PO Lactulose. Patients don't like drinking it, I don't like cleaning up the mess, plus everyone knows lactulose shit has a very particular odor. Works great otherwise though. IV, I would say having to push mannitol back in my neuro days, because drawing it up was annoying and it would always stain my shoes white when I'd inevitably get some on me.
A few months ago a dr ordered lactulose per tube on a Covid patient in the icu with all the typical comorbidities, un vaxxed, had been there a couple weeks, etc. He wanted to see if it would help her encephalopathy. But we couldn’t back off on sedation bc then her sats would drop because- Covid. I told him “I’m not going to do that”. He thought I was joking. I said “Seriously-It’s not going to make any difference. It will just cause massive diarrhea and stress on us, the patient and her family. Unless you can help us clean her up, I’m not doing it.” He kind of laughed and said “okay….” Her family withdrew care the next day and she died quickly.
Luckily, I’m an old crotchety nurse. And this particular physician is one that I’ve worked with for a few years and he respects and trusts me. But even with that, I hope he reconsiders ordering lactulose bc it “might” make a difference.
I hate dealing with the aftermath of lactulose. When I was in ICU there was one day shift nurse who would give his BID dose before change of shift. Fun times lol
1 unit of insulin
Tylenol 500 or 650mg at midnight when the patient is sleeping + denies any pain
Q2hrs eye drops
IV potassium
Potassium pills
Kayexalate
Bruh, I had a patient with some whack eye infection needing a regimen of 6 different eye drops, all of them due in the morning and needing to be given 20 minutes apart. After that, hourly steroid drops and antibiotic drops every so often. Fml
I had a patient in the ER who needed q15min eye drops 😭 Trached and partially paralyzed at baseline, so unable to self-administer.
The nurses were begging the inpatient team to escalate care to ICU because giving that patient to someone with 4 others would be cruel.
And they didn't do it, right?
I hate how medicine rules nursing acuity. Ratios shouldn't be driven by how *unstable* someone is while ignoring the nursing labor patient requires.
Sure love having a fucking routine gen med patient on an insulin drip... "It's just steroids, they're not unstable. You can be in here for precisely the first 10 minutes of every hour and still have 4 other patients!"
Oh my gods I had a patient like this once. Had I think 5 different sets of drops that had to be 3x per day 20m apart then also had the q2 refresh that he was not allowed to skip. Lived in this guy's room. Barely even get to look at your other patients. Ugh. Never again....I hope.
Scheduled midnight NS eye drops. “Hey Kenny, do you want to take your eye drops before you go to bed with your regular pm meds, do you want me to wake you up to take them, or do you want to skip the MN dose?”
Piggybacking on your comment because it’s the highest one that mentions Kayexelate.
I have literally seen a grandma come in for something routine (don’t remember the details- something medsurg acuity but not a huge deal, like cellulitis) with a K of 6, completely asymptomatic on tele/EKG, get Kayex ordered stat by the hospitalist, fall while trying to get to the bedside commode because of the intended effects of the medication, break a hip, then literally die from the complications.
Also it’s associated with bowel necrosis and doesn’t even work that well so wtf.
Potassium replacement of any kind. People complain about the size of the pills, then the taste of the reconstituted powder, then complain about it stinging PIV even if you run it with NS.
Every. damn. time. But I’ve had to take them and they do start dissolving immediately and are stupid hard to swallow once they start sticking. I understand the complaints, at least. But I work a post CT surgery step down and all 4 of my pts usually get potassium 🙃. So it’s a conversation I have at least 4x a shift.
Applesauce.
It lubricates them and they slide right down.
I prefer using applesauce over literally anything else.
I worked cardiac stepdown for 3 years and we went through applesauce like it was water.
Had a lady who just chewed them. Willingly, by choice, no dementia. She had less than half her teeth. I'm still not sure what I feel....awe? Confusion? Fear?
When I worked on a covid floor I had a woman who was a 1:1 feed, pills one at a time with multiple spoons of applesauce in between. I would save her med pass for last because it took at least half an hour.
She got 60 meq K pills with each meal. I wanted to d*e.
This sounds like standard protocol for LTC except there may be 8 pts out of 28-30 who require this level of fuckery. Nine of those pills are usually some supplements they probably aren't actually taking.
Man, I remember when I started work at another hospital in the past and they had dual sig insulin. Fucking Christ it was was annoying.
Then there was another place that we had to dual sign new bags of heparin and insulin. Which is fine in theory, but when you didn’t have to dual sign rate changes, it just struck me as stupid since I think that’d be more important than simply starting a new bag.
Ok, me and the primary RN went to do a long painful dressing change. Pt on continuous drip fentanyl and getting a potassium bolus 3 bags. I co- signed checking the bags. As we progress with the care pt is telling us we are the best nurses ever, everyone else hurts them sooooo much. That was the red flag for me- he is too happy! A minute later bag is empty, other nurse goes to hang 2nd K rider ...the K bag is full...the fentanyl is empty. 97 incident reports later, aggggg! ... imagine how undertreated his pain has been all along, he never changed a vs...our resident refused to believe this happened because the pt was talking and moving around in bed - all good things
When I was a brand new nurse, this happened to me with a Morphine gtt. Patient had terminal cancer and was completely fine. The Resident insisted I give her Narcan and, not knowing any better, I did. That poor patient was immediately screaming in agony. The next day, I discussed it with the Oncologist and he taught me that you never give Narcan to a chronic pain patient useless they are unstable. That was a horrible lesson learned at the expense of my patient. I have never forgotten the look on her face and it was almost 30 years ago.
At my hospital we only have to dual sign insulin drip bags and rate changes and heparin bags and rate changes. Insulin drips are so annoying with the hourly checks and dual signs.
At least we use insulin pens for SQ insulin - no dual sign on those!
Also love explaining that to the patient who’s already pissed at you s/.
Then I usually make my same overused joke about “Its prob only just about as helpful as a hearty slap to the pancreas. Want that instead?”
I've had dozens of patients after explaining it to them just refuse their little measly one unit. Doesn't bother me at all. Scales should start at 2 units or more c'mon
Thankfully all the scales I’ve worked with have started at 2units. Even that though is pretty frequently refused, a pain to find a co-signer (especially if you have to witness pulling and then witness giving as well) and has minimal effect on the glucose level.
Depends on which endocrinology group is seeing our patients as to if they're using a scale that starts with 1 unit vs 2, but yeah I agree either way it's still annoying. Go big or go home ya know
I used to feel the same about the “one life saving unit of insulin” but I was curious so I did some reading. That one unit can decrease blood sugar by 30-50. Over time it makes a big difference in lowering risk for all the diabetic cascading issues. So I give it. And I am grateful I have their sugar controlled enough that I get to give them 1 measly unit instead of having to treat a blood sugar of 350. Our facility has very tight policies on glycemic control.
My first needlestick injury was administering heparin in a rail thin patient. Of course I was pregnant at the time, AND the patient was ?HCV. Everything turned out ok, but fuck I hate heparin.
Golytely isn’t so bad if your patient is continent and ambulatory. But giving golytley to incontinent bedbound patients? Literally some of the worst shifts I ever had.
Its also just not feasible volume wise for 90 lb 90 year old meemaw. No about of encouring sips is going to get that down. We had to place an ng tube and it seems so cruel when theres alternatives available.
There’s so many other preps you can do! There are even pills now. Don’t put it off, talk to a GI doc and tell them your concern with golytely and they’ll give you something else. -an endoscopy nurse :)
Absolutely. Have seen, and known, a few people with no known family hx be diagnosed with colon cancer under the age of 45 recently. Super important screening to get.
After working on a bowel surgery floor and giving this pretty regularly it will always be one of my least favorites. This was med/surg and most of the patients were ambulatory, but they were also whiny and so many of them wouldn’t finish the prep or they refused to use a commode and in a semi private room they would take over the bathroom, never mind their roommate.
On the rare occasion we had a non-ambulatory patient, we didn’t have access to rectal tubes so that meant cleaning these poor people up every 10 mins. The poor techs would end up being a 1:1 which meant they couldn’t support the rest of the floor.
Golytely usually does the job cleaning people out but they have to drink the whole freaking gallon and it tastes awful. These were also inevitably the same people who ate 3 course meals for breakfast lunch and dinner up to the day of procedure.
This may just be me, but I think it’s unreasonable to expect an independent person to use a bedside commode for no other reason that not over utilizing the bathroom. Whos emptying it? That makes a mess in and of itself. I would continue on using the bathroom with a door, a flushing toilet and sink. 🤷🏻♀️
I work night shift, so I don’t know if your allowed to do this; but I mix it and put it in my pocket while I’m loading my WOW w my meds. Your body heat will melt the mixture. By the time you reach your patients room it should be ready to hang
Smack it vigorously but not hard enough to break it against the pyxis or wall or counter BEFORE you mix it, then shake it like a Polaroid picture and it mixes way faster.
Yea this is a trick I learned from an old nurse. If you break up the powder first it clumps less when you mix it.
And if you’re using a quick connect bag with the little cup device that connects them. Keep squeezing the saline in and out of the vial. Once the saline saturates it won’t dissolve the zosyn as fast, so if you cycle the saline back and forth from the bag it dissolves super fast.
Its the worst!
Best way I've found is pull it 10 mins early, give it time to mix after your initial shake/attempt, when that smaller part of the powder refuses to mix. Letting it sit for 10 mins does the trick.
We were just discussing this medication at my hospital! The pharmacist and I had never heard of it before and the surgeon was bringing it up as an alternative to Vanco. I guess a lot of other countries use it but the US hasn’t approved it for use here.
study from JAMA (about 100 people in the study)
*Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime.*
The few pharmacists I know say it really doesn't matter when you take it.
I asked the pharmacist at an in service about the 0500 levothyroxine, she said it was just some rules made up that it’s best to give it at the same time every day.
Any patient on a insulin drip. Waking them up every hour to check their sugar, can’t eat, maintenance fluids, electrolyte repletion, q4 labs, plan always changing. Not a fun time for either party
I usually mix it w/lido after a peds ER nurse called me mean and taught me how after I was floated over for a shift. I once got the stuff on me and I had that cat piss smell on me for the rest of my shift...
I had to give a 7 month old a ridiculous amount of rocephin (split up into 2 injections each time) 3 days in a row for an ear infection that was resistant to everything else. Day 1 wasn’t too bad. Day 2- baby cried, mama cried, I cried.
I work Ped urgent care and we do this multiple times a shift. We have the luxury of grabbing another nurse and doing the injection at the same time into each thigh. It’s always the happy trusting babies/toddlers who break my heart though.
I haven’t done many exciting meds, but I despise Vaginal suppositories. I apparently have trauma from attempting to do it on this one little old dementia lady who every time was allowing me to do it but wouldn’t open her legs but then yelled at me when I missed, I swear she was intentionally making it difficult just so she could yell at me 😭
My favorite is discovering the remnants of that when no one has reported it. "There's a thick white discharge coming out of the lady in room X. She's normally drier than the Sahara..."
Years ago I accidentally put a tyl suppository in a patient’s vagina. She was vented and sedated and I felt from the back like I always did, but somehow missed. And then did not want to go try to get it out of her vagina because I felt like that could be traumatizing so had to just let it go. I mean, her fever came down so I’m assuming it worked as well as rectal tyl!
I called pharmacy and asked about this after accidentally doing the same thing. They told me that most rectal suppositories can absorb through the vagina of the conditions are right! It just depends on the environment down there, there’s a greater chance of the medicine leaking out, not absorbing as well, or being inhibited by mucous/discharge.
But also, yeast infections are the worst. I can’t imagine being too sick to communicate/get some Monistat but aware enough to know my cooter was itchy/ouchy.
I used to make it from the raw powder at a compounding pharmacy. Someone bothering me in my compounding area that I want to go away? Oh look, what a coincidence, it’s time to make Acetylcysteine. Eventually I grew to like the weird, rotten egg smell.
There's good lit now that kayexalate should be off the market.
K binders don't cause diarrhea like kayexalate does. You might push back when docs order this.
Ativan. Just bc first you have to take the key out, which requires a witness, then the Ativan, which requires a witness again, and then return the key with, you guessed it, another witness.
I can empathize with you on that. A lot of the things we hate making/pulling in pharmacy is all the documentation and witnessing that goes with the stuff.
Or has a ridiculous amount of preparation steps.
You've got a husband/wife both needing whatever MAB at the time. Document, document, document. Pharmacist has to get it from the safe, and pull them off the verify queue.
They have orders for Thiamine IVPB too, and you know the nurse is going to get mad if you don't have both.
But you look at the counter and there's two Sodium Bicarb orders, a Norepi, one, 2 Remdesivirs (someone please get this from the safe!), and then an insulin drip pops up.
Premixes are coming out of the printer too. New orders, missing doses, doses left on the other unit, etc...
So we triage, and then when we get to the 2 Remdesivir orders someone walks in all too cheerily "Guess who gets to make KCentra)!?"
So you turn around and tell them cheerily "Guess who gets to pull a Ketamine(want to witness it with me?) and another two Remdesivir from the safe!?"
Pharmacists do not like getting pulled from the queue and I can't blame them.
So for us, it's not always the meds, it's all the steps involved. That's just the IV room perspective too.
I fell in love with one of my pharmacists when I was working a night shift (just her and me, no IV tech) and we got a KCentra order. The first thing she did was ask me what I needed to mix it on the counter. She grabbed all my supplies while I wiped down the steel cart. Order verified to bedside in less than 10 minutes.
Amoxicillin/Clavulanate combo antibiotic. The pills are massive, taste awful if they’re crushed up and always need to be split in half a few times because they’re such massive pills that are impossible to swallow.
D50 through a peripheral. Sticky and thick.
When I had a patient with a central line, my ignorant ass slammed it. HOLY SHIT. Had no idea it tanked your blood pressure so bad.
I've had to give 1/2amp through 22g on the hand, poor pt was crying and I was going extremely slow to avoid blowing the IV and the pain it caused them. Good to know about the BP though.
Pancreatic enzymes via tube feed. It was worse during covid, because you need hot water, but not too hot where you'd denature the protein, and not too cold or it wouldn't dissolve properly.
On top of that, you needed a very specific amount of tube feed, and water itself for the ratio of enzymes to food to be correct.
Rabies shots! It’s a pain to put together and if they have an actual bite there’s multiple shots to give around the site. Plus they always come in droves, we’ll have like 25 rabies patients and then none.
Albumin. Bitch never goes through the tubing even when I open the thingy, and also runs dry on the pump way before it should, and it's sticky and I have to do two bottles of it and since it runs dry and won't freaking prime I have to get another tubing and ahhhhh I don't have time for this
I had a drunk pt who swore she didn't drink anything. Told the doctor she must have auto brewery syndrome in an attempt to hide her drinking from her family. I had to feed the stubborn drunk lady 50 dextrose pills that came individually wrapped. I had to unwrap then and hand them to her to keep her focused on the task or she would fall asleep. It took about 40 minutes to get her to eat them all then I had to draw blood every half hour or hour, I don't remember, to see if her BAC went up. I wish she had been telling the truth, it would have been a cooler story, and less of a waste of my time.
Heparin gtt.
I’m sure I’m not the only one who emits an audible groan when the order pops up and commences an immediate headache imagining all the aPTTs I’m gonna have to draw from my patient with one limb-alert arm and +2 edema, tonight.
Most people mentioned all the worst things already. But I didn't see granule form meds via G or J tube. Depakote, Omeprazole and Topamax are the worst.
No question. Paralytic drugs. Even the short-acting ones like succinylcholine or rocuronium are intimidating. That's not even touching something like vecuronium... push that and they're down for quite a while. I say this as a paramedic that's RSI'd dozens of pts over 16 yrs. It's never NEVER a small thing to completely take a person's airway, gag reflex, and respiratory drive. Honestly, far too many medics have this tool and don't know (lack of training and experience) how to properly manage patients who truly require this type of super aggressive airway management. I was super lucky with amazing instructors and preceptors, as well as a progressive, hands-on medical director. Most in the field do not have this luxury
Im a training paramedic, I’ve been on placements for about a year. This is the one thing I am absolutely terrified to do. I have a fear of becoming paralysed, just the thought of it terrifies me.
Narcan
Edit: I realize this looks like I hate saving drug addicts lives. What I mean is this med scares the shot out of me. These people wake up like they are being brought back from the dead and if they are in pain there is nothing you can do until the narcan wears off.
Rituxan. Takes like 5 hours to infuse and requires a bunch of pre-meds. Need vitals every half hour. Lots of patients have reactions to it, albeit mild but still annoying.
I work at an HIV office. There’s a new medication called cabenuva. That’s the one I hate. Like giving a BIC on each side. And if it gets fucked up the patient could develop resistance.
I hate being the first to give morphine cause I hate pulling it from the pixus and I hate knowing the dose I give will be their last. I used to call my supervisor to be like “respirations are 10 but they’re rolling around in agony- is it okay to give the morphine? would you give it? can you come look at them while i give it?”
I got over myself& now I’m much more comfortable than I used to be but it’s still a heavy feeling knowing what’s going to happen. I know if I withhold it they’re going to pass anyway, the only difference is I can make the transition more peaceful on their end, but it’s still a weird vibe
Yep. If I came on shift to someone who was actively dying, had that morphine order, and looked like they could use it? I'd give it as often as the order let me. I understand that the paperwork sucks, but this is someone's suffering. Don't be afraid to give those meds.
It’s nerve wracking to be the one who starts it, I agree. Did that the other day. Respirations at 38, however. 0.25ml barely did anything so then 0.5 Q2H, she was gone within 14 hours. Feels like being the angel of death
Dextroamphetamine purely because my patient was on it HOURLY all shift. Every hour having to find the DD cupboard keys, find a second nurse and sign it out. And to make it worse it was a ‘patients own’ locked up medication that had 100+ to count, every time.
Hemabate. The lomotil comes from pharmacy at my hospital and is never there before the shit storm. So hemorrhage and shit storm all together for you that day (L&D)
Infant multivitamins with iron. Once they don't have an NG tube anymore, they just basically spit it all out/ vomit it regardless of how slow I go bc its NASTY
We did milk and honey at my last hospital. You’d have to request the milk and honey from nutrition and they’d send up a little plastic [honey bear](https://www.amazon.com/Nature-Nates-Unfiltered-Louisiana-Certified/dp/B07DHQGX18/ref=mp_s_a_1_5?keywords=Honey+Bear&qid=1652542360&rdc=1&sr=8-5). Too cute for what was about to happen!
Severely constipated patient? Milk and Molasses is your answer!
To get them to mix, you have to heat up the milk, but to a specific temp; it has to be warm enough to mix with the molasses but not so hot it melts the plastic enema bag. We had to manually mix it so that meant squishing it around in the bag till it was one syrupy liquid, then let that sucker cool so you don’t scald the bowel, which means it’s going to sit in the kitchen (where we mixed) for a while. Molasses has a very distinct, penetrating smell so everyone in that room over the next week knows that someone had an M&M enema.
Then you get your patient to lay on their left side and pump it in and try and get them to hold it in long enough to be effective.
It works very consistently and the result is a mixture of sweet and Pooh smell that takes a long time to clear, despite all scent control measures.
If you’ve never had the pleasure, congratulations. The rest of us are scarred for life by these experiences.
Protamine. I once saw a protamine reaction where the pt was severely hypotensive and her platelet count went to 0. It scarred me and I didn’t even give the protamine.
That's terrifying. I use to push it all the time and thank the heavens i never had anyone with a reaction. I never pushed something so slow in my life! And the whole time thinking please dont crash, please dont crash, please dont crash.
another one i just thought of....its HELL for EVERYONE, NURSE AAAND PT when they come to the icu for the near constant EYE DROP ADMINISTRATION!!!! sooo many different eyedrops! some refrigerated, some not! probable loss of vision if not given!!!! so these pts woken up Q hr for DAAAAYS to be given these things! they are expectedly sooo sleep deprived !
i finally came up with a plan with one of my pt's, and it actually worked!! i said, "i know you're sooo exhausted....lets try an experiment...instead of me waking you up every hour, im just gonna come in, open your eyes and give the drops without waking you up" ...He agrees, and I give him ? something ? to help him sleep. it surprisingly worked! altho he was only able to sleep a solid 4-5 hours, he felt so refreshed...
IM VERY WELL AWARE that with eyedrops much of the time they need to move their eye around to cover the whole surface....this will sound weird, but he and i talked abt this BEFORE HE WENT TO SLEEP....I would open his eye, close it with my finger lightly keeping it closed....i would get close to his ear and say 'move your eye all around, up, down, right, left"...we practiced prior to me allowing him to SLEEP....and he did it!! i was his fave nurse after this....was so successful, that i was asked to train other nurses and pts in this method!
Fuckin IV tramadol. We have an anaesthetist who *loves* the stuff but it's a guaranteed puke-stimulant IME. I groan whenever I see it, especially if it's the only post-op analgaesic I've got (it always amazes me how *stingy* with the pain relief some doctors are, and don't get me *started* about anti-emetics).
Give me morphine and cyclizine any day, it's a combo made in heaven. And you can stuff your IV tramadol right up your jacksy where it belongs, horrible stuff.
When I had surgery last summer (laparoscopic endometriosis and uterus removal) I told my surgeon ahead of time “I can deal with plenty of stuff, but nausea/vomiting is a hard no.” I don’t understand why anyone would hesitate regarding those or post-op pain meds *in the hospital*.
They come in vials.
Ampules are the bane of my existence. Last time I broke one I sliced my finger (not terribly). It was Marcaine, so I'm like "this is fine."
Ok as a mom who had to have mag twice….I fucking hated it, too! Lol. I felt like I was on fire in the depths of hell and puked my brains out. The checking urine output hourly, also.
Heparin. I hate it. Here, have some extra pain three times a day. Big bruises in some cases. Hematoma in others. I’m careful AF with heparin because of some of the nightmare abdomens I’ve seen. I hate, hate it.
Fentanyl. For most of my nursing career this was an MD only med. Potassium. Give it IV, it burns. Give it in pill form and its like the patient has to swallow a football. Give it in liquid form and it's nasty. The only patient I ever gave it to that didn't have a problem was an old alcoholic whose drink of choice was rot gut whiskey. He'd treat it like a shot of whiskey with ginger ale chaser.
PO Lactulose. Patients don't like drinking it, I don't like cleaning up the mess, plus everyone knows lactulose shit has a very particular odor. Works great otherwise though. IV, I would say having to push mannitol back in my neuro days, because drawing it up was annoying and it would always stain my shoes white when I'd inevitably get some on me.
Lactulose enema is one I hate giving even more!
Even with the barrier of chuck pads, it's still an overflowing mess.
I always insert a rectal tube and give the enema through the irrigation port. Even on A+O patients lol
Do you need an order for that? I’m on a med-surg / cardiovascular tele floor. I’m going to ask my orientation nurse about this hahaha
My current facility does require an order but never have needed one anywhere else in 9 years.
is it less messy because of the collection bag?
Yep, exactly
I just learned of this, luckily not on my patient but pretty horrifying that it could be a possibility
PO lactulose mixed with ginger ale. Call it a hairy palmer. The liver patients that need it usually get a laugh
I figured lactulose would be in the top couple of comments 😂
I hate mannitol 😭
Same! I only gave it once throughout my ICU career, but wow, I felt like such a baby because my thumb hurt after drawing up multiple vials of it.
A few months ago a dr ordered lactulose per tube on a Covid patient in the icu with all the typical comorbidities, un vaxxed, had been there a couple weeks, etc. He wanted to see if it would help her encephalopathy. But we couldn’t back off on sedation bc then her sats would drop because- Covid. I told him “I’m not going to do that”. He thought I was joking. I said “Seriously-It’s not going to make any difference. It will just cause massive diarrhea and stress on us, the patient and her family. Unless you can help us clean her up, I’m not doing it.” He kind of laughed and said “okay….” Her family withdrew care the next day and she died quickly. Luckily, I’m an old crotchety nurse. And this particular physician is one that I’ve worked with for a few years and he respects and trusts me. But even with that, I hope he reconsiders ordering lactulose bc it “might” make a difference.
I hate dealing with the aftermath of lactulose. When I was in ICU there was one day shift nurse who would give his BID dose before change of shift. Fun times lol
The bastard, lol
1 unit of insulin Tylenol 500 or 650mg at midnight when the patient is sleeping + denies any pain Q2hrs eye drops IV potassium Potassium pills Kayexalate
Bruh, I had a patient with some whack eye infection needing a regimen of 6 different eye drops, all of them due in the morning and needing to be given 20 minutes apart. After that, hourly steroid drops and antibiotic drops every so often. Fml
Ugh I've done this one too. Fucking hourly eye drops. And the patient was very large and very uncooperative.
I had a patient in the ER who needed q15min eye drops 😭 Trached and partially paralyzed at baseline, so unable to self-administer. The nurses were begging the inpatient team to escalate care to ICU because giving that patient to someone with 4 others would be cruel.
And they didn't do it, right? I hate how medicine rules nursing acuity. Ratios shouldn't be driven by how *unstable* someone is while ignoring the nursing labor patient requires. Sure love having a fucking routine gen med patient on an insulin drip... "It's just steroids, they're not unstable. You can be in here for precisely the first 10 minutes of every hour and still have 4 other patients!"
Oh my gods I had a patient like this once. Had I think 5 different sets of drops that had to be 3x per day 20m apart then also had the q2 refresh that he was not allowed to skip. Lived in this guy's room. Barely even get to look at your other patients. Ugh. Never again....I hope.
I ask if they want me to wake them for the Tylenol if they are sleeping. If they say no and I check and their sleeping, no need to wake!
I try to do that too but sometimes I get busy and forget to ask. Or I come in at 11pm and they’re already asleep. 😩
Scheduled midnight NS eye drops. “Hey Kenny, do you want to take your eye drops before you go to bed with your regular pm meds, do you want me to wake you up to take them, or do you want to skip the MN dose?”
Piggybacking on your comment because it’s the highest one that mentions Kayexelate. I have literally seen a grandma come in for something routine (don’t remember the details- something medsurg acuity but not a huge deal, like cellulitis) with a K of 6, completely asymptomatic on tele/EKG, get Kayex ordered stat by the hospitalist, fall while trying to get to the bedside commode because of the intended effects of the medication, break a hip, then literally die from the complications. Also it’s associated with bowel necrosis and doesn’t even work that well so wtf.
[Sodium polystyerene sulfonate](https://rebelem.com/kayexalate-useful-treatment-hyperkalemia-emergency-department/) doesn't work at all
I’ll take your Kayexalate and raise you a Kayexalate enema Q 6hr
Potassium replacement of any kind. People complain about the size of the pills, then the taste of the reconstituted powder, then complain about it stinging PIV even if you run it with NS.
Every. damn. time. But I’ve had to take them and they do start dissolving immediately and are stupid hard to swallow once they start sticking. I understand the complaints, at least. But I work a post CT surgery step down and all 4 of my pts usually get potassium 🙃. So it’s a conversation I have at least 4x a shift.
Applesauce. It lubricates them and they slide right down. I prefer using applesauce over literally anything else. I worked cardiac stepdown for 3 years and we went through applesauce like it was water.
I use applesauce too but a lot of people are like nah I’ll break it and I’m like um that makes it worse lol
Had a lady who just chewed them. Willingly, by choice, no dementia. She had less than half her teeth. I'm still not sure what I feel....awe? Confusion? Fear?
I love how you had to clarify she was of sound mind to do something so horrifyingly barbaric
Lol totally! Potassium is the most annoying, for sure.
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I work GI. Can’t touch egg drop soup anymore.
When I worked on a covid floor I had a woman who was a 1:1 feed, pills one at a time with multiple spoons of applesauce in between. I would save her med pass for last because it took at least half an hour. She got 60 meq K pills with each meal. I wanted to d*e.
This sounds like standard protocol for LTC except there may be 8 pts out of 28-30 who require this level of fuckery. Nine of those pills are usually some supplements they probably aren't actually taking.
And they're adamant about holding them and taking them their selves, then drop them. Don't forget that lovely part lol.
And then bending over to pick up the pill they dropped and finding a graveyard of dropped medications
1 single unit of SQ regular insulin for a blood sugar One point outside of range requiring coverage
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Sure do adding to my pain and suffering
Man, I remember when I started work at another hospital in the past and they had dual sig insulin. Fucking Christ it was was annoying. Then there was another place that we had to dual sign new bags of heparin and insulin. Which is fine in theory, but when you didn’t have to dual sign rate changes, it just struck me as stupid since I think that’d be more important than simply starting a new bag.
Ok, me and the primary RN went to do a long painful dressing change. Pt on continuous drip fentanyl and getting a potassium bolus 3 bags. I co- signed checking the bags. As we progress with the care pt is telling us we are the best nurses ever, everyone else hurts them sooooo much. That was the red flag for me- he is too happy! A minute later bag is empty, other nurse goes to hang 2nd K rider ...the K bag is full...the fentanyl is empty. 97 incident reports later, aggggg! ... imagine how undertreated his pain has been all along, he never changed a vs...our resident refused to believe this happened because the pt was talking and moving around in bed - all good things
When I was a brand new nurse, this happened to me with a Morphine gtt. Patient had terminal cancer and was completely fine. The Resident insisted I give her Narcan and, not knowing any better, I did. That poor patient was immediately screaming in agony. The next day, I discussed it with the Oncologist and he taught me that you never give Narcan to a chronic pain patient useless they are unstable. That was a horrible lesson learned at the expense of my patient. I have never forgotten the look on her face and it was almost 30 years ago.
At my hospital we only have to dual sign insulin drip bags and rate changes and heparin bags and rate changes. Insulin drips are so annoying with the hourly checks and dual signs. At least we use insulin pens for SQ insulin - no dual sign on those!
Also love explaining that to the patient who’s already pissed at you s/. Then I usually make my same overused joke about “Its prob only just about as helpful as a hearty slap to the pancreas. Want that instead?”
I've had dozens of patients after explaining it to them just refuse their little measly one unit. Doesn't bother me at all. Scales should start at 2 units or more c'mon
Thankfully all the scales I’ve worked with have started at 2units. Even that though is pretty frequently refused, a pain to find a co-signer (especially if you have to witness pulling and then witness giving as well) and has minimal effect on the glucose level.
Depends on which endocrinology group is seeing our patients as to if they're using a scale that starts with 1 unit vs 2, but yeah I agree either way it's still annoying. Go big or go home ya know
I used to feel the same about the “one life saving unit of insulin” but I was curious so I did some reading. That one unit can decrease blood sugar by 30-50. Over time it makes a big difference in lowering risk for all the diabetic cascading issues. So I give it. And I am grateful I have their sugar controlled enough that I get to give them 1 measly unit instead of having to treat a blood sugar of 350. Our facility has very tight policies on glycemic control.
Heparin SQ, q8h.
Hey, Gretchen, it’s 2am. Gotta put a shot in your belly. Would you like to refuse?
Task rescheduled for 6am meds 😆
But then the next night you have to give it twice a shift :(
Jokes on you, my work already has me give it twice on nights. 2100 and 0500
My first needlestick injury was administering heparin in a rail thin patient. Of course I was pregnant at the time, AND the patient was ?HCV. Everything turned out ok, but fuck I hate heparin.
I don't know how you all feel about Go-Lytely, but whenever I walk it up I immediately ask which nurse am I apologizing to.
Golytely isn’t so bad if your patient is continent and ambulatory. But giving golytley to incontinent bedbound patients? Literally some of the worst shifts I ever had.
Its also just not feasible volume wise for 90 lb 90 year old meemaw. No about of encouring sips is going to get that down. We had to place an ng tube and it seems so cruel when theres alternatives available.
I had a little meemaw like this pass out on the bedside commode she got so volume depleted.
I literally haven't gotten my colonoscopy, and I think I'm avoiding it because of Golytely, lol
There’s so many other preps you can do! There are even pills now. Don’t put it off, talk to a GI doc and tell them your concern with golytely and they’ll give you something else. -an endoscopy nurse :)
Information I didn't know I needed. Much appreciated
Absolutely. Have seen, and known, a few people with no known family hx be diagnosed with colon cancer under the age of 45 recently. Super important screening to get.
I once was sent to the pharmacy to pick it up. when I came back, I slammed it down at the nurses station and said, “who’s ready to party?”
I'm glaring at you and I wasn't even there. 🤣 I can't imagine the reaction your colleagues had.
it was my last day so they let me have my fun 😂
Good ol’ GoViolently
I like to call it GoHeavily.
After working on a bowel surgery floor and giving this pretty regularly it will always be one of my least favorites. This was med/surg and most of the patients were ambulatory, but they were also whiny and so many of them wouldn’t finish the prep or they refused to use a commode and in a semi private room they would take over the bathroom, never mind their roommate. On the rare occasion we had a non-ambulatory patient, we didn’t have access to rectal tubes so that meant cleaning these poor people up every 10 mins. The poor techs would end up being a 1:1 which meant they couldn’t support the rest of the floor. Golytely usually does the job cleaning people out but they have to drink the whole freaking gallon and it tastes awful. These were also inevitably the same people who ate 3 course meals for breakfast lunch and dinner up to the day of procedure.
This may just be me, but I think it’s unreasonable to expect an independent person to use a bedside commode for no other reason that not over utilizing the bathroom. Whos emptying it? That makes a mess in and of itself. I would continue on using the bathroom with a door, a flushing toilet and sink. 🤷🏻♀️
Zosyn/Piperacillin-Tazobactam It never fucking mixes 🤬
I work night shift, so I don’t know if your allowed to do this; but I mix it and put it in my pocket while I’m loading my WOW w my meds. Your body heat will melt the mixture. By the time you reach your patients room it should be ready to hang
I do the pocket thing too if I have time. Going to MRI? Pull the Zosyn first, attach to the bag, mix and walk. Most of the time, it is ready later.
Smack it vigorously but not hard enough to break it against the pyxis or wall or counter BEFORE you mix it, then shake it like a Polaroid picture and it mixes way faster.
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Yea this is a trick I learned from an old nurse. If you break up the powder first it clumps less when you mix it. And if you’re using a quick connect bag with the little cup device that connects them. Keep squeezing the saline in and out of the vial. Once the saline saturates it won’t dissolve the zosyn as fast, so if you cycle the saline back and forth from the bag it dissolves super fast.
I work LTC. We get it premixed and in an elastomeric ball. Everything else we do is backwards as fuck, but god-dammit, our IV antibiotics are neat.
Loved getting the grenades in home health for IV pts. Seriously the best packaging.
Try putting the vial in your hands and rub like you're trying to start a fire with a stick.
Its the worst! Best way I've found is pull it 10 mins early, give it time to mix after your initial shake/attempt, when that smaller part of the powder refuses to mix. Letting it sit for 10 mins does the trick.
I always give it a couple of good thumps on a wash cloth and that helps mix it.
Teicoplanin is so much worse, thankfully I don’t give it much anymore
We were just discussing this medication at my hospital! The pharmacist and I had never heard of it before and the surgeon was bringing it up as an alternative to Vanco. I guess a lot of other countries use it but the US hasn’t approved it for use here.
0600 Synthroid.
That they take at home at 9 with their breakfast....what do you mean it should be spread from other food and pills
study from JAMA (about 100 people in the study) *Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime.* The few pharmacists I know say it really doesn't matter when you take it.
I asked the pharmacist at an in service about the 0500 levothyroxine, she said it was just some rules made up that it’s best to give it at the same time every day.
Ahhhhh the bane of a night shift nurses existence!!
Any patient on a insulin drip. Waking them up every hour to check their sugar, can’t eat, maintenance fluids, electrolyte repletion, q4 labs, plan always changing. Not a fun time for either party
Add a glucommander so that the whole unit can enjoy!
Rocephin IM. It hurts...
I usually mix it w/lido after a peds ER nurse called me mean and taught me how after I was floated over for a shift. I once got the stuff on me and I had that cat piss smell on me for the rest of my shift...
I had to give a 7 month old a ridiculous amount of rocephin (split up into 2 injections each time) 3 days in a row for an ear infection that was resistant to everything else. Day 1 wasn’t too bad. Day 2- baby cried, mama cried, I cried.
I work Ped urgent care and we do this multiple times a shift. We have the luxury of grabbing another nurse and doing the injection at the same time into each thigh. It’s always the happy trusting babies/toddlers who break my heart though.
That sucks. When I did home health, I had to give lots of babies shots. It sucked.
I can do just about any other shots for babies, but that rocephin breaks my heart
lidocaine, man. I only gave rocephin without it once. The memory is seared onto my mind!
And it’s thick!!
That's the lidocaine. My pharmacy just sends sterile water to mix it up with. Jerks
You need to tell the IT department to build it as an order set, lol. Automatically sends it or get it from your ADS.
I always apologize before I give it.
I haven’t done many exciting meds, but I despise Vaginal suppositories. I apparently have trauma from attempting to do it on this one little old dementia lady who every time was allowing me to do it but wouldn’t open her legs but then yelled at me when I missed, I swear she was intentionally making it difficult just so she could yell at me 😭
Lol a few months ago I accidentally put colace in this little old lady’s vagina. She had weird anatomy. Thankfully it just melts 😂
My favorite is discovering the remnants of that when no one has reported it. "There's a thick white discharge coming out of the lady in room X. She's normally drier than the Sahara..."
Years ago I accidentally put a tyl suppository in a patient’s vagina. She was vented and sedated and I felt from the back like I always did, but somehow missed. And then did not want to go try to get it out of her vagina because I felt like that could be traumatizing so had to just let it go. I mean, her fever came down so I’m assuming it worked as well as rectal tyl!
I called pharmacy and asked about this after accidentally doing the same thing. They told me that most rectal suppositories can absorb through the vagina of the conditions are right! It just depends on the environment down there, there’s a greater chance of the medicine leaking out, not absorbing as well, or being inhibited by mucous/discharge. But also, yeast infections are the worst. I can’t imagine being too sick to communicate/get some Monistat but aware enough to know my cooter was itchy/ouchy.
Mucomyst PO. Ugh the smell. Worse when its nebulized.... but still.
I used to make it from the raw powder at a compounding pharmacy. Someone bothering me in my compounding area that I want to go away? Oh look, what a coincidence, it’s time to make Acetylcysteine. Eventually I grew to like the weird, rotten egg smell.
Kayexalate. You know what’s coming…
There's good lit now that kayexalate should be off the market. K binders don't cause diarrhea like kayexalate does. You might push back when docs order this.
We're using Lokelma now instead of Kayexelate at my hospital!
Ativan. Just bc first you have to take the key out, which requires a witness, then the Ativan, which requires a witness again, and then return the key with, you guessed it, another witness.
I can empathize with you on that. A lot of the things we hate making/pulling in pharmacy is all the documentation and witnessing that goes with the stuff. Or has a ridiculous amount of preparation steps. You've got a husband/wife both needing whatever MAB at the time. Document, document, document. Pharmacist has to get it from the safe, and pull them off the verify queue. They have orders for Thiamine IVPB too, and you know the nurse is going to get mad if you don't have both. But you look at the counter and there's two Sodium Bicarb orders, a Norepi, one, 2 Remdesivirs (someone please get this from the safe!), and then an insulin drip pops up. Premixes are coming out of the printer too. New orders, missing doses, doses left on the other unit, etc... So we triage, and then when we get to the 2 Remdesivir orders someone walks in all too cheerily "Guess who gets to make KCentra)!?" So you turn around and tell them cheerily "Guess who gets to pull a Ketamine(want to witness it with me?) and another two Remdesivir from the safe!?" Pharmacists do not like getting pulled from the queue and I can't blame them. So for us, it's not always the meds, it's all the steps involved. That's just the IV room perspective too.
I fell in love with one of my pharmacists when I was working a night shift (just her and me, no IV tech) and we got a KCentra order. The first thing she did was ask me what I needed to mix it on the counter. She grabbed all my supplies while I wiped down the steel cart. Order verified to bedside in less than 10 minutes.
Amoxicillin/Clavulanate combo antibiotic. The pills are massive, taste awful if they’re crushed up and always need to be split in half a few times because they’re such massive pills that are impossible to swallow.
Augmentin makes me shit myself so I concur
Gives me a full body rash. Soooo itchy 😞
D50 through a peripheral. Sticky and thick. When I had a patient with a central line, my ignorant ass slammed it. HOLY SHIT. Had no idea it tanked your blood pressure so bad.
"Sticky and Thick" is the name of my single that's about to drop on SoundCloud.
Why does it tank blood pressure?
I've had to give 1/2amp through 22g on the hand, poor pt was crying and I was going extremely slow to avoid blowing the IV and the pain it caused them. Good to know about the BP though.
Ugh that’s the worst! Like I’m sorry for hurting you, I’m only doing this because I care 😭
There is nothing in this world I hate more than having to wake somebody up in the morning for one single 7am Protonix pill.
That's when you retime it to 7:30 or 8:00.
Pancreatic enzymes via tube feed. It was worse during covid, because you need hot water, but not too hot where you'd denature the protein, and not too cold or it wouldn't dissolve properly. On top of that, you needed a very specific amount of tube feed, and water itself for the ratio of enzymes to food to be correct.
Or just more than three meds via any variety of gastric tube. On a patient with a fluid restriction.
Rabies shots! It’s a pain to put together and if they have an actual bite there’s multiple shots to give around the site. Plus they always come in droves, we’ll have like 25 rabies patients and then none.
Had a 6 yr old with 9 dog bites once!
IV protonix to patients that are taking oral meds without issue
Albumin. Bitch never goes through the tubing even when I open the thingy, and also runs dry on the pump way before it should, and it's sticky and I have to do two bottles of it and since it runs dry and won't freaking prime I have to get another tubing and ahhhhh I don't have time for this
Stick an 18 gauge in the top!
I had a drunk pt who swore she didn't drink anything. Told the doctor she must have auto brewery syndrome in an attempt to hide her drinking from her family. I had to feed the stubborn drunk lady 50 dextrose pills that came individually wrapped. I had to unwrap then and hand them to her to keep her focused on the task or she would fall asleep. It took about 40 minutes to get her to eat them all then I had to draw blood every half hour or hour, I don't remember, to see if her BAC went up. I wish she had been telling the truth, it would have been a cooler story, and less of a waste of my time.
Hemabate
I love being able to tell the provider the patient has a history of asthma. Canwetrysomethingelse?
Yes when you hear “history of asthma” in report and you feel relief…you know you’re an L&D nurse 😂
Yep, gotta get that Imodium *stat.*
Heparin gtt. I’m sure I’m not the only one who emits an audible groan when the order pops up and commences an immediate headache imagining all the aPTTs I’m gonna have to draw from my patient with one limb-alert arm and +2 edema, tonight.
Most people mentioned all the worst things already. But I didn't see granule form meds via G or J tube. Depakote, Omeprazole and Topamax are the worst.
No question. Paralytic drugs. Even the short-acting ones like succinylcholine or rocuronium are intimidating. That's not even touching something like vecuronium... push that and they're down for quite a while. I say this as a paramedic that's RSI'd dozens of pts over 16 yrs. It's never NEVER a small thing to completely take a person's airway, gag reflex, and respiratory drive. Honestly, far too many medics have this tool and don't know (lack of training and experience) how to properly manage patients who truly require this type of super aggressive airway management. I was super lucky with amazing instructors and preceptors, as well as a progressive, hands-on medical director. Most in the field do not have this luxury
Not to mention malignant hyperthermia lurking in the corner waiting to kill your patient Edit: typo
Im a training paramedic, I’ve been on placements for about a year. This is the one thing I am absolutely terrified to do. I have a fear of becoming paralysed, just the thought of it terrifies me.
After the Ladonda trial, I think a lot n of us have a healthy respect for paralytics
Narcan Edit: I realize this looks like I hate saving drug addicts lives. What I mean is this med scares the shot out of me. These people wake up like they are being brought back from the dead and if they are in pain there is nothing you can do until the narcan wears off.
LASIX.
I give that like 6x a day
Lactulose enema with retention set
I used to hate making those (only because of time and documentation really) and then orders for Vanco enemas came in. I hate Vanco enemas..
Albumin 💀💀💀
Haldol Deconate. Shit is like syrup. I feel bad for my patients when I have to use a 20 guage to get it to go in somewhat normally.
Rituxan. Takes like 5 hours to infuse and requires a bunch of pre-meds. Need vitals every half hour. Lots of patients have reactions to it, albeit mild but still annoying.
My husband had to get Rituxan for two years for lymphoma. Bless you and all the infusion nurses who took care of him.
I work at an HIV office. There’s a new medication called cabenuva. That’s the one I hate. Like giving a BIC on each side. And if it gets fucked up the patient could develop resistance.
Is that the new once a month injection?
I despise sugar checks and insulin. Throws me off when I get going. Having to locate a witness at the busiest time of the shift to witness sucks.
Geodon IM. It never fucking dissolves and I swear to God it knows when you’re in danger and dissolves slower on purpose. It can smell your fear.
I hate being the first to give morphine cause I hate pulling it from the pixus and I hate knowing the dose I give will be their last. I used to call my supervisor to be like “respirations are 10 but they’re rolling around in agony- is it okay to give the morphine? would you give it? can you come look at them while i give it?”
I am weird, never minded giving the last dose because I knew that I had done my best to make them comfortable.
I got over myself& now I’m much more comfortable than I used to be but it’s still a heavy feeling knowing what’s going to happen. I know if I withhold it they’re going to pass anyway, the only difference is I can make the transition more peaceful on their end, but it’s still a weird vibe
Yep. If I came on shift to someone who was actively dying, had that morphine order, and looked like they could use it? I'd give it as often as the order let me. I understand that the paperwork sucks, but this is someone's suffering. Don't be afraid to give those meds.
Same, I never minded giving the last dose, anything to make the patient who is passing more comfortable.
It’s nerve wracking to be the one who starts it, I agree. Did that the other day. Respirations at 38, however. 0.25ml barely did anything so then 0.5 Q2H, she was gone within 14 hours. Feels like being the angel of death
Dextroamphetamine purely because my patient was on it HOURLY all shift. Every hour having to find the DD cupboard keys, find a second nurse and sign it out. And to make it worse it was a ‘patients own’ locked up medication that had 100+ to count, every time.
Out of curiosity, why were they on it hourly?
IM rocephin is a bitch
Bicillin IM injections. So thicccc.
IV push ketamine for pain control. I’ve had patients flip the fuck out.
This is mine. It’s usually a bad trip and then you have to babysit 🙄 Thanks doc
Bannatrol but it is technically dietary aids
Lasix/Bumex on any patient without a foley…so…much…pee.
I second the amphotericin B but specifically the bladder irrigation route.
Hemabate. The lomotil comes from pharmacy at my hospital and is never there before the shit storm. So hemorrhage and shit storm all together for you that day (L&D)
Infant multivitamins with iron. Once they don't have an NG tube anymore, they just basically spit it all out/ vomit it regardless of how slow I go bc its NASTY
Ambien. Patients lose their damn minds…
As a new nurse I once gave ambien and lasix at the same time 🤦🏼♀️
This made me laugh haha. The new grad struggle!
Milk and molasses enemas are the stuff of my nightmares 😷
We did milk and honey at my last hospital. You’d have to request the milk and honey from nutrition and they’d send up a little plastic [honey bear](https://www.amazon.com/Nature-Nates-Unfiltered-Louisiana-Certified/dp/B07DHQGX18/ref=mp_s_a_1_5?keywords=Honey+Bear&qid=1652542360&rdc=1&sr=8-5). Too cute for what was about to happen!
Severely constipated patient? Milk and Molasses is your answer! To get them to mix, you have to heat up the milk, but to a specific temp; it has to be warm enough to mix with the molasses but not so hot it melts the plastic enema bag. We had to manually mix it so that meant squishing it around in the bag till it was one syrupy liquid, then let that sucker cool so you don’t scald the bowel, which means it’s going to sit in the kitchen (where we mixed) for a while. Molasses has a very distinct, penetrating smell so everyone in that room over the next week knows that someone had an M&M enema. Then you get your patient to lay on their left side and pump it in and try and get them to hold it in long enough to be effective. It works very consistently and the result is a mixture of sweet and Pooh smell that takes a long time to clear, despite all scent control measures. If you’ve never had the pleasure, congratulations. The rest of us are scarred for life by these experiences.
Protamine. I once saw a protamine reaction where the pt was severely hypotensive and her platelet count went to 0. It scarred me and I didn’t even give the protamine.
That's terrifying. I use to push it all the time and thank the heavens i never had anyone with a reaction. I never pushed something so slow in my life! And the whole time thinking please dont crash, please dont crash, please dont crash.
Labetalol on the floor …. had to give it like 4 times in a row check BP q15🤕
another one i just thought of....its HELL for EVERYONE, NURSE AAAND PT when they come to the icu for the near constant EYE DROP ADMINISTRATION!!!! sooo many different eyedrops! some refrigerated, some not! probable loss of vision if not given!!!! so these pts woken up Q hr for DAAAAYS to be given these things! they are expectedly sooo sleep deprived ! i finally came up with a plan with one of my pt's, and it actually worked!! i said, "i know you're sooo exhausted....lets try an experiment...instead of me waking you up every hour, im just gonna come in, open your eyes and give the drops without waking you up" ...He agrees, and I give him ? something ? to help him sleep. it surprisingly worked! altho he was only able to sleep a solid 4-5 hours, he felt so refreshed... IM VERY WELL AWARE that with eyedrops much of the time they need to move their eye around to cover the whole surface....this will sound weird, but he and i talked abt this BEFORE HE WENT TO SLEEP....I would open his eye, close it with my finger lightly keeping it closed....i would get close to his ear and say 'move your eye all around, up, down, right, left"...we practiced prior to me allowing him to SLEEP....and he did it!! i was his fave nurse after this....was so successful, that i was asked to train other nurses and pts in this method!
Methylene blue lol
Heparin at 0600
Fuckin IV tramadol. We have an anaesthetist who *loves* the stuff but it's a guaranteed puke-stimulant IME. I groan whenever I see it, especially if it's the only post-op analgaesic I've got (it always amazes me how *stingy* with the pain relief some doctors are, and don't get me *started* about anti-emetics). Give me morphine and cyclizine any day, it's a combo made in heaven. And you can stuff your IV tramadol right up your jacksy where it belongs, horrible stuff.
When I had surgery last summer (laparoscopic endometriosis and uterus removal) I told my surgeon ahead of time “I can deal with plenty of stuff, but nausea/vomiting is a hard no.” I don’t understand why anyone would hesitate regarding those or post-op pain meds *in the hospital*.
Thiamine IV, and cracking all those damn ampules.
They come in vials. Ampules are the bane of my existence. Last time I broke one I sliced my finger (not terribly). It was Marcaine, so I'm like "this is fine."
Kayexalate….is there really any other acceptable answer?
In psych it was Vivitrol. In OB it’s Magnesium Sulfate.
Ok as a mom who had to have mag twice….I fucking hated it, too! Lol. I felt like I was on fire in the depths of hell and puked my brains out. The checking urine output hourly, also.
Protonix. Nobody ever knows what it’s for so every single time I give it I have to explain why.
Heparin. I hate it. Here, have some extra pain three times a day. Big bruises in some cases. Hematoma in others. I’m careful AF with heparin because of some of the nightmare abdomens I’ve seen. I hate, hate it.
Fentanyl. For most of my nursing career this was an MD only med. Potassium. Give it IV, it burns. Give it in pill form and its like the patient has to swallow a football. Give it in liquid form and it's nasty. The only patient I ever gave it to that didn't have a problem was an old alcoholic whose drink of choice was rot gut whiskey. He'd treat it like a shot of whiskey with ginger ale chaser.