Dealing with an Unexpected Death

[Newgurl17, CNA, LPN]

Hey everyone,

So I was working at this long term care facility today and had my first unexpected death. I came into the resident's room because the cna's had wanted me to see him. He was sitting in his wheelchair, skin was pale and cool to touch, mouth cyanotic, on 3 L oxygen (24/7), and was drooling a lot. He tried to clear it by coughing, but it didn't work. So we were trying to clear his mouth. I tried calling the other nurse for help, because I had never dealt with a situation like this before. Only been working as a nurse prn for a year. Other nurse's phone was dead. I tried first aid for choking. As per his medical degree of intervention, we were not to resuscitate him. Called the ambulance, as per his care orders.

Resident was unresponsive with his eyes open when I tried talking with him. Had been on the call light the night before as per report but I guess he wasn't able to express his needs at the time.

We left him in bed for breakfast because we figured he wanted to get more sleep. Had been requesting to see a nurse but wasn't able to say what he wanted. I told him to slow down his breathing, i spent a little time with him, held his hand and re-assured him that we would be in his room again for breakfast. We elevated the head of the bed. He was fine with his pills this morning, no coughing and was calm at the time I gave them to him. It was as soon as the cna's transferred the resident into his wheelchair that he started to decline. Now normally he is better in his wheelchair because he can breathe better.

Informed my DON who also spoke with my co-nurse. I could hear his voice on the phone and it wasn't on speaker and he said that since being admitted to the facility, the resident had been declining. Since i hadn't dealt with an unexpected death before, the DON instructed me to phone the coroner, i told her everything that happened, that he had a history of pulmonary fibrosis. She wasn't concerned because the resident wasn't in any pain and didn't fall, so she never came to the facility.

The other nurse said that there was nothing we could do for this resident, but was she right? This gentleman passed away so quickly from the time the cna's reported his condition (1015) to the time I was calling the ambulance while the nurse was upstairs with him (1030). Also had to find out what his resuscitation orders were. CouldnI have saved this man's life? What were some things that should not have been done in his situation? Resident was born in 1919.

[CapeCodMermaid, RN]

Your first death as a nurse always leaves you asking questions. It's really difficult for anyone who wasn't there to say what you should or shouldn't have done. Was his airway clear? I hate suctioning because it's invasive and unpleasant but would that have cleared his mouth? There isn't much one can do in 15 minutes that would make a huge difference for a 99 year old person.

[BirdieBird, BSN]

Oh my! Don't blame this on yourself- this all happened so fast, I can't think of any interventions that could've prevented this. As mentioned above, he was 99 years old at the time. Life just has to end at some time, and fortunately this resident was not in pain as it happened. Even better, your kind words and touch likely provided a sense of wellbeing in his final hours.

[Oswin]

Your first death, especially unexpected ones, are so hard. Most of all through what you typed, I'm sorry you didn't have the support of another more experienced nurse to reassure you in your actions. I can't imagine what I would have done without that for my first (few) abrupt declines.

It's hard to say without knowing his background and baseline, but the using his call light and not able to express his needs and drooling makes me think it MAY have been consistent with a series of strokes. Regardless of the exact cause...

He was 99 with health issues. You were alerted of a problem, you assessed the resident, you tried to call a more experienced nurse for help which you didn't receive. You talked to him, held his hand, and comforted him. You elevated his HOB (so many people forget this crucial step when people are struggling).

You then followed his advance directive.

15 minutes is not a lot of time, especially in LTC when you can't call a rapid response team to be there in a minute for help. That he was gone that quickly suggests to me that there was nothing you could have done at that point, and it was probably just his time.

[Newgurl17, CNA, LPN]

Your first death, especially unexpected ones, are so hard. Most of all through what you typed, I'm sorry you didn't have the support of another more experienced nurse to reassure you in your actions. I can't imagine what I would have done without that for my first (few) abrupt declines.

It's hard to say without knowing his background and baseline, but the using his call light and not able to express his needs and drooling makes me think it MAY have been consistent with a series of strokes. Regardless of the exact cause...

He was 99 with health issues. You were alerted of a problem, you assessed the resident, you tried to call a more experienced nurse for help which you didn't receive. You talked to him, held his hand, and comforted him. You elevated his HOB (so many people forget this crucial step when people are struggling).

You then followed his advance directive.

15 minutes is not a lot of time, especially in LTC when you can't call a rapid response team to be there in a minute for help. That he was gone that quickly suggests to me that there was nothing you could have done at that point, and it was probably just his time.

Yeah, i was reassured by the fact that he had apparently been decling since admission and that he was already 98 years old. I spoke about this with an rn at work though and yes, I do feel like his life could have been saved unfortunately. She talked to me about suctioning and now that I think of it, I think it's important to always know where the suction machine machine is at your facility. When we were talking about it, the rn said that we had it DOWNSTAIRS but resident's room was UPSTAIRS. Do you think that maybe facilities should have suctioning machines on all floors? Oh, and I've never suctioned anyone before. Talked about suction ing in class, but never actually practiced it, not even on a mannequin.

The RN said that the cause of the resident's death could have been heart related. He couldn't tell me what he wanted because I noticed that working with him, it just takes him a little time to explain himself because he has to catch his breath. Even when he wasnt short of breath it would still take him a while for him to tell you what he wanted.