Can I get a situation review from experienced nurses?

Published

Here's what happened:

I took over care of a "comfort-measures only" 37 yo woman who was comatose and dying -- I was the night shift nurse. Her vital signs were being monitored via telemetry but were not being displayed in her room. Her vital signs were normal when I assumed care except for an 02 sat in the 80's. I was told that her family was all exhausted beyond belief but wanted to be called if she had any changes.

So, about an hour into my shift she is satting in the 60-70s and throwing lots of PVC's for over half an hour. So, I thought "This is it." I called her family and let them know. The entire night she lived, satting in the 60's and throwing occasional to frequent PVCs.

She was on 16mg morphine/hr, btw.

Her family all came in after I called. But after I realized that her status had really reached a plateau I was honest with them. I said that she had not gotten worse over the last few hours and I didn't know whether she had a few hour left in her or a couple days. I said that I would try to keep them updated via phone if they decided to go home and catch up on their rest. I said that whether they decided to go or stay -- neither decision was wrong -- just to say their goodbyes if they decided to take a break and that would be very understandable.

But no one wanted to miss her death, of course! So, then I left my shift feeling like she was probably going to die any moment after the family had an unneccessarily sleepless night. Probably, thanks to me, they'd miss her death AND be sleep deprived wrecks.

What should I have done?

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i would have done what you did. based on the information you had at the time you made a decision. funny thing about death: until it actually, literally happens, no one can say for sure when it will happen. all the signs can be there, but the body hangs on for some reason.

you gave the family all the best information and they made the decision to stay. you did great. think of the alternative if you had done the opposite.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

That situation happened in our family recently as we were waiting for my Grandpa to pass away. The nurse thought he was dying and so all the family showed up. He was exhibiting all of the signs of imminent death yet continued to live for almost another 24 hours. The whole family was exhausted but wouldn't have had it any other way. My grandpa was a "tough old bird" and wasn't the kind to die without a little bit of a fight. We as humans do not have a read on the future. We interpret vital signs and assessments and make a judgment about what probably will happen--that doesn't mean it will! If I were you I would have called the family, too. If there was a scientific test to determine when someone would die I'm sure the inventor of it would be living high off the hog.

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Thanks for the helpful responses.

I just felt like an idiot. I feel like they were thinking "Idiot nurse, woke us up and dragged us out here for no reason." Not that they said that, but that's how I felt.

Also, if they crash and burn at home after extreme sleep deprivation and THEN she dies, I'll feel TERRIBLE.

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Specializes in ED, ICU, PACU.

You did exactly what the family had asked you to do. There is no way to predict when death will actually occur in the situation you described. Maybe your patient wasn't ready to let go. Maybe your patient needed the family's permission to let go. I remember having a situation similiar; and, I had a gut feeling I needed to tell the wife that it might help if she told her husband that she would will be alright and he doesn't have to keep fighting. Although he was comatose, she talked to him and shortly afterwards an incredible look of peace was on his face as he took his last breaths. I felt so guilty for what I had suggested that his wife had to console me. So, please stop feeling guilty for doing the right thing-you did the best you could do given the situation; and, all that is expected is that you make the best effort in an uncertain situation. Good Job!

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Specializes in Medical and general practice now LTC.

I would not have done anything differently, Hard to predict and have seen it many times where family called in stay by the bedside and it is only when the family leave that the patient finally goes on their way and also seen it with the other side where they hang on until the family arrive and say their goodbyes. You gave the family time to say their goodbyes and also all the facts, they would have appreciated that

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Thats the thing. We never know. It all sounds appropriate and well handled.

Try not to stress out about if and when. As many times as you guess will be the number of times that you guess wrong.

You did good.

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Specializes in telemetry, med-surg and hospice.

You did great! There is no way to predict and his O2sats were significant. People go when they are ready. Like the other posts said, think of the alternative.........if he had gone and you hadn't called you would have felt terrible. Always better to call and update the family and let them make the decision to come or not.

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Specializes in Cardiac, ER.

"Comfort measures only" doesn't include telemetry!! I also gave up on trying to "guess" when someone is going to die,..that's in waaayyy bigger hands than mine.

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Specializes in IM/Critical Care/Cardiology.

I think you did a very compassionate thing,by contacting the family. Don't beat yourself up.

I had a pt DNR/DNI expire 10 mn after I suggested to the family to get some coffee. I felt terrible. The pt may just have been waiting? Who really knows?

I agree, good job.

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I think you did a very compassionate thing,by contacting the family. Don't beat yourself up.

I had a pt DNR/DNI expire 10 mn after I suggested to the family to get some coffee. I felt terrible. The pt may just have been waiting? Who really knows?

I agree, good job.

I've seen this happen too - the family takes a break, the patient goes asystole. I've also seen a patient "wait" ? to die about an hour after all the family is there (flying in from everywhere in the USA) It can go both ways.

You did what the family wanted, I always preface any answer to the inevitable question "how much time do they have" with we never Know, it could be soon, it could be a few days.

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Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.

Hon you did exactly what the family requested. Good for you :)

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