did i fluid overload her to death??

Specialties Cardiac

Published

may I plz take your opinion about patient I cared for during my sho year in Egypt. I had a 17yr old girl with prosthetic mitral valve for rheumatic heart disease. she came few months postop with heart failure, endocarditis, was cachectic, anemic, and in chronic slow AF which frequently turned into rapid AF. the resident had prescribed her 0.9 saline and dextrose infusion due at night over a short infusion period. she was stable before the infusion but 15 minutes before it, she developed markedly increased dypnoea orthopnoea restlessness as used to happen to her. the nurse asked me whether to run the prescribed infusion of saline according to previous residents order in view of her current deterioiration. I told her there was no problem and she started the drip; the patient took about 125-150ml over a 10 minute period and then suddenly arrested and died inspit of cpr.without any preceding warning signs. I am quite worried know that perhaps the saline bolus aggravated her heart failure markedly causing hypoxic death or inciting Vtac and VF. the resident had told me that her episode of dyspnea which started before infusion was probably rapid AF. thank you very much

Specializes in Public Health, TB.

I agree with barbhnat. I think she was probably dying before the infusion started. Hard to say if anything would have changed the outcome. My guess is that her mitral valve failed/ruptured. NS with dextrose is seldom given for malnutrition, it might have been ordered for low bp or worsening renal function.

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Specializes in Cardiac.

If the pt had known heart failure and was possibly being treated with a potassium wasting diuretic, as well as being acutely malnourished, she may have also had a severe electrolyte imbalance.

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Specializes in Thoracic Cardiovasc ICU Med-Surg.

YOu didn't kill this patient,. Her endocarditis most likely with septic emboli from the diseased valve probably did it. Either way, she was dying when she came in and nothing you could have done would have made a significant difference.

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If you are not 100% sure, ask, call and don't be afraid to look stupid. Why hid it. It cost someone their life. It cost much pain and suffering in a families life that will be for years, because you did not listen to your gut. When in question, question. Don't do something because you are told to when your gut is telling you that it isn't just right. Doctor's are not God. They have drinking issues, family issues, gambling issues, and lack of caring issues just like all human beings. Soooooooo, they can and do make mistakes. It is not worth your license or conscience knowing you killed someone. Happened to me. Nurse hung 2 iv bags at once and didn't know why she was doing it. "just following orders". Sadly, mother died of fluid overload. 77 pounds gained in 6 days. You took an oath to do no harm, ever.

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As a nurse, I am shocked how nurses and medical staff cover up their mistakes and blame anything they can to cover up their mistakes. Everything else except their stupidity. Let's be real. Let's be honest. Let's be nurses with integrity. Integrity is doing the right thing even when no one is looking. I had a nurse 25 years in, ask me how to do the 3 checks for medication administration. Shocking. know your stuff or get into a department where excellence in standard of care is not needed. People are trusting us to make the right decisions to save lives. People are counting on us to do the right things. I have worked besides hundreds of nurses and am shocked at their mistakes and their cover-ups. I am shocked at how other nurses will cover each other in their wrong. Shame on them.

I took an oath to do no harm and to study so that I do not hurt someone, because I new families would be counting on me to do the best for their loved ones.

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As a nurse, I am shocked how nurses and medical staff cover up their mistakes and blame anything they can to cover up their mistakes. Everything else except their stupidity. Let's be real. Let's be honest. Let's be nurses with integrity. Integrity is doing the right thing even when no one is looking. I had a nurse 25 years in, ask me how to do the 3 checks for medication administration. Shocking. know your stuff or get into a department where excellence in standard of care is not needed. People are trusting us to make the right decisions to save lives. People are counting on us to do the right things. I have worked besides hundreds of nurses and am shocked at their mistakes and their cover-ups. I am shocked at how other nurses will cover each other in their wrong. Shame on them.

I took an oath to do no harm and to study so that I do not hurt someone, because I new families would be counting on me to do the best for their loved ones.

This is an old thread from February. Your profile states you are a pre nursing student who registered today with a total of 3 posts. You have 3 posts that are very accusing of the original posters. The other thread is years old.

If you are not a nurse yet, I would caution that unless you were with the OP, you can only speculate as to the cause of death and whether the actions of the nurse had any bearing on the patient's death. In medicine, we must consider the human factor. Neither patient nor caregiver is a perfectly functioning machine without flaws and outcomes are never 100% predictable.

I believe the OP was trying to learn from a clinical outcome to prevent (if possible) similar outcomes. If you never make a mistake in your career sorkay, you will be the first nurse to accomplish this feat. Just my 2 cents.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
If you are not 100% sure, ask, call and don't be afraid to look stupid. Why hid it. It cost someone their life. It cost much pain and suffering in a families life that will be for years, because you did not listen to your gut. When in question, question. Don't do something because you are told to when your gut is telling you that it isn't just right. Doctor's are not God. They have drinking issues, family issues, gambling issues, and lack of caring issues just like all human beings. Soooooooo, they can and do make mistakes. It is not worth your license or conscience knowing you killed someone. Happened to me. Nurse hung 2 iv bags at once and didn't know why she was doing it. "just following orders". Sadly, mother died of fluid overload. 77 pounds gained in 6 days. You took an oath to do no harm, ever.

Welcome to AN! The largest online nursing community!

I am so sorry to hear about your Mom.

I am not sure if you are a nurse or student...but it is clear you are hurting from the loss of your mother.

Every patient situation is different and one cannot judge without ALL the information available. The original post sound like a very sick patient and the poster was coming here to learn...I feel that the fluid had very little to do with this particular situation. As nurses we take every opportunity to seek advice from other nurses.

This community also serves nurses from ALL over the world where medical standards are not even across the board nor do they have the technology available to them as we have in the states. If you are a nursing student you will learn that medicine is not all black and white...there is a lot of grey.

Again....I am very sorry for your loss.

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Specializes in Telemetry, Psych.

It is possible that a quick influx of fluids may have increased the blood pressure significantly, which could cause complications in the post operative period. (additional pressure causing sutures to tear etc.) Would need more information before we could actually determine the cause of death. Will their be an autopsy? 150cc's over 10 minutes is quite quick, sounds like you were giving an ordered bolus? Ordered bolus for malnutrition seems odd, I'm assuming the resident was under the impression the patient was dehydrated? Perhaps the HR was elevated compensating for a low blood pressure?

Listen to your gut in the moment. Residents can be good resources but are also learning on the job. Asking for an explanation re: their line of thinking is totally appropriate. It is important for us to understand what we are doing, before we move forward with doing it. Don't get too hung up on this one situation, you can't change what is done. We learn and move forward, so our future patients can receive better care.

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Specializes in Neuro/Med-Surg/Trauma ICU.

Dyspnea restlessness and cough. Classic symptoms of a pe? Could blood clot from the afib become pe?

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