Having a really hard time after today

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Hi Everyone,

I had one of those days where I know I did what a patient wanted, but I'm still crying about it. I had an older male pt with respiratory disease (end stage). Pt was supposed to go home with hospice care today and was supposedly comfort measures. I come in to find a confused, hypercarbic?(high co2) pt on 6L nasal cannula, 02 sat at 83%.

So, I talk to the NP on his management team..and he's like, put him on Bi-PaP...and I say, BiPaP? (Because last I checked we let comfort measures patients go..not support them on BiPap) So I call my charge nurse and respiratory, verify that it's ok, and get it set up. Pt absolutely hates the mask, but is ventilating better. I talk to another RN working with NP's team..and she says, oh, so yeah, comfort measures is a grey area. This pt is supposed to go home today and was up walking around yesterday etc etc. So is the pt just DNAR? Full Code?

Beep beep beep...goes the Bipap. Incessantly. And since I work med-surg, where we supposedly never have Bipap, I'm not trained and am calling the respiratory team every 20 minutes..and neglecting my other four patients. Beep Beep Beep.

Pt becomes more alert and wants to eat lunch. I'm like, sure, anything you want, we can take that mask off for a while. I get pt's favorite foods and spoon feed him. I stay there for the entire time, not leaving his side. Pt starts to look more lethargic, cyanotic. I put BiPap back on..and despite connection to the wall not being messed with, No 02 is flowing. I call respiratory and get it set back up..but 02 sats are in low 70's.

NP from the morning that asked me to place BiPap starts freaking out..do we work him up? What do I do? Finally, I'm like, call the attending. Attending says, Do what the family wants. NP doesn't know..is so anxious and bothers me with questions. I'm like, call the family, you know them, I've never seen them.

Beep Beep Beep. Family is in the room taking off Bipap so patient can drink. Pt is smiling at everyone and appears to be saying goodbyes.

Beep Beep Beep. Family says, we know she does not want this and asks me to remove Bipap. I give pt ativan, scopolamine, morphine. The beeping stops.

45 minutes later..held by two adult children, patient takes his last breath.

I held it together at work..but now I've been crying. I know it's partly exhaustion, but I'm upset too.

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It sounds like you did all you could do. And the best part is that you didn't want to leave the patients side. God bless you... :-) It is sad to you but life and death are both sad events. But death is better than life so to speak. I love life but this world is so much pain and death in many ways is peaceful. God has a hold of you and your heart. Even though you feel sad about it and wanted to do more... you actually did.

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it sounds like your adrenaline and anxieties were on high today...

but all i saw is that your pt was smiling, said her goodbyes and died a very peaceful death...

thanks to you, sonjailana.

get a good night's sleep.

you've certainly earned it.

you did really well, honey.

leslie

beep beep beep...;)

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I feel for you, sounds like you had a very harsh day. I have worked Hospice for almost 2 years. I love it, it is my calling I do believe. But on a personal note, last year my mother in law passed away. She had E/S COPD, and emphysema. She too was on BiPap for about 48 hours, and it brought her sats up. She was on Hospice, and had it at home. The thing to remember is, when they are end stage, it is what it is. Bipap wasn't gonna save the pt, just make them a little more comfortable, and allow them a little more time, so they could say that last good bye. You stayed by their side, comforted them, fed them, and supported them. You did everything you could do, and then some. Even dealing with the NP, and that annoying beep.....Sometimes we just have to let off a little steam, and it just so happens that you waited til you got home to do it. I hope your next day at work isn't quite so hard.....God puts us in situations that he knows we can deal with. You're always where you are for reason... :)

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Specializes in Peds Critical Care, Dialysis, General.

You did a wonderful job and gave the patient and family a wonderful gift of those last few hours, and they sound like good one to me.

You were there and present. You also did a good job advocating for your patient and trying to do the right thing getting orders clarified and such.

Your patient and family got a wonderful transition from this life to the next.

You are going to hurt and cry - do so. And take some time for yourself to relax and refresh your mind, body, and soul.

Don't loose your sweet spirit.

Cindy

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Sonjailana, you did a wonderful thing, this shows that you're a loving & compassionate nurse who only wants the very best for your patients. Give yourself a pat on the back:wink2:. God bless you sweetie.

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Specializes in psych, addictions, hospice, education.

The world needs more nurses like you. You did a wonderful job!

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Specializes in Cardiac Telemetry, ED.

I'm not sure why you're upset. It sounds like a harsh day, but in the end the patient died peacefully. That's something to feel good about, IMO.

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I was upset because it was an emotionally taxing day..and I was grieving for a patient. That's allowed.

Thanks for the hugs!

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Specializes in ICU.

THANK YOU for caring!

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You are a wonderful nurse! You made this patient's last moments as comfortable as possible and I'm sure they were grateful for your empathy and compassion. Bless you and I hope that when my time comes that I have a nurse that is as compassionate as you were to this patient. Lot's of hugs for you!:icon_hug:

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