[mama2amaya]

Alright, more of a personal Q than a nursing student Q but here goes:

My sister is 23, hepatorenal failure from alcoholism and drug abuse, heart murmur, diabetic. She arrested two nights ago, on a med-surg floor after she had stabilized and her liver function returned to 25-30% with normalization of kidney function... they said it might have been 'a septic picture' causing the arrest - first said maybe electrolyte imbalance, then possibly lung infection, now they aren't sure... CPR for less than a minute, back breathing, back on the vent and back into the ICU, now on flow dialysis, had a paracentesis of her abdomen today, central line and arterial line placed, bp meds because her bp is low, CT-guided aspiration of fluid from her back area yesterday, broad spectrum antibiotics and IV fluids are being administered... afebrile. Responding to commands, awake.

I've been told 'she is doing ok...we really won't know for a few days how she will stabilize....she is answering questions with blinks and moving extremities,..."

I'm pretty sure it is a bleak picture but can't get an outright answer that she is not going to make it. Is it typical for the nurses to be more reassuring than anything and to not be brash about the goings on or does it just depend on the personality of the nurse?

[patwil73]

Depends on the nurse, although from this picture I would probably say the same, as it appears infection related -- with the infection you have to wait and see if the antibiotics clear things up and then you can tell if the damage is reversable. From what you write it appears she is moving in a positive direction (being awake and responding to commands) but the dialysis needs with bp (drips or just regular meds?) say she is definitely not out of the woods (so here we need a couple of days to see if her kidney functions will return on their own and if her heart can compensate on its own).

It also for me depends on the patient and family. I always try to tell people bad news in the easiest way possible, but with young patients or very grieving families I'm even more gentle (sugar-coating if you will).

Hope this helps

Pat

[ZASHAGALKA]

I try not to sugar coat. It is my experience that family members typically only hear 'good news' anyway, even if it's just a sprinkle on a donut of bad news.

It fits w/ the stages of grief, in that denial is right up there.

I have told a family member before: "Your mom has almost no blood pressure, despite every measure we can do to improve it, she is not breathing well and might not make the night" only to get as a response, "So, you're saying she's doing better?" Um, no, that's not what I said at all.

I'm not saying that is what you are doing. But you did state that you were told she is likely in septic shock and multi system failure and you are aware that aggressive techniques are being applied to turn a bad situation around, and that you would have to wait and see if she does better long term.

But what you focused on was - she's doing ok at the moment.

So my question is this: is the nurse sugar-coating it, or did all you hear was the sugar part?

I mean, I do try to instill a grain of hope if a grain of hope is realistic - and more if more is realistic: I believe in the power of prayer and don't want to dismiss that opportunity by saying 'all is lost'. I would rarely say that in any case in that I've been proven wrong about that before. But the downside of trying instill a small measure of realistic hope in an otherwise grim situation is that all families hear sometimes is the hope. . .

Take what was told to you at face value. Your sister is doing OK at the moment, but her situation is such that that could change because she is nonetheless critically ill. That is, in fact, what I understand you were told.

~faith,
Timothy.

[DidiRN]

Originally Posted by mama2amaya

I'm pretty sure it is a bleak picture but can't get an outright answer that she is not going to make it. Is it typical for the nurses to be more reassuring than anything and to not be brash about the goings on or does it just depend on the personality of the nurse?

I don't think they can answer if she is going to make it or not. It seems like you want to know for sure if she will survive when they simply do not know at this point. I'm not so sure a nurse should outright tell families that their loved one is not going to make it anyways. I know it must be awful to be left hanging like this, but I think that answer was very appropriate, only time is going to tell. But I'm sure the wait is awful.
What are the physicians telling you about her prognosis?
Hopefully things will turn for the better for her...I'm so sorry you have to go through this. The waiting really must be awful.

[papawjohn]

Hey Mama2amaya

What a tragic story you and your family are living through!! My warmest thoughts go to you.

I have to tell you--you're asking the question about the likelihood of survival and level of functioning over the long run, to the wrong person. ICU nurses almost always think in terms of THIS SHIFT. I know I do anyhow. So when I'm asked 'is my sister doing better?'--I tend to say things like: Well, I've been able to wean the Levophed by giving her some extra fluid and that makes me think we'll do OK tonight. Or: The fever came right down after I gave tylenol and bathed her.

That is what we do and what I'm saying is 'it's working.'

That is entirely different from the longer term and deeper knowledge of the MDs and those are the people you need to nail with those questions.

Again--all the best to y'all
Papaw John

[zambezi]

I definately agree with all of the responses thus far...I agree with papawjohn about thinking in terms of the the last 12-24 hours...it is just too hard (read: impossible) to predict what will happen much farther out than that...

I too do not try to sugar coat situations- but i will point out things that are going well...from your brief description of the situation, it sounds like considering the situation she is doing oaky...I would say somthing like: she is doing okay right now- she remains critical at this point and we are having to give some medicines and fluid to keep her bood pressure but she is still responding to commands and does not have a temperature at this point. We are still waiting on the results of the various tests that we have done... however, at this point she is doing well with what we are doing...

when someone is that sick, there are various stages on the spectrum...she sounds very ill but she may be making small baby steps of progress, therefore doing "OK"...

If someone is not doing ok, I will usually state that the situation is very critical, that we are doing what we can to fix whatever the issues are (but I will go into detail about what we are doing in layperson terms)...I, like most others, don't try to sugar coat- I am realistic with the families about the situation- that said, I also try not to take away all hope either-

[mama2amaya]

Thanks everyone for your responses. I really respect everyone's opinions and thoughts on the subject and the information you've given me.

I totally understand the need to be sensitive, the grueling work involved in the ICU nurse's job and long hours, and not being able to predict anything. As far as me saying she is doing ok now, that is actually what the nurse usually says when I call... "she is... ok" or "she is a little worse off today..." so that's what I meant by she is ok. Didn't mean to confuse!

I understand she is in the woods and critically ill... just praying!

[DidiRN]

How's she doing? Any improvement?

Originally Posted by mama2amaya

Thanks everyone for your responses. I really respect everyone's opinions and thoughts on the subject and the information you've given me.

I totally understand the need to be sensitive, the grueling work involved in the ICU nurse's job and long hours, and not being able to predict anything. As far as me saying she is doing ok now, that is actually what the nurse usually says when I call... "she is... ok" or "she is a little worse off today..." so that's what I meant by she is ok. Didn't mean to confuse!

I understand she is in the woods and critically ill... just praying!

[earle58]

i had a very different experience in the icu w/my mom. she had aml and became septic as a complication from the chemo. she was in icu for 3 wks, 2 of which i was present.
she never did regain consciousness, but even when she had a total vasculature collapse, blew up like a balloon, temp 104 w/wbc count of 3....i said aloud to the nurse, this is not looking good at all. she was vented, on 3 different pressors, 4 different abx....and basically the only feedback i could get was 'it's too soon to tell'....even after her vessels collapsed, 3rd spacing along w/ascites. the only way i could get specific info was to ask the doctor himself. so although no one sugar-coated the situation, they were as evasive as possible. i auscultated her lungs myself and there were absent lung sounds 2/3 way up. that's when i found out she had bil pneumonia. the icu nurse was shocked to see my pull out my stethescope as she didn't know i was a nurse. when i told her my findings, that's when she told me about the pneumonia. i didn't appreciate being withheld all this information. so i guess it goes to show you that different facilities utilize different policies on what they tell the families.

leslie

[DidiRN]

This is something that I have seen in two different places I've worked at ...should the nurses be telling the families the medical diagnosis of a patient before the physician does? I'm up the air about it, I can see where the families have the right to know this asap and not be kept waiting (and already stressed out enough as it is), yet I am not sure that is truly my responsibility to report this.
Had this happen the other night to me, a family wanting to know if the patient had cancer (he did). In that kind of diagnosis, I really do not want to reveal that at all to them. I'm sure it seemed like I was sugar coating it to them, however, I just felt it was not my place to give them that news.
But in all honesty, I can see both sides of this.

Originally Posted by earle58

i had a very different experience in the icu w/my mom. she had aml and became septic as a complication from the chemo. she was in icu for 3 wks, 2 of which i was present.
she never did regain consciousness, but even when she had a total vasculature collapse, blew up like a balloon, temp 104 w/wbc count of 3....i said aloud to the nurse, this is not looking good at all. she was vented, on 3 different pressors, 4 different abx....and basically the only feedback i could get was 'it's too soon to tell'....even after her vessels collapsed, 3rd spacing along w/ascites. the only way i could get specific info was to ask the doctor himself. so although no one sugar-coated the situation, they were as evasive as possible. i auscultated her lungs myself and there were absent lung sounds 2/3 way up. that's when i found out she had bil pneumonia. the icu nurse was shocked to see my pull out my stethescope as she didn't know i was a nurse. when i told her my findings, that's when she told me about the pneumonia. i didn't appreciate being withheld all this information. so i guess it goes to show you that different facilities utilize different policies on what they tell the families.

leslie