So I last worked the other night. Had a pt who was having severe chest pain. 93 yr old DNR. At the beginning of the shift, his vitals were ok, EKG was ok, lungs clear etc. Pt was totally freaking out, full of anxiety. Nothing we did relieved his pain. He had a hx of angina (and about a million other health problems) and so while I thought he probably really was having chest pain, I also thought the anxiety was exacerbating the whole issue. This guy was on the light literally every 3 minutes. You could barely walk out of the room and he'd hit the light again. My preceptor and I (I'm a new grad, going to be off orientation in 2 weeks) were literally running like crazy trying to take care of this guy (never mind the other patients I had) and every time he got on the light, you'd walk in the room and he'd say "You gotta do something". So both of us were getting fairly annoyed with it- him being on the light every 3 minutes and the whole "you gotta do something statement" like we weren't doing anything when in reality we had spent between the 2 of us 4 hours straight trying to help him. Preceptor was on the phone with drs while I'm running back and forth to room with meds. Finally the cardio dr orders fentanyl and follows that with versed. So the guy calms down but still says his chest pain is no better when asked. About 3 hours into the shift I'm in the room and his breathing was audibly wet. So listen to lung sounds, they were wet too. He went from clear to wet in about a half hour. ABGs were ordered, they were crap, he goes on bipap. Family finally gets there, and the guy is still feeling the effects of the fentanyl and versed. Still complaining of pain, but his primary wasn't ordering more morphine for him. He was on scheduled vicodin, and morphine q 3 prn. (At that point neither dr expected him to make it thru the night, and neither did we. I thought they should have put him on a morphine PCA) As day shift came on thursday morning his family had left and I think the sedatives started wearing off because he was back on the light every 3 minutes. I had been thoroughly annoyed by the guy, but still gave him the best care I could, but there were a couple times earlier on in the shift where I might have been a little short with him. I did one time explain to him that we had given him everything we had orders for and had to call the dr for new orders and that I couldn't be in the room with him and on the phone with the dr at the same time and to give me a few minutes and I'd be back. (he hit the light again as soon as I left anyway, and when I walked back in he once again said "you gotta do something")
So I saw in the obits that he died that day. (after I left) Now I'm feeling bad because I was annoyed with him. I do know though, that as annoyed as I was there were several times I took his hands and tried to comfort him and help him calm down. I've had patients die before, but I just feel bad because I was annoyed with this guy even though I knew he was dying. Everything was just really frustrating.
pts get well, pts go bad...pts die, and pts annoy us.
We are not perfect, but we give the best care we humanly can....and I think we all know that.
BB, know that you are a good nurse...and what you're feeling is that guilt. We all do it when there is a bad outcome...rest easy, and hopefully never forget the care you gave him.
Keep one thing in mind; just because someone's dying doesn't turn them into a saint. A dying jerk is still a jerk.
I've had both the sweet little folks that it's breaking your heart to see them go, and the complete SOB's that the family doesn't stay with them as they died -- and with the constant verbal and emotional abuse, I can't say I blame them. I had one guy on a morphine PCA that the last words he said on earth were "You stupid b****, I hope you burn in Hell" -- for no other reason than he was a coke addict who'd finally toasted his heart and I wouldn't go out and buy him more coke! I also had a guy dying from prostate cancer who started weeping, looked at me, and said, "tell me I'm a good person. Tell me I'm going to heaven." Needless to say, everyone in the room was in tears, and while it wasn't me, there was a nurse holding his hand when he went.
Human beings are emotional creatures, and unless your name is Mother Theresa, you're going to get aggravated with folks. Remember, there's two people in a nurse - pt relationship, and they both deserve compassion.
\93 yr old DNR. At the beginning of the shift, his vitals were ok, EKG was ok, lungs clear etc. Pt was totally freaking out, full of anxiety. every time he got on the light, you'd walk in the room and he'd say "You gotta do something". So both of us were getting fairly annoyed with it- him being on the light every 3 minutes and the whole "you gotta do something statement" like we weren't doing anything when in reality we had spent between the 2 of us 4 hours straight trying to help him. Preceptor was on the phone with drs while I'm running back and forth to room with meds. About 3 hours into the shift I'm in the room and his breathing was audibly wet. So listen to lung sounds, they were wet too. He went from clear to wet in about a half hour. ABGs were ordered, they were crap, he goes on bipap. .
I don't know what facility you're at, but . . . his anxiety sounds a lot like hypoxia symptoms as they intially present. Despite clear lungs, he may have been O2 starved. You state his lungs sounded wet at one point. Did anyone give Lasix? And in high enough volumes?
I know he was a DNR, and I'm not knocking you, but it kills me when docs see "DNR" as "DO NOT TREAT". And it's why I will never fill out a DNR for myself.
Specializes in Board Certified in Gerontological Nursin.
I think doctors are more goal-oriented toward curing disease, while nurses focus more closely on patient comfort. To that end, on our (geriatric) unit we have palliative care orders and I recently completed a class in that area for continuing education. The guy clearly needed more morphine, which improves ABG values in COPD patients because it relaxes the drive for respiration. The mild euphoric also works against the anxiety, but if you can stop the pain, that's the best part. What were the doctors worried about, that he'd become an addict for the next six hours of his life? In the end, you'll carry this guy in your heart somewhere for the rest of your life, and if he inspires you to change and grow, then you're lucky to have known him. Don't feel bad about it. Respect your education and intentions and trust with time you'll realize you did a fine job of caring for him.
Specializes in Infusion Nursing, Home Health Infusion.
He was truly suffering and panicked...what an awful way to die! I think I would have have told that MD to get his or her but in there to take a look at him or give me an order for something that will allow this man to die with some dignity and peace. I think you did the best you could. Did your preceptor advocate for something different for this patient to help him?
Specializes in onc, M/S, hospice, nursing informatics.
I agree. It's despicable they didn't give him more morphine and keep this poor man comfortable. He was hitting the light constantly because he was in pain and desperate. You're right..awful way to die. What a disgrace the doctor allowed this to happen.
:yeahthat:
The only thing I can say is that sometimes as nurses and patient advocates we must be more assertive with the docs if we don't think that our patient is comfortable. Keep on calling until the patient gets relief. Once the doc knows you are going to keep on waking him up, he'll give you some serious pain med orders!
I think you took good care of him and didn't let on to him that you were annoyed, busy maybe but not annoyed and you handled it politely and respectfully.
A 93 year old patient with a history of CP and a multitude of other health problems, could not possibly have had an unexpected death, forgive yourself, he's out of pain now and at peace. You did everything you possibly could have to help ease his CP. There was nothing else you could have done.
I think his family members who left him should probably be feeling the guilt, not you.
They might have been at the end of their ropes, too. i agree that they should have stayed with him, rotating the duty in shifts. This isn't easy, though, if the family is small, if they have their own health issues, if, if, if. Let's not be too quick to condemn them. I do think the patient was more scared than anything and I wish a volunteer or someone, chaplain, not sure who else could have been appointed to just stay with him. Modern America does not do death very well sometimes.
Was the patient hospice? Typically hospice nurses more familiar with aspects of dying and grief could have made sure his last hours were comfortable. Was the family told he may not live the night? I guess am a little surprised they left. That was a tough situation you were in, and VERY hard with other patients to take care of.
It is so hard when we read in obits that a patient has died. Yes, as nurses we do replay in our heads every interaction we had with the patient and family examining was something missed did we do all we could.
I to have asked other staff members what happened? Again looking for closure is how I see it.
Rest assured, you did what you could to care for him.
So I last worked the other night. Had a pt who was having severe chest pain. 93 yr old DNR. At the beginning of the shift, his vitals were ok, EKG was ok, lungs clear etc. Pt was totally freaking out, full of anxiety. Nothing we did relieved his pain. He had a hx of angina (and about a million other health problems) and so while I thought he probably really was having chest pain, I also thought the anxiety was exacerbating the whole issue. This guy was on the light literally every 3 minutes. You could barely walk out of the room and he'd hit the light again. My preceptor and I (I'm a new grad, going to be off orientation in 2 weeks) were literally running like crazy trying to take care of this guy (never mind the other patients I had) and every time he got on the light, you'd walk in the room and he'd say "You gotta do something". So both of us were getting fairly annoyed with it- him being on the light every 3 minutes and the whole "you gotta do something statement" like we weren't doing anything when in reality we had spent between the 2 of us 4 hours straight trying to help him. Preceptor was on the phone with drs while I'm running back and forth to room with meds. Finally the cardio dr orders fentanyl and follows that with versed. So the guy calms down but still says his chest pain is no better when asked. About 3 hours into the shift I'm in the room and his breathing was audibly wet. So listen to lung sounds, they were wet too. He went from clear to wet in about a half hour. ABGs were ordered, they were crap, he goes on bipap. Family finally gets there, and the guy is still feeling the effects of the fentanyl and versed. Still complaining of pain, but his primary wasn't ordering more morphine for him. He was on scheduled vicodin, and morphine q 3 prn. (At that point neither dr expected him to make it thru the night, and neither did we. I thought they should have put him on a morphine PCA) As day shift came on thursday morning his family had left and I think the sedatives started wearing off because he was back on the light every 3 minutes. I had been thoroughly annoyed by the guy, but still gave him the best care I could, but there were a couple times earlier on in the shift where I might have been a little short with him. I did one time explain to him that we had given him everything we had orders for and had to call the dr for new orders and that I couldn't be in the room with him and on the phone with the dr at the same time and to give me a few minutes and I'd be back. (he hit the light again as soon as I left anyway, and when I walked back in he once again said "you gotta do something")
So I saw in the obits that he died that day. (after I left) Now I'm feeling bad because I was annoyed with him. I do know though, that as annoyed as I was there were several times I took his hands and tried to comfort him and help him calm down. I've had patients die before, but I just feel bad because I was annoyed with this guy even though I knew he was dying. Everything was just really frustrating.
You did the best you could in the circumstances.:icon_hug:
I know how you feel. Been there.. Such is the life of a nurse. No one knows howlong someone will last. All we can do is be the best caregiver we can. And being frustrated is all part of it. It isnt always easy. But we are a nurse because we care about people. Or we wouldnt be in the profession we are in. I have had several experiences like that. When someone dies and they made me frustrated the last time I took care of them. But you need to take a good hard look at yourself and realize you did your best. OK? Your a great nurse. And remember "This too shall pass"...
I do know though, that as annoyed as I was there were several times I took his hands and tried to comfort him and help him calm down. I've had patients die before, but I just feel bad because I was annoyed with this guy even though I knew he was dying. Everything was just really frustrating.
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locolorenzo22, BSN, RN
2,396 Posts
pts get well, pts go bad...pts die, and pts annoy us.
We are not perfect, but we give the best care we humanly can....and I think we all know that.
BB, know that you are a good nurse...and what you're feeling is that guilt. We all do it when there is a bad outcome...rest easy, and hopefully never forget the care you gave him.