First clinical day was a nightmare

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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 and CHF. I went into her room at around 9 AM to do vitals, a physical exam and my assessment on her. She was very anxious when I arrive but she was a sweet lady and was very cooperative with the things I had to get accomplished. She had dyspnea, use of accessory muscles, coorifice rales and rhonci on anterior and posterior chest and an irregularly irregular heartbeat. She was very congested and had a nonproductive cough. As I was getting to know her, we had to go down to Chest Xray. She was very anxious going down there and kept saying that she couldnt breathe even though she was on 5 L via Nasal Cannula of oxygen. Once the Xray was over, we headed back upstairs and I was about to prep for my AM care. My instructor came in my room to check on everything and see if there was anything we needed. I told her about my findings on the physical exam and she explained and clarified some things. Then she wanted me to weigh the patient but we couldnt figure out how to work the bed so we looked at the instructions that were on the bottom of it.

As the instructor was reading, I noticed my patient got very quiet and wasnt anxious sounding like she had been all day. I looked up and my patient looked like she was about to sneeze but it wasnt a sneeze. She looked out of it and unresponsive. I told my professor to look at her because she didnt look right and my professor went by her side. My professor and I called her name and she was not alert or answering us. So I called the primary nurse from down the hall to come over to the room. Of course the nurse was probably thinking "What does this student nurse want? Its probably something stupid" Although she was a very sweet nurse, but I think its just a typical response for a nurse to think a student nurse is overreacting. So the nurse came to the room and we told her what happend and then they called the Rapid Response team. They did what they had to do and I was standing at the side lines watching this whole thing. Seeing the different procedures they were attempting to do and how fast everyone rushed to the room. My instructor was helping out the staff which I thought was pretty neat to see my instructor use her skills instead of talking about her skills in lecture all the time. As I watched what was going on I told myself I will be okay and that I think I can handle it. I work as a Nurse's Aide at a hospital so I have done post mortem care before and could handle death pretty well. But as the chaos finally subsided, one of the staff members asked me if I was okay and that it is okay to cry. I think just having someone say its okay to cry made me let it all out. Before the water works came, I told my professor I need to step out for a second and I took my gown and gloves off. I was so numb to the core and walked out shaking and hives all over my body. I went to the bathroom to clear my head on what just happend.

I literally saw the life get sucked out of this woman which I think is what scared me the most. To be interacting with my patient for the 2 hours that I did, I enjoyed it and this was the last thing I was expecting. I saw her go from anxious, to slowly turning blue and unresponsive and then dead. It was interesting to see this happen right before my eyes because not many see the process of when they are on the brink of life and death and boy did it happen quickly. Many just walk into something like that when the patient has already collapsed and dont see that transition. I think its very ironic that this happend to me because I always thought it was so cliche' for something like that to happen to a nursing student on their first day of clinical. My instructor even said out of all the years she has taught, she has never been a part of something like that. It was a mindblowing experience and definetely a story to tell my grand kids. But it is still kind of a shocker for me because I wasnt expecting it and it has left me in this weird funk all day. It was sure a learning experience because I was understanding how Pneumonia and COPD and CHF effect the body and its just interesting how it all plays out in the end and the destruction it can cause on the body.

Anyways, Im sorry this is a long post but I am just venting out my feelings about my day that I was not expecting

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 :cautious:

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 coorifice 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!

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)

Specializes in ED.

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".

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

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.

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.

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.

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.

Specializes in Medical Surgical.

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!!!

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!

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.

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