The last couple nights at work were rough, especially the first one.
I had admitted the pt at approx. 2100. Frail, confused, elderly woman...came in for COPD. Pt was a DNR. She looked like she was close to "leaving". I kept that in the back of my mind but a part of me was hoping for at least some improvement...I was afraid she was going to let go during my shift...
I kept an eye for her during my shift, provided suction and oral care, called RT for tx at around 0330. At approx 0615, I noted the pt was wet. The cna stated she just cleaned her up 10 min prior. Anyway, we cleaned her up again. Pt was still awake and moving, pt was on O2... afterwards I went to complete my I&Os, change another pt's iv site, then give report to oncoming shift.
During change of shift I was looking for the nurse to give report on this pt, but 10 min prior to clock out, a nurse asked who was caring for the pt in room .... I said it was me, went over there. The RT said he couldn't get a pulse ox reading, the AM cna said he couldn't get a bp reading...the pt was cool, pale, unresponsive, not pulse felt. My heart dropped.
This was my first pt death on my shift. Pt was a DNR, but it was my failure to notice sooner. That time when the cna and I changed her, I notce she looked a little pale, but I thought to myself, pt is awake and moving...she's ok...
I called the UC md to pronounce her, he did, but stated she must've died some time (he said at least a couple hours) ago. It was only 0730 at that time. I called the family and that was nerve wracking and heart breaking at the same time, espeically since I just saw some of them less than 12 hours prior.
My manager said I had to endorse everything else since it was already 0800. So I didn't do the post mortem care or see the family.
It was my failure for not noticing sooner, my failure for not being with the patient when it happened.
My supervisor asked me if this is my first time experiencing this, I did shed a few tears (embarrassingly) in front of her and my charge nurse and said yes. She replied, "don't worry, this is just the first of many."