Could have Lopressor contributed to death?

[Anagray]

I need your opinions, guys, because It is eating me up. Basically, I am not even 2 years into nursing on a very busy med-surg floor and I had my first sudden death this week. I'm trying to cope with it as best as I can, but I still keep thinking what if , etc.

82 y-o. admitted sunday with a C-2 fracture. Fell on her head :uhoh21: out of wheelchair in Nursing Home. When I saw her, I knew she wasn't doing well. Per family, this lady had a bypass for valve replacement 30 years ago, a major stroke 10 years ago and was paralyzed severely on right side. Prior to fall, pt ate well by mouth and made contact with sign language, was not really confused. This woman got to our floor with signs of heart failure, rapid a-fib 170s, but was awake and making eye contact, head CT was negative for bleed. I got her at 3 pm, pulmonary/critical care was there assessing her for ICU due to respiratory failure, pt was on bi-pap due to desaturation. Family had pt DNR/DNI so they left her with us. The nurse giving me report told me pt missed 5 mg IV lopressor at noon, but was given lasix and dig in am and respiratory symptoms started in early am. Lopressor Iv was given @ 6 am as well to control arrythmia.

When I got her , pt was making eye contact, neuro surgery saw pt, everything was OK. She did have pretty labored breathing at that point and had no gag reflex. Fluctuated on oxymetry from 82 to 97%, HR 112, BP 140/78.

At 18 00 pt was no longer making eye contact. Called admitting MD.

For some odd reason I felt like I should have not given Lopressor at 18 00, but everything seemed right by logic - lungs clear, vitals stable pretty much, etc. Gave 5 mg lopressor , first 2 sets of vitals were fine, the third set - pt had no bloodpressure and begant to go down. Respiratry therapist was with me, I was calling MD again, then started listeing to her heart when I did not hear a pressure - her heart stopped and she stopped breathing within 40 seconds. Family was at bedside, they started crying, etc.

Attending came, PAs came, everyone (including the family) assured me that I did everything I was suppose to, but I still feel like I should have follwed my gut feeling. I probably would not have saved her anyway, but I am just wondering if Lopressor caused bronchospasm and it just speeded up the inevitable.

Wierd thing is, I told her daughter in law that I was going to have some Fuzzy navel (random choice) after work and she said that it was patient's most favorite drink.

Thanks. Nat

[RazorbackRN, BSN, RN]

I don't know why it is such a shock that an 82 y/o dies.

I don't think the OP was insinuating that it was a shock for an 82y/o to die. Her question was asking if the Lopressor hastened her death.

[interleukin]

Nate,

Yes bblockers can cause spasm...but it is not common, especially if one does not have a hx of, say, asthma. As long as her bp was ok when you gave the drug there was nothing for you to worry about, at that time, regarding that specific order.

You can always reaffirm an order with the doc...that's what they're there for, unless it's an emergency situation, at which time there should be someone present of higher ordering authority or clinical ability.

Anyway, she also could have had a PE which could have caused her symtoms, especially if they came on suddenly. But making dxs without all details and without being is not a good idea.

Remember, Nate--unless you do something egregiously wrong, with intent, or the orders are really wacked out and you don't question them and then carry them out, or you ignore institution policy--it is the doc who carries the final burden. Easy to say, but legally valid(not to say you wouldn't experience some psychological hell)

This situation, with any number of variations, will arise again and again in your practice, Nate.

Memorize standard emergency algorithms and the probable etiologies.

You will then grow more and more confident that what you do, when you do it, will be based on the best clinical practices guidelines available to anyone, anywhere.

[Anagray, BSN]

Thank you so much for your replies and kind words. I probably have some psychological baggage from my childhood in relation to death, so this is probably the reason why it bothers me so much. But, I think I wouldn't have it any other way.

Love, Nat

[subee, MSN, CRNA]

Thank you so much for your replies and kind words. I probably have some psychological baggage from my childhood in relation to death, so this is probably the reason why it bothers me so much. But, I think I wouldn't have it any other way.

Love, Nat

The whole country has a problem with death. Putting a fragile 82 year old women post head-injury in an ICU is a perfect example of an innocent patient being a cog in the medical-industrial complex. She was lucky enough to have a family willing to participate in a peaceful death and she was lucky enough to have you, who wished a good death for her. It was 1975 - mine was a Filipino sailor who spoke no English. I was pretty raw but knew that he was having a serious, acute problem. He was coded within a short time and died. Can't remember his name, but remember he was in bed A in room 205 with three other patients. Wish we had Allnurses back then so that we could get through the trauma more easily (it is better when you discover that your first patient death is the one of the bittersweet realities of working with sick people and that almost EVERYONE has to give themselves permission to grieve that loss of youthful immortality).