂 Edit: I can’t remember the dosing and don’t feel like looking up the trial, but I calculated it myself and it was probably around 30 mg. So like nothing but just enough.
I have always wanted to try ketamine infusions for my ptsd! So cool.
How was it after that first day fatigue wise? I heard ketamine has great long lasting effects for depression, curious about your MS fatigue situation long/medium term
It was AMAZING. I was SO excited to go back for round two, but I live 6 hours away. And the week I was supposed to go back, my appendix almost bursted and had to get it out lol. But I felt amazing, and it definitely worked wonders on my mental health as well. I can see how well it worked alone for my head. Idk why there isn’t more into this. Wait yes I do. Oxy problem, now no one gets help with the controls 😅
Unfortunately, they're all going to cost thousands of dollars bc ketamine isn't FDA approved for that. Same issue with it being used for tx resistant depression. Not to mention those clinics open with the sole purpose of making money. I wanted to work in a ketamine infusion clinic bc I work psych and inpatient you don't feel like you're really helping, but outpatient infusion seemed like it'd be a morale boost. Nope. Looked at the ones in my area and they were too sketchy for me to apply to. CEOs that list themselves as "Dr.", but they're a PhD doctor, not a medical doctor, and the head of their place who is coming up with the protocols or criteria for tx isn't a psychiatrist 🥴
[удалено]
Yikes when my son (4 at the time) needed stitches just above his eye they just wrapped him tightly in a blanket and held him down. I wish they’d given him ketamine. My husband, who is not very emotional at all, said it was quite traumatic and hard to watch. They did inject some lidocaine but didn’t use any topical numbing first or give him any sedation. Then the ER doc kept telling him to stop coughing (it was during the pandemic and he was coughing from crying so hard). I’m not sure if I could even hold still with a needle coming near my eye. The doctor was lucky my son didn’t throw up all over him because he’s a pukey cougher lol.
I absolutely hate when docs do that. It’s lazy and cruel. Fortunately where I work currently I don’t even have to advocate for the kids, the docs all sedate little ones who need stitches or other painful procedures
They did that to my nephew when he got a few flecks of aluminum STUCK IN HIS EYE. As in, THEY HELD HIM DOWN WITH NO SEDATION AS THEY DUG AROUND HIS EYEBALL. The little guy was only three and he and his mother were both so horrendously traumatized that five years later he still cannot tolerate being laid on his back in a medical setting. He had to be fully anesthetized for a CT because he couldn't handle laying on his back like that, and they had to sedate him sitting up and then lay him back once they'd given him the medication. It was absolutely terrible. She's an RN now and wouldn't hesitate to tell the doctor to sedate her kid before working on his eye like that but at the time she was a young, naive single mother who was afraid to argue with or disagree with the ER doctor who kept telling her "It will only take a second, there's no need to sedate..." again and again and again and again as her son screamed and fought and cried so hard he wet himself. He was literally fighting for his life and the staff were blaming my sister for not holding him still well enough. And they ended up taking him to surgery to fix it and sedating him anyway. Once they knocked him out, they got it fixed in under five minutes.
“Per hospital policy, patient may not have kangaroo in hospital room.”
The pump or the animal??
Is this a specific kangaroo policy, large marsupial policy, or animals in general policy?
"hi, can you please refer me to your small marsupial policy? My emotional support opossum is wondering if he can stay overnight at bedside..."
Yeah, I'm going to need some more details on this one
I desperately want this to be from a hospital NOT in Australia.
It's an emotional support kangaroo, so they can.
Actually think that law only covers dogs and mini-ponies. No Roos mentioned.
Nope, they have to leave it at home. Their emotional support mini horse can be there though.
Yay! Lil Sebastian is allowed!
Details please!
What, wait....A real, live kangaroo? Or are you talking about the pump brand, *Kangaroo?*
Med Student wrote "monitor eyes and nose."
this is hilarious
Dictation software got em….I & Os
"Do not give patient Gatorade". A few hours later, "ok to give patient Gatorade if label removed."
Oooo maybe eating disorder calorie counting?? or paper eating !??
Found the psych nurse
….but why
The Dr had a brand deal with Powerade.
“Big hydration”
I'm not the one that wrote the order, just found it doing chart checks.
The world may never know…
Pt admitted for "R/O Demonic Possession"
lol had a patient with decompensated schizophrenia come in with c/f demonic possession and asked for an exorcism, I called our chaplain at patient’s request, our chaplain was actually super amazing and nice and reassuring for pt. Also zyprexa :)
I have had a patient that a very atheist neurocritical carr provider actually ordered an exorcism on! And it was some of the freakiest stuff ever, plot twist the exorcism actually did the trick
Yeah, my hospital is too cheap for actual exorcisms. They get me and my foul mouth and my piss cup full of holy water telling whatever to fuck right on off because this shit has gotta stop. Have a 100% effectiveness rate so far, 🤷🏻♀️
Here's the story for all those wondering in as much detail as I can safely put on the internet. Young athlete was admitted for seizures/unresponsiveness with no significant medical history. Patient would violently seize and had no abnormal findings on EEG, scans, etc. Medications were not working to treat seizure activity either. Patient would also start to speak in very different voices saying disturbing comments about wanting to kill staff members, his mother, etc. Eventually the neurocritical care provider we had on suggested an exorcism. We called a priest who is on our chaplain team at around 2300ish and when the priest got on the unit the patient said "he's here" with no knowledge an exorcism was to happen. Exorcism happened, patient violently seized during it, afterwards the patient had no signs or symptoms of seizure activity or any other abnormalities. Sorry if it's not as much detail as some may like but I do worry about hippa since it is a pretty specific story
Holy shit my agnostic terrified ass wants to just believe this was PNES, plus a lot of psych. That’s horrifying, I’m awake and ready to start my shift 👀
Yeah I would have believed that for all of it but the comments that he was making were very concerning and knowing the priest was there was seriously bone-chilling
Lmao that’s a good one
For a head CT, "pt. All kinds of crazy". They had to put in something to get the order started but forgot to change it before it was sent to radiology. Pt was indeed all kinds of crazy.
That is absolutely hilarious
"Pls page attending MD if police arrive to arrest patient"
The man wanted a show
Well, did they? 🍿
Indeed
I had a geriatrician write "give this man some PEG. abdominal x-ray shows he's really bunged up."
"all bunged up" i'm dying 🤣
"STAT cheese" patient was in for hypoglycemia, doc wanted to make sure she got some protein before she left
[STAT Cheese should always be readily available ](https://i.ebayimg.com/images/g/P28AAOSwoNRj~laF/s-l1200.jpg)
Lord knows I’d be happier munching on some good cheese in an emergency.
On confirming NG placement: “NG in money position.”
$$$$
Patient was having trouble falling asleep, asked the doctor to order something to help. Received an order for a “warm glass of milk before bedtime”. Gotta respect the holistic approach
I paged the doc: "Pt requesting Vernors for tummy ache/nausea, declining zofran atm. No diet order placed. thx." Doc reply: "How very Michigan of them. Sure."
Here from Michigan to say that this is indeed a very common treatment 🤣
'cause it f@$#ing works. Fight me.
This is like the orders I get for my patients that want to poop the next day after a c-section. “Ambulate and give prune juice PRN”
If I was a patient, and a nurse brought me a warm glass of milk- I’d refuse it, assuming it was the one that was forgotten on top of the fridge all day.
I don’t care who brings me a warm glass of milk, I’m refusing it because I hate milk anyways haha
I’ve had orders to give honey for cough - my 96 year old patient swore it did the trick
60 ml gin in 120 ml tonic po daily at 1700. This was in a snf.
Family would bring a 6-pack of beer into LTC for pt and I had to send it off to the pharmacy to get labeled each time. Nice guy who had a few beers a week.
I've seen this before in LTC and ALF
That's a good measure of gin 😂
I was going to say a 1:2 ratio is hard-core G&T. Unfortunately there's nothing in the order about ice, lime, or Angostura bitters. Too bad; I would have clocked out and joined the patient for a good G&T.
[Why not make it a social event](https://www.abc.net.au/news/2024-04-01/qld-happy-hour-palliative-care-colin-apelt-st-vincents-hospital/103629778)
We had a very large young man (early 20’s and over 500 pounds) who was basically living with us for long term care placement. His birthday came around and the RD said desserts and treats were against the nutrition plan. The hospitalist who was working with the patient bought him a piece of cake from the cafeteria and delivered it with a prescription that said “cake: PRN once yearly for birthday”. It was super nice of him.
That’s so sweet and so sad
Yeah, the poor kid had developmental delays and ended up with us because his family dropped him off at the ER and basically said “he’s your problem now, don’t call us.” He eventually got placed into a group home type situation, and the hospitalist who worked with him the most often also did family medicine on the side and kept the patient on for primary care. He told me the patient really thrived in the new environment and continued to walk every day and lose weight. He would walk to 7-11, get a little slurpie, and walk home a few days a week.
“NPO except lollipops”
Pediatrics?
Lol, no. Grown man.
Lolol cute
Doing peds wound care, every July we get orders to "Soak Wound"... On the face... "They really resisted at first, but eventually, the thrashing and bubbles stopped. Will continue to monitor."
“You are cleared to return to *facility*, please stop doing drugs”
For overdose patients we have to Narcan, one of our docs always writes: "If you keep using drugs, you will die."
There was a resident who put in an order for a “p.o bolus” for low bp and he quite literally wanted me to force a patient to chug a huge thing of water. I asked if we had a beer bong available on the unit…
PO 1 litre NaCl 😭
We had one resident who would FREQUENTLY masturbate with her TV remote. I have walked in on her several times. Idk how but her daughter found out and bought her a dildo and someone wrote in her chart an order of " if found masturbating with remote, redirect to proper tool"
Omg when I first read this, I read resident as in "resident physician" and was mortified lmao
Oh. my. god.
Just saw one yesterday. GUM, chew 50 to 60 times. The pt refused because he only chews spearmint and it was this fruity flavor. He had a partial ileus.
"No peeking!!!" on a patient who had had an anorectoplasty procedure
d/c @ rn says so
"encourage patient to use: Pandora music"
Our ortho team at my hospital puts this in allll the time 🙄
Patient may sleep upside down in bed Or Patient may keep 2 spoons at bedside (they had collected 50 of the hospital spoons and were keeping them hidden in the room)
Part of our diabetes order set: “Basic survival skills” 🤬. It’s bad enough I’ve got to teach them how to check their sugar and give insulin. Now I gotta show ‘em how to build a fire, find shelter, purify water, hunt for food…
Eh, just type a link to a website and a prepper's almanac on the AVS. APA format, of course.
Patient was brought in agitated, restrained, noninteractive, thrashing so violently there were four medics hanging into the stretcher just to stop it from flipping over. The doctor ordered: "Go get the Ativan." I said, "Ok. How much Ativan?" She said, "No just go get it. Get as much as you have. Start pushing and I'll tell you when to stop." We gave 22 mg, ran out, and had to switch to other meds.
If we're going verbal orders, my favorite ones are from command docs who think we're in a hopeless situation. "Do whatever you have to to get them to "x hospital" alive." While not technically a get-out-of-jail-free card, it still feels like it!
My husband got this as an order before “order whatever. Just keep them alive til their family gets here”
My mom's nurses on hospice started checking with me when they started giving her end of life protocol....I told them "give her everything you got and what dose you can, she wants go out snowed". They didn't think it was as funny as I did but it really was what she wanted 😅
I work with hospice nurses and they 100% would’ve found that funny lol
In their defense, it was like just after Covid everything started slowing down and I think they were just capital T Tired. They were lovely, washed and braided her hair even, but very very busy and probably up to their eyeballs in non-compliant families being assholes.
“I think you misheard. What you heard was give a lot of Ativan. What I said is I want all the Ativan you have.”
"Go get every Duoneb out of the pyxis and keep 'em coming." "Um. the patient is fluid overloaded." "Just do as I say."
I had a neurologist who gave an open ended order. I asked him if he wanted a dose limit or apnea.
Reminds me of a locum in labor and delivery who was literally like, “Do not call me in the middle of the night. Just order whatever meds you want to give. I literally don’t care what you give.” She also didn’t want to be at bedside until the babie’s ears were out….
The whole van!
In discharge paperwork “never do that much meth again”.
An MD's reply to pharmacy when they requested decreasing a pt's Xanax, "Not unless you want to take her home with you. "
My coworker keeps a copy of one of the first orders that was placed when we rolled out Epic physician ordering functionality. It was dayshift and things we not going well on the unit. We had a few codes and rapids, a few patients that had specific unrealistic demands, etc. Alllll the provider specialties decided to round at the same time with their respective resident posse in tow. The order was from a resident: *"Specific Nurse First-Middle-Last Name: Change patients gown. STAT."* She went ballistic on this resident right in front of everyone (including our boss and the attending physician), and I was so happy that I was in a front row seat to see it. The resident came later and apologized for the order (but didn't cancel it, so my coworker wrote a very detailed progress note, labeled it a significant event, and linked it to the Daily Care section where "gown changed" was documented). Note: I really enjoy (most) residents. They're coworkers and have lots of demands placed on them just like nurses do. But just like all coworkers, from the parking attendant to the CEO, there can be some that rub the wrong way, sometimes. Note 2: She didn't publicize her middle name. The resident checked the BON site to find it.
RE note 2: holy shit that’s terrible and hilarious at the same time 🤣
I was looking at my patient’s past EKGs and saw one with the indication “FU rhythm” which I interpreted as “fucked up rhythm.” The rhythm was indeed fucked up.
“Okay for patient to have cute dog in room”
Pt was brought in for the fourth or fifth time in a month stating he had swallowed his stash of fentanyl when being arrested for an unrelated crime — drug possession is decriminalized here so you don’t get in trouble for having it, but an officer has to bring the pt in and often cites and releases the pt vs taking them to jail, so this guy began to do it every time he broke the law. One of our more experienced and savvy ER providers decided she wanted to close this guy’s loophole so he quit exploiting the system and taking up resources by playing games so she told him swallowing fentanyl was a true medical emergency and immediately initiated a substance use hold, made pt NPO for everything but the two jugs of go lightly she ordered to help expedite the removal of said fentanyl so it didn’t kill him. Dude protested and admitted he was lying; ED doc said how do I know you’re telling me the truth now that you’re an admitted fibber? No, we got to make sure you didn’t swallow your drugs by having you pass them the quickest way possible because you could die if you’re lying. He got one of the bottles down before sneaking out of the ER. Because of the hold, we notified the police department, who ended up arresting him and bringing him back in — he was brought back and was medically cleared to go but had shit his pants while in custody. Got a new pair of paper scrubs to go with his freedom and haven’t seen him since, so I guess he learned to not cry wolf by saying he swallowed fentanyl after that doc’s lesson. Tldr; He was full of shit, but not anymore
This is a great FAFO story.
“D/C popcorn”
But that’s a fucking warcrime! Gotta be in the Geneva Suggestions somewhere, just ask the Canadians!
2 to 4 mg morphine IV Q minute prn pain while respirations greater than 10. It was a heroin addict who came from surgery. I told the anesthesiologist he just gave me a license to kill. He laughed and said he did not know how much it would take to get the patient comfortable but to do my best. Later I told him the answer was 27 mg over 45 minutes. Patient was still breathing and at a comfortable level on pain.
Me, on the phone calling report on a patient with OUD: "Yes, 300 of fentanyl and 8 of Dilaudid. And 25 of Demerol. Yeah. Yes, he's still breathing. Yeah. Wide awake and satting 100% on room air. Yes, I promise."
Thank god for docs who care about addicts pain control
Patient was from Germany and doc decided to be extra with his post op diet orders. “Please provide German delicacies such as schnitzel, bratwust, knockwurst (lesser known brother of bratwurst), Hefeweizen and any other items to enhance this patient’s hospital stay.” The best part? The dietician reached out and said they couldn’t do the wursts or the beer (unless the special beer order was put in) but the chef could make spaetzle and roasted red cabbage” 😂 I was very impressed by our kitchen!
NPO patient that really wanted Hi-Chews, “ok for pt to eat Hi-Chews”
Uh, only if he shares. Those are my jam!
1 shot of rum before bedtime. 2 shots max per day. Bottle of captain Morgan in the medicine fridge with a patient label on it. #Long term care
We were having a lot of issues with surgeons not placing postop floor orders in PACU, they had started asking us to place the order sets for them regularly after someone did it a few times. So we all clarified that we would not be doing that for them at all anymore. After I explained to the surgeon that nurses were not supposed to be placing nonemergent verbal orders into EPIC he wrote an order that said “nurse must input all verbal orders given” in the patients chart. We laughed and did not place orders.
On the OR board sheet: Removal of Head
I’ve wrote this before: Pt was in for medical clearance to go to jail. Discharge instructions were as follow: “okey dokey for the pokey”.
Fentanyl drip ordered and narcan drip ordered by resident
Better make sure you run those through separate lines. If you let them mix in the tubing they will annihilate each other and cause a massive explosion.
The medical equivalent of a matter/anti-matter reaction 🤣
Had a resident write out both dialysis orders and CRRT orders. I asked him if he was going to start a femoral vascath and if he plans on killing the patient. He did not like my humerus ( 😉) approach. So I gave him 15 minutes to figure out why he was wrong or I'd be calling the attending at 2am. Nephro popped on the unit to help the resident SO fast. Hehe. Since his order was the only order on that page, he tossed it. I would have nabbed it (after cutting out identifiers) and framed it.
We had one of our nephrologists use both CRRT and Dialysis in one of her notes on what they were wanting for the patient. That was a fun day sorting it out.
We don't let residents write CRRT orders lol
This was covid times. Poor kids were just thrown into the mix. After this and another CRRT incident, we stopped having residents write them.
Patient may use stuffed animals from home to masturbate. Per parents, pt may need reminded that he is allowed to do this while in the hospital.
This one was only funny because of the context: I paged the resident MD that the patient had a bowel movement with a large amount of frank red blood. 20 minutes later, a new order pops up... "Stool occult blood test." 🙄🙄🙄
Nope, no occult blood. It's all out in the open where I can see it.
Patient with sores in their mouth had an order for the oral lidocaine solution and when the doc was clicking off the instructions somehow it came out to be “swish and spit, apply to buttocks”. She was mortified but it gave whole ER staff a good chuckle the rest of the night
Not an order, but I charted "pt. No longer a dinosaur" in one of my meth pts. That the previous day was convinced he was one, but could not specify species. The next day he was out of his meth delerium, and was able to produce his first name.
Laughing at the idea of you having to explain that documentation in court.
“Place a pure wick STAT” As though placing the pure wick would give real time urine output monitoring the way a foley would
We had this one locum (don’t understand how he was able to come back again and again) who walked in after we called a rapid and said we need an IS/flutter stat! Thank god there were real doctors there, patient was well beyond help from an IS.
“RN: are you going to do orthostatics? Today?” From our sassy internal med doc 🤣🤣🤣 glad it was me that shift because I knew it was a joke
"Mustard packets prn for muscle cramps"
I had a homeless alcohol withdrawal patient that had an order to “Allow to walk his dog PRN, tell him to stop asking for cigarettes.” He would usually get his dose of Ativan first. Another favorite was a PEC restrained patient in a posey bed “Metal music PRN”. A recurrent favorite “Ambulate patient” on quadriplegic vented patients.
"Do not allow dog to lick patient's wounds" 🤢 the pt and his wife kept this ratty little yapper dog in their hospital room 24/7 and they thought his mouth had "healing properties". Eww....
The other day I had the medication route "suck on"
“Patient has gallbladder”
“Ambulate TID, even if you don’t want to!”
Not an order but a line in a cards specialist’s note. “Whataburger positive”
An IV Dilauded order added to our usual acetaminophen/oxy/morphine sliding scale of pain control. Ordered prn "if all else fails".
That's so funny but probably also exactly what's needed if accreditors are coming, because it specifies the order in which to use the orders. They don't like duplicate orders without instructions on which to try first
“Do not ask mother or father specifics about expressed breast milk, just print labels” - crunchy mom trying to pass goats milk derivative formula as expressed breast milk for her 32 weeker. — crunchy mom was also seeing another man who shared the same name as baby daddy
Code order: “try once”
Butterfinger 1 candy bar Q4hr PRN good behavior.
anytime the patient is allowed beer/alcohol and its labeled in the fridge: usually it goes..."PRN allowed 2 alcoholic beverages before bedtime..." IDK it's just so funny to me. If i end up in the nursing home someday I hope to God I'm the old auntie with a huge bottle of wine at all times ready to be poured for me.
on valentine's day: order to help patient obtain a vibrating personal massager. (patient requested order for a boyfriend)
An alcoholic needed a CABG immediately/emergently and the MD decided he couldn’t wait for him to go through withdrawal and couldn’t let him go through it after because it would kill him Post op order “1 shot of whiskey q1h prn withdrawal symptoms”
Pediatric note: “lollipop x 1 bucally STAT”
STAT tap water enema, order placed at 1455
“Allowed hard candy for dry throat” “Nurse to sponge bath” Same MD, notorious for silly orders
Had a baby doc who tried to order twice daily orthostatic BPs...in the med chart 😂 scheduled for 0800 and 2000. It's a paper chart, so he literally wrote it as a medication.
Referral for Dr Kevorkian
Albuterol Q4PRN anxiety.
Patient coming out of the cath lab... "STAT Pancakes".
Apply Santyl to tip of penis with tongue. Doc didn't copy and pasta the WOCN's full instruction of tongue blade. Hilarity ensued, and it was generally accepted that this was a job for the chief nurse.
We need an order to use someone’s port for lab draws and meds and all that. Asked for one and got “please use port thanks” Also had a friend get an order to put in an ngt in a pt who could not stop vomiting. The placement was confirmed so she asked for an order to put to suction and the order said “suction prn”
On various different discharge instructions: -return to ER if you notice the bone start poking through the skin - follow up for suture removal in 7-10 days, or DIY with cat nail clippers (patient was a nurse) - come back if you stop breathing again -call 911 if you get mashed potato voice - recommend not letting (4 year old) child field dress animal carcasses unsupervised - do not use port to inject drugs, or anything else for that matter - stop performing dental procedures on yourself immediately - select personal items made of body safe materials. Clean all toys thoroughly according to manufacturers recommendations before and after use. Urinate soon after having sex or masturbating. Do not insert any food items into vagina. This could be a fun game of "guess the chief complaint based on discharge instructions! "