Have you ever gone in to find a patient dead? What happened? - page 6

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   HMtravelRN
    Quote from jgrossberg
    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.
  2. by   P_RN
    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.
  3. by   ktwlpn
    Quote from hmtravelrn
    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......
  4. by   sjaubert
    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
    Last edit by sjaubert on Jun 22, '08
  5. by   nrsang97
    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.
  6. by   megananne7
    Quote from nrsang97
    She had some paperwork from the ECF where she lived.
    What's ECF?
  7. by   leslie :-D
    Quote from megananne7
    What's ECF?
    ecf = extended care facility

    leslie
  8. by   megananne7
    Quote from earle58
    ecf = extended care facility

    leslie
    Thanks.

    I'm assuming that its similar to an ALF or nursing home?
  9. by   nrsang97
    A ECF (extended care facility) is a nursing home.
  10. by   blueheaven
    Quote from nrsang97
    A ECF (extended care facility) is a nursing home.
    We also have another definition for ECF....ETERNAL CARE FLOOR (morgue)
  11. by   One Flew Over
    We had a man who was Care and comfort, had been failing for a long while. He was having a usual day, I mean he was bad, but nothing told us that he was close to the end or anything. Me and another aide were just chatting away going to grab some linen out of the closet (just outside of his room) when we both did a double take. "Oh my god, he doesn't look right," the other aide said to me. His son was in, sitting beside him, holding his hand. But when we saw his face, the color, we knew he had passed. We called the nurse, and sure enough, he was gone. God bless him, I was so glad his son was there for his last moments, though that seemed like just a good stroke of luck. Nothing clued any of us that it was his day to go.
  12. by   megananne7
    Had a patient while I was on orientation on a med surg unit. She was admitted right at shift change, so my preceptor and I were going to do her admission assessment. I got a brief report about her... they expected her to pass during the night. She had a CVA a few years before, which had left her non-verbal and basically a total care pt. Family was caring for her at home.

    First, the CNA couldnt get a BP on her, but she was tachycardic. She was only on fluids and antibiotics. When she was admitted her INR was 10.0 She had SO many decubs on her, I RAN OUT OF PLACES TO DOCUMENT THEM (we use computer charting)!! And they were all HUGE! She had one that was yucky, brown, draining brown purulent, foul smell, lots of tunnelling. We turned her over to assess the back of her body and she started turning gray on us, so we hurried up and got her back on her back and her color improved. During this time, her legs and feet were already mottled.

    Checked on her throughout the night and her mottling was progressing. Someone had turned off her tele b/c they were tired of hearing it ding and ding b/c she was tachy. Went to check on her at about 4-something in the morning, noticed her color was HORRIBLE, from adistance didnt see her chest rising. at about the same time, someone ws turning her tele back on. They said there were little blips on the screen and when I walked in, went asystole.
  13. by   MassED
    Quote from chad_ky_srna
    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.
    did you mean to write something else, regarding the statement "as long as they don't have a dnr, oxygen will go in and out and blood will go round and round. - i don't understand what you wrote... did you mean, if they're not a dnr, cpr will be started?

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