Is my patient going to die??

**canoehead, BSN, RN** · Feb 8, 2005

Given her history, if she says she is going to die she probably will. Probably before you get back tomorrow. The best thing you can do for her is the turning, coughing, suctioning etc, but don't sacrifice her time with her family to do those things. Tell the doc what she is saying and see if you can get a DNR order before she goes. Your patient has a chance of surviving the pneumonia, but virtually no chance of surviving a code intact. If she goes downhill talk to your instructor about the appropriateness of meds to lessen her discomfort. Good luck.

**canoehead, BSN, RN** · Feb 8, 2005

I should add that your first death hurts like a SOB, but death is as natural as birth, puberty, moving away from home...those things are scary for everyone, but it opens so many new horizons and experiences. So there is no need to fear for your patient, just for her family that will miss her.

Mystery5 · Feb 8, 2005

Probably her condition will be treatable. It sounds like she might have pneumonia. She might end up getting transfered to the unit for a while. She need neb txs and antibiotics, and I wouldn't be surprised if she recovered. She also has a good likelyhood that she has CHF.

But, she is near the end of her life. If this illness doesn't kill her,then something else will come along. It sounds as if she is very rational. She wants to prepare with God and also say her goodbyes. She sounds very cool. She is just being honest with herself. What a neat lady!

As far as you, you sound like you'll be a great nurse. Once in a while, though, your empathy will get away from you and a pt will strongly affect you. It's good to be detached somewhat otherwise the job will totally drain you, but you can't help but be affected deeply by a pt.

DelightRN · Feb 8, 2005

I just wanted to add that it is not at all a bad thing, or an unprofessional one, to cry over a patient. I have done it on more than one occasion.

RN2Bn2006 · Feb 8, 2005

Given her history, if she says she is going to die she probably will. Probably before you get back tomorrow. The best thing you can do for her is the turning, coughing, suctioning etc, but don't sacrifice her time with her family to do those things. Tell the doc what she is saying and see if you can get a DNR order before she goes. Your patient has a chance of surviving the pneumonia, but virtually no chance of surviving a code intact. If she goes downhill talk to your instructor about the appropriateness of meds to lessen her discomfort. Good luck.

Well I'm hoping that all the talk about not making it was just because she was somewhat disoriented. (who knows??) But she was very adament about it, and seemed oriented at the time. But I did go ahead and call her husband because I would have never forgiven myself if I didn't and she died.

I didn't know if the pneumonia was usually fatal for someone her age. Also, as a student I feel so stupid when it comes to situations like this. I honestly DIDN'T know how to help her other than turning her, having her breathe and cough. At one point I wondered about suction since she wasn't able to actually get that stuff out herself, but didn't ever ask about it (I should have) but I had my instructer in there twice, asking her what else I could do - she said basically nothing. And I asked her primary nurse which just basically said nothing also - I just felt so dang helpless. I hate that I have such a limited knowledge - I know it will come with time..... but in the meantime -sometimes I feel like a big DUMB KLUTZ in my patients room. I guess that will get better with time too (It HAS to!! )

Thanks for your reply. Oh, and I didn't even think about asking about a DNR??????????!!!!!!!!!!!!!!! Maybe one of these days I will finally get the big picture!!!!!!!!!!!!!

javanurse2000, BSN, RN · Feb 8, 2005

Just reading your post, you sound like you'll be a wonderful nurse....when do you graduate? Are you considering geriatrics?

kaseysmom, LPN · Feb 8, 2005

The congestion and the cough could be due to the anesthesia (?) from surgery..i didn't check when this thread was posted so im not sure if that would still be occuring. There should be orders to TCDB for postop pt's (that's how things are done here, anyway). Pneumonia is very easy to treat as long as it is caught early.

I had a pt once who had lung cancer with mets to the scapula (and probably a lot of other places but he was comfort measures only). Anyhow, he had pneumonia and got over it but right after that he became disoriented and started to go down hill - morphine and ambien were very helpful to him. But, he was a DNR and on hospice...i doubt your pt is either of these..Good luck, and whether or not your patient dies - it is a wonderful expierence for every nurse to have (the death of a pt) because it brings you back down to earth =)

Tweety, BSN, RN · Feb 8, 2005

I just wanted to add that it is not at all a bad thing, or an unprofessional one, to cry over a patient. I have done it on more than one occasion.

I agree. I think it shows what a caring person you are. Granted we can't get all emotional, and have to detach within reason, but crying over a patient is not a bad thing. It shows humanity.

medsurgnurse, RN · Feb 8, 2005

I am 2nd semester Nursing Student. The patient I had tonight was an 86 yo female who colon surgery on Friday.
The bad part is her respitory status. She had a horrible horrible cough which sounds full of mucous, but she cannot "cough it up". I hear wheezes, crackles all through her lungs. She is running low grade temp. So think it is probably pneumonia.
Her and her husband have been married for 60+ years, and were the sweetest couple I have seen in a long time. They just really touched my heart. After he went home for the night, my patient became anxious, saying she couldn't hang on anymore, and that she wouldn't make it though the night, and please call her husband so she could tell him she loved him, and goodbye. I kept telling her not to talk like that - because she had been confused somewhat throughout the day, and seemed to get upset over little things, so didn't know if that was her personality (to be dramatic) or what, but she kept insisting, that she wouldn't be there tomorrow. I called her husband and held the phone while she talked. I had to fight the tears from falling down my face. He is elderly and can't see to drive at night, so he called their neice to come spend the night with her. She kept begging not to be left alone. So I stayed with her until her neice arrived (which made me late for post conference) While I was trying to console her she kept praying to God to forgive her of her sins (like so she'd be ready to go) and said she wished her preacher would come by. Her neice showed up and was able to calm her down, and I had to leave - my clinical was over.
I know no-one can tell me if she's going to die - but IF she does have pneumonia - at 86, what are the chances she will survive this????? I've never had a patient die, and for some reason - just being with this woman for five hours (I never left her room - except to get the VS machine) I am very emotionally attached. I go back on Wednesday to take care of her. Another student from my class has her tomorrow - she's supposed to call and let me know how she's doing.
Just wanted your opinions.
I'm afraid if she passes, I will be very emotional:crying2: - is this OK? I don't want to seem like a baby - I want to be professional. But how do you stop your heart from hurting for these people? How do you keep yourself un-attached emotionally. this is actually the first person I have emotionally connected to.
Is there anything - as a student nurse- that I can do besides keep her moving in the bed, coughing, and I.S.?
Thanks

My question is did you report all of the above to the nurse responsible for the patient? And I mean the facility nurse assigned to the patient, not you clinical instrcutor( althought you would do post conference with her also). You did a nice thing by holding the phone for her, if she would pass, just think how lovely it is that her husband got to talk to her one last time. Now, Immediately when a patient states that they are going to die, they usually mean it, it is a sign of acure distress, the patient knows something is not right. But your responsibility as the student was to immediately notify the nurse, who could then notify the MD that the patient was in distress. And it is ok to feel sorrow for the patient, if you have the opputunity to tell a family member that this couple touched you heart and won't forget them, they will appreciate that. As long as your emotions do not interfere with your ability to do your job.

nursemary9, BSN, RN · Feb 8, 2005

Hi

I have often seen that when pt's are sure they're going to die, they do.

It sounds like you did a wonderful job with the patient; please remember that you are a student & not expected to know everything that is going on with the pt.

I, too, hope that you reported everything to the RN assigned to this pt.

It sounds like you were a BIG help to her--you would have been a big help to me if I was that RN. Just knowing how much you cared about this pt. & how you stayed with her would have been a big relief to me.

When pt's are this freightened it is so helpful to be able to have someone there for them.

You know I've been doing this for 38 yrs now, not counting mt student years & I still cry when a pt. passes. It's still very emotional for me. I don't say I sob & become out of control, but I do quietly cry. I also hate it when pt's are alone as they're dying. If I see this, I try to stay with them as much as possible. I know when the time comes, I think I'd like someone with me when I go!!'

It sounds like you will be a good nurse

mary Ann

RN2Bn2006 · Feb 8, 2005

Just reading your post, you sound like you'll be a wonderful nurse....when do you graduate? Are you considering geriatrics?

Thank You ..... I can only pray I am a wonderful nurse someday. I feel I have the bedside manners down, it's the rest of the stuff that's my problem - ha ha.

Actually I came to nursing school because I want to work in Labor and delivery, but you know my heart really goes out to the elderly. So who knows...... I may surprise myself. I mean these people (most of them) have worked all these years, taken care of families, served in Wars, etc........ and here they are some almost helpless, and I feel is it a priviledge for me to make their life a little better by giving them some extra love and care. I am afraid when I begin in my RN career that I will be unhappy by NOT being able to spend time with my patients. Maybe home health is an option for me. This would so blow me out of the water if I went this route because for the past 10 years I have been dead set on being an OB nurse. Once I am out of school, I am just going to follow my heart -

Thanks for your kind words.:)