Anxiety following patient death

[Hockeynursing]

Hi friends- I hope I can call you that:) some wonderful people on this forum have helped me through some hard nursing times.

My anxiety has been getting the best of me lately regarding a shift I finished.

i had a palliative patient (PPS 10 %) on a night shift who was declining quickly. He had been unresponsive since early in the morning. I came on at 7 pm and he had zero output since the morning. He had a morphine infusion subcutaneously at 6 mg/hour. His family left at 1230 and I hung a new bag at at 1250 (50 mg of morphine in a 50 ml bag).

Now, I went in at 0120, half an hour after hanging the new bag, and I am ashamed to admit this, but turned it down to 4 mg/ hour (4 mls/hour). He was only breathing at a rate of 5-6 an hour. It was almost like Cheyne- stoking but it was a 15 second gap, and then a big breath, and then another gap.

I pronounced him at 0140. 40 minutes after the new bag was hung. I can't help but think I did something wrong- I know I put the right medication in the bag, but what if I accidentally infused it at 50 mls (50 mg) per hour instead of 6 mls per hour. I mean 25-30 minutes after I hung new bag, he was struggling for air.

I know there is no way to know but my anxiety is eating me alive. The hard part is, I love palliative and hospice nursing. It is so rewarding. This death is just clinging with me for some reason. I'm hoping some nurses can provide me guidance. I have no reason to believe I messed up other than the fact he died quickly after changing the bag.

[AnotherRNisnew]

You have no control over when your patient expires. This patient had been doing poorly all day long and it was just his time. You did nothing wrong.

[Steffy44]

I don't think that you did anything wrong. I remember my first death vividly...probably because it was only a few months back. She transferred up at 0730 from post on room air with sats in the 90s. At 10sh she her sats plunged into the 60s. We couldn't get her past 80 with a nonrebreather. We called the doc in the MET call who told us she was dying and the family needed to decide what they wanted (she was 98). They opted EOL cares. I had given morphine once and atropine mostly to help calm the family after they arrived. They thought she was getting restless and wanted her to have more morphine. She died right as I approached her IV at 1320. I think she just decided it was time to go. Confirmed my desire that I do want to become a hospice nurse after I gain more experience.

[nurseinthezoo]

OP, what you perceived as gasping for breath were most likely agonal resirations, a very terminal phenomenon that often occurs just prior to the final shutdown that is death.

Don't make yourself crazy picking nits on this - you did fine.

That's what I thought. Just his time to go.