I've been feeling bad the past few days since a resident at a LTC where I'm a nurse died unexpectantly on my shift. When I say unexpectantly I mean she was not in the dieing processl, not that she wasnt very sick. She had COPD and chf and wasnt always compliant with her breathing treatments in that she would refuse the maak nebulizers in favor of the pipe, but did these poorly. She almost died a few weeks ago when she started having trouble breathing due to a lot of fluid in her lungs and throat. At this time she got suctioning and because wasnt fully conscience, got a mask neb treatment. She recovered and was doing OK for a while until last week she decided that she was going to not do the mask nebs but only pipe. This meant she would not be getting the full benefit of the treatment, but we could not force her to do the mask nebs. A few nights ago on my shift, she started to have audible gurgles and labored breathing. She had just had her scheduled breathing treatment, using the pipe about 15 minutes before. Her o2 sats were in the 50s. I put oxygen nasal canula 3L on her and then gave her another neb treatment, this time with the mask. Her sats got to 69 but woulnt improve past this. About five minutes into the neb treatment she took off the mask saying she couldnt breathe. I tried to get her to leave the mask on but she wouldnt. She had refused suctioning when this all started but now asked for it. This is the part I feel bad about. I went to get the suction machine and it was not hooked up properly and ready to go. Being a fairly new nurse I did not know how to get it hooked up correctly so I called the nurse from the other unit who came to help me. We got it hooked up and I began suctioning my resident. This was maybe 5 to 10 minutes between when I went to get the machine and when I started suctioning. Once we started suctioning my resident did not improve but went downhill. Her sats started to drop into the 50s, then 40s and was 38 at one point. The other nurse suggested high flow oxygen which we did at 5L. We continued with the mask neb treatment which was still hooked up. Nothing worked and my resident died. She was a DNR. The other nurse said we did everything we could but that her heart had probably just gave out. She did say that if the suctioning machine had been ready it may have made a difference but she also said at the same time that this resident was very full of fluid that it may not have made a difference.
I just feel so bad because I should have known how to hook up the suction machine but had to call the other nurse. Also I think I was the one who hadnt hooked it back up correctly after it was used on this same resident the time she almost died. At that time I called for an emergency because this resident was turning blue and our acute floor charge nurse came and suctioned my resident at that time. It was my job to get the machine ready to use should it be needed. Im not positive it was me who didn't hook it up right but it probably was.
The other nurse who was helping me this last time just said to remind staff to hook the machine up so its ready to use right away.
Should I feel bad or is this a case of I did everything I could with what I had at the time?