Is my patient going to die?? - page 2

I am 2nd semester Nursing Student. The patient I had tonight was an 86 yo female who colon surgery on Friday. The bad part is her respitory status. She had a horrible horrible cough which sounds... Read More

  1. by   RN2Bn2006
    Quote from kaseysmom
    The congestion and the cough could be due to the anesthesia (?) from surgery..i didn't check when this thread was posted so im not sure if that would still be occuring. There should be orders to TCDB for postop pt's (that's how things are done here, anyway). Pneumonia is very easy to treat as long as it is caught early.

    I had a pt once who had lung cancer with mets to the scapula (and probably a lot of other places but he was comfort measures only). Anyhow, he had pneumonia and got over it but right after that he became disoriented and started to go down hill - morphine and ambien were very helpful to him. But, he was a DNR and on hospice...i doubt your pt is either of these..Good luck, and whether or not your patient dies - it is a wonderful expierence for every nurse to have (the death of a pt) because it brings you back down to earth =)
    Well her surgery was on Friday and she was my patient on Monday. She was running a low grade temp, and her 02 stats were dipping a little on 3L/NC. What was so awful was all the mucous you could hear when she coughed, and I mean she would cough her little head off, but she could NOT spit up one ounce, and her family said she had been like that her entire life.

    I'm just encouraged to know that she can recover from pneumonia. I just wasn't sure about someone her age. I plan to study it today before I go back tomorrow.

    Thank You
  2. by   RN2Bn2006
    Quote from DelightRN
    I just wanted to add that it is not at all a bad thing, or an unprofessional one, to cry over a patient. I have done it on more than one occasion.
    Thanks! That's nice to know. It's weird, I've enjoyed all my other patients (well most of them) but I have never felt this emotional attachment before. I'm not sure what it is. Her husband just really made an impact also. He loves her so much, and they had both been through so much. I couldn't be a nurse if I felt this attachment to ALL my patients..... I'd be sad all the time!
  3. by   sblanchet
    It is certainly all right to cry at such a sad situation as this. When you get some more experience under your belt you may find yourself more able to detach yourself from events such as this but there is no denying that situations such as this are very sad. Just remember that your presence there, providing comfort and listening to and helping this woman reach her family are all such very important things in this world. I work in oncology and had always shied away from this area, fearing the sadness of it all, not knowing what to say. I do not cry often but there are always those few patients who touch you deeply. I have cried with families after things are over. Just remember that yours is a hard job but so much better to do something to help the suffering than to fear it so much that you cannot do it at all. I am sure you will be a fine nurse.
  4. by   RN2Bn2006
    Quote from nursemary9
    Hi

    I have often seen that when pt's are sure they're going to die, they do.

    It sounds like you did a wonderful job with the patient; please remember that you are a student & not expected to know everything that is going on with the pt.

    I, too, hope that you reported everything to the RN assigned to this pt.

    It sounds like you were a BIG help to her--you would have been a big help to me if I was that RN. Just knowing how much you cared about this pt. & how you stayed with her would have been a big relief to me.

    When pt's are this freightened it is so helpful to be able to have someone there for them.

    You know I've been doing this for 38 yrs now, not counting mt student years & I still cry when a pt. passes. It's still very emotional for me. I don't say I sob & become out of control, but I do quietly cry. I also hate it when pt's are alone as they're dying. If I see this, I try to stay with them as much as possible. I know when the time comes, I think I'd like someone with me when I go!!'

    It sounds like you will be a good nurse

    mary Ann
    Well, I'm glad I'm not the only one who's a little emotional. I honestly don't think I would be crying for the patient (she seemed very much at peace) but for her dear little husband who worships the ground she walks on.

    As I posted to someone earlier -- I reported several times to the RN about her anxiety about me leaving, and the physical findings & breathing status - which she basically just said "is nothing new". Which like I said - this is probably her 100th patient that has come down with pneumonia, so she knows what to expect. One my part - this is my 1st patient with pneumonia, and really didn't know enough about it to know what to expect and what is worrisome and what is not. You can believe when I go back on Wednesday - I will know all about pneumonia. The one thing I did NOT do was tell the RN that my lady said she was going to die. I realize now that I should have. I won't make that mistake again.

    Thanks for your thoughts.

    OH, one thing is I DID feel good about the way I stayed with the patient - which calmed her anxiety alot. I do realize the RN had several patients and could not spend time with my little lady to calm her, so I feel like I was a benefit in that perspective. I treated her like I would want someone to treat my grannie. I talked to her about her arts & crafts - which I knew she loved, and things I knew she had an interest in, which helped. So, At least I did some things right!!!!!!!!
    Last edit by RN2Bn2006 on Feb 8, '05 : Reason: forgot something
  5. by   RN2Bn2006
    Quote from sblanchet
    It is certainly all right to cry at such a sad situation as this. When you get some more experience under your belt you may find yourself more able to detach yourself from events such as this but there is no denying that situations such as this are very sad. Just remember that your presence there, providing comfort and listening to and helping this woman reach her family are all such very important things in this world. I work in oncology and had always shied away from this area, fearing the sadness of it all, not knowing what to say. I do not cry often but there are always those few patients who touch you deeply. I have cried with families after things are over. Just remember that yours is a hard job but so much better to do something to help the suffering than to fear it so much that you cannot do it at all. I am sure you will be a fine nurse.
    Thank you for saying that.
  6. by   twinmommy+2
    What an awsome responsibility we have as nurses (and students) that we help a person to be ready for their final moments on earth and help them to move on comfortably into the next chapter of their existance. I am a student as well and I hope I hold up as well as you did when it comes my time to care for someone who might be on their way out of this world. Thank you for posting your experience
  7. by   RoadRunner
    I'll just add that nursing means "caring" a lot more that "treating", so, I think what you did was great. We sometimes think that a procedure or a medication is more necessary than our empathy but in cases like these (and you'll learn with experience when to react and when to just be there), I think reassurance and listening was the thing to do. People who feel they are dying need to be heard and understood. I think it was great that you called the husband at the demand of your patient. Because a patient who says she feels like she's dying... well, she feels like she's dying! (wheater they are or not in our professionnal view). Not a benign feeling!

    As someone said before, death is an important part of life, and we tend to forget that in our super-mega-extra-stronger than God-today's medecine. Take care and good luck!
  8. by   RN2Bn2006
    Quote from RoadRunner
    I'll just add that nursing means "caring" a lot more that "treating", so, I think what you did was great. We sometimes think that a procedure or a medication is more necessary than our empathy but in cases like these (and you'll learn with experience when to react and when to just be there), I think reassurance and listening was the thing to do. People who feel they are dying need to be heard and understood. I think it was great that you called the husband at the demand of your patient. Because a patient who says she feels like she's dying... well, she feels like she's dying! (wheater they are or not in our professionnal view). Not a benign feeling!

    As someone said before, death is an important part of life, and we tend to forget that in our super-mega-extra-stronger than God-today's medecine. Take care and good luck!
    Oh my Gosh, I never thought of it this way. The reason I felt so inadequate was because I couldn't come up with another "medical' intervention to do. Therefore I felt like I had failed. I never thought that what I actually did was what was best for her. That's awesome to think about.
    And also - like you said - even if she really wasn't "passing" --- in HER MIND she was, and that's the important thing - instead of dismissing her as "oh she's just confused" I think I actually helped by acknowledging what she was saying - whether it was true or not - and called her husband. It gave her peace.

    Thank you SO much - you helped me see things from a different perspective.

    PB
  9. by   DutchgirlRN
    Geriatric patients can be amazingly strong. No one but God knows if this patient will live or die. Sometimes the patient can clue you in but you just never know she just may have been scared and confused once her husband left. You spent 5 quality hours with her and that's all you can do. If she does pass while you're taking care of her try to look at it as an honor. It's tough to lose a patient, especially your first. Don't worry about crying. We all do at times. There are patients who just touch us and that makes us human and makes us better nurses. Let us know.
  10. by   lpauley1
    Many nurses have big hearts and tend to wear them on their sleeve, so to speak. I have been a LPN for 17yrs. and I too have been attached to many of my patients. It is ok to cry. Sometimes I try to keep it from the patient and family, but there are those times when it can't be helped.
    I have went home many nights and cried and prayed for my patients and their families. Sounds like you will make a good nurse. Keep up the good work.
  11. by   RN2Bn2006
    Quote from RN2Be06
    Many nurses have big hearts and tend to wear them on their sleeve, so to speak. I have been a LPN for 17yrs. and I too have been attached to many of my patients. It is ok to cry. Sometimes I try to keep it from the patient and family, but there are those times when it can't be helped.
    I have went home many nights and cried and prayed for my patients and their families. Sounds like you will make a good nurse. Keep up the good work.
    Thank You. I'm glad we aren't expected to be emotionless!!!
  12. by   Dorito
    Quote from RN2Bn2006
    Well I'm hoping that all the talk about not making it was just because she was somewhat disoriented. (who knows??) But she was very adament about it, and seemed oriented at the time. But I did go ahead and call her husband because I would have never forgiven myself if I didn't and she died.

    I didn't know if the pneumonia was usually fatal for someone her age. Also, as a student I feel so stupid when it comes to situations like this. I honestly DIDN'T know how to help her other than turning her, having her breathe and cough. At one point I wondered about suction since she wasn't able to actually get that stuff out herself, but didn't ever ask about it (I should have) but I had my instructer in there twice, asking her what else I could do - she said basically nothing. And I asked her primary nurse which just basically said nothing also - I just felt so dang helpless. I hate that I have such a limited knowledge - I know it will come with time..... but in the meantime -sometimes I feel like a big DUMB KLUTZ in my patients room. I guess that will get better with time too (It HAS to!! )

    Thanks for your reply. Oh, and I didn't even think about asking about a DNR??????????!!!!!!!!!!!!!!! Maybe one of these days I will finally get the big picture!!!!!!!!!!!!!
    My experience....if someone tells you they are going to die.....believe it. You absolutely did the right thing by calling her husband and niece. If you hadn't and she had you would have felt much worse. Good luck, you'll be a great nurse someday.
  13. by   meownsmile
    I agree that she probly felt like she would die. But,, a few things that could be done with doctors order. And i have seen so many people with colon resections etc say they were going to die, because they feel like they are. And its very very difficult for them to take deep enough breaths to prevent respiratory complications.
    An order could have been written for nasotracheal suction to promote the cough reflex,, with suctioning during coughing. Would help her get it up and you could help remove it if she couldnt cough it up far enough.
    When i have a patient with post op atelectsis or pneumonia, sitting them in a chair and having them deep breath, do blow bottles, incentive spirometer, whatever. Works better if they are in a upright position.
    Did the doctor order some type of duo neb or percussion for her? That may have helped her get some of it broken up enough to get it out.
    Believe me, if she desats enough and isnt a DNR they will vent her and they will get that stuff up then. And she wont die.
    I hope for the best for this lady, there are a lot of things that can be done.
    Just had one similar this last week, she's going back to the LTC this week. Ya just never know.

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