Orders I'd like to write

[OldPsychDoc]

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So I'm on call, and I have to give a verbal order for a patient to have a PB&J because she skipped breakfast. 🙄

And I'm just thinking--here are some other orders I'd like to write:

"Ditch the loser boyfriend--STAT."
"Up off of couch prn"
"Get a job, 8 hrs q day, M-F"
"Move out of parents' basement as tolerated"

Other suggestions?

 

[JayneCobb]

"ativan 5mg q 5 minutes until asleep or considerably less bitchy"
"1 bar of fragrant soap, judicious application on skin with water q12 hours"
"restrict Jerry Springer viewing to q week"
"Pt may wipe his own backside s/p defecation"
"Cheetos restriction: 1 bag q month."
"disconnect pts phone upon physician visitation"

 

[Doc Samson]

Ativan 2 mg IM to nurse prn patient BS>400

 

[Anasazi23]

So I'm on call, and I have to give a verbal order for a patient to have a PB&J because she skipped breakfast. 🙄

And I'm just thinking--here are some other orders I'd like to write:

"Ditch the loser boyfriend--STAT."
"Up off of couch prn"
"Get a job, 8 hrs q day, M-F"
"Move out of parents' basement as tolerated"

Other suggestions?

This sounds like me in a typical outpatient day....I'm actually not kidding - especially the "get a job" part.

 

[Anasazi23]

Disability Office restriction. First dose now.

 

[BabyPsychDoc]

I am oncall. It is 3 am. I am called to do a suicide risk assessment on a patient who took 5 g of paracetamol and called the ambulance 10 min later. The ER doc tells me it is this patient's 87th(!!!!!) presentation within the last 10 months (no, I am not kidding). She had ditched DBT AND therapeutic community as "they were pointless". What do I want to write on her order sheet?

Deal with it - STAT.

 

[maranatha]

Please give 6 yo patient the following prescription:

Novusparental (Generic: New Parents), Functional Type, SR
Sig: qD and PRN as tolerated
Disp: Lifetime

Please have patient immediately stop his previous Parental, F*&%#-up Type, prescription--no need to taper.

 

[MBK2003]

Insight (depot form) IM q1 yr, first dose STAT

To the mother of my reactive attachment, conduct disorder client whose Mom is looking for the next baby daddy: Copper T IUD STAT

MBK2003

 

[jay dub]

I just want to say these are all fabulous. HA! You guys have made my night. I needed a laugh. Thanks...

 

[enanareina]

d/c crack cocaine

 

[Dienekes]

"Ass beating per security PRN for bad attitude"
"Haldol 10 mg, Ativan 2 mg, Benadryl 50 mg for primary care physician ordering Q4 neb treatments on a stable COPDer without SOB; maybe given to either physician or RT."
"Subscription to 'Guns and Ammo' or a copy of this for hx of failed suicide 'attempts' n = >2"

 

[Chewbacca Jung]

I just wish there were labs you could draw for malingering and B.S.ing--

 

[Dienekes]

I just wish there were labs you could draw for malingering and B.S.ing--

There is....it's called a femoral ABG. That, or even just the suggestion of it, tends to clear up malingering REAL quick......unless you're dealing with a true masochist.

 

[sikegeek]

d/c crack cocaine

 

[BabyPsychDoc]

There is....it's called a femoral ABG. That, or even just the suggestion of it, tends to clear up malingering REAL quick......unless you're dealing with a true masochist.

Better still, do an LP. However, if you have a true malingerer or factitious disorder sufferer even this would not work.😱

 

[Dienekes]

However, if you have a true malingerer or factitious disorder sufferer even this would not work.😱

Point taken.

 

[Chewbacca Jung]

I thought that perhaps a rectal would do... but you guys are hard core...


If someone is that adamant about their malingering to go through one of those proceedures, then I think they earn their ativan, narcotic, bed and a sandwich, etc...

 

[Dienekes]

I thought that perhaps a rectal would do... but you guys are hard core...


If someone is that adamant about their malingering to go through one of those proceedures, then I think they earn their ativan, narcotic, bed and a sandwich, etc...

Hell, anyone who voluntarily takes a needle to the crotch has my respect, regardless of psychopathology.

 

[Anasazi23]

I thought that perhaps a rectal would do... but you guys are hard core...


If someone is that adamant about their malingering to go through one of those proceedures, then I think they earn their ativan, narcotic, bed and a sandwich, etc...

Won't give urine because you know it's tainted?

I was always partial to the involuntary cath. That seems to get the gears turning at 3am.

 

[Dartos Vader]

A friend of mine who is an FP resident, formerly a surgery resident gave me some great advice. A nurse had called me during the half hour I normally try to close my eyes during call (i've been on IM for two months now) to have the following conversation

nurse-doctor, I'm glad I got a hold of you
me-what's going on?
nurse-it's about your patient, mr soandso
me-yes?
nurse-I'm starting to get a feeling, that they may be getting ready to spike a temp sometime soon (I'm not exaggerating here)
me-stunned silence
nurse-doctor?
me-ummmm, ok. Are they having any symptoms?
nurse-no
me-and their temp is?
nurse-97.6
me-alright then, i'll keep that in mind

my friends advice for situations like that was to thank the nurse for her vigilant care and tell her you also are concerned. Tell her we need to keep a close eye on this critical patient. Thusly we should get them out of bed every hour, get a waist measurement and weigh them. Check temp q 15 minutes and of course, stool studies.

That is an order I would like to write.

 

[Anasazi23]

A friend of mine who is an FP resident, formerly a surgery resident gave me some great advice. A nurse had called me during the half hour I normally try to close my eyes during call (i've been on IM for two months now) to have the following conversation

nurse-doctor, I'm glad I got a hold of you
me-what's going on?
nurse-it's about your patient, mr soandso
me-yes?
nurse-I'm starting to get a feeling, that they may be getting ready to spike a temp sometime soon (I'm not exaggerating here)
me-stunned silence
nurse-doctor?
me-ummmm, ok. Are they having any symptoms?
nurse-no
me-and their temp is?
nurse-97.6
me-alright then, i'll keep that in mind

my friends advice for situations like that was to thank the nurse for her vigilant care and tell her you also are concerned. Tell her we need to keep a close eye on this critical patient. Thusly we should get them out of bed every hour, get a waist measurement and weigh them. Check temp q 15 minutes and of course, stool studies.

That is an order I would like to write.

I've seen some ugly turf-wars in the ICU that ended up looking something like that. Full Neuro-checks every 30 mins, etc, etc, etc. Not pretty...

 

[Chimed]

A friend of mine who is an FP resident, formerly a surgery resident gave me some great advice. A nurse had called me during the half hour I normally try to close my eyes during call (i've been on IM for two months now) to have the following conversation

nurse-doctor, I'm glad I got a hold of you
me-what's going on?
nurse-it's about your patient, mr soandso
me-yes?
nurse-I'm starting to get a feeling, that they may be getting ready to spike a temp sometime soon (I'm not exaggerating here)
me-stunned silence
nurse-doctor?
me-ummmm, ok. Are they having any symptoms?
nurse-no
me-and their temp is?
nurse-97.6
me-alright then, i'll keep that in mind

my friends advice for situations like that was to thank the nurse for her vigilant care and tell her you also are concerned. Tell her we need to keep a close eye on this critical patient. Thusly we should get them out of bed every hour, get a waist measurement and weigh them. Check temp q 15 minutes and of course, stool studies.

That is an order I would like to write.

I was on call one night and had a nurse come up to me and tell me that she thought the patient wasn't doing well and was worried the pt. might code sometime overnight. she couldn't explain why, she just had "a bad feeling." When we worked the patient up, all the labs and VS were normal and the patient seemed stable on exam. I did my best to assure the nurse that the patient was fine and to let me know if things got worse. For some reason, I decided to check on the patient on my own at about 3:30 AM, just to make sure things were OK. I walked in the room and the patient's O2 sats were dropping right before my eyes--90-84-80-70-65...😱.I called a code and the patient was intubated and survived.

You could argue that it might have been a coincidence, but sometimes a nurses intuition can be a good thing.

 

[Dienekes]

I was thinking the same thing. I'll take the advice of an experienced nurse most any day simply because they generally have a good idea of what is going on (NH nurses notwithstanding).

 

[Dienekes]

I've seen some ugly turf-wars in the ICU that ended up looking something like that. Full Neuro-checks every 30 mins, etc, etc, etc. Not pretty...

My personal favorite was watching the chief pulmonologist tell the med student that if she ever woke him up again for a bull**** ICU admit (they were in the ICU because the floors were full) that she would regret it dearly. Next night, she tested this and wound up being ordered to do Q30min DREs on a cranky and morbidly obese gentleman named Rodrigo.

 

[caroladybelle]

I was thinking the same thing. I'll take the advice of an experienced nurse most any day simply because they generally have a good idea of what is going on (NH nurses notwithstanding).

And if you want to thank them (in keeping to the spirit of the thread)and help yourselves the following orders:

Valium salt lick to the family waiting room, PRN.

Aerosolization of Ativan 20mg in air vent of patient with terminal condition but not remotely close to death, that was accompanied by 8 overwrought family members (all of whom are regulars on the Jerry Springer show, and have a combined felony/misdemeanor records that are higher than any of their IQs) - repeat Q15 minutes until family sedated.

Depo injection stat to teenager in ER for her third "free" pregnancy test in three monthes.

Dietary order to 300 lb chronic back pain type 2 diabetes patient (preferable several floors and significant distance from the kitchen) - Permit consist carb. diet, but only if patient gets the food him/herself from the kitchen - no delivery, no calling escort for them to wheel them down for it.

Smoker/ETOHer repeatedly admitted for pancreatitis - PRN pain meds will be held, if pt c/o of 10/10 pain, if pt has: been off the floor in the last 2 hours for a smoke break......had his buds bring in fried chicken and pt eats it despite NPO order.....if nurse catches him with white powder around his nose after said buds have visited....if he just finished sex with his third baby mama.....gets caught shooting up in bathroom.

 

[Solideliquid]

My favorite order...

Discharge patient from inpatient unit to home. (byyyyyyye)

 

[Puffle]

Personality transplant, STAT.

 

[Dartos Vader]

Anyone remember Ben Stiller in the movie Happy Gilmore

"You want a nice warm glass of milk? How bout a nice warm glass of Shut the hell up!"

 

[Dienekes]

Personality transplant, STAT.

I see you've met one of the guys I share an apartment on campus with. I am thinking of bringing him along to "mediocre rounds" (aka abnormal psych) as a "show and tell" to demonstrate flat affect. It worries me that he has NO emotion and can't read people at all. Thank God he's not violent.

 

[sikegeek]

consult surgery for reproductive organ-ectomy

 

[Anasazi23]

Please implant haloperidol/benztropine norplant SQ, 5-year today.

 

[MBK2003]

Please implant haloperidol/benztropine norplant SQ, 5-year today.

Fabulous. Do you have a male version for all the baby daddies out there?

 

[OldPsychDoc]

Fabulous. Do you have a male version for all the baby daddies out there?

Risperidone--oral + Consta. Can add a little paxil if the increase in prolactin from risperidone isn't enough to sap their libido.

 

[Poety2]

I'll miss ya OPD - I'm moving onto internal med - hopefully!


How r u? HOpe all is well around here!

Poety😛

 

[MDhasbeen]

I'll miss ya OPD - I'm moving onto internal med - hopefully!


How r u? HOpe all is well around here!

Poety😛

whoa, you're switching to im or just the rotation? 😕 hope all's well either way! pgy-2's peachy for me... busy but peachy.

 

[Anasazi23]

Fabulous. Do you have a male version for all the baby daddies out there?

They both get the same....🙂

Actually, I was just using the word Norplant so people would understand what I was talking about. The norplant portion was to reference a 5-year dec-like implant device so that we wouldn't have to deal with this q2 week or q month nonsense.

 

[Poety2]

My favorite order...

Discharge patient from inpatient unit to home. (byyyyyyye)

SOLIDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD HOW THE HELL R U????????????????????????????????????????????????????????????????
🙂🙂🙂

 

[Hurricane]

Lithium-D IM qmonth

D/C all the Xanax in the world

 

[Puffle]

Pharmacy order- Please compound 1mg Klonopin and 62.5mg Antabuse; take 4 times daily for alcohol abuse prevention with positive reinforcement.

 

[Poety2]

Ativan 2 mg IM to nurse prn patient BS>400

OMG YES!!! or the whole "Dr. X, I just wanted to let you know Mr. J's BS is 78 ok?"

Its 4am, you don't need to check his BLOOD SUGAR NOW GRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR

 

[Poety2]

Pharmacy order- Please compound 1mg Klonopin and 62.5mg Antabuse; take 4 times daily for alcohol abuse prevention with positive reinforcement.

I think they actually do something like this?

 

[Poety2]

whoa, you're switching to im or just the rotation? 😕 hope all's well either way! pgy-2's peachy for me... busy but peachy.

IM gonna, that is, if I can get an interview beyond these board scores