First clinical day was a nightmare - pg.2 | allnurses

First clinical day was a nightmare - page 2

So I have had a very rollercoaster day today. I am a Nursing I student, 21 years old and today was our first day of doing clinical at the hospital. I got my patient assignment and she had some major... Read More

  1. Visit  freckles23 profile page
    0
    Quote from akulahawk
    Remember folks, this patient had pneumonia on top of COPD... It's not all surprising that she was on 5L. If she's already low O2 sat already, toss in a whole lot of crud in the airway to further decrease the available alveoli and it's not at all surprising that she needed that 5L for adequate oxygenation. If anything, I might be more concerned about adequate gas exchange for CO2...

    Oxygen isn't the immediate killer of COPD patients that it's advertised to be. Very few truly go to pure oxygen drive breathing. I was always taught that if you do have to put a COPD patient on a high concentration of oxygen, get the BVM ready but you probably won't have to use it.

    To the OP: That was a really rough first day, and your story will probably be told around the school for a few years, because you really were that nursing student that had the patient that died on her first day... just so that others can be "warned" to be ready and prepared. You were probably quite the good presence that patient had and while the outcome wasn't all that good for her, you were able to see quite vividly the teamwork involved and is necessary at times. You also now know that your instructor really can "walk the talk." I hope that this doesn't change your outlook for nursing... as this is also a rare gift. You were shown how to handle emergencies and how the nursing process works even in that setting.

    Vent away if you need to, because we've all had one of those days where you just need to.
    Well that was an interesting point about the O2 levels, but im happy that it most likely wasnt the killer. She had alot going on with her. And it was definetely something I was not prepared for but it was very neat to see. The Rapid Response thought that she might have been seizing because she was kind of getting tense but my professor said that it had something to do with the muscles, not quite sure what she said. But now that I think back to it, the signs of hypoxia/hypoxemia were definetely there. Very anxious, restless, dyspnea, tachypnea, very coarse rales and rhonchi was so loud I could barely hear her apical heart beat when I was listening and cyanosis in the end. I still want to be a nurse, I always wanted to be one. This situation hasnt hurt me in anyway, only emotionally a little bit, but other than that it was a good learning experience indeed!
  2. Visit  SleeepyRN profile page
    1
    Quote from CrunchRN
    Think about how glad she was to have a caring student with her all morning. It would have been horrible for her to spend her last time on earth alone because her nurse was busy with her other patients. You did good.
    I don't know if OP believes in God, but I can see God having sent this student to her to be with her through the whole process. (Since patients get extra attention when they have a student nurse in addition to their nurse)
    LiLev likes this.
  3. Visit  Racer15 profile page
    0
    I've seen COPD patients on more than 5 L of O2 before. That alone would not have killed the patient. Anyways, sounds like you had a pretty abrupt start to clinicals! You get used to it after awhile. I work in the ED, so I see death a lot, but I remember my third semester having a patient that was AOx3 and had an inoperable AAA(and the patient knew how serious it was)...we were basically just sitting around, waiting for it to rupture while the patient told me how pretty and nice I was, commented about the weather...it really sucked knowing this person was going to die, and that they would be totally aware when they began to bleed out. Not to mention the fact that I was just going into the room to see the aneurysm, which was massive and apparently pretty rare. I felt bad so I stayed longer than I had to just talking with the patient. That was always something that bothered me as a student, that I would be sent into patient rooms like they were some kind of educational sideshow. I still go through it as a new nurse. I know it's necessary for the learning process, but it will never be something I really "enjoy".
  4. Visit  freckles23 profile page
    0
    Quote from SleeepyRN
    I don't know if OP believes in God, but I can see God having sent this student to her to be with her through the whole process. (Since patients get extra attention when they have a student nurse in addition to their nurse)
    I have mixed feelings about god. I'm catholic but I really don't practice it and some days ill say it is what it is and that no one above is controlling what is going on in the earth and then there are times like the incident that to me at clinicals that makes me wonder did someone put me together with this woman for a reason and to test my strength on how I could handle it being my first day and make me a stronger person throughout nursing school. Its like I got the hardest obstacle on the first day dealing with death and that if I can handle that, I can handle anything
  5. Visit  LiLev profile page
    0
    I agree that she was fortunate to have some company for her final hours of her life. I'm a student as well and I would have cried if any of my patients in my first clinical died on me.
  6. Visit  HippyDippyLPN profile page
    0
    If this patient were my family member I would feel so grateful that you were with her in the final hours. She must have enjoyed the company and conversation you had together and made her feel a little less scared I'm sure.
  7. Visit  LuciaHernandez profile page
    0
    COPD patients vary and some, depending on their state, can have up to 4 or 5 L of Oxygen depending on % of saturation. It just all depends on the patient and how bad their disease was. We do not know all the facts here. Bless her for being there with this patient during her last hours.
  8. Visit  dah doh profile page
    0
    To the OP: your patient was hypoxic! She needed more oxygen, not less! You are taught to not give the COPD patient too much oxygen, but you aren't taught to take into consideration her comorbidites of pneumonia and CHF; which would cause an increase in oxygen demand. Your patient probably needed to be electively intubated and most likely diuresed because she sounded terrible and was hypoxic. I bet you her Cxr was wet or whited out and abg was horrible too. I am not berating you, just trying to let you know that people aren't text book examples when they get sick. I'm sorry that happened to you on your first day. Take comfort that the patient was probably happy prior to dying because you spent with her prior to her death. By the way, we had a code blue my first day if clinicals too; my clinical instructor called it.
  9. Visit  J.A.B.,RN profile page
    0
    I am a first semester nursing student and would never have dreamed of something like this happening! We are on a med-surg unit and most people are discharged from there. Thank you for sharing, though. It is situations like this that keep me on my toes and motivate me to keep studying even when my brain can't take it anymore!!!
  10. Visit  freckles23 profile page
    0
    Thank you all for the feedback, you made me look at the situation in a different light and made me feel like I wasnt crazy for feeling the way I did that day!
  11. Visit  freckles23 profile page
    0
    Quote from dah doh
    To the OP: your patient was hypoxic! She needed more oxygen, not less! You are taught to not give the COPD patient too much oxygen, but you aren't taught to take into consideration her comorbidites of pneumonia and CHF; which would cause an increase in oxygen demand. Your patient probably needed to be electively intubated and most likely diuresed because she sounded terrible and was hypoxic. I bet you her Cxr was wet or whited out and abg was horrible too. I am not berating you, just trying to let you know that people aren't text book examples when they get sick. I'm sorry that happened to you on your first day. Take comfort that the patient was probably happy prior to dying because you spent with her prior to her death. By the way, we had a code blue my first day if clinicals too; my clinical instructor called it.
    Well her pulse ox was pretty bad, it was still at like 89% on 5 Liters, but Im not the one who wrote the orders and Im not sure what the staffs plan was for her. She was in pretty bad shape and her lungs were a mess when I was listening to them. I kept telling the nurse the patient is very anxious and she just told me that the pt is always like that. So the nurse gave the pt the anxiety meds and then about 20 mins later the patient passed away. Even my instructor said the nurse felt guilty like she shouldnt have gave the pt the anxiety meds. I just wish the nurse paid more attention to her patient because when I was telling her how bad the lady's condition was she kind of blew it off like she already knew the information so I did the best I could in the situation because she is with the patient way more than I was so im not sure what the patient's norm is and if she has always been like that.
  12. Visit  dah doh profile page
    0
    To the OP: if the SaO2 is < 90%, the PaO2 is in the toilet...look up the oxygen dissociation curve. Although COPD patients can tolerate even lower SaO2's such as high 80's, giving anxiolytics or pain meds can knock out or severely depress their respiratory drive, so they need careful monitoring. A few days ago, this happened to a registry nurse who gave a tiny dose of dilaudid to a COPD/dialysis patient with a very low ejection fraction. I went in the room because of alarms of O2 sat was in 70's on a nasal cannula. The registry nurse was upset at me for giving the COPD patient 100% oxygen to get the Sats up, but them I also gave the patient narcan because the patient was periodically apneic and unarousable. After the patient started breathing better and the O2 was weaned down, I told the registry nurse to monitor her and informed the RT to start making more frequent rounds on her too. The registry nurse did a horrible job if it because I had to call the anesthesiologist to intubate the patient a few hours later due to continued decreased LOC, frequent desaturations, and inadequate ventilation before the patient crashed. Regarding your patient, in order to deal with the patient's anxiety, the nurse should have looked into the cause which was hypoxia rather than just treating the symptom which was anxiety.
    Last edit by dah doh on Mar 24, '13
  13. Visit  ckh23 profile page
    0
    Quote from freckles23

    Well her pulse ox was pretty bad, it was still at like 89% on 5 Liters, but Im not the one who wrote the orders and Im not sure what the staffs plan was for her. She was in pretty bad shape and her lungs were a mess when I was listening to them. I kept telling the nurse the patient is very anxious and she just told me that the pt is always like that. So the nurse gave the pt the anxiety meds and then about 20 mins later the patient passed away. Even my instructor said the nurse felt guilty like she shouldnt have gave the pt the anxiety meds. I just wish the nurse paid more attention to her patient because when I was telling her how bad the lady's condition was she kind of blew it off like she already knew the information so I did the best I could in the situation because she is with the patient way more than I was so im not sure what the patient's norm is and if she has always been like that.
    She was probably anxious because she couldn't breath.


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