Medication Used For Dosage Calls To Nurse: Fill & Download for Free

Shit, you don’t.If you value your license—and your sanity—you will jump over the Grand Canyon to avoid working with an incompetent doctor.I used to work at the VA Hospital in Houston, circa 2000.I worked in the ICU/CCU. Pulse oximetry, telemetry, Holter monitors, pain management, you know the deal.Back then, doctors wrote medication orders in what could only be called chicken scratch. When it came to these orders, there was one doctor who was really arrogant and full of himself. You know the type; he was always right, patients were dumb and nurses were inferior and didn’t know what they were talking about.At least I knew the damn difference between milligrams and fucking micrograms, which is the standard unit used for dosages of Fentanyl.The hospital had a policy that required physicians to personally correct these kinds of orders; I think it was a liability issue. So if an order needed to be corrected, the physician had to make a personal appearance to correct it and/or write new orders. Most physicians had no issue with this, but this douche canoe felt it was just to punish him and make him suffer.So when an order for 50 mg of Fentanyl came across the nurses station, I immediately flagged it and called the physician who wrote it—arrogant Dr. Know-It-All. I informed him of the problem and reminded him of the hospital policy.The doctor refused to come back to the hospital to fix it. Nurses cannot just change or alter orders and we certainly cannot just write up new orders without authorization, especially for pain meds like this. So the patient, who had undergone surgery, was left in pain for several hours until the doctor decided to come in and correct the orders.Of course the patient complained about not getting pain meds. The doctor bitched at the nurses for not giving the meds and called us stupid and incompetent for not just giving the patient something for the pain. The patient’s family made a complaint against the nurses and when I pointed out the mistake—milligrams instead of micrograms—the doctor flipped out on me and threw a fucking Mayo stand tray at me.It took a lot of red tape to get out of that fucked up situation. I immediately transferred to a new department to get away from that doctor before he effectively fucked up my license and my career.

The oops was mine.This was several decades ago, and I was working as an ICU nurse taking care of patients after open-heart surgery. It was a quiet Sunday afternoon and we had almost cleaned out the ICU of patients, so it was just me and another nurse -let’s call him L - taking care of four stable patients. One of my patients was a man in his 70’s who had surgery the day before and was doing well. I got him out of bed and sat him in a chair for the first time since his surgery. He complained of some chest pain, which was perfectly normal after having your sternum literally sawn open and your ribs pulled apart by metal rib spreaders.I decided to give him a narcotic pain medicine, and since I believed in the old medical adage of “start low and go slow”, and also “you can always give more, but you can’t take away”, I gave him just one Percocet tablet instead of two until I could determine how he reacted to the meds. He swallowed the pill, then settled in the chair in front of the TV and relaxed. I went to check on my other patient and everything seemed fine.About fifteen minutes later, I returned to check on him and saw that he had fallen asleep in the chair. At that moment, his monitor started to alarm. His oxygen levels had dropped low. His heart rate was going up and his blood pressure was dropping.A thousand possible reasons for his symptoms started running through my mind. Could he have blown his heart graft and was hemorrhaging internally? Was he having a vasospasm of one of his coronary arteries? I glanced at his chest tubes as I moved to his side, dreading the sight of blood pouring uncontrollably out of them. Nothing. They looked normal. I turned up his oxygen and called his name to wake him up.He stayed asleep. I shook his shoulder and called to him louder. He remained unresponsive. Sh-t, I thought, did he have a stroke or throw a clot to his brain? I quickly pulled open his eyelids and checked his pupils. Normal. No sign of stroke. He still wasn´t responsive and was barely breathing.I yelled for L. to come quickly and bring me the crash cart in case he coded. L. was still a fairly new nurse and had been my trainee when he graduated from college. He didn´t question my order, he just came running pushing the big red cart before him. By this time, I had straddled the patient´s lap and grabbed his shoulders shaking him hard and calling his name trying to get some response from him. My mind was still racing through possible diagnoses for what could be happening to him and the only thing that made sense was he was having some bizarre reaction to the Percocet.I found that hard to believe, since I had given double the dose of Percocet to 85-year-old, 90-pound (45 kilo) women hundreds of times and they never had any problems handling it. But it was the only thing I could think of.“It must be the Percocet!” I yelled at L. “Get me the Narcan!” I gave the patient a hard sternal rub that normally wakes the dead and he still didn’t respond.“Seriously?” He said. “You think it´s the Percocet?” As he ripped open the drawers of the crash cart and pulled out the vial of medicine that is used as an antidote for narcotic overdose.“I don´t know. I can´t think of anything else it could be. Just draw it up and give it to him!” I said, watching the monitor with horror as his blood pressure tanked and his heart rate which had been very fast now started crashing down 5 beats every other second.“I can´t believe I am going to lose this guy over a stupid Percocet.” I muttered to myself.L., who had never given Narcan in his life, paused with the syringe hovering over the vial. “What´s the dose?” He called to me.“0.4 mg” I yelled. Thinking I had been remiss in not drilling emergency drug dosages into his head well enough.He immediately drew it up and reached for the patient’s IV line.I was still straddling the patient in the chair, and glancing at the monitor with its infuriating alarm screaming loudly how close he was to death. I moved my hands over his heart, prepared to start chest compressions and thinking how much I hated having to do CPR with someone sitting in a chair, while debating whether I should waste precious seconds trying to drag him onto the floor. He then stopped breathing altogether and his heart rate dropped to 20 beats per minute.L. pushed the Narcan into the patient´s central line directly into his heart and within 3 -2-1..the old man gave a huge gasp and his eyes flew open. He stared directly into the eyes of his 28-year-old nurse who was doing a very believable imitation of a lap dance, straddling his groin while her hands were splayed on his chest.“What in the hell do you think you are doing?” He yelled into my face, looking shocked and angry.I sighed with relief and looked up at his monitor. Oxygenation back up, blood pressure OK, heart rate and rhythm normal.“Why are you sitting on me? Have you lost your mind?” He pushed me away.I climbed off his lap. “You have no idea how glad I am that you are OK. You had some sort of reaction to the medicine. You died there for a minute.” I said quickly in explanation of my unprofessional position on his lap.“Are you insane?” He shouted angrily. “I took a nap for five minutes, and next thing I know you are sitting on me and doing God knows what to me. What the hell kind of nurse are you that you can´t tell the difference between someone who´s sleeping and someone who´s dead?”L. looked at him and shook his head. “Dude, she´s right, you were dead.” He said flatly.The old man looked at him. “Are you crazy too? You mean I have two idiots taking care of me? I´m going to report you to someone.” He rubbed his chest. “Now my chest is hurting all over again with all this nonsense.” He looked at me angrily. “Honey, get me another one of those pain pills, now.”I couldn´t help but laugh. “Sir, there is no way I am EVER giving you another one of those pills. I will get you something else for pain, but not that. In fact, you need to remember this name. P-E-R-C-O-C-E-T. You are NEVER to take one of them again, do you understand? You are allergic to them.”“Nonsense!” He said. “I´m not allergic to anything.”“Oh, yes you are.” I grabbed a bright red allergy armband and wrote Percocet in big letters with a sharpie under allergy and quickly wrapped it around his wrist. I slapped an allergy sticker onto the front of his chart and wrote the warning that his allergic reaction was DEATH.That was my oops, giving a patient a single innocuous pill that almost killed him.

It sounds like you had a very bad experience with the painful demise of a loved one who died in severe pain. That must have been horrible for you to watch, and you have my deepest sympathy.I worked on an oncology unit where many people died of painful diseases. I never saw a situation where the doctor just left the patient crying in pain. I did see patients who required rather high doses of narcotics which were given in an IV drip, so that they received a continuous dose of morphine or dilaudid. The doctor would prescribe an upper dosage or ceiling at which we could infuse the narcotic drip. Since prolonged use of narcotics creates tolerance to same, it was not unusual for patients to complain of uncontrolled pain at the current maximum dosage. In that case the nurse would inform the physician who would then increase the dose. We would also call to get an increased dosage for unconscious patients who exhibited painful behavior such as moaning or grimacing.In an end of life situation addiction is not a concern. Pain control is. I say control because pain cannot always be eliminated for someone with chronic pain, but the level of pain can be decreased so that it is tolerable.Someone mentioned that achieving pain control might not be possible in areas where euthanasia is illegal. Nurses know that one of the side effects of narcotics is to slow breathing down to a very low rate. That is what Narcan is for. Narcan quickly reverses a narcotic. Since the patient will then be in severe pain, the nurse needs to be ready to restart the drip, albeit at a lower rate. Another option is to slow the rate down while watching the patient closely.My mother had chronic pain and was a very anxious woman with quite an extensive medical history which included chronic back pain which was severe. When she was dying she was unable to inform the staff that her back hurt, so they did not know this. She was getting low doses of IV morphine to decrease the distress caused by dying but not enough for any pain control. Like I said she was unable to complain but was able to nod when I asked her if her back hurt. Because of my work experience and knowledge of Mom's history, I was able to inform the nurse and request a morphine drip for Mom's pain and routine doses of IV push Ativan for her anxiety. I often wondered what people did who didn't know to ask for this. Along with what I already mentioned, she did not look or act painful. Fortunately health care workers now know that people who are not fully conscious could still be experiencing pain and not groan or grimace. The current thinking would be to ask ourselves, “what if this were happening to me? Would I be I in pain?” and then medicate accordingly. I, and every nurse I know, would much rather give pain medications to a patient with a decreased level of consciousness who was not in pain than to withhold it from someone who was.Now if none of this applies to your situation, and you truly had a loved one who was left howling in pain while the physician refused to address it, you need to report that physician. Such behavior is barbaric, and he or she has no business caring for people who are dying.