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

jgrossberg · Nov 8, 2005

several times, but 2 stand out in my mind. when i first became an lvn, working in a large long-term care facility, just after change of shift, an oncoming rn doing rounds on the residents came in and said that the lady in room __ was deceased. i went in to find her lying almost on her stomach, face in a pillow. it appears an na did this during rounds. i was shocked. rns try to follow your nas!!
recently, a fresh post-op was assigned to an lvn, who i was covering. in this facility, the lvn is put in the middle of the unit, and the rns share the coverage of her patients. i was also in charge, had 6 patients of my own, and 2 other patients of the lvn's to cover. it was a very busy shift, still i had been in to round on this patient 3 times. and the lvn documented that he had been alert and oriented x3 just a short time before.
he had been reported to have sleep apnea. even his roommate and one of the responding docs (to the code) commented on this. yet no official diagnosis was found. i had hung an iv on him and he was breathing. ashort time later, my na came to me saying he wasn't breathing. we all thought 'he has sleep apnea' - but he really wasn't breathing. with his lips blueing, i quickly called the code, grabbed the crash cart, placed the cpr board, and the code team arrived. he could not be resuscitated. i no longer assign fresh post-op patients to an lvn. i don't care what the facility practice is. it was hard on all of our staff when he passed after (to quote his doc) having a "simple ortho procedure.". (what exactly is a "simple ortho procedure"? if it's simple, why do they have to pound them with mallets?) so... pe? mi? hypovolemic shock/anoxia? i still haven't been told.
the legalities rest not only on my license, i'm sure. it was my head when i had to notify the attending. but the larger concern is these are not just patients or "cases". they are people. this man could have been my father. and he had a family that grieved for him. therefore, rns, watch your assignments, dare to challenge facility practices, and cover your lvns well!!

i hope this isn't a duplicate reply, as i was typing one a minute ago that "disappeared" off my screen...anyway, i am a student who has cared for a few fresh post-op patients on the ortho/neuro floor. i was wondering whether you felt there was some failure of proper care or monitoring on the part of the lvn, or whether there was some other reason for your decision not to assign fresh post-op patients to lvns after this incident. i wasn't quite clear from your message what formed the basis for your decision. thanks for your response!

Inspired_2b · Nov 9, 2005

Yes, just last night, I found my patient's roommate unresponsive. He was ambulatory - going back and forth to the BR because he had diarrhea. His nurse did initial rounds on home and went to pour her meds. When I went to see my patient in the next bed, he stopped me and asked if I could put on a diaper for him because he wanted to get some sleep as he was too tired from rushing to the bathroom every few mins. I put the diaper on for him, plugged in his IV pump and turned his light off. About half an hr later, I came back to the room carrying meds for my patient and as I was passing his bed, I just happened to glance at him. He was lying in bed unconcious and so very pale! I didn't even remember where I put my meds. I started yelling his name. No pulse. No breathing. I pulled the callbell out of wall. I started compressions because I had covered for his nurse during break the night before I didn't recall him being a DNR. Sure enough, he was a full code. We called the code. They couldn't resuscitate him.

... it was a very unexpected loss.

kadokin, ASN, RN · Nov 15, 2005

just wanted to reply to zachary2011 i am a nurses aide (srna in kentucky is state registered nurse aide) and i couldn't find a stethoscope because i don't have keys to the med carts where they were all locked up and mine happened to be at home that particular day. i now carry a backpack to work with me where i keep my bp cuff, stethoscope, thermometer, bandage scisssors, extra pens and markers, time card, and so much more. i bring it every shift. as long as they don't have a dnr, oxygen will go in and out and blood will go round and round. they do not die on my unit, they are pronounced dead in the er or they rarely (never seen it) get better.

state registered nurse aide. i have never heard of that. is there a test to become registered? what is the educational/clinical requirement? it sounds like ky has high standards and good for them. tell me more, i'm curious. where i live, most nurse's aides are cnas, certified nurse aides. they can get their certification through a short vocational course. some facilities use non-certified nurse's aides and pt care technicians. it is always nice to hear that a state has high standards for this critical component of our health care system.

Turd.Ferguson · Nov 15, 2005

Back to the original question...

Several years ago a coworker of mine walked into a room to do some maintenance. He saw a patient who was obviously dead. He summoned the nurses and returned back to our department. Upon arriving, he saw me and another guy (third guy) I work with and was telling us about what he had seen. When the first guy told us what room it was, the third guy recognized it as his wife's grandfather who had unexpectedly died.

The third guy then went up to the room where he was soon met by the returning family (who had gone to lunch before the death). By this time, the code team had arrived, but the patient was long gone. Pastoral Care was there to comfort the family and told them that the nurses had been with the patient until the very end. Pastoral Care had no idea that one member of the family knew the real story.

erShocker · Nov 15, 2005

Yes. It happens. Especially when you deal with older people and DNRs. Even in the ED you see them coming in looking fine and minutes later your coding them for a AMI and they dont make it. It happens and you best is not going to stop someone who is intent on dying, no matter how much both of you want them to live.

If finding someone dead on you shift is upseting to you talk to you fellow nurses or spiritual leader. i would not worry about it until it happens. When it does, react to your training an follow you algorythmns. you can think about it latter.

HMtravelRN · Nov 16, 2005

i hope this isn't a duplicate reply, as i was typing one a minute ago that "disappeared" off my screen...anyway, i am a student who has cared for a few fresh post-op patients on the ortho/neuro floor. i was wondering whether you felt there was some failure of proper care or monitoring on the part of the lvn, or whether there was some other reason for your decision not to assign fresh post-op patients to lvns after this incident. i wasn't quite clear from your message what formed the basis for your decision. thanks for your response!

i think there were a multitude of failures. the facility should have had a policy in place wherein lvns are not assigned fresh post-op patients. lvns do not generally get the extra (rn) year of intensive assessment drilling in school that rns do, nor the year of of more intensive pathophysiology - at least not at the college that i attended. i'm not even sure that the lvn actually went into the room to assess the patient at all that night. on the floor i worked that night, it seemed standard to do initial rounds on patients at the start of the shift, then to let them sleep until meds and or vitals were due - at least that was true of some of the staff.

mainly i recall how much more intense that rn year was in school, and how much more i had learned on assessments, disease processes, and potential complications. i know some very seasoned lvns that have continued to gain knowledge beyond their practical nursing degree. however, from my own experience - having worked as both (and a cna prior), i could see the difference in knowledge and skills that the extra rn year of nursing school gave me, as well as the subsequent opportunities to apply that knowledge. prior to going to that facility, i worked on 2 units that did not allow lvns to have fresh post-ops as primary patients.

P_RN, ADN, RN · Nov 16, 2005

My very first patient in my very first clinical.

His room was next to the nurses station. When I went in he was cool and obviously dead.

The night nurse said she had just checked him. This was way back when one nurse might have a whole floor with or without an aide.....(Think Cherry Ames Hospital Nurse etc.) early 1960's.

I don't remember what I did but I know it scared the fool out of me.

ktwlpn, LPN · Nov 17, 2005

ashort time later, my na came to me saying he wasn't breathing. we all thought 'he has sleep apnea' - but he really wasn't breathing. with his lips blueing, i quickly called the code, grabbed the crash cart, placed the cpr board, and the code team arrived. he could not be resuscitated. i no longer assign fresh post-op patients to an lvn. i don't care what the facility practice is. it was hard on all of our staff when he passed after (to quote his doc) having a "simple ortho procedure.". (what exactly is a "simple ortho procedure"? if it's simple, why do they have to pound them with mallets?) so... pe? mi? hypovolemic shock/anoxia? i still haven't been told.
the legalities rest not only on my license, i'm sure. it was my head when i had to notify the attending. but the larger concern is these are not just patients or "cases". they are people. this man could have been my father. and he had a family that grieved for him. therefore, rns, watch your assignments, dare to challenge facility practices, and cover your lvns well!!

hmmm-nevermind-i won't go there tonite.i just don't have the strength...... :coollook:

sjaubert · Jun 22, 2008

A pacer on a telemetry unit is as good as dead if they code because no one knows it. I've discovered this before and probably will again. In the future i will encourage such patients to request a dnr order as they may 'stick around' for a while after we code and keep their corpse functioning. I think it might be that their spirit is 'captured' here until they actually die. Of course they may be lucky and gone and all we may have is the remains but who can tell??? Steve

nrsang97, BSN, RN · Jun 22, 2008

I was working on Christmas day 2006. I was afternoon charge. I had 6 patients already. I was admitting a 7th. I had admitted the man around 8pm. I knew it was going to be bad because ER report started out with " Hi I am calling to give report on Mr.Jones(name not real) he is like really old about 80." Yes that is what the nurse giving report said to me. He came up to the floor. His color was bad. He came in for abdominal pain. He needed blood. I had another pt getting blood as well. I was about to medicate my other pt with pain meds and get his second unit up and go see my pt that came up from the ER that night. I was pulling pain meds for the other pt and had his blood in my hand and the aide comes up to me and says that she can't find the new admit. I was like WTH you can't find him? I went into the room and sure enough he isn't in the bed. I looked and he disconnected the foley from the bag, and walked to the bathroom (steps away from the bed) I opened the door and found him slumped over the toilet. Checked pulse and laid him back the aide pulled the code light and I started CPR. When the secretary came over the intercom we screamed for the crash cart. Code team called and up to the unit. We couldn't bring him back. I had another nurse call his family. I called his doctor. I really think he had a MI, and with his symptoms I am suprised they didn't do a EKG in the ER. I think this could have been avoided.

I have another story.

I was getting a admit from the ER. I got report and VSS. Pt confused. So they changed admit to me since pt in another room was whining about last roomate that was confused. I had a open private room. I said OK. Pt not up after about 30 min so I thought transport backed up but made me happy I could finish up some meds and charting. Pt comes up and I look at her only slightly. I ask the transporter to place O2 back into nose. They put pt into bed. She is about 80 y/o and about 80 pounds. I went back to the room after getting a dynamap and pulse ox. I look at her and she is ashen color. I touch her and she is cold. No repsonse. I feel for pulse and she is dead. I walked out into the hall and yelled for the crash cart. I also start CPR. Code team arrived. We intubate her and get a rhythm back and her pupils are blown. House MD says "We brought her back brain dead." We called family. She had some paperwork from the ECF where she lived. Very unclear about code status, said no cpr no intubation but nothing about meds. That paper work in invalid anyway since no hospital code sheet was made out. We extubated her and let her pass with her family at bedside, at their request. I just don't know how the ER staff had no idea she was dead.

megananne7 · Jun 22, 2008

She had some paperwork from the ECF where she lived.

What's ECF?

leslie :-D · Jun 22, 2008

What's ECF?

ecf = extended care facility

leslie