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Are You Scared Yet? ... (Part 1)

posted 10/28/2007 6:33:52 PM |
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tagged: medical, nurse, hospital

Yes, I work in a hospital… Lot’s of them, in fact. Yes, I provide direct patient care. I’m I perfect? Hell no! There is always something new to learn and I believe this is true no matter what kind of job that you do, but especially applies to healthcare types. So, what the hell is all this about? It’s about the fact that many healthcare providers scare the hell out of me. What?!? Yes, absolutely! I see things daily which cause me to scratch my head repeatedly in utter disbelief at what I’m either seeing or hearing. Still confused? Let me explain…

Interview with Dr. X.. (or shall we say Kervorkian):

Dr. X (to me as I am caring for a patient on life support): I don’t believe I have ever met you.

Me: We did meet, but it was several months ago. I was working in the ER and you were down there admitting a patient to the ICU. (that initial meeting could be the subject of a whole other blog!)

Dr. X: How did that turn out?

Me (wondering what the hell he is talking about): Turn out?

Dr. X: The patient.. Was their outcome good?

Me: You know, we have seen so many patients since then. I don’t recall the patient exactly, but I’m fairly certain that they were okay eventually.

Dr. X: Oh Good! I just wanted to make sure that I hadn’t killed them.

Phone conversation with Nurse T (for terror):

Nurse T: I need you to come to the ICU to deep suction Mrs. Doe.

Me: Is there a physicians order to nasotracheally suction Mrs. Doe?

Nurse T: Well she NEEDS it. She also needs a nebulizer treatment.

Me: Tell you what. I will be right there to assess Mrs. Doe and to make sure we actually have an order for NT suctioning, since it is, after all, an invasive procedure which requires a doctors order.

4 minutes later, I am in Mrs. Doe’s room. Yes, the poor thing does indeed sound like crap. She is suffering from congestive heart failure and her lung tissue is full of fluid… nothing that could be ‘fixed’ by sticking a suction catheter up her remaining nostril (one is already occupied by a nasal-gastric tube) and down into her lungs. What the woman needs is her lasix.. Which incidentally she actually DOES have an order for… along with some other well placed meds for anxiety.

So, I get Mrs. Doe’s chart to verify that indeed, there IS NO order for invasive suctioning.

Nurse T: What about that treatment. She REALLY needs it.

Me: Bronchodilators do nothing to alleviate interstitial lung fluid. They are indicated for bronchospasm and wheezing… which Mrs. Doe is clearly not experiencing. Besides, there is no physician’s order.

Nurse T: But she does have a prn order!

Me: Yes, she does, but you know, I saw Mrs. Doe about an hour ago. Her prn order is for every 2 hours… and well, its too soon and isn’t indicated right now anyway.

I pull up a chair at Mrs. Doe’s bedside. Mrs. Doe, honey. You need to cough for me. Mrs. Doe who, although is very sick, does respond when you talk to her, immediately complies with my request. It’s a nice strong cough too. She not only coughs once, but many times, in fact. No, she doesn’t cough anything up.. As there is nothing to cough up. But it does help force some of the interstitial fluid out of the space surrounding her lungs.

Incidentally, NT suctioning is extremely traumatic, can cause bleeding, and requires sterile procedure, as well as a physician‘s order. It is also NEVER indicated for a patient who is able to cough on their own. Score 1 point for Mrs. Doe who did not have to endure, by me anyway, having the air literally sucked out of her lungs when she was experiencing shortness of breath due to her heart problems. Score -1 for the nurse who was miffed because SHE is a nurse and SHE knows everything.. many of which seem to believe they are immune from the requirement to obtain or request physician’s orders for respiratory medications or some invasive procedures. Damn did I say that out loud?

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Oct 28 @ 6:53PM  
Thank you for sharing. I for one take care of myself, so far so good. I help my friends also. The best to you. Yes, I have put those quacks to shame, a few times.


Oct 28 @ 7:08PM  
You are truly an angel. I have the up most respect for the nurses that are dedicated to their career. They strive to know and learn more everyday. My Mom is in SICU after triple bypass last Monday. The nurses that know what they are doing are so busy teaching their skills to the younger nurses to make the SICU the best possible. You have all my respect and will have rewards in heaven for the good you did on earth.

Oct 28 @ 7:32PM  
That is real reasuring. I suppose it is best to die at home and save the expnenses to the estate.

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Are You Scared Yet? ... (Part 1)