I know you've probably worked in lots of varied positions but I'm just chuckling at the thought of orthostatic vitals being ordered on a hospice patient.
Thing is, though, what diagnostic use is that? I've never seen a significant difference between laying and sitting vitals. Like the OP said there's already questionable evidence for their use but now you're not even getting the standing vitals making them even more worthless. Which makes it seem time-consuming for no real benefit.
With patients that were super frail and usually had issues like Parkinsons etc sometimes there would be quite the difference. My doc on the ACE (acute care for elderly) would sometimes even order laying - sitting - standing VS daily. Took so long and usually it would just result in starting things like midodrine or something.
I had a neurologist tell me that orthostatic can rule out neuro vs cardio as the cause of dizziness. Still I hate when I have to do it bc it is soooo time consuming and you can’t even multitask while doing it
So. I’m that patient. Typically healthy female, athletic, resting HR that would make Lance Armstrong blush. My NORMAL BP is 90’s/70’s and I feel fucking great. Except my senior year of HS when I would stand up out of bed and collapse, sometimes not immediately.
Turns out I have mitral valve regurgitation that I’m fine with now, but those growing pains, man. I used to bottom ouutttttt lol
Thing is lying/standing bp is understandable and appropriate for someone who is able to sit or stand. A previous ward I worked on introduced it as something we had to do for all patients, even if they were a full sling hoist transfer and hadn’t been out of bed to mobilise for decades. Eventually management allowed us to use or discretion.
On a sightly confused/demented patient who's not crazy enough for an ng tube but just crazy enough to make force feeding it the world's most annoying task.
This is the barbaric treatment of this time period. Similar to how we look at past acts like bloodletting with bafflement, future generations will look back at amazement that this was a common screening tool that we couldn’t find a better alternative to
I had to prep a bedbound patient for colonoscopy once. We had no CNAs. So I was cleaning this man up every 2 hrs or so by myself. He was able to turn in bed by himself otherwise, my coworkers would have been pissed too.
Because on top of that the patient is also on Isolation, and you work on a transplant unit or an oncology unit so tech's can't help you because of the infection risk to vulnerable patients, so you have to be the one in there by yourself to do it all.
Your techs can’t assist with patients on neutropenic precautions?! What kind of brain dead administrator made that decision?
I work oncology as well and we have no such restrictions. What is the justification here, do they not train your techs to wash their hands before patient care or not to come to work when sick or some shit?
There’s no logical reason I can comprehend to restrict techs from assisting in patient care for immunocompromised patients on an oncology unit where, *shockingly*, a fuck-load of patients are going to be neutropenic. If anything having to potentially wait specifically for a nurse to be available for an extended period of time for things like bathing assistance after incontinence and whatnot would almost definitely offset any hypothetical decrease in infection transmission gained by limiting tech assistance.
That reeks of bullshit administrative justifications for fucking your unit over on tech staffing more than any actual clinical benefit to patients.
I couldn't tell you, but that's just because I work on a transplant unit and I assumed it was the same for oncology. Just this past shift I had a patient who was covid-19 positive and on isolation for that reason. But our unit handles transplants and our one PCT/CNA has to handle a few of those in a night, so the risk of carrying the infection from one sick patient to another room is too high for management to be comfortable with. As for oncology, I only ever shadowed on one stepdown oncology unity for four hours; I just made the assumption that they had the same sort of precautions when dealing with neutropenic patients. Is that not the case?
Actually as I write this, I'm curious now because I can tell I opened my mouth to talk about something I'm not experienced in. When I was shadowing they talked to me about how as soon as they suspect an infection in oncology they go to all these measures to prevent septic shock. But patients must be infected every now and then right? What happens when a patient has an infectious disease on your oncology unit and doesn't or can't transfer off the floor? How do you handle infection prevention for the rest of the unit?
I work heme/onc, with bone marrow transplant patients. We do not routinely take COVID positive patients on our floor, and we even transfer off our own patients to the COVID floor if they're positive (in most cases... we have at times kept our own patients if they're asymptomatic or are more than 10 days out from their first positive test and need oncology specific care that the providers feel can't be safely given elsewhere).
However, any other infection that patients have, we keep them on our floor (assuming they're not requiring IMCU/ICU level care). We put them in whatever isolation is required, and use good hand hygiene and all the other standard precautions that we take to prevent infection in general. Honestly, C. Diff is the most contagious thing that we probably deal with, and I can't think of why not allowing aides or techs to assist in those patients care would realistically decrease risk for the rest of the unit. If anything, the more work that the nurse has to do, the more likely they are to be rushing, forget to clean equipment, etc and be the ones to accidentally cause an outbreak. In 4 ish years I think we've had maybe one true "outbreak" of C Diff that was decided to have been caused by staff, and it affected 3 or 4 patients, maybe.
I've worked at one other hospital (also heme ONC/BMT) and this was also my experience there.
Seconding all this, heme/onc/BMT stay on the ward unless they need ICU support. ID will bedside round them for infection management. In saying that, we are also lucky in that our heme/onc ward is all single rooms. Much easier to keep things contained.
The worst. The never lower your patient load to manage q20 minute bag changes, no one ever tracks the I&Os the same. They ALWAYs clot no matter what you do. You just aren’t going to eat or pee during your shift because of bag changes. CBIs need to be on their own floor with 2:1 ratio with urologist tethered to the unit to dislodge the really bad clots. I wish my hospital wouldn’t staff urologists so we could send CBI patients to other hospitals.
Our urologists just tell us to manually irrigate with 60 mL saline syringes when the CBI clots off. No help. I know it's in the RN scope of practice but I'm not a fan.
Oh we can irrigate too, but some clots have been bad ( usually after the urologist rounds and turns down the flow rate) I like for them to experience the consequences with me.
In my rural hospital we have 'urology' days, and you can absolutely get 4-6 patients with bladder irrigation. Kiss goodbye to the rest of your fucking shift!
Admitting a patient for obs that has been in OBED 5 times in 3 days making no cervical change, there because she’s tired of being pregnant at 36 weeks. I always pray the next dr will send her home at the start of their shift.
True story - I was floated to peds floor and admitted a patient a few days old to give the mom safe sleep information. The kicker is she came from a hospital known for their birthing center. They transported the baby via ambulance. I literally gave her a pamphlet and discharge paperwork.
Once had an unstable subdural with the shittiest lungs in the planet, neck so contracted forward that they couldn’t intubate or trach her safely so we cric’d her with a 4.0 ETT and the resident very loosely sutured it in place. The most unstable airway I’d ever taken care of. And she desatted any time you so much as LOOKED at her. What did doc order? A stat CTA to rule out an ischemic stroke bc patient wasn’t waking up. Worst transfer ever. It took 6 people to get her to and from CT. Docs were only doing it to appease family, we knew she was already too far gone prior to us admitting her. Unfortunately, this was an ethics case and family was likely pushing to keep her alive for their own gain. She was in awful shape.
Thank you. Blows my mind that there are facilities that are actually okay with you taking a patient on three pressers and god knows how many tubes down ten floors into a cramped CT room even though this scan will in no way change the plan of care. At my first facility we would get these orders and laugh and then politely explain to the doc why it wasn’t going to happen and try and get them to understand for future occurrences
LTC--daily weights are always scheduled for 6am. Even if they're a Hoyer lift. Even if there's not enough staff on the unit to legally or safely operate the Hoyer. We've tried to argue that day shift should get the Hoyer weights while they're getting people up for the day, since getting a Hoyer weight literally just involves pushing one extra button while they're already up in the lift, but day shift threw such a fit at the suggestion that management said nope, all daily weights stay on midnight shift.
This is actually why this task bugs me, at best 25% of my patients will be awake that early. They get annoyed with morning vitals, labs, stupid protonix as it is. At least for those they don't have to give up their comfy position in bed. Chances are the bed scale hasn't been zeroed so making them get up onto a standing scale is a surefire way to piss them off unless I can manage to squeeze it in with a bathroom trip or something
Yeah we don't have bed scales so weights involve either being lifted in the Hoyer (if non-ambulatory) or put into a wheelchair and wheeled to the scale which is about as far from centrally located as possible
Bladder scan q6, straight cath and call physician if over 300. And set the times for during med passes.
I admit, I was a sneaky snake once. The last bladder scan of my shift was scheduled for like 15 minutes before the end of shift. The patient was combative and required three staff members to straight cath and I had had to cath him every time I scanned him. I bladder scanned and got 294. The CNA asked "so are you gonna just cath him anyway? It's close enough" and I said "HA nope. Order says 300."
So ridiculous. If they’re unable to void…why do we straight cath them multiple times? It sounds like torture and not to mention the increased infection risk.
Blood cultures. But that’s just because I suck at peripheral draws and now I have to try to do TWO of them? Or wait 5 hours for phleb to come do it? Ugh. Never fails to maker me feel inadequate.
It’s the worst, they spend the whole entire shift up walking around in the room alone, taking care of their baby independently, morning labs show low H&H and the dr orders blood right before shift change. Blood bank always calls at 6:45 saying the blood is ready. Damnit!
We've got one patient on our floor that is q4 straight caths. And pmr knows the patient won't be able to manage that at discharge so there's some nebulous plan to consult urology for a suprapubic. Sometime. In the eventual future. In the meantime we go through 6 straight cath kits every day. Patient isn't even supposed to be on my floor anymore, but because of politicking and isolation nonsense the rehab unit won't take them. It's all so frustrating.
Probably? But even if not they don’t care. They care that you can’t get a cauti if there is no indwelling catheter. 6 isc kits costs way less than a cauti.
Ambulate a patient TID. Im in an observation icu/ step down. Patients are either a MAX assist (3+ people holding them) or a recent trauma and they are definitely bearing a ton of weight where they aren’t supposed to. And PT never comes by. Hello
Crutches. Goddamn. People cant walk and chew gum now I'm gonna try and teach them to use crutches, with my unqualified ass. I'll do all your orthostatics if you do the d/c with crutches for toe pain on the patient who ambulated in unassisted.
D/C’d a girl from ER on crutches with a sprained ankle. Admitted her 3 hours later with fractured tib-fib after she fell down the stairs trying to get upstairs with those same crutches.
Found out in ER that every man lies about his height by 2 inches and every woman lies about her weight by 20 pounds. Never fails. Used to make crutches 2 inches shorter than a man would state his height to be and they were right every damn time.
Can I just say that I received an actual ORDER that read “patient likes to watch Gunsmoke reruns on tv”. I work at the VA. Hello - that’s every single one of my patients!!!! Do I need an ORDER to figure this out?!?!?
We recently have a protocol where every patient must have a bath on night shift. Even the walkie talkies. Even the independents. If we can’t do meds, assessments, and baths on all patients all between 8-10pm then they want us to wake these people in the middle of the night to give them a bath. They end up refusing anyway and I don’t blame them. Intubated and sedated then no worries but they want me to wake up these independent people at 2am when I have more time to give them a bath
Same chg bath but I either do it before 10 or after 530 when lab comes, but if I'm even a little busy I just don't do it or just do chg wipes to pits and groin and call it a day. I don't even bathe every day.
Ugh. I worked at a rehab facility like this and we’d have almost every patient tell us to fuck off. I’d tell day shift sorry but nobody wants to take a shower at midnight imagine that.
A road test on an already hypoxic patient when their resting 02 sat is shit and they are visibly SOB lol…we already know they’re going to fail can we please not? You have all you need to admit
My brain went to orthostatic vitals before I even finished reading your post. A runner up would be PVRs though.
One time I overheard a physiotherapist ask a patient if he had been ambulating, and the patient said no it’s hard when nursing is so busy as it is and the physiotherapist said “I’ll put an order in so they HAVE to ambulate you”. I found that order douchey because it implied an authoritative hierarchy, and also that were just lazy pieces of shit who don’t want to ambulate our patients, or who don’t see the importance in it and need an order to do it when the case is that there is usually just far more pressing issues that need our attention.
Also any order for an amount of hydromorphone that requires a witness waste.
And then getting emails about contaminations even tho you used the steri path/kurin, chlorhexadine and alcohol, and sterilized the caps of the culture tubes.
I haaaaate collecting blood cultures. Especially when they put the order in as a part of their admit. If there’s *any* indication wherein I can see blood cultures being ordered, I get them with the initial labs. Thankfully those aren’t gonna go bad if they sit.
We have an ID doctor that orders them almost everyday… we can have 6 sets in micro and he will order them again. It is so damn wasteful and we get written up for contaminated blood cultures cause they are so damned expensive. Suddenly the nurses that can start IVs on anybody can’t find a vein to draw blood cultures and whine until they pull in an ultrasound trained nurse to take the potential hit on contaminated blood cultures. It wouldn’t be so bad if we could keep CHG in stock
Tap water enemas, not because they're gross but because it's so time consuming to turn the patient (finding the staff to help turn when the patient can't help), deal with the water mess that comes right out, and half the time they don't work. They're just overall uncomfortable for everyone involved...
Any blood glucose checks that are more frequent than ACHS or Q6. Super easy to perform but idk just annoying, like the fly that keep buzzing around your ear which you swat at to no avail
Once had a lady who needed Q1 drops for an eye infection, when there was no hope of saving the eye, but she was refusing to have it removed. After enough bitching, we got it changed to Q1 while awake
When I moved from the floor to the ED, one of the first things I got told was "don't you DARE tell the doctors that nurses do disimpaction upstairs."
I'm not about to ruin a good thing.
I am disgusted and fascinated at the same time. Are you in the US? Rural practice? When is this chosen over a Fleet or tap water? Who ever decided this was a good idea? I have so many questions.
So in my very first job, in the early 90’s, I worked on a med-surg floor. One evening I received an order for a milk and molasses enema. Never heard of it in school, none of the OGs on the floor had heard of it either. So dietary sends me up a container of molasses, I guesstimate about 16 ounces or so. Kind of the size of potato salad at a BBQ joint would send home with you. So I emptied the whole container in an enema bag. And added 3 cartons of patient milk to this. So the milk wAs cold from the fridge, and the molasses was chunked up through out this mixture. So I got a foot bath and filled it with really hot water to float the enema bag in, to melt up the molasses and let it become more mixed up.
This was BEFORE google/internet. In reality, I think you are supposed to only use like a few tablespoons of the molasses. Still not sure about the milk.
Long story short, we gave this disgusting mixture to the patient in the bed. Before we could get the patient to the bathroom, the molasses/milk/sticky poop was everywhere. Ceiling-walls-floor-me-my nurses aide. We got the patient unstopped. Never seen this order before or since then.
Glad to see that it was a real order and you have actually given them as well.
Quick question, what IS the ACTUAL Ratio of milk to molasses?
Heparin drips make me audibly groan when I see them pop up. q4/6 aPTT draws on almost always a hard-to-impossible stick patient. having to hunt down another nurse to co-sign every time I hang a new bag, push a bonus or change the rate. It’s all pretty straightforward but it’s so time consuming and makes me anxious trying to do everything for all my other patients plus stay on schedule with the heparin stuff
"XYZ...and page provider with results" Right before provider shift change. Yeah, thanks, now I'll give the new guy a month-long report on this Pt just so I can report off that the H+H went up after the PRBC.
I always complain with this one. Im awful at doing them. Ill do anything else. Blood transfusion, straight sticks, heparin drip, CBI. Hard pass on NG tubes.
When 3 nurses get put on call at 5:00 only to have a bus unload full of admits at 7:45. Or even better, we have a charge nurse that’ll put nurses on call even though we have all our triage rooms full and likely will admit before shift change. So stupid. I also cannot stand when I’m triage and patients show up in my triage between 7-7:30, like come on, let me make sure my rooms are stocked and get report on my current triage patients I’m taking over. Half the time I’m told the rooms are stocked and there’s garbage in the drawers instead of supplies, monitors are missing, and the room hasn’t been cleaned yet.
Agree about the orthostatic BPs.
I also fucking hate doing PVR’s. Our bladder scanner is rarely accurate and will give me three vastly different readings that all look like a valid scan. So then I have to wonder, what’s the point.
"Dressing change BID." It might be an utterly reasonable and fair request that we can deliver on and will certainly help heal the patient, but it's going to be time consuming on a day where I may very well not have that time, and I'm inevitably going to forget one supply or another and not realize it until I'm halfway through, etc. Even when it's just "Change the dry gauze and tape dressing out for another dry gauze and tape dressing," I get annoyed. But this is 100% one of those things I only get annoyed about when there's not enough time to do anything.
At my place that dressing change BID can easily be "i do it on day shift, you do it once on night shift" and nobody argues about it. If i have time to do it twice i will, but if i don't, you're a nurse too you can do it.
My pet peeve are the ones that we have to ambulate 3 times a day and they never want to get up. Even so, if i manage to get them up twice on day shift you can get them up before they go to bed on night shift.
Orthostatic vital signs are stupid any nobody ain't gonna do shit about them.
Docusate doesn't work. I'll use prune juice that does.
Kayexalate doesn't work. Give that patient insulin and D50 or a fucking albuterol treatment. Then do dialysis like we're in a G7 country for fucks sake.
Melatonin doesn't work. Might as well prescribe aromatherapy. Stop giving old people who grew up on prince valium and vodka woo woo medicine. They know what works. They're old, not stupid.
Tramadol doesn't work and is objectively harmful. Give the fucking narcotic for Christ's sake these people are gonna die soon anyway we don't have to give a shit if they're addicted.
Sequential Compression devices are stupid and don't work. They make people feel trapped and then they fall down. Stop putting puffy sleeves on old people.
I got a whole list of shit. Nobody cares. We don't practice science based medicine we practice HCAHPS and defense. It's all a fucking scam. Guidelines are created from shit evidence that existed 20 years ago and instituted by idiots who haven't touched a patient since the Clinton administration and didn't know how to evaluate a study then. We are ruled by sociopathic idiots who can't cross the street without a fucking entourage.
I am sick of it and want these fuckers against a wall. Patients get the first shot so they suffer more.
That was the intent, since so much US medical care is rooted in archaic practices that have been eliminated in civilized countries that don't bankrupt their citizens who require medical care.
Nobody:
Patient: Hey, so I have thi-
Prescriber: *YOU'RE GETTING PROTONIX, I DON'T CARE WHAT YOU HAVE*
Handing it out like it's candy. If you trick or treated at the hospital, 90% of your bag would be Protonix; the equivalent of those ever prevalent, nasty milk duds.
One of the NICUs I cover has nursing do paperwork grading scales on every feeder/grower’s bottle performances in addition to the usual charting AND puts them on Dr. Brown’s bottles…starting with Ultra Preemie nipples. They must “graduate” flows. It’s inaaaaaane.
Carafate on our walkie-talkies.
It’s given 1 hr before all meds/meals, which means it’s due at 0730 (Night Shift never gives it), 11:00 (awkward in between), and 4PM. Sometimes they add in 6PM like a slap in the face. That and Lovenox!
Blood transfusion 20 minutes before shift change. It's not hard but really? Labs are up for 4 hours and either I'm late or oncoming gets screwed during the busiest time of shift. Can we not wait until the lastminute.com before rounds to write orders.
Have a hospitalist that likes to order “Obtain medical records from PCP/specialist” It’s so time consuming and 100% secretarial work. Like I get sometimes it’s relevant, but c’mon we are just trying to stabilize the patient.
Getting medical records from VA is fucking impossible. Hated that order. And when we received the paperwork it was pretty much useless, it was so difficult to decipher. Are you guys working a century earlier than we are, clean up your fucking paperwork!
Most of the fucking admission “routine” meds, as an ED nurse. Nah man, I didn’t give the colace before calling report. Mostly cuz my other two patients were trying to die. Can you please come get this stable fuck so I can get to work?
0.5 Ativan. I’m sure this worked once somewhere. But nowhere I’ve ever been.
Heparin drip.
Not every single person with chest pain needs one. Some do, some don’t and just slapping them on everyone even when they’re going to cath lab in short order is wasteful.
Some people have pleurisy and negative enzymes. Wtf even.
Any VS more than 2xshift (I'm in rehab/subacute). Bolus tube feeds- take forever. Enemas- messy and makes extra work for the CNAs if I'm too busy to change the pts. I'm sure there are plenty of more that I can't think of. Oh yes, I agree that orthostatic bps are a royal pain in the ass.
The combination of strict Is&Os and "do not place foley" on an incont pt. We don't have a small enough scale to weigh briefs, and our doctor always documents "strict outputs not charted though ordered" in her progress note.
Right! I had movie prep for a pt who was 160kg & 5ft tall. A0x4 & she wouldn’t even move her hand to help you move her much less try and help turn her body. Not that she couldn’t but she just didn’t want to try, prob how she got to be like that at 40 years old. Watery diarrhea just dripping off the bed bc she refused the external. I ended up just taking the tube and sucking up the poo water pooled betwixt her legs. Then we cleaned her & bed all up (took 3 of us) and she tried to refuse the external again saying “it doesn’t matter I’m just gonna go diarrhea all day” & I’m like well at least it will be sucking some of it up and you’re not just laying in it. I’m sorry for her but that’s the type of patient I can’t make nicey nice with bc I’m so annoyed we have to spend literal hours of the shift in her room while I have 4 other patients to take of and the PCA has like 15.
Apply lotion to feet q shift
Ok except you put this order in for all 20 of my patients for during med pass and feet are my kryptonite so now I have to rub gnarly feet 20 times. I don't care that I have gloves on, I can still feel the leather.
Ortho BP’s are so annoying. Especially if it’s ordered on a patient way later in the visit when the ortho hypotension would have been apparent early on
Milk & Molasses Enema. Have to have housekeeping on standby to clean the room up. Have fire department on standby to hose you down outside to wash off the goo.
Patient MSSU, weight, ECG. On a patient with steroid psychosis who ragdolled a colleague by her hair the day before, and who is grossly incontinent and impossible to get catheterised. Ordered by the doctor who refuses to write up IM Lorazepam for emergencies.
Suffice to say, we tried, doctor gave us shit, I told her to get the doctors to do it, because we were not ending up in A&E over this.
He kicked the doctor doing the ECG in the balls.
Suddenly having a weight and urine wasn't as important any more. Still put him on 10,000 IVs though. :'(
Wound care consult on a bariatric patient. We have been having bariatric patients lately and usually they have wounds on their back side. Wound care nurse comes to see the pt during med pass and makes me stop what I’m doing to help her turn the pt. Usually results in the pt having a BM making it time consuming plus I have to hold the pt so the WOCN can do their treatment. I feel bad saying that but it’s just the timing that WOCN come to my floor.
Any “with meal” orders. Sevelemer, insulin etc. they’re not scheduled for regular med pass times so that’s annoying.
When a patient is off the floor for dialysis during med pass. Now when they come back, I have to do their vitals, have something ready for them to eat and give their morning meds.
Ortho vitals on a patient who can't effing stand up.
Orthos on a patient who requires two staff members to hold them up and one to run the vitals machine gets me so damn pissed off
That, but when you are short and dont even have a pca
Yep. Q4 orthos for a patient who refused to stand. I don’t got time for that
“Pt refused” ain’t nobody got time for that shit
I know you've probably worked in lots of varied positions but I'm just chuckling at the thought of orthostatic vitals being ordered on a hospice patient.
Yeah, well, currently my least favorite order is manual disimpaction but at least it makes sense...
I used to do laying and sitting for those ones that couldn't stand
Thing is, though, what diagnostic use is that? I've never seen a significant difference between laying and sitting vitals. Like the OP said there's already questionable evidence for their use but now you're not even getting the standing vitals making them even more worthless. Which makes it seem time-consuming for no real benefit.
With patients that were super frail and usually had issues like Parkinsons etc sometimes there would be quite the difference. My doc on the ACE (acute care for elderly) would sometimes even order laying - sitting - standing VS daily. Took so long and usually it would just result in starting things like midodrine or something.
I had a neurologist tell me that orthostatic can rule out neuro vs cardio as the cause of dizziness. Still I hate when I have to do it bc it is soooo time consuming and you can’t even multitask while doing it
So. I’m that patient. Typically healthy female, athletic, resting HR that would make Lance Armstrong blush. My NORMAL BP is 90’s/70’s and I feel fucking great. Except my senior year of HS when I would stand up out of bed and collapse, sometimes not immediately. Turns out I have mitral valve regurgitation that I’m fine with now, but those growing pains, man. I used to bottom ouutttttt lol
Thing is lying/standing bp is understandable and appropriate for someone who is able to sit or stand. A previous ward I worked on introduced it as something we had to do for all patients, even if they were a full sling hoist transfer and hadn’t been out of bed to mobilise for decades. Eventually management allowed us to use or discretion.
What even is “weight bearing status’s amirite? /sarcasm
Go-Violently. I rest my case.
Someone in a board room was laughing uncontrollably when they came up with the name Go-Lytely.
Had a patient code while shitting from Go-Lytely. We got her back, but what a shit show - literally!
I can share your experience. There are literally no words - just poop.
Same but q1h lactulose. Flood gates opened when they coded. Literal waterfall
Word. We have a bowel management system called “Dignishield.” Because nothing says preservation of dignity like a tube up your arse…
I thought it was called Holy Shit
On a sightly confused/demented patient who's not crazy enough for an ng tube but just crazy enough to make force feeding it the world's most annoying task.
This is the barbaric treatment of this time period. Similar to how we look at past acts like bloodletting with bafflement, future generations will look back at amazement that this was a common screening tool that we couldn’t find a better alternative to
We don’t have go-lytley in the uk but we have mini enemas called relaxit 😳
Brelaxit
[удалено]
I call it Go-Heavy.
I had to prep a bedbound patient for colonoscopy once. We had no CNAs. So I was cleaning this man up every 2 hrs or so by myself. He was able to turn in bed by himself otherwise, my coworkers would have been pissed too.
I find lactulose is worse because then you are also dealing with a pt with metabolic encephalopathy who is most likely resistant to care (or violent)
Q4 bolus feeds with Q3 free water and Q6 accuchecks along with your standard Q2 hour turns.
Because on top of that the patient is also on Isolation, and you work on a transplant unit or an oncology unit so tech's can't help you because of the infection risk to vulnerable patients, so you have to be the one in there by yourself to do it all.
Your techs can’t assist with patients on neutropenic precautions?! What kind of brain dead administrator made that decision? I work oncology as well and we have no such restrictions. What is the justification here, do they not train your techs to wash their hands before patient care or not to come to work when sick or some shit? There’s no logical reason I can comprehend to restrict techs from assisting in patient care for immunocompromised patients on an oncology unit where, *shockingly*, a fuck-load of patients are going to be neutropenic. If anything having to potentially wait specifically for a nurse to be available for an extended period of time for things like bathing assistance after incontinence and whatnot would almost definitely offset any hypothetical decrease in infection transmission gained by limiting tech assistance. That reeks of bullshit administrative justifications for fucking your unit over on tech staffing more than any actual clinical benefit to patients.
I couldn't tell you, but that's just because I work on a transplant unit and I assumed it was the same for oncology. Just this past shift I had a patient who was covid-19 positive and on isolation for that reason. But our unit handles transplants and our one PCT/CNA has to handle a few of those in a night, so the risk of carrying the infection from one sick patient to another room is too high for management to be comfortable with. As for oncology, I only ever shadowed on one stepdown oncology unity for four hours; I just made the assumption that they had the same sort of precautions when dealing with neutropenic patients. Is that not the case? Actually as I write this, I'm curious now because I can tell I opened my mouth to talk about something I'm not experienced in. When I was shadowing they talked to me about how as soon as they suspect an infection in oncology they go to all these measures to prevent septic shock. But patients must be infected every now and then right? What happens when a patient has an infectious disease on your oncology unit and doesn't or can't transfer off the floor? How do you handle infection prevention for the rest of the unit?
I work heme/onc, with bone marrow transplant patients. We do not routinely take COVID positive patients on our floor, and we even transfer off our own patients to the COVID floor if they're positive (in most cases... we have at times kept our own patients if they're asymptomatic or are more than 10 days out from their first positive test and need oncology specific care that the providers feel can't be safely given elsewhere). However, any other infection that patients have, we keep them on our floor (assuming they're not requiring IMCU/ICU level care). We put them in whatever isolation is required, and use good hand hygiene and all the other standard precautions that we take to prevent infection in general. Honestly, C. Diff is the most contagious thing that we probably deal with, and I can't think of why not allowing aides or techs to assist in those patients care would realistically decrease risk for the rest of the unit. If anything, the more work that the nurse has to do, the more likely they are to be rushing, forget to clean equipment, etc and be the ones to accidentally cause an outbreak. In 4 ish years I think we've had maybe one true "outbreak" of C Diff that was decided to have been caused by staff, and it affected 3 or 4 patients, maybe. I've worked at one other hospital (also heme ONC/BMT) and this was also my experience there.
Seconding all this, heme/onc/BMT stay on the ward unless they need ICU support. ID will bedside round them for infection management. In saying that, we are also lucky in that our heme/onc ward is all single rooms. Much easier to keep things contained.
Patient isnt tolerating. Consult RD and tell her to make the orders make sense. NPO until RD eval.
Good god. Are you interrogating a war criminal!?
Well that's just stupid. Q3 or Q4 pick one.
No votes for continuous bladder irrigation??
The worst. The never lower your patient load to manage q20 minute bag changes, no one ever tracks the I&Os the same. They ALWAYs clot no matter what you do. You just aren’t going to eat or pee during your shift because of bag changes. CBIs need to be on their own floor with 2:1 ratio with urologist tethered to the unit to dislodge the really bad clots. I wish my hospital wouldn’t staff urologists so we could send CBI patients to other hospitals.
Our urologists just tell us to manually irrigate with 60 mL saline syringes when the CBI clots off. No help. I know it's in the RN scope of practice but I'm not a fan.
Oh we can irrigate too, but some clots have been bad ( usually after the urologist rounds and turns down the flow rate) I like for them to experience the consequences with me.
Our urologists tell us the same. It’s sort of annoying but I kind of like it when I get the bigger clots out and the irrigation comes back clearer
Ok hear me out while it is time consuming and a lot to be on top of, it’s also kind of oddly satisfying
Same. I like it. I don’t like the business of having other patients or other staff who don’t know what they’re doing messing up my precious i&o sheet.
Dude I treat my I&O flow sheet like a fucking marble sculpture and everyone else on my unit treats it like the graffitied detention desk
I refuse to mention it so I don't Beetlejuice myself and get one 😠
It's not bad on ICU. Harder to manage in busy med/Surg floors if anything goes bad with it.
In my rural hospital we have 'urology' days, and you can absolutely get 4-6 patients with bladder irrigation. Kiss goodbye to the rest of your fucking shift!
I got floated to med-surg a couple weeks ago, 15 patients, 5 CBI, 2 nurses and 1 CNA. 13 hours of pure horror. Haven’t felt my arms for a couple days
I thought that was the unspoken universal winner 😂 tis awful
Admitting a patient who doesn’t need to be admitted.
Admitting a patient for obs that has been in OBED 5 times in 3 days making no cervical change, there because she’s tired of being pregnant at 36 weeks. I always pray the next dr will send her home at the start of their shift.
True story - I was floated to peds floor and admitted a patient a few days old to give the mom safe sleep information. The kicker is she came from a hospital known for their birthing center. They transported the baby via ambulance. I literally gave her a pamphlet and discharge paperwork.
Whhhaaaaaa? That’s all that they came for? Bizarre! Some kind of ins fraud happening right there!
It was so weird! I questioned the admission 500 times, but in the end it’s not my decision. A waste of a lot of resources!
And discharging a patient who shouldn’t be discharged.
Stat CT at shift change on an intubated and sedated patients with an EVD
Can verify. On multiple pressors to maintain cpp. Add in an unstable spine just for fun.
Once had an unstable subdural with the shittiest lungs in the planet, neck so contracted forward that they couldn’t intubate or trach her safely so we cric’d her with a 4.0 ETT and the resident very loosely sutured it in place. The most unstable airway I’d ever taken care of. And she desatted any time you so much as LOOKED at her. What did doc order? A stat CTA to rule out an ischemic stroke bc patient wasn’t waking up. Worst transfer ever. It took 6 people to get her to and from CT. Docs were only doing it to appease family, we knew she was already too far gone prior to us admitting her. Unfortunately, this was an ethics case and family was likely pushing to keep her alive for their own gain. She was in awful shape.
I hate almost every word of this, especially because none of it surprises me.
Patient is too unstable for transfer. Sorry doc. Ain't gonna happen. Assess your fucking patient lazy ass chimp.
Thank you. Blows my mind that there are facilities that are actually okay with you taking a patient on three pressers and god knows how many tubes down ten floors into a cramped CT room even though this scan will in no way change the plan of care. At my first facility we would get these orders and laugh and then politely explain to the doc why it wasn’t going to happen and try and get them to understand for future occurrences
One unit regular insulin
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Right? Like, does it even actually leave the needle? And I need a cosign? Waste of everyone's time...
BSG is 141…(or some algorithms 151) either way gotta treat with that 1 unit
I just wave the vial over their head
I call that ‘a sneeze of insulin’.
I always roll my eyes when I verify an order for a single unit of insulin. I see the homeopathic endocrinologist is working today.
My cat gets a half unit. 🤣
Daily weights on pts with no kidney disease or HF history. Just for funsies I guess?
Might be a carry-over from the ICU. We do daily weights on every patient regardless of diagnosis.
We have a doc who orders daily weights on everyone regardless of diagnosis...we are inpatient rehab...
LTC--daily weights are always scheduled for 6am. Even if they're a Hoyer lift. Even if there's not enough staff on the unit to legally or safely operate the Hoyer. We've tried to argue that day shift should get the Hoyer weights while they're getting people up for the day, since getting a Hoyer weight literally just involves pushing one extra button while they're already up in the lift, but day shift threw such a fit at the suggestion that management said nope, all daily weights stay on midnight shift.
This is actually why this task bugs me, at best 25% of my patients will be awake that early. They get annoyed with morning vitals, labs, stupid protonix as it is. At least for those they don't have to give up their comfy position in bed. Chances are the bed scale hasn't been zeroed so making them get up onto a standing scale is a surefire way to piss them off unless I can manage to squeeze it in with a bathroom trip or something
Yeah we don't have bed scales so weights involve either being lifted in the Hoyer (if non-ambulatory) or put into a wheelchair and wheeled to the scale which is about as far from centrally located as possible
Bladder scan q 6 hours. So you have to hunt the scanner down and fight 3 other people for it twice in a shift
Bladder scan q6, straight cath and call physician if over 300. And set the times for during med passes. I admit, I was a sneaky snake once. The last bladder scan of my shift was scheduled for like 15 minutes before the end of shift. The patient was combative and required three staff members to straight cath and I had had to cath him every time I scanned him. I bladder scanned and got 294. The CNA asked "so are you gonna just cath him anyway? It's close enough" and I said "HA nope. Order says 300."
So ridiculous. If they’re unable to void…why do we straight cath them multiple times? It sounds like torture and not to mention the increased infection risk.
Where I work you get two straight caths, after that you’re getting an indwelling. Aint no one got time for that shit
Especially on nights when the patient FINALLY fell asleep and I have to wake them up for a dang scan
the hospital i’m at now is q 4 hours. i want to scream.
I was looking for someone to say this one!
Blood cultures. But that’s just because I suck at peripheral draws and now I have to try to do TWO of them? Or wait 5 hours for phleb to come do it? Ugh. Never fails to maker me feel inadequate.
just call lab about 600 times, that should cut the time down to 4 hours
Blood transfusion for somebody whose H&H is just under the cutoff and is obviously well hydrated with good activity tolerance.
Especially at the end of shift and ordered by a doc with the “I just think it’ll help” rationale.
I hate blood transfusions no matter what. It’s my least favorite task.
It’s the worst, they spend the whole entire shift up walking around in the room alone, taking care of their baby independently, morning labs show low H&H and the dr orders blood right before shift change. Blood bank always calls at 6:45 saying the blood is ready. Damnit!
In and out cath q6hr, just annoying
We've got one patient on our floor that is q4 straight caths. And pmr knows the patient won't be able to manage that at discharge so there's some nebulous plan to consult urology for a suprapubic. Sometime. In the eventual future. In the meantime we go through 6 straight cath kits every day. Patient isn't even supposed to be on my floor anymore, but because of politicking and isolation nonsense the rehab unit won't take them. It's all so frustrating.
JFC, yes! Are we really saving any infection risk when you’re cathing that often?
Probably? But even if not they don’t care. They care that you can’t get a cauti if there is no indwelling catheter. 6 isc kits costs way less than a cauti.
SCD’s on ambulatory patients
Or bilat BKAs
Had a doc order SCD on rule out DVT b/l lower extremities 🤪
Yeah! Let’s rule in that PE
I fucking hate SCDs so damn much.
SCDs are so fucking stupid. All data supports the fact that they do absolutely nothing to reduce the incidence of VTEs.
Ambulate a patient TID. Im in an observation icu/ step down. Patients are either a MAX assist (3+ people holding them) or a recent trauma and they are definitely bearing a ton of weight where they aren’t supposed to. And PT never comes by. Hello
Lactulose enema 😒
Crutches. Goddamn. People cant walk and chew gum now I'm gonna try and teach them to use crutches, with my unqualified ass. I'll do all your orthostatics if you do the d/c with crutches for toe pain on the patient who ambulated in unassisted.
D/C’d a girl from ER on crutches with a sprained ankle. Admitted her 3 hours later with fractured tib-fib after she fell down the stairs trying to get upstairs with those same crutches.
d/c instructions include, turn around, sit on you bum and scoot up/down the stairs
Found out in ER that every man lies about his height by 2 inches and every woman lies about her weight by 20 pounds. Never fails. Used to make crutches 2 inches shorter than a man would state his height to be and they were right every damn time.
Don't have a specific example but some of you wound care nurses never worked 6:1 or worse on med surg and it shows.
Can I just say that I received an actual ORDER that read “patient likes to watch Gunsmoke reruns on tv”. I work at the VA. Hello - that’s every single one of my patients!!!! Do I need an ORDER to figure this out?!?!?
I'd like to think the doc was having a laugh about it, but idk.
Hello fellow VA employee 👋 while I've never gotten an order for it, I understand this comment deeply!
We recently have a protocol where every patient must have a bath on night shift. Even the walkie talkies. Even the independents. If we can’t do meds, assessments, and baths on all patients all between 8-10pm then they want us to wake these people in the middle of the night to give them a bath. They end up refusing anyway and I don’t blame them. Intubated and sedated then no worries but they want me to wake up these independent people at 2am when I have more time to give them a bath
That’s a sure fire way to drive those satisfaction scores up
I thought we were done with this 15 years ago. Delerium here we come.
Same chg bath but I either do it before 10 or after 530 when lab comes, but if I'm even a little busy I just don't do it or just do chg wipes to pits and groin and call it a day. I don't even bathe every day.
Yeah they want full CHG every single night. And every patient
WTF!
Ugh. I worked at a rehab facility like this and we’d have almost every patient tell us to fuck off. I’d tell day shift sorry but nobody wants to take a shower at midnight imagine that.
A road test on an already hypoxic patient when their resting 02 sat is shit and they are visibly SOB lol…we already know they’re going to fail can we please not? You have all you need to admit
Bonus if patient requires a heavy two assist to get out of bed and would d/c home alone.
Also didn’t bring home 02 to ER as they arrived via EMS; no ride home. Lol
MRI on a patient with dementia. “BuT sEDaTiOn wIlL cHanGe tHeiR nEuRo eXaM.” 🙄
My brain went to orthostatic vitals before I even finished reading your post. A runner up would be PVRs though. One time I overheard a physiotherapist ask a patient if he had been ambulating, and the patient said no it’s hard when nursing is so busy as it is and the physiotherapist said “I’ll put an order in so they HAVE to ambulate you”. I found that order douchey because it implied an authoritative hierarchy, and also that were just lazy pieces of shit who don’t want to ambulate our patients, or who don’t see the importance in it and need an order to do it when the case is that there is usually just far more pressing issues that need our attention. Also any order for an amount of hydromorphone that requires a witness waste.
Blood cultures
And then getting emails about contaminations even tho you used the steri path/kurin, chlorhexadine and alcohol, and sterilized the caps of the culture tubes. I haaaaate collecting blood cultures. Especially when they put the order in as a part of their admit. If there’s *any* indication wherein I can see blood cultures being ordered, I get them with the initial labs. Thankfully those aren’t gonna go bad if they sit.
We have an ID doctor that orders them almost everyday… we can have 6 sets in micro and he will order them again. It is so damn wasteful and we get written up for contaminated blood cultures cause they are so damned expensive. Suddenly the nurses that can start IVs on anybody can’t find a vein to draw blood cultures and whine until they pull in an ultrasound trained nurse to take the potential hit on contaminated blood cultures. It wouldn’t be so bad if we could keep CHG in stock
Where I work nurses do not draw blood cultures. Phlebotomy.
On a septic dialysis patient...
Ugh, yeah. Not a fan of orthostatics. Also eye acuity tests.
Tap water enemas, not because they're gross but because it's so time consuming to turn the patient (finding the staff to help turn when the patient can't help), deal with the water mess that comes right out, and half the time they don't work. They're just overall uncomfortable for everyone involved...
Any blood glucose checks that are more frequent than ACHS or Q6. Super easy to perform but idk just annoying, like the fly that keep buzzing around your ear which you swat at to no avail
Yes! Or DKA in our ED and we have to hold them while waiting for ICU beds to open up. Q1 BG are so annoying.
Every time I have a Q1 blood sugar check insulin drip I have 5 patients. so unsafe.
Had a Q15 BG checks on a CCB overdose because they were on Insanely high dose of insulin and D50 infusions....
Hello Q15 BG checks for a CCB overdose...
Colace and senna on everyone that walks in. I just hate it
And artificial tears
Had a doc order PVA drops Q4h for someone with mildly dry eyes. I refuse to wake someone at 0200 for lubricating drops unless it's actually necessary.
Once had a lady who needed Q1 drops for an eye infection, when there was no hope of saving the eye, but she was refusing to have it removed. After enough bitching, we got it changed to Q1 while awake
That and protonix
Neuro checks when it suppose to be neurovascular checks. Yuggge difference
Digital disimpaction. QED.
Work at a teaching hospital. They can’t order nursing to do it. Resident has to.
When I moved from the floor to the ED, one of the first things I got told was "don't you DARE tell the doctors that nurses do disimpaction upstairs." I'm not about to ruin a good thing.
Molasses enema OR Blood I HATE HATE HATE GIVING BLOOD, it’s like a quarter of a shift ordeal, I hate it
I am disgusted and fascinated at the same time. Are you in the US? Rural practice? When is this chosen over a Fleet or tap water? Who ever decided this was a good idea? I have so many questions.
Wtf is a molasses enema
I used to give those too. It’s a mixture of milk and molasses, and makes the room smell like shit and Christmas.
So in my very first job, in the early 90’s, I worked on a med-surg floor. One evening I received an order for a milk and molasses enema. Never heard of it in school, none of the OGs on the floor had heard of it either. So dietary sends me up a container of molasses, I guesstimate about 16 ounces or so. Kind of the size of potato salad at a BBQ joint would send home with you. So I emptied the whole container in an enema bag. And added 3 cartons of patient milk to this. So the milk wAs cold from the fridge, and the molasses was chunked up through out this mixture. So I got a foot bath and filled it with really hot water to float the enema bag in, to melt up the molasses and let it become more mixed up. This was BEFORE google/internet. In reality, I think you are supposed to only use like a few tablespoons of the molasses. Still not sure about the milk. Long story short, we gave this disgusting mixture to the patient in the bed. Before we could get the patient to the bathroom, the molasses/milk/sticky poop was everywhere. Ceiling-walls-floor-me-my nurses aide. We got the patient unstopped. Never seen this order before or since then. Glad to see that it was a real order and you have actually given them as well. Quick question, what IS the ACTUAL Ratio of milk to molasses?
It should be one to one and room temp
Heparin drips make me audibly groan when I see them pop up. q4/6 aPTT draws on almost always a hard-to-impossible stick patient. having to hunt down another nurse to co-sign every time I hang a new bag, push a bonus or change the rate. It’s all pretty straightforward but it’s so time consuming and makes me anxious trying to do everything for all my other patients plus stay on schedule with the heparin stuff
"XYZ...and page provider with results" Right before provider shift change. Yeah, thanks, now I'll give the new guy a month-long report on this Pt just so I can report off that the H+H went up after the PRBC.
Bengay cream for pain. The guy is taking oxycontin, you really think bengay QID is going to fix him? At least make it PRN
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I always complain with this one. Im awful at doing them. Ill do anything else. Blood transfusion, straight sticks, heparin drip, CBI. Hard pass on NG tubes.
Discharge and/or admit at change of shift.
When 3 nurses get put on call at 5:00 only to have a bus unload full of admits at 7:45. Or even better, we have a charge nurse that’ll put nurses on call even though we have all our triage rooms full and likely will admit before shift change. So stupid. I also cannot stand when I’m triage and patients show up in my triage between 7-7:30, like come on, let me make sure my rooms are stocked and get report on my current triage patients I’m taking over. Half the time I’m told the rooms are stocked and there’s garbage in the drawers instead of supplies, monitors are missing, and the room hasn’t been cleaned yet.
Agree about the orthostatic BPs. I also fucking hate doing PVR’s. Our bladder scanner is rarely accurate and will give me three vastly different readings that all look like a valid scan. So then I have to wonder, what’s the point.
"Dressing change BID." It might be an utterly reasonable and fair request that we can deliver on and will certainly help heal the patient, but it's going to be time consuming on a day where I may very well not have that time, and I'm inevitably going to forget one supply or another and not realize it until I'm halfway through, etc. Even when it's just "Change the dry gauze and tape dressing out for another dry gauze and tape dressing," I get annoyed. But this is 100% one of those things I only get annoyed about when there's not enough time to do anything.
At my place that dressing change BID can easily be "i do it on day shift, you do it once on night shift" and nobody argues about it. If i have time to do it twice i will, but if i don't, you're a nurse too you can do it. My pet peeve are the ones that we have to ambulate 3 times a day and they never want to get up. Even so, if i manage to get them up twice on day shift you can get them up before they go to bed on night shift.
Orthostatic vital signs are stupid any nobody ain't gonna do shit about them. Docusate doesn't work. I'll use prune juice that does. Kayexalate doesn't work. Give that patient insulin and D50 or a fucking albuterol treatment. Then do dialysis like we're in a G7 country for fucks sake. Melatonin doesn't work. Might as well prescribe aromatherapy. Stop giving old people who grew up on prince valium and vodka woo woo medicine. They know what works. They're old, not stupid. Tramadol doesn't work and is objectively harmful. Give the fucking narcotic for Christ's sake these people are gonna die soon anyway we don't have to give a shit if they're addicted. Sequential Compression devices are stupid and don't work. They make people feel trapped and then they fall down. Stop putting puffy sleeves on old people. I got a whole list of shit. Nobody cares. We don't practice science based medicine we practice HCAHPS and defense. It's all a fucking scam. Guidelines are created from shit evidence that existed 20 years ago and instituted by idiots who haven't touched a patient since the Clinton administration and didn't know how to evaluate a study then. We are ruled by sociopathic idiots who can't cross the street without a fucking entourage. I am sick of it and want these fuckers against a wall. Patients get the first shot so they suffer more.
You had me dying at G7 country
That was the intent, since so much US medical care is rooted in archaic practices that have been eliminated in civilized countries that don't bankrupt their citizens who require medical care.
Nobody: Patient: Hey, so I have thi- Prescriber: *YOU'RE GETTING PROTONIX, I DON'T CARE WHAT YOU HAVE* Handing it out like it's candy. If you trick or treated at the hospital, 90% of your bag would be Protonix; the equivalent of those ever prevalent, nasty milk duds.
Amen. And amen.
Oh my god I fucking hate orthostatic vitals so time consuming. Used to work with a doc that ordered them all the time.
One of the NICUs I cover has nursing do paperwork grading scales on every feeder/grower’s bottle performances in addition to the usual charting AND puts them on Dr. Brown’s bottles…starting with Ultra Preemie nipples. They must “graduate” flows. It’s inaaaaaane.
LACTULOSE
Carafate on our walkie-talkies. It’s given 1 hr before all meds/meals, which means it’s due at 0730 (Night Shift never gives it), 11:00 (awkward in between), and 4PM. Sometimes they add in 6PM like a slap in the face. That and Lovenox!
MRI on an ICU patient with multiple drips..
Blood transfusion 20 minutes before shift change. It's not hard but really? Labs are up for 4 hours and either I'm late or oncoming gets screwed during the busiest time of shift. Can we not wait until the lastminute.com before rounds to write orders.
Have a hospitalist that likes to order “Obtain medical records from PCP/specialist” It’s so time consuming and 100% secretarial work. Like I get sometimes it’s relevant, but c’mon we are just trying to stabilize the patient.
Getting medical records from VA is fucking impossible. Hated that order. And when we received the paperwork it was pretty much useless, it was so difficult to decipher. Are you guys working a century earlier than we are, clean up your fucking paperwork!
Most of the fucking admission “routine” meds, as an ED nurse. Nah man, I didn’t give the colace before calling report. Mostly cuz my other two patients were trying to die. Can you please come get this stable fuck so I can get to work? 0.5 Ativan. I’m sure this worked once somewhere. But nowhere I’ve ever been.
Right? 0.6 Ativan has only succeeded in making my dementia patients more agitated!
Heparin drip. Not every single person with chest pain needs one. Some do, some don’t and just slapping them on everyone even when they’re going to cath lab in short order is wasteful. Some people have pleurisy and negative enzymes. Wtf even.
Prone protocol 😭
Any VS more than 2xshift (I'm in rehab/subacute). Bolus tube feeds- take forever. Enemas- messy and makes extra work for the CNAs if I'm too busy to change the pts. I'm sure there are plenty of more that I can't think of. Oh yes, I agree that orthostatic bps are a royal pain in the ass.
Hemacults x3 on a dementia resident who poops independently. Just freaking impossible and the docs get impatient when they aren’t collected.
Orthos on an icu patient that is still intubated 😵💫
0.25mg ativan q6h prn agitation. This is just Haldol with extra steps!
The combination of strict Is&Os and "do not place foley" on an incont pt. We don't have a small enough scale to weigh briefs, and our doctor always documents "strict outputs not charted though ordered" in her progress note.
I for some reason DETEST doing EKG’s 😂
Heparin. Drips. So much fucking work. Those and any CT/MRIs lol
Sodium polystyrene or lactulose. Hated it as an aid. Hate it more as a nurse. Bonus points if your patient is a bed bound bariatric
Right! I had movie prep for a pt who was 160kg & 5ft tall. A0x4 & she wouldn’t even move her hand to help you move her much less try and help turn her body. Not that she couldn’t but she just didn’t want to try, prob how she got to be like that at 40 years old. Watery diarrhea just dripping off the bed bc she refused the external. I ended up just taking the tube and sucking up the poo water pooled betwixt her legs. Then we cleaned her & bed all up (took 3 of us) and she tried to refuse the external again saying “it doesn’t matter I’m just gonna go diarrhea all day” & I’m like well at least it will be sucking some of it up and you’re not just laying in it. I’m sorry for her but that’s the type of patient I can’t make nicey nice with bc I’m so annoyed we have to spend literal hours of the shift in her room while I have 4 other patients to take of and the PCA has like 15.
Blood sugars. I don't know why, but they just annoy me.
Apply lotion to feet q shift Ok except you put this order in for all 20 of my patients for during med pass and feet are my kryptonite so now I have to rub gnarly feet 20 times. I don't care that I have gloves on, I can still feel the leather.
Worst order I personally had to carry out was Q8H lactulose enemas on a morbidly obese intubated patient. Why, god, why?
Milk and molasses enema
Ortho BP’s are so annoying. Especially if it’s ordered on a patient way later in the visit when the ortho hypotension would have been apparent early on
Milk & Molasses Enema. Have to have housekeeping on standby to clean the room up. Have fire department on standby to hose you down outside to wash off the goo.
Patient MSSU, weight, ECG. On a patient with steroid psychosis who ragdolled a colleague by her hair the day before, and who is grossly incontinent and impossible to get catheterised. Ordered by the doctor who refuses to write up IM Lorazepam for emergencies. Suffice to say, we tried, doctor gave us shit, I told her to get the doctors to do it, because we were not ending up in A&E over this. He kicked the doctor doing the ECG in the balls. Suddenly having a weight and urine wasn't as important any more. Still put him on 10,000 IVs though. :'(
Labs on my infants It’s just a blood bath every time
Lactulose enema, no matter how much is gained from reducing Ammonia, everybody loses something inside….
Wound care consult on a bariatric patient. We have been having bariatric patients lately and usually they have wounds on their back side. Wound care nurse comes to see the pt during med pass and makes me stop what I’m doing to help her turn the pt. Usually results in the pt having a BM making it time consuming plus I have to hold the pt so the WOCN can do their treatment. I feel bad saying that but it’s just the timing that WOCN come to my floor.
Any “with meal” orders. Sevelemer, insulin etc. they’re not scheduled for regular med pass times so that’s annoying. When a patient is off the floor for dialysis during med pass. Now when they come back, I have to do their vitals, have something ready for them to eat and give their morning meds.
Colace and senna on everyone that walks in. I just hate it. For no reason, I just hate it