This is a case that has happened and I wanted some feedback: (I'm gonna try my best to shorten it)
I work on a med-surg/telemetry floor. I get an admission with admitting diagnosis of AIDS/weakness. 53yo male who's been off HAART therapy for 2+ years; very cachexic appearance, very weak, but able to voice needs. Received him AAOx3; chest congestion heard w/o stethoscope (coorifice rhonchi--NP cough). Patient was on an admission diet (which means regular diet until further notice). He requested a sack lunch per diet orders. 15 minutes later portable CXR into see patient (ordered xray), I noticed he was very diaphoretic and tachypneic. We nasally suctioned him in atempt to try and relieve some of the congestion. Blood sugar of 170s. BP elevated c diastolic >110. Make a LONG story short we did everything on our unit to prevent this patient from coding (which he didn't)...he became unresponsive (c pulse) on our unit ICU team came in and intubated then we transferred him to ICU. That night he coded twice in ICU; family came in next morning and made him DNR. He died later that day.
My thing is I'm a new nurse (almost a year), but I made sure I did everything 'right'. I had my charge nurse in there c me. We had the crash cart in the room just in case he lost his pulse. The team docs were notified immediately when I first noticed he was diaphoretic/tachypneic. But I feel bad that he died. Knowing that I was the one that gave him that sandwich that he supposedly aspirated on. Of course, if I knew there was any chance of him aspirating I wouldn't have left him alone with that sandwich.
Also, my charge nurse stayed over with me to make sure that EVERYTHING we did was documented correctly.
Just looking for feedback on this. Thanks in advance!
Specializes in Acute Care Cardiac, Education, Prof Practice.
Sounds like you did everything you could. I am not sure how much any of us can guess from here if it was aspiration or not. He sounded like a trainwreck from the start.
Keep working your process, learn and give yourself a little grieving room for the situation and move forward.
:icon_hug:
Tait
PS. It is one thing to have something happen, it is another when you KNOW the patient is sinking, and no one will listen.
Specializes in 4 years Geriatric/Psychiatric Nursing.
Let's see, aspiration most possibly. But the point here is, you did your best with your scope of practice. Stuff like this happens almost everyday, I feel like crap when the first patient I lost under my care. Also, my patient was in great AOX3 talking to me all of sudden, he slouched and slid off the chair unconsiously, coded kept him alive until EMT/Paramedic took over and he just passed away.
I know I did everything I could with in my scope of pratice, but when its time its time. At least you guys got him a fighting chance. :top:
After a while you will understand that when it is your time to go, it's time to go. from what you wrote you did every thing you could all the right things.
From what you wrote, there was no indication of dysphagia, so you could not have known he would be a potential aspiration, and obviously the doc didn't either if he ordered an admit diet that translates to regular diet. Sometimes the wierdest things happen. And it is not for sure that it was an aspiration event. The important thing is you responded. When you discovered a problem, you recruited the appropriate help. And did what you could to help the patient. So keep this in mind and continue to follow your gut. We can't save everyone. I can relate a similar case. We had a patient that was incomplete quad, full dietary assist. Doc wrote to take trach out and transfer to regular floor. Pt developed issues, had vomiting after meal and suspected aspiration. Trach put back in and transferred back to ICCU. Put back on vent. Come in second night to get report(I am charge) that patient does not look good. Go assess and find severe tachycardia and severe hypotension. Fluid resuscitate patient and vitals stabilize, UO picks up(was pretty non-existent). The previous nurse had not addressed these issues and the patient was pretty severe when the next crew had arrived. My point, assess, address issues, consult with doc. And from your post, this is what you did. Kudos to you! Luckily, the patient I wrote about is now back and doing well.
It could have been flash pulmonary edema, with a diastolic BP in the 110's. What was the systolic? Where there pink frothy secretions when he was intubated? If the doctors thought he aspirated, did anyone bother to bronch him to confirm that and clear the airway?
Don't beat yourself up, you did nothing wrong and intervened appropriately.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
this is a case that has happened and i wanted some feedback: (i'm gonna try my best to shorten it)
i work on a med-surg/telemetry floor. i get an admission with admitting diagnosis of aids/weakness. 53yo male who's been off haart therapy for 2+ years; very cachexic appearance, very weak, but able to voice needs. received him aaox3; chest congestion heard w/o stethoscope (coorifice rhonchi--np cough). patient was on an admission diet (which means regular diet until further notice). he requested a sack lunch per diet orders. 15 minutes later portable cxr into see patient (ordered xray), i noticed he was very diaphoretic and tachypneic. we nasally suctioned him in atempt to try and relieve some of the congestion. blood sugar of 170s. bp elevated c diastolic >110. make a long story short we did everything on our unit to prevent this patient from coding (which he didn't)...he became unresponsive (c pulse) on our unit icu team came in and intubated then we transferred him to icu. that night he coded twice in icu; family came in next morning and made him dnr. he died later that day.
my thing is i'm a new nurse (almost a year), but i made sure i did everything 'right'. i had my charge nurse in there c me. we had the crash cart in the room just in case he lost his pulse. the team docs were notified immediately when i first noticed he was diaphoretic/tachypneic. but i feel bad that he died. knowing that i was the one that gave him that sandwich that he supposedly aspirated on. of course, if i knew there was any chance of him aspirating i wouldn't have left him alone with that sandwich.
also, my charge nurse stayed over with me to make sure that everything we did was documented correctly.
just looking for feedback on this. thanks in advance!
as a hospice nurse i will suggest that this gentleman was possibly dying when he got to you. the grossly audible rhonchi could be identified as terminal congestion. he was experiencing a destabilization of his core controls...temp, bp, loc, etc. it does not sound like you caused his death or that he aspirated. it sounds like he asked for his last meal and you gave it to him. we can't keep people from dying...we can only (sometimes) prevent it from happening in that moment. don't beat yourself up and don't go looking for zebras...the hoofbeats belong to a black horse that visits all of us sooner or later, sooner for patients like the one you describe.
I agree completely with the Tewdles and Leslie. By giving him the sandwich he asked for you honoured his last request. Not every patient is going to have a happy outcome.
Tait, MSN, RN
2,142 Posts
Sounds like you did everything you could. I am not sure how much any of us can guess from here if it was aspiration or not. He sounded like a trainwreck from the start.
Keep working your process, learn and give yourself a little grieving room for the situation and move forward.
:icon_hug:
Tait
PS. It is one thing to have something happen, it is another when you KNOW the patient is sinking, and no one will listen.