Wong Baker FACES Scale Pet Peeve

Unfortunately, this is how several aides and even nurses use the pain scale. NO, you the nurse/aide/whatever are not supposed to select the smiley/frowney face that most resembles the level of discomfort you think the patient has. The correct usage of this "tool" is for the patient to actually physically select with his/her finger the face that depicts their comfort/pain level.

Just so you know- everytime someone documents a "0" on the FACES scale on a patient that is demented, nonverbal, and immobile, a kitten dies. True story.

Stick to What You Know

Dear, primary care physicians, I admire your commitment- really I do.  BUT. Perhaps acute, inpatient management is not an appropriate application of your knowledge and skills. Case in point: 100 mcg Fentanyl IV push is not an appropriate dose for a LOL whose extent of opioid tolerance is the occasional Vicodin tab.

Separate case in point: Just because thus far the vital signs are stable, doesn't mean that a patient with abrupt delirium (periods of lethargy interrupted by confused yelling out, and overall twitchiness) is "stable". Just because the head CT and MRI were negative, and you have no clue as to the cause of this altered state doesn't mean this patient is "stable" and therefore should not be transferred out of med/surg to a higher level of care.

A Fist Full of Pills

Tying into the whole The Good, The Bad, and The Ugly thing.... but we're actually talking about two fistfuls of pills. First of all, I die a little bit inside each time I have to float to the "stepdown" unit anyway. God help me, the 0900 meds. Let's see what we have here:

1) allopurinol
2) bumetanide
3) carvedilol
4) darbapoetin alfa
5) enoxaparin
6) fluoxetine
7) gemfibrozil
8) hydralazine
9) isosorbide
10) Januvia
11) ketoconazole
12) levofloxacin
13) metronidazole
14) niacin
15) omeprazole
16) potassium chloride
17) quetiapine
18) rosuvastatin
19) sildenafil
20) tamsulosin
21) ursodiol
22) valsartan
23) warfarin
24) Xopenex
25) Yieronia
26) zinc

"And For a Few Pills More": Colace, Senna, Fish Oil, Vitamin C, Vitamin D, Multivitamin, Calcium, and a few sprinkles of Nystatin powder on top.

I place the most important pill in the cup first (quetiapine, naturally) and the octogenerian patient wrestles it down. Here comes pill #2....... Now pill #3..........Pill #12........Pill #13.... by now the patient is begging to stop. He is tired of taking pills. He has had enough. But if I am very unlucky, the patient's psychotic daughter will be at the bedside cajoling the unfortunate soul to sally forth until the last life-saving fish oil capsule is choked down with applesauce. This patient doesn't have the energy to argue anymore and resigns himself to another spoonful of applesauce/pill combo. Pill #16.....Pill #17......

45 minutes later- lather, rinse, and repeat for the next patient, and the next.... My only comfort is that when I get back to my home unit, I'll be administering meds through the various assortment of tubes- as is proper.

Pretty Much Says It All