Dealing with medical emergencies

pagandeva2000, LPN · Oct 22, 2008

Unfortunately, death is part of nursing on any level. They teach you CPR, and you should take time to review it every now and then, however, the most important thing is to get the patient into a safe position and yell loud for the nurse to come. If it does take awhile, then remembering your CPR, you will know that if there is no breathing or a pulse to begin the process. I watched two patients die while I was a CNA, one at a psych hospital I worked for and another during home care (that death was anticipated-was a hospice case). The first time, it was harrowing. I came home and cried to my mother. I have seen patients dead in the bed, but I didn't see their last breaths. Somehow, I wasn't afraid to clean the body. Even as a nurse, I wouldn't want to witness it, but somehow, I have to accept that this can happen. At least you responded, got help and the ambulance came to get the patient. One of the major responsibilities of the CNA is to let others know of a change in patient status.

rancelumsden · Oct 22, 2008

Unfortunately, death is part of nursing on any level. They teach you CPR, and you should take time to review it every now and then, however, the most important thing is to get the patient into a safe position and yell loud for the nurse to come.

Exactly --- be prepared, get help, but don't 'internalize' it.

I was a CNA in med-surg/oncology unit. We had someone die on the unit at least every couple of weeks (on one shift or another). You have to accept that death is the final act of life (CNA instructor continually used that phrase in class). Now, psychologically, if you can't deal with that I don't have the ability to 'make' you accept that. Death is sad, but not tragic, and it is inevitable.....

sjt9721, BSN, RN · Oct 22, 2008

...You have to accept that death is the final act of life...Death is sad, but not tragic, and it is inevitable.....

The first death I witnessed was a woman with end-stage heart failure. She was working so hard to breathe; no amount of O2, positioning, or meds could relieve her suffering. One of my last interventions for her was to find fan for the room. She smiled as the air blew across the bed and cooled the sweat on her face. She died later that night and her family was grateful that she was more comfortable near the end.

The second death I witnessed was a woman brought into the ED. She was a DNR from an assisted living facility. She was actively dying and her family wasn't there yet. I stayed with her, held her hand, and watched her as she took her last breath. Her daughters arrived a few moments later and we broke the news to them. Their first question? "Was Mom alone when she died?" I remember them reaching across their mom's body to grasp my hand and say "Thank you for staying with her".

Watching someone die doesn't have to be scary or creepy. I considered it an honor (for lack of a better term) to have been there at such an intimate time in a person's life.

Sally Field has a great line in Steel Magnolias after her daughter Shelby was buried: "I just sat there. I just held Shelby's hand. There was no noise, no tremble, just peace. Oh god. I realize as a woman how lucky I am. I was there when that wonderful creature drifted into my life and I was there when she drifted out. It was the most precious moment of my life."

vmoh18 · Oct 22, 2008

Unfortunately, death is part of nursing on any level. They teach you CPR, and you should take time to review it every now and then, however, the most important thing is to get the patient into a safe position and yell loud for the nurse to come. If it does take awhile, then remembering your CPR, you will know that if there is no breathing or a pulse to begin the process.

I forgot to add that this woman is DNR so if she stoped breathing there was nothing I could do. I think that is what scared me the most.

AudreyJ · Oct 25, 2008

I once had a resident who started seizing in the dining room, we got him into bed, and called the private transport company. His O2 sats were low, he was tachy, and continuously seizing. It took the private transport about 15 mins to get there, the fire dept would've been there in 3 (this was the nurses error). Would it have made a difference? I don't know but it still makes me wonder. He returned to the nursing home a week later then passed on another week after that.

Another resident came to us and was a WONDERFUL man! He had lost use of his legs (I don't know what his diagnosis was) and was undergoing PT to hopefully walk again. Both he and his wife were wonderful individuals. He went to the hospital about a month into his stay and came back a week or two later and was rapidly declining. He became very confused, incontinent of bowel and bladder, and too weak to even raise his own hand. His family brought him home to spend his final days in a familiar comfortable setting, he passed about a week after that.

Recently we had a resident for comfort care. He had severe CHF and was at our facility to die. Our nurse sent him out due to severe SOB, he was a DNR. She checked the computer but it wasn't entered yet, there was a copy in the chart. The POA came to *US* for a copy of the DNR while the staff in the ER were performing life saving measures. He was supposed to die at our facility, not in a cold ER. He did die later that nite. This was TOTALLY the nurses fault, the family had every right to be ticked.

Death is to be expected, tho sometimes it's very unexpected. And at my facility we were told to begin CPR even if the person was a DNR. The DNR status had to be confirmed by a nurse before CPR would cease. In my assignment I made darn sure who my DNRs were, who my full codes were, and who my hospice residents were.

And if you can look at the charts make sure you know what their DNR status is. Ours have 2 boxes, one was only attempt CPR if respirations were absent but a pulse was still present, the other was DO NOT attempt CPR if respirations were absent but a pulse was still present. Knowing what your patients status is will help you in the event that something happens (tho ALWAYS call the nurse if something does happen).