First clinical day was a nightmare - page 2

by freckles23 6,953 Views | 30 Comments

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 diagnoses of Pneumonia, COPD... Read More


  1. 0
    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.
  2. 0
    That is definetely a good way of looking at it!
  3. 0
    Im not quite sure. She had pneumonia and CHF as well, it was written in the chart as well from the physician's notes to give her that much. Im not sure their reason behind it. There had to be some kind of reason... Makes me wonder
  4. 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!
  5. 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.
  6. 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".
  7. 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
  8. 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.
  9. 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.
  10. 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.


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