Nurse Gives
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Nurse Gives
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We live in a time that is different than any time that any of us have ever lived in the past. Although it is true that times change as we move forward, we now live in a time of pandemic and the new norm is different than the old normal. One of the things that has changed is the fact that we all wear masks and it can be difficult to communicate properly when we are wearing them. It’s frustrating in real life but in the following joke, it leads to a very funny and intimate situation.
A male patient is lying in bed in the hospital, wearing an oxygen mask over his mouth and nose. A young student nurse appears and gives him a partial sponge bath.
“Nurse,”‘ he mumbles from behind the mask, “are my testicles black?”
Embarrassed, the young nurse replies, “I don’t know, Sir. I’m only here to wash your upper body and feet.”
He struggles to ask again, “Nurse, please check for me. Are my testicles black?”
Concerned that he might elevate his blood pressure and heart rate from worrying about his testicles, she overcomes her embarrassment and pulls back the covers.
She raises his gown, holds his manhood in one hand and his testicles in the other.
She looks very closely and says, “There’s nothing wrong with them, Sir. They look fine.”
The man slowly pulls off his oxygen mask, smiles at her, and says very slowly, “Thank you very much. That was wonderful. Now listen very, very closely:
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Contact: social@viralslot.com or 303-731-6063.
This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the ...
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
Funny
Life
Animals
Entertainment
Inspiration
Entertainment
Quiz
More stories to check out before you go
We live in a time that is different than any time that any of us have ever lived in the past. Although it is true that times change as we move forward, we now live in a time of pandemic and the new norm is different than the old normal. One of the things that has changed is the fact that we all wear masks and it can be difficult to communicate properly when we are wearing them. It’s frustrating in real life but in the following joke, it leads to a very funny and intimate situation.
A male patient is lying in bed in the hospital, wearing an oxygen mask over his mouth and nose. A young student nurse appears and gives him a partial sponge bath.
“Nurse,”‘ he mumbles from behind the mask, “are my testicles black?”
Embarrassed, the young nurse replies, “I don’t know, Sir. I’m only here to wash your upper body and feet.”
He struggles to ask again, “Nurse, please check for me. Are my testicles black?”
Concerned that he might elevate his blood pressure and heart rate from worrying about his testicles, she overcomes her embarrassment and pulls back the covers.
She raises his gown, holds his manhood in one hand and his testicles in the other.
She looks very closely and says, “There’s nothing wrong with them, Sir. They look fine.”
The man slowly pulls off his oxygen mask, smiles at her, and says very slowly, “Thank you very much. That was wonderful. Now listen very, very closely:
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Did she violate patient confidentiality?
Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Specializes in Med nurse in med-surg., float, HH, and PDN.
Specializes in NICU, PICU, Transport, L&D, Hospice.
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Specializes in Med Surg, Tele, ICU, Ortho.
Has 30 years experience.
On December 26, 2017, a tragic and preventable death occurred when a patient at Vanderbilt Hospital was sent for a Positron Emission Tomography (PET) scan and received a lethal dose of Vecuronium instead of Versed.
PET scans are typically performed in the outpatient setting and not inpatient. They are not emergent. This was a full body inpatient PET scan which might be said is inappropriate resource utilization.
If it had been done in the outpatient setting, it's unlikely that Versed would have been administered. Essentially a patient died because a dangerous medication that was never ordered was given.
The patient, a 75 yr old female, was admitted to neuro ICU on 12/24/2017 with intraparenchymal hematoma of the brain, headache, homonymous hemianopia (loss of visual field bilaterally), atrial fib, and hypertension. She was alert and oriented and doing well, about to be transferred to SDU. While the patient was waiting for her scan, she asked for medication to prevent claustrophobia. The provider ordered 2 mg of Versed, and the pt's nurse was asked to come down and administer it.
At the time, the pt's nurse was covering a lunch break for another nurse and asked the "help all nurse" to go down and give the Versed so the procedure would not be delayed or rescheduled. The "help all nurse" performs different tasks, but there was no job description for a "help all nurse". It is not clear if the "help all nurse" was an ICU nurse, or a nurse floated from elsewhere, such as Med Surg. Clearly, the "help all nurse" was not trained in conscious sedation, and was seemingly unfamiliar with both Versed and Vecuronium.
The "help all nurse" searched for Versed under the pt's profile in the Pyxis but it did not come up. So she chose override and typed in "VE". The first drug to come up was Vecuronium, which she selected. She then proceeded to reconstitute the drug, not recognizing that Versed does not need to be reconstituted, and not taking heed of the red cap on the vial or the words "paralytic agent". Next, she administered 2 mg of the Vecuronium IVP and left the patient.
Vecuronium is a neuromuscular blocking agent that causes paralysis and death if patients are not monitored.
Basically, the patient will be paralyzed, conscious and unable to draw a breath. All sensation will be experienced- panic, pain, fear, but the patient is unable to cry out. It's truly the stuff of nightmares.
Versed is often given for procedural sedation but is not a paralytic. Versed can affect respirations, and patients must be closely monitored for hypoventilation.
Here is a timeline of events, where the time was documented.
The Department of Health and Human Services Centers for Medicare and Medicaid (CMS) did not investigate the event until October, 2018 as the death was not reported to them at the time.
According to CMS standards, patients have a right to receive care in a safe setting and hospitals have a responsibility to mitigate potentially fatal mistakes.
CMS ruled that Vanderbilt failed to provide safe care and protect patients. Vanderbilt was placed in serious and immediate jeopardy by CMS.
Since that ruling, the CMS has accepted Vanderbilt's plan of action.
The simplest thing is to blame the nurse for 100% of the error. Her failure to follow basic medication safety steps is not defensible.
But stopping there prevents us from learning how it happened and preventing future mistakes. We need to learn more about the science of mistakes. We all make them. Something in our brains allows us to see what we expect to see and not always what is there, as in running a red light. Or not registering red caps and cautionary labels on a high-alert medication.
The "help all nurse" was distracted in that she had an orientee with her, and immediately after giving the medication, went to the ED to perform a swallow screen test. She was performing a series of tasks.
The patient's nurse did not delegate appropriately as she did not confirm the "help all nurses " knowledge and skills. Tasks should be delegated to the right person, and this was not the right nurse to administer Versed. Maybe nurses are not all interchangeable as administrations sometimes like to think.
Vanderbilt did not clearly define role expectations, or patient monitoring in conscious sedation.
What do you think were the causes, and would have prevented this from occurring?
Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.
Specializes in Nephrology, Cardiology, ER, ICU.
Has 30 years experience.
164 Articles;
21,180 Posts
What a series of errors that caused this. The first was the lack of knowledge by the nurse in knowing the difference between versed and vecuronium. If she had an orientee with her, thats two nurses that should have known the difference between these two drugs. The nurse should have remained in the room with the pt with a monitor, pulse oximetry and immediate access to resuscitative equipment as well as being certified to administer conscious sedation.
Then, we get to the Pyxis override, the pharmacy, the provider themselves who ordered the sedation.
Mandatory double verification would be helpful for paralytic as well. If we have another RN witness insulin, heparin, amio, why not do the same with vecuronium?
Specializes in Travel, Home Health, Med-Surg.
Has 20 years experience.
1 Article;
2,120 Posts
I cannot even imagine the horror that the patient must have went through!!
The nurse should have known what her role as "help all nurse" entailed. I have worked as a resource nurse and knew it was my responsibility to know not only the role, but also, as any nurse should know, my personal limitations including the meds you are giving. Although I will say that when there are too many warning labels on everything they do tend to get overlooked. The nurse was (obviously?) just running from one task to the next which can be even more hectic than having your own patients and you dont always have the full picture. Although it sounds like there is plenty of blame to go around at this facility regarding this situation.
Specializes in ICU.
Has 11 years experience.
467 Posts
I'm sure that the nurse was rushed or distracted and many factors lined up to cause this error but...
Every dose of every paralytic I've ever given came out of a vial with very large "PARALYZING AGENT" on the top, side, and lid of the vial, as well as a distinct neon yellow color on the labels.
Specializes in ER.
Has 30 years experience.
6,837 Posts
I wonder how long she had been a nurse. If she was running around trying to please everyone, or if she had a year or two experience. The more I hear about it, the nurse was inexcusably negligent, but there are certainly a lot of ideas for improvement within the system too.
Imagine grabbing a med, Versed, not finding it, then going V-E- "ah, close enough!" Let alone not looking up either one. Good grief.
Specializes in ICU, LTACH, Internal Medicine.
Has 9 years experience.
1 Article;
2,674 Posts
No job description for someone who holds the job? Really? In USA, 2017?? In a large academic hospital???
Nurse working in ICU (although without job description - see above) has no idea about drugs used in ICU pretty much all the time (well, maybe not vecuronium, but Versed??) She never even hold a bottle of Versed so that not to know that it is not reconstituted? Vec also is in really special bottles, they look like nothing else...??
ICU level patient left "alone and unmonitored" for 30 min. She is not hooked to transport monitor, there is absolutely no sensors (in imaging suite within a large academic center), there is no ACLS certified staff member from ICU who took her there. She was laying absolutely motionless on PET table (30 min is just about right time for the scan) and no one noted she was not moving?
"Lethal" (loading) dose of vec is 0.08 - 0.1 mg/kg. The bottle normally holds 10 mg - enough for one IV push load for patient weighting 70 to 100 kg. 2 mg would cause weakness which could, in turn, cause respiratory acidosis and secondary arrest, more likely on an already weakened patient with not much muscles to begin with. But it still doesn't make it "lethal".
PET scan suite, within the hospital walls, apparently run by... no one? Techs alone? No one to monitor the patient? No one yelled their constant "how are you doin' there?? Almost done, just a second more!" No one paid attention to lack of movement artifacts???
Pixes program allows simple overwrite for everything as long as it starts with the same letters? Dilaudud = dilantin = diazepam = diclofenac? I wanna work with such a miracle box!
Either things in Vanderbilt are run by a group of recent Acute Psych unit escapees, or I do not know.
Specializes in anesthesiology.
316 Posts
Nurse working in ICU (although without job description - see above) has no idea about drugs used in ICU pretty much all the time (well, maybe not vecuronium, but Versed??) She never even hold a bottle of Versed so that not to know that it is not reconstituted? Vec also is in really special bottles, they look like nothing else...??
ICU level patient left "alone and unmonitored" for 30 min. She is not hooked to transport monitor, there is absolutely no sensors (in imaging suite within a large academic center), there is no ACLS certified staff member from ICU who took her there. She was laying absolutely motionless on PET table (30 min is just about right time for the scan) and no one noted she was not moving?
"Lethal" (loading) dose of vec is 0.08 - 0.1 mg/kg. The bottle normally holds 10 mg - enough for one IV push load for patient weighting 70 to 100 kg. 2 mg would cause weaknes
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