Getting a Second Opinion to Confirm a Patient's Death

[purplegal]

So, last night, I experienced the death of a patient for the first time. She was on hospice, so was expected to pass soon. As I was assigned to her, I was often making checks on her to offer her pain medication, mouth swabs, medication for secretion and reposition if necessary. During the middle of my shift, I went into the patient's room to notice her status had changed dramatically.

Instead of the continuous gurgling noise from the secretions, all I heard was a soft, almost hissing noise coming from her mouth. I went to check her pulse, which appeared to be absent. When I moved her arm so I could place a pulse oximeter on one of her fingers, her limbs went limp. There was no strength to them at all. However, she did still feel warm, not cool like I was expecting and still had color to her.

Because I was unsure if maybe I was missing a pulse (maybe it had become very weak), I went and asked another nurse to come in and see the patient. I'd had a strong feeling the patient had passed, but I wasn't 100% sure since she was still making some noise which I wasn't sure meant if she was breathing or not, and she was still warm.

When the second nurse went in there, she immediately announced that the patient was gone. She did not check a pulse, check the patient for responsiveness, or anything. Of course, by that time, only moments later, the hissing noise from the patient had stopped.

But I was wondering, was it right to ask for a second opinion? Or should I have known that the patient passed? Because the other nurse was very confident that the patient was no longer alive.

[AJJKRN]

In my experience, both of you should have checked an apical heartbeat for approximately one minute while listening for breath sounds, etc.

[Okami_CCRN, BSN, RN]

Agree with AJJKRN, you should feel for a carotid pulse, then auscultate an apical heartbeat. When your blood pressure falls below 70mmHg it is extremely difficult to palpate peripheral pulses.

[SierraMoon, ADN, BSN, RN]

I've always gotten a second nurse to confirm and have been the confirmation as well. I think it was the policy even.