Have you ever gone in to find a patient dead? What happened? - page 4

About 20 years ago I was making my initial rounds on my patients and went into a room and didn't see the patient. I knocked on the bathroom door, no answer. I went to see if he had been checked out... Read More

  1. by   NawtyNurse69
    Quote from Franemtnurse
    Definitely!!! I'm actually surprised to read this. I was a CPR instructor for many years, and a VR or a VT rhythm is easily noticeable. It's when the rhythm goes all haywire, and a lot of times you can get the pt back if it's witnessed. This is one of the reasons why even BLS courses now have the AED. The thing tells you when to shock when to continue CPR, and when to stand back.
    Actually, I just renewed my CPR last week. The AED's are great, and will shock if there's a shockable rhythym, and does not require any medical knowledge on the part of the user. However, in the hospital, we don't use AED's. So if you slap the patient on the Zoll, you need to know what you're looking at and whether it's shockable. And the way most hospitals work, that's the job of the code team. Most med surg floor nurses, unless they are on a code team or on a telemetry unit, do not know what they are looking at, unless they have prior experience...ICU, TELE, ED etc. I've worked a lot of places....one place was an oncology floor, where an actual code was a rare occurrence, most pt's were DNR. Ortho is another place that tends to have codes rarely. It's also been my experience that a lot of places, especially on nites, tend to have a lot of new grads/newer nurses working together, who just don't have the experience and knowledge yet. I've also worked places where a good percentage of the staff haven't ever worked in other areas. And, as I said before, usually by the time you call the code, get the cart, put the backboard under the pt, establish an airway, and start to put the pt in the monitor, the code team is usually there to take over. Most floor nurses can step back then and let the team do their job and don't really get into knowing what the various rhythyms are. So while learning how to use the AED's is extremely useful, outside the hospital, it's not something your average floor nurse is going to gain a lot of knoweldge from in a basic cpr course. It's funny too..years ago, they used to teach us to do a precordial thump on a pulseless patient. They don't teach it any more, but I used it recently on a patient and it WORKED!!! He was actually on tele, we saw him go into VF on the monitor and went running in. Someone went out to call the code, get the cart etc. And I just thumped him without thinking about it. Well, I got him back, but he did it a couple more times that nite, and eventually passed away. But I was totally blown away that it actually worked!!!
  2. by   RnRatchet
    I remember about 8 years ago when I was working as a nurse aide going to nursing school that a pt was coded under the christmas tree on one of our hospital's med surg units!
    She was in a geri chair at the nurse's station on night shift because she was a little old lady that wouldn't stay put and would fall if she tried to get up alone.
    There were several jokes about intersting things under the christmas tree!
  3. by   Ruby Vee
    when i was a new grad in the late 70s, i was floated to a med/surg floor to team lead. (i worked on the telemetry unit.) it was 3-11 shift, and i was struggling to get my meds passed, vital signs done, treatments and dressing changes taken care of while doing incontinent care on just about every patient i encountered. it was nearing 1730, and i was still doing my 1600 meds on my 15 patients. the diet aide came up to me to tell me that "mrs. m hasn't touched her dinner tray, and she didn't touch breakfast or lunch, either. she's just sitting in her chair, and she isn't talking to me. maybe she don't like her food." i hadn't gotten to mrs. m's room yet, so with a "funny feeling" about the whole situation, i marched down there to see what the problem was. of course you've guessed it -- that's what this thread is all about! she was deader than a doornail, and quite obviously had been since right around breakfast time! she had three medicine cups of pills in front of her, and the mar had them charted as given.

    another time, i wasn't team leading in my own unit. i was a team member. i had my five or six patients, the lpn had hers and the team leader had 3 or 4 patients. harvey was the team leader -- he was certainly an entertaining co-worker. halfway through the shift, one of his patients died, and as he claimed to be too busy, the lpn and i called the doc, called the family, made the patient presentable for her family to come sit with her, etc. etc. the family was sitting at the bedside, talking about the deceased and waiting for one last son to show up before letting us send the body to the morgue when one of the daughters came tiptoeing into a room where i was changing a dressing and asking to speak to me. it seems that harvey had pranced into the patient's room, nodded to the assembled family members and hung an iv. then he pranced right out of the room again without even looking at the patient. "does harvey even know that mother is dead?" the daughter asked. evidently it hadn't registered!

    another time, i was working in a large teaching hospital in another state -- in the early 80s. i was working with an aide, and we had 14 patients between us. there was no one else. the ho came by and ordered a stat ct on one of our patients. it was a floor patient, so i called the transport team to take her to ct, but they were booked up. they couldn't do it, they said. i'd have to. i was the only nurse, and i couldn't leave. there had to be two staff members on the floor at all times, so neither could the aide. the ho would have to either let it wait until morning or take her himself. he drafted the medical student, and they took her themselves. they were gone an awfully long time, and i heard them coming back before i saw them. they came around the corner, pushing the stretcher between them and having a nice chat over the patient's head about the interesting things they had seen on that ct. apparently neither of them noticed the patient's decidedly blue complexion or the fact that she wasn't breathing! sad outcome on that one!

    ruby
    never assume malice without first ruling out stupidity.

  4. by   NurseChick
    I was working one afternoon at a LTC facility and hadn't been and aide for very many months, and therefore hadn't seem many dead people. A lady was sitting in the hallway in a geri chair, and she had just gotten back from a Dr.'s appt. I happened to glance at her and thought she looked really pale compared to what she normally looked like. I kept studying her for a moment to see if she was breathing and then finally went and asked another staff member to look at her because she didn't look right. We took her into the nurses office right away because she was actually dead. When the lady that had drove the van to take her to the Dr. found out she was dead, she was so upset because she had been talking to her in the van, but didn't notice she had passed away.
  5. by   GrnHonu99
    Quote from DutchgirlRN
    About 20 years ago I was making my initial rounds on my patients and went into a room and didn't see the patient. I knocked on the bathroom door, no answer. I went to see if he had been checked out to go to another dept for testing, no his name wasn't there. I went back to the room and opened the bathroom door and he was sitting there on the toilet dead. Leaned up against the wall. Deader than a doorknob. He was 103 y/o but gees I hope to never have that kind of experience again. Nothing happened. He was a DNR terminal CA patient and the family was very relieved.

    I think I would be devastated...id cry.
  6. by   MTK
    actually, dying on the toilet is not that unusual. That old valsalva maneuver can be fatal in some compromised patients (age, heart disease, embolic disease etc)
  7. by   galfromnairobi
    i had a patient die yestarday. when i received report from the agency nurse,all he told me was the patient was scheduled for dialysis at 1400, all other "systems were fine". when i walked into the room, i believed i was in the wrong room. the pt had TF running via an NGT, his left leg was in traction, he was also recieving PSS, and his last blood sugar was 54 and had received D50 jugding from the empty carton of D50 placed in the sink. the pt sounded horrible. to start, he was almost lying flat in bed never mind the sign placed on the wall with bold "aspiration precautions" on it. the pt was so gurgly attempts to suction him were almost impossible.he bit the catheter when i attempted oral suction, i was not able to advance the catheter into
    his only usable left nare. i called respiratory and a couple of the more experienced nurses but success was minimal. his sats were 84-88% the man was DNR/I. called the md, said just monitor.the weird thing is,i had to send the pt to nuclear med for a HIDA that was ordered the day before, i asked the md if we should hold off on the test but she said no. pt left the floor for 2 hours and made it back fine. he seemed to be doing alright, the iv nurse even placed a PICC on him. we left the room when the x-ray guy came to do an x-ray to confirm placement. x-ray was done,and a therapist went to the room shortly after,she called out for help, the pt had apparently died. it was quick. what disturbed me about this incident was i felt a need to tell anyone who cared to listen that i had just stepped out of the room. i had not neglected the pt in any way, in fact just the opposite, he took up more time than all my other 5 pts put together. the pt most likely aspirated, or the picc had something to do with it.family did not want an autopsy.
  8. by   sis14rn
    I had a patient that was getting a 12-lead EKG, I left the room while the tech did the test, came back in while he was unhooking the patient. i was looking at the strips when i noticed that all I was reading was pacer spikes. I then looked up at the patient and noted that he was gone (he was DNR), I asked the tech if he noticed that the patient was dead. I will never forget the deer in the headlights look I got!:uhoh21: :uhoh21: :uhoh21:
  9. by   ecugirl
    Oh yes! There was about a 6 month period on my unit where myself (working 7p-7a shift) and another nurse lost 3 DNRs after we assisted them back from the bathroom; once they hit the bed; they were gone. The worst one was a man whose wife had spent every night with him; until the last one. He had felt sooo much better and was sooo alert during the day, that she felt comfortable leaving him alone and of course, he passed away that night. Have you ever noticed that DNRs have a perking up period right before they pass awya? Anyway, that was an awful phone call to have to make in the middle of the night.
  10. by   FNimuaeMae
    When I was a CNA at the nursing home, was doing nite shift 2am rounds on the patients with a new CNA.... went into a dimly lit room and was checking people to make sure they didn't need changing or peri care of any sort... the new CNA checked one lady... I glanced at her but she didn't look right... started heading towards her and the CNA was like "oh, she's dry..." I said "um, no, she's dead." Something about the cyanotic face and the tongue stucking out....

    M
  11. by   Retired Nurse
    Sure, a few times. But I work in LTC many years. One that stands out in my mind: This lady (generally up and around on her own) didn't come down for supper. On checking, found her dead in her chair in front of the TV. When reported to her Dr. he ask, "What was she watching? Truth or Consequences?" I told him. "Bet it was the news." His reply. "That would do it!"
  12. by   seanymph
    I started out as a LPN 11yrs ago and was working just every other weekend on a Med/surg floor while I finished up my RN.
    I was working nights with 2 other RNs who were great. I offered to make rounds on the patients, just to make sure everyone was all right. Well, I walked into this one room where the gentleman was a DNR and I could tell that "something wasn't right" when I got to the first bed (he was in the window bed. I stood there watching to for any chest rise and fall and didn't see a thing. I slowly backed out of the room....scared to death. Mind you I had never been around any who had died before so this was all new to me and very unsettling. I went to get the RN who was taking care of him and I said "I think Mr. so and so has died." She went down to the room with the other RN, as it took 2 RNs to check hearbeat to verify. I stood in the doorway. The RNs were very nice and understanding. I felt so bad that i couldn't approach this gentlman when I first walked in the room.
  13. by   nialloh
    Quote from ecugirl
    Oh yes! There was about a 6 month period on my unit where myself (working 7p-7a shift) and another nurse lost 3 DNRs after we assisted them back from the bathroom; once they hit the bed; they were gone. The worst one was a man whose wife had spent every night with him; until the last one. He had felt sooo much better and was sooo alert during the day, that she felt comfortable leaving him alone and of course, he passed away that night. Have you ever noticed that DNRs have a perking up period right before they pass awya? Anyway, that was an awful phone call to have to make in the middle of the night.

    If they are on deaths door and suddenly perk up/become AAO/ect, we are on tender toes. We watch them very carefully, as it's not if, but when they will pass.

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