First clinical day was a nightmare

[freckles23]

So I have had a very rollercoaster day today. I am a Nursing I student, 21 years old and today was our first day of doing clinical at the hospital. I got my patient assignment and she had some major diagnoses of Pneumonia, COPD and CHF. I went into her room at around 9 AM to do vitals, a physical exam and my assessment on her. She was very anxious when I arrive but she was a sweet lady and was very cooperative with the things I had to get accomplished. She had dyspnea, use of accessory muscles, coorifice rales and rhonci on anterior and posterior chest and an irregularly irregular heartbeat. She was very congested and had a nonproductive cough. As I was getting to know her, we had to go down to Chest Xray. She was very anxious going down there and kept saying that she couldnt breathe even though she was on 5 L via Nasal Cannula of oxygen. Once the Xray was over, we headed back upstairs and I was about to prep for my AM care. My instructor came in my room to check on everything and see if there was anything we needed. I told her about my findings on the physical exam and she explained and clarified some things. Then she wanted me to weigh the patient but we couldnt figure out how to work the bed so we looked at the instructions that were on the bottom of it.

As the instructor was reading, I noticed my patient got very quiet and wasnt anxious sounding like she had been all day. I looked up and my patient looked like she was about to sneeze but it wasnt a sneeze. She looked out of it and unresponsive. I told my professor to look at her because she didnt look right and my professor went by her side. My professor and I called her name and she was not alert or answering us. So I called the primary nurse from down the hall to come over to the room. Of course the nurse was probably thinking "What does this student nurse want? Its probably something stupid" Although she was a very sweet nurse, but I think its just a typical response for a nurse to think a student nurse is overreacting. So the nurse came to the room and we told her what happend and then they called the Rapid Response team. They did what they had to do and I was standing at the side lines watching this whole thing. Seeing the different procedures they were attempting to do and how fast everyone rushed to the room. My instructor was helping out the staff which I thought was pretty neat to see my instructor use her skills instead of talking about her skills in lecture all the time. As I watched what was going on I told myself I will be okay and that I think I can handle it. I work as a Nurse's Aide at a hospital so I have done post mortem care before and could handle death pretty well. But as the chaos finally subsided, one of the staff members asked me if I was okay and that it is okay to cry. I think just having someone say its okay to cry made me let it all out. Before the water works came, I told my professor I need to step out for a second and I took my gown and gloves off. I was so numb to the core and walked out shaking and hives all over my body. I went to the bathroom to clear my head on what just happend.

I literally saw the life get sucked out of this woman which I think is what scared me the most. To be interacting with my patient for the 2 hours that I did, I enjoyed it and this was the last thing I was expecting. I saw her go from anxious, to slowly turning blue and unresponsive and then dead. It was interesting to see this happen right before my eyes because not many see the process of when they are on the brink of life and death and boy did it happen quickly. Many just walk into something like that when the patient has already collapsed and dont see that transition. I think its very ironic that this happend to me because I always thought it was so cliche' for something like that to happen to a nursing student on their first day of clinical. My instructor even said out of all the years she has taught, she has never been a part of something like that. It was a mindblowing experience and definetely a story to tell my grand kids. But it is still kind of a shocker for me because I wasnt expecting it and it has left me in this weird funk all day. It was sure a learning experience because I was understanding how Pneumonia and COPD and CHF effect the body and its just interesting how it all plays out in the end and the destruction it can cause on the body.

Anyways, Im sorry this is a long post but I am just venting out my feelings about my day that I was not expecting

[HeatherMax]

Vent away! Shoot if you can get through a first day like that and go back again, you got this nurse thing!

[lovinlife11]

I agree with heather!! Holy cow, what a start!! If it makes you feel any better I have been known to shed a few tears when a patient passes away, it's ok to be human too. Best of luck to you!!

[emijen2girls]

you had such a rough start....you poor thing.....I had a nursing student the other day that got to observe similar situation except that no one died.....I had a pt in one room that was shivering/shaking really hard so I told her: let's go back to basics and do vitals, she got to hear B/P of 200/120 and saw us call rapid response and see all of us brain storm....while next door the Pt had B/P of 85/48 and was getting symptomatic....ad we had to send her to an emergency surgery.....so she saw how to handle 2 emergencies at the same time...

[mzrainydayz, BSN, RN]

I had a somewhat similar situation last week at clinical, it just happen so fast. I am still in shock and because this patient was so young. I went home feeling some type of way. I saw the whole process of them calling a full code and rapid response. Me and my classmates with my instructor did the postmortem care, it was weird at first, but an experience.

[CrunchRN, ADN, RN]

Think about how glad she was to have a caring student with her all morning. It would have been horrible for her to spend her last time on earth alone because her nurse was busy with her other patients. You did good.

[brat514]

Wow! What a first clinical day. I agree with the previous poster, just by being with your patient I'm sure you made her last moments special.

Just out of curiousity (I'm a student also), why was she on 5L of oxygen? I've been taught that if someone has copd that they need to be on a lower dose of oxygen since their body is accustomed to decreased levels of oxygen and increased levels of carbon dioxide, and that higher doses of oxygen can be toxic to them.

[flyersfan88]

I didn't even finish reading, so I'm sorry if this was answered....but why on earth was a COPD pt on more than 2L of O2? Uhh....no wonder she stopped breathing. What on earth is going on with her nurses/physicians?

[flyersfan88]

I apologize, I didn't mean to sound insensitive, I was just taken aback by that level of O2 administered. I wonder if anyone was held accountable. What a traumatic first day, yet quite the learning experience. I hope you're feeling better after the shock has worn off.

[ckh23, BSN, RN]

I apologize I didn't mean to sound insensitive, I was just taken aback by that level of O2 administered. I wonder if anyone was held accountable. What a traumatic first day, yet quite the learning experience. I hope you're feeling better after the shock has worn off.[/quote']

5L of O2 is hardly the reason behind what happened, so why would anyone be held accountable for it? Maybe if she was on a 100% NRB than maybe, but 5L is highly doubtful.

[akulahawkRN, ADN, RN, EMT-P]

Remember folks, this patient had pneumonia on top of COPD... It's not all surprising that she was on 5L. If she's already low O2 sat already, toss in a whole lot of crud in the airway to further decrease the available alveoli and it's not at all surprising that she needed that 5L for adequate oxygenation. If anything, I might be more concerned about adequate gas exchange for CO2...

Oxygen isn't the immediate killer of COPD patients that it's advertised to be. Very few truly go to pure oxygen drive breathing. I was always taught that if you do have to put a COPD patient on a high concentration of oxygen, get the BVM ready but you probably won't have to use it.

To the OP: That was a really rough first day, and your story will probably be told around the school for a few years, because you really were that nursing student that had the patient that died on her first day... just so that others can be "warned" to be ready and prepared. You were probably quite the good presence that patient had and while the outcome wasn't all that good for her, you were able to see quite vividly the teamwork involved and is necessary at times. You also now know that your instructor really can "walk the talk." I hope that this doesn't change your outlook for nursing... as this is also a rare gift. You were shown how to handle emergencies and how the nursing process works even in that setting.

Vent away if you need to, because we've all had one of those days where you just need to.

[freckles23]

That is definetely a good way of looking at it!