As The Hospital Pervs

Aspiration Pneumonia is a risk. I often worry about this when preparing to swallow a big load.

"Your voice sounds a little thick, today," he said.

The Wrath of Dr. Khan
hahahahahahahaha

2 sniggling medical students

http://www.drunktiki.com/wp-content/uploads/2011/09/Trust-me-Im-a-doctor.jpg

sweepthefloor said:

The Wrath of Dr. Khan
hahahahahahahaha

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Bad lip reading is outstanding.

gotsnowgotslush said:

2 sniggling medical students

http://www.drunktiki.com/wp-content/uploads/2011/09/Trust-me-Im-a-doctor.jpg

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hehehehe

jomar said:

Bad lip reading is outstanding.

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That was the best part!

sweepthefloor said:

That was the best part!

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There is a website devoted to bad lip reading. Hilarious.

sweepthefloor said:

That was the best part!

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Bad Lip Reading

jomar said:

There is a website devoted to bad lip reading. Hilarious.

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I clicked it out, very funny.

My neck hurts. I have a sore throat. No fever. I woke up today and could barely swallow. The NP prescribed antibiotics and steroids. Now, I need a nurse for me.

Soup, steroids, milkshake, Z pack plan. It works. I thought this morning I was going to have to intubate myself with a straw to protect my airway.

Have an hour before and an hour after the scheduled time to give meds. Little old lady who is a regular remembers me and loves me has to wait until midnight every night to give her ativan. She has extreme anxiety from chronic breathing problems, and couldn't understand why she didn't get it with the rest of her bedtime meds. I told her with a wink that I would get it for her at 11. Of course, she likes me anyway, but now she sees me as her personal drug dealer. Calling on her call light early this morning, she asked to talk to Hope about her "ativan prescription." I tell her it isn't due until 0800 (it's TID). She leans in close to me and whispers, "Is it due at 8 o clock real time or your time? Can I get it at 7?"
Oh goodness, what have I started? I really need to give it at 11 exactly and see if my manager won't let me switch it to an hour ahead. I hope I haven't screwed up her med schedule even more.. She's just such a sweet old lady.. and it is within the time limits! *sigh*....

Give Us Hope!

I like to read your stories here, it reminds me that I am not alone.

Anxiety secondary to breathing problems is tricky. Many times we think the patient is having 'anxiety' but often times it is a sign of impending distress. It's anxiety now, respiratory distress in a few more hours. I watch these patients carefully. Also, it is a sticky situation because chronic lung issues, and sedatives can be a problem at bedtime if the sedation shallows the respirations and the CO2 can't be blown off.

Aww here is my take on the situation: If the clinical picture is stable, and the anxiety is not secondary to acute distress, then I would give the medications an hour early. I do not think I would tell her in a way that makes her think I am 'breaking any rules.' This way, she is not seeming to manipulate you. I would just bring the Ativan in at 2300, before she calls you for it.

It makes you trustworthy to her. You are just going in at 2300, to check on her, to see how she is doing, when you find her anxious you ask her if she would like the Ativan now.

At that time I would have a discussion with her. How much Ativan does she take at home? If she is getting less, that could be why she is always anxious at the H. I would also have her describe, and rate her anxiety. This will help us know what other problems are going on, if any. Then I would take all of this information-- contact the physician, and pretty much demand for a better assessment. Most times they will just say: "What do you want?" And I will say: "An extra dose if needed, and an order to give early if needed, and further evaluation because this seems to be chronic." I am Ok, with getting a one time extra dose PRN, till further evaluation. Then I would write my little note about it, and pass it on.

Now, the other side to this: if the patient is manipulative, and we know they exist, and how they torture us sometimes. Boundaries need to be created from the beginning. I find that being clear and firm is the best way. I will speak to the patient, only about the patient. If they ask me personal question, I turn the focus back to them, and reveal nothing about myself. I reinforce the plan so that they know what to expect: "No, you can't have a regular diet when you are here with severe 10/10 abdominal pain. You can have pain medications, and shortly you will go to CT scan. Does that make sense?"

This also builds trust because you show that your concerns revolve around them: time, and time again. It's not easy.

I have no problem pushing all kinds of drugs, because the pain that causes them seeking, whether it is emotional, or physical is valid to me. I bring the pain medication within the time frame. I plan my day around it. I see the clock, and know when they will be calling. I don't stretch over their allowed time. This also builds trust too, because when they know I show up when they call with the medication, they ease up on the other problems that manipulative people can cause.

I keep them happily drugged up as they wish, because the three day visit to the H, is not going to fix their drug seeking problems. That is beyond my control. I leave that control to the physician, happily. If the physician wrote the orders for every two hour pain medication: I give it without bias. If I have to call the doctor more than a few times for more, and more pain medications-- then the physician needs to assess in person, and I leave myself out of it.

I might bring it up in conversation, I will educate about health promotion. I will listen to them. I will always make a referral to social work, and provide resources for follow up care. I will not let it wreck my shift.

And yes Hope, I can see the picture clearly, she loves you. Make boundaries, and stick to them, because we can be firm, comforting, and compassionate at the same time. This doesn't mean let her suffer, it means find out the problem, and get the solution. (Then you can resolve the issue on the care plan! I love that!) That is what makes us special.

sweepthefloor said:

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Wow. Interesting style. Did you draw this?

Bitchy obese male patient with diabetic leg ulcer. Does not want to be disturbed until early morning. Alright, cool. However, noone tells me this. Come in @ 0200 with his Clindamycin and fucking 80 mg of lasix. I knock on the door, gently wake him with voice without touching him first. He lies there, awake. Ignores me. Doesn't even bother to throw off his CPAP mask all pissed off at me like the night before (he was just annoyed to be woken up the previous night). So, anyway, he is awake. Refuses to turn over; refuses to aknowledge my presence. His wife lies there sighing at me the entire time that I talk.
I tell him it is important medicine, and if he quickly (motherfucking) throws his arm over, I will be more than happy to do it bothering him as little as possible.
His wife finally leans up out of bed and smartly says to me, "He had asked not to be disturbed. He has not gotten any sleep and he needs his rest." Then, after telling her how fucking important the antibiotics and lasix is (especially since he was not compliant with his 500CC FLUID RESTRICTION and also got smart with me when I asked how many pops he had drunk to accurately do his Is and Os), she tells me that I can come back in at 6 and try then.
THANK YOU FOR YOUR FUCKING GRACIOUSNESS! I, of course, put on a shit eating grin and my nicest little innocent young nurse voice and tell them, "I am sorry. I did not know you had asked not to be disturbed. I will come back in later this morning!" With a nice inflection.

Okay, here is my disclaimer. I understand it is very difficult to sleep in a hospital, especially when meds are at a crazy ass time and you are on telemetry and q4 hour vitals. It gets you out of your home routine and messes you up in alot of ways, especially if you are specific with the way that you do things at home every day. Now, for my personal angry passive agressive rage answer.

Really?!
REALLY!?!?!?!?!
MOTHERFUCKING REALLY?!
If you don't want to be treated, GET OUT OF THE HOSPITAL! I don't feel like spending any more time with you either! That's why I waited to do you last on med pass and didn't come to stick your finger until I got your meds ready! He is one of those kinds of patients.
I understand that I could have changed time time on his beds had it been DAILY lasix or DAILY antibiotics, but that cleocin was on a strict, if retarded, schedule. WHAT THE FUCK DO YOU WANT ME TO DO BUDDY?!
Wow this has turned into an awful rant. I just literally have not had any patient EVER incite such rage in me! I think it's because he ignored me. You can get as smart with me as you want; but do not ignore me! I am debating whether or not this sounds too awful to post, but I think I will, just because I spent so much time on typing it

Vent away Hope, vent away.

Oh, and just so I don't sound too evil, I will post that I had an old tough male patient tell me "I love you" this morning, and all of my patients usually love and remember me xD

Hopeorless1 said:

Oh, and just so I don't sound too evil, I will post that I had an old tough male patient tell me "I love you" this morning, and all of my patients usually love and remember me xD

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Having three nurses in my family, two now, but anyway I have a fond appreciation for what you do.

Nice ranting and raving, we all need an outlet. If you can’t verbalize your own rage you might end up as one of those impaired alcoholic nurses, masking the stress as we try to be goodie two white shoes.

Angry nurses! It’s funny how the medication room often sounds like a sailor saloon. Clean hands, dirty mouths, crushing pills with a vengeance and beating up the MedSTATION 3000. And then flipping face around as soon as we walk out of that private staging area.

His wife lies there sighing at me the entire time that I talk.

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Fuck that!
The wife aka enabler of poor health, needs to go home at bedtime. I’d have the right mind to tell her: “Save your efforts for home care, instead of condescending me. Work on getting your man to comply at home so that he doesn’t end up here, if you truly care you fucking bitch! You probably feed him chocolates and salty chips! Why are you here?”

I support family advocacy and presence, but when it interrupts acute care treatment: GTFOff the unit. Stop clinging to the bedside to make up for your fucking guilt, especially at bedtime.

Hospital bedside guilt must be as subliminal as it gets.

Hopeorless1 said:

Oh, and just so I don't sound too evil, I will post that I had an old tough male patient tell me "I love you" this morning, and all of my patients usually love and remember me xD

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The hearts of angry old men/women are hard to win, but when we do, it does feel good.

Sometimes when I am getting a verbal assault, from the angry- I just sit down in the chair to their level and say: "What's up, what is really going on here?"

They say: They don't always remember your name, but they will remember the way you helped them feel.

It's a paraphrase of a some quote I read somewhere before, and it is true.
And the funny thing is it is the 'little things' they remember: "You washed my hair." "You cared for my Father." "You rubbed my back." "You just cared."