Could have Lopressor contributed to death?

  1. 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
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  2. 15 Comments

  3. by   SuesquatchRN
    I think that the poor old thing was dying when she came in and you could have done nothing more than you did, Nat.
  4. by   annmariern
    Hi Nat.
    Been doing this for 20 years. I remember vividly the first pt who died on me, right down to where he lived and his sons face. I can't see that you did anything wrong, or did not do anything that would have changed this outcome. She was 82 years old, already severely incapacitated. It was time. Thats all. The lopressor, did its job, reduced her HR from 170. Her family were with her, she was obviously well taken care off. If you hadn't given it, maybe her HR would have gone up again. You did your best to give this lady a dignified death with her family at her side. Would more would any of us want at 82? Stop beating yourself up over it, because this won't be the last or the worse you will see. We can't save everyone and sometimes we just aren't mean't to. You sound like a nurse I would want around if I were in trouble, but step back a bit or you will drive yourself nuts.
  5. by   GardenDove
    She probably stroked out from a thombolytic CVA, which would have shown negative on CT. I see nothing in your description that would indicate that lopressor should not have been given.
    Last edit by GardenDove on Jan 11, '07
  6. by   UM Review RN
    As a tele nurse, I can tell you quite frankly that without very aggressive treatment, this patient didn't have a chance in the first place. I think the family made a very wise, extremely difficult decision, and your interventions were appropriate and timely.

    In short, it was her time. You did everything right. Let it go now.:icon_hug:
  7. by   gentle
    Quote from 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
    Nat,
    First of all, you were a wonderful nurse for her.

    Secondly, I don't think the patient should have come to your floor. She should have gone straight to the ICU from the ER, until advance directive status was known.

    Secondly, a C2 fracture is very high. Breathing problems are most certainly to be expected. I am wondering if the fact that her body moving from the bi-pap despite c-spine precautions may have hastened the inevitable. Again, I wonder why not ER to ICU and intubation/paralytics while c-spine precautions maintained.

    Thirdly, Nat, she had a chance to make eye contact with her family before her death. The family had the opportunity to be present. Though it was a painful experience for them, they may look at it as a blessing later, because, they had the opportunity to say goodbye.

    Fourth, a beautiful conclusion to their experience to hear that their departed loved ones spirit touched theirs through you--"a fuzzy navel, huh?"

    In conclusion, Nat you were wonderful. Thank you for loving a patient and their family, in a difficult situation. Thank you for desiring to pursue excellence, by being transparent with us on the board. And no, you didn't do anything wrong; but you sure did do alot of things RIGHT.

    --gentle
  8. by   Jo Dirt
    I don't know why it is such a shock that an 82 y/o dies.
  9. by   Rnandsoccermom
    5mg of Lopressor didn't kill her. She was dying and her heart failed, you didn't. God bless her family for their strength to let her go. One of the hardest lessons to learn is that you can't change what is going to happen no matter what you do. We're only human.
  10. by   TazziRN
    You did nothing wrong, sweetie. Sounds like you did everything right.
  11. by   VivaLasViejas
    Quote from Angie O'Plasty, RN
    As a tele nurse, I can tell you quite frankly that without very aggressive treatment, this patient didn't have a chance in the first place. I think the family made a very wise, extremely difficult decision, and your interventions were appropriate and timely.

    In short, it was her time. You did everything right. Let it go now.:icon_hug:
    I agree with Angie.

    For all anyone knows, the patient may very well have been in the process of throwing a massive clot, bleeding into the brain, having an MI, or stroking out, and no power on earth would have saved her. You did exactly what any prudent nurse would have done, given the patient's VS and the doctor's orders.

    She was lucky to have you as her nurse. It was her time to go home.........nothing you could have done would have changed that.

    Take care.
  12. by   nuangel1
    you did a great job .she was very ill .the lopressor had nothing to do with it .the family made a tough decision .you did what was needed .it was her time to die.atleast the family was there with her .
  13. by   KaroSnowQueen
    I agree with the other posters. You did nothing wrong. It was her time to go and she went. 5 mg would not have caused this.
  14. by   RazorbackRN
    Quote from motorcycle mama
    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.

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