first patient died on me

Nurses Relations

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I admitted a patient elderly patient DNRCCA a& o x 3, that came in with coffee ground non stop emesis. The ER tested her positive for blood per emesis, she was so weak, vitals stable. Per doctor orders NPO and all that was ordered were zofran and protonix...H&H was normal, labs were fine but non stop emesis. My heart broke watching her going this.. I recommended NG tube because she could not stop throwing up, doc didn't agree. I recommended a unit bed since she was so weak and I had 4 other patients to care for, Also not needed.

NEXT day pulse ox drops to 50%, mental status declinced ABGS bad.unit nurses come in and say well shes a DNR anyways which my mouth dropped.... they move her to the unit and she dies.. I just cant believe she died having going through all that pain and suffering... I just feel horrible. I can say when I spoke with her daughter before all this happened I had a feeling and told her, come be with her she needs you..

I duno...:(:unsure:

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I'm really sorry. That sounds terrible. It sounds like the patient was "Comfort Care Only", is that right? I would think that if antiemetics were ineffective, that an NGT would be indicated. I'm sorry the doc wouldn't listen to you. I'm not sure how hard you pushed for it, but sometimes pushing harder is warranted if it's in the best interest of the patient. That, and waiting until shift change and asking the next doc on duty.

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Specializes in Hospital Education Coordinator.

this is why facilities have chain of command. You advocate all the way to the top if you have to. Sorry you had this experience.

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Specializes in Neuro ICU and Med Surg.

I am so sorry you had that experience. That is sad that she had no pain meds or antiemetics to help with the emesis. Sometimes no matter how hard we push we just don't get what we need from the doc. Was this the attending or resident? I would have kept asking for the NGT and additional antiemetics and pain meds.

The ICU nurses were just wrong. I had a pt who had started passing huge clots and bright red blood per rectum. His SBP was in the 50's manually and he was alert surprisingly. At that facility our ICU staff came to the unit and got the pt. They came and saw us put the crash cart outside the room so they could get the bed in and asked me "Oh did the pt die already?" I was stunned and told them he was very much alive and could probably hear them. DNR doesn't mean do not treat.

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Did this patient have orders that included not doing anything invasive? I have had many patients that would not wish for a NG tube or anything else that would cause more discomfort. But would rather die in peace. If that was the case the patient should have had proper medication orders to make them unaware of, or stop the vomiting. There are many different advanced directives, and all can be DNR. DNR in that if you find them dead leave them be, but want full treatment otherwise. DNR's that only wish to be treated with medication but nothing invasive, including NG tubes. Without knowing this patients full wishes it is difficult to say if the MD was wrong in not wanting the NG tube or in sending them to the ICU.

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Specializes in Trauma Surgical ICU.

Was this a comfort care only pt?? The CCA after DNR leads me to believe it was. With that an ICU transfer would not be warranted, however, the pt needed more meds for N&V control as well as something for pain and anxiety if this was the case. I feel with the limited information we have the MD dropped the ball because the pt was a DNRCCA.. I don't think an NGT would be very comfortable but should have been an option and left up to the pt and family.

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Specializes in Rehab, Med-surg, Neuroscience.

I was always taught to understand that the main point of a CCA DNR order is to keep the patient comfortable... but I bet that patient wasn't very comfortable vomiting constantly. I feel very sad for the patient when it's possible and NG tube might have helped her. It is also true though that the MD might not have wanted to do anything invasive, although if I was in your position I would have agreed with you. I'm sad for you that you had to deal with this and I hope you are able to recover from it alright.

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I am sorry to hear about your experience. It is never easy losing a patient. Unlike a DNRCC (comfort care only) patients with a DNRCCA in place should receive standard medical care up until cardiac or respiratory arrest....at that point resuscitative efforts would cease. I agree with the above comment about following chain of command until you get an answer you like or someone explains why certain measures are not being taken for the patient.

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