I'd like to share my clinical experience

[vindy]

Hi everyone,

I'd like to share a story...

On a Friday morning, a regular clinical day, I was assigned to a patient that was a 90 y/o F. She has a history of cancer, htn, a-fib, COPD and so on. I had taken care of her two weeks ago and she was absolutely wonderful! I joked with her how her elizabeth arden face lotion is the secret to looking so young because she looked 65, not 90! =) So back to this friday morning. I went in to her room to measure her V/S. T 97.4 axillary (i took it axillary b/c she was breathing thru her mouth and had rapid respirations), HR 93, BP 98/64, RR 40, O2 80% (so I put her in high fowlers and it went up to 90%) , she is also on O2 2L via Nasal Cannula. I asked the patient how she slept last night, and asked her questions to see if she was A & O x3 and her speech was hard to understand. I thought her voice was dry from mouth breathing and she was also SOB. So I gave her a sip of water, and she she sipped it fine until she began swallowing. She started to cough. I was like uh-oh! she tried talking some more but I just couldn't understand her.

So I immediately reported to the nurse and then my instructor. My instructor and I went to speech therapy to ask for an eval to be done with this pt and then we went to see my pt cuz then it hit my instructor that OMG, it can be a stroke! So we went in my pt's room and assessed her. She only had the garbled speech. She smiled evenly, her hands were raised evenly, etc. The nurse also came in and retook her V/S. the nurse then called the Dr to inform him. He came in a little while later and assessed her. He said she was fine, and in front of my eyes she answered his questions clearly! granted they were a few words but she sounded fine! when he left and i asked her a question, her speech was garbled again! She also tried to itch her face and her arm just kept falling down! So I told the nurse, and went back in to stay with my pt and her hand was fine again! ST also came in and said something is wrong with her while they were assessing her eat, and changed her diet from regular to puree with nectar liquids...

the Dr. then put her on a nebulizer treatment and put in an order for hospice to come in an evaluate her. he also told me this is what happens when it comes to an end...interesting i thought, I never been around anyone who was dying to know the s/s of death like some people describe it to be...is she really dying?....

Now comes for the most horrible part of the day... the handyman came in and said there is an order for her to be on an air mattress.

so i said we'll get her up after I am done giving her her bed bath. So after the bath, me and another student tried to sit her up in bed, but the pt was so slooped we decided not to put her in a w/c. so like a half hour or so after leaving my patient in her room to rest, I was informed they put her in the wheel chair so they can put the air mattress on. WHAT! that is so ridiculous i thought! so i went in to her room and made sure she was okay. she was tired, but okay, so i thought id check on her in a little bit while I tend to my other patient. I left her room for ten minutes, only ten minutes, and when i went to check on her, she was on the floor! omg, my heart almost stopped! I was so angry and shaken!

So finally we got her up, and where did we put her? on the other bed next to her bed, w/o an air mattress because the air mattress wasn't even on her bed yet. go figure. So, we took her V/S, BP still low, RR still high, HR 94, O2 sat 77% and desatting! We tried to tell her to breathe thru her nose and out thru her mouth... so my teacher raised her O2 to 4L...and finally her O2 went to 95%...the aDON thought nothing was wrong cuz her O2 was fine..um hello? She is on 4L (w/o a Dr. order and because of a nurse's judgement) and she is a COPD patient and her original order was for 2L!!! oh well...ignorance is bliss i suppose =)....so after a while I lowered her O2 back to 2L and O2 sat was stable...

So later on i went in to do her wound treatments and treat the abrasion on her leg from the fall... I tried to wake her to tell her what I was doing...no response....I shook her, yelled her name, nothing...my teacher came in and performed a sternal rub....nothing.....so my teacher told me to take of her wound care and she will be back. So i performed my wound care telling her what I was doing =)...

Another nurse came in and performed the sternal rub even harder I suppose cuz the patient lifted her hand to remove the stimulus...but she never opened her eyes. Her pupils were slightly reactive when the nurse used the penlight and forcefully opened her eyes.

So, unfortunately she never got sent out as we had hoped because we wanted to rule out a stroke with a head CT and we figured with the fall she would have gotten to go out to the hospital...but all she got was an in house X-ray of the hip and arm...hospice did come in, but not on my shift, and the next day, my pt passed away.

even though my patient passed away, I was satisfied to know I treated her with respect and dignity as she probably began to leave the world the day of my shift. this makes nursing worth everything!

thank you for reading, =)

[on eagles wings, ASN, RN]

aw thanks for sharing. i can tell you really love your patients :) this was obviously a big learning experience. i can't wait til next semester's clinicals.

[SoCalCrystal, CNA]

I do in home hospice care and this experience really hits home. It takes a special person to be a nurse and an even more special one to have the compassion and care you did.

[yanes2011]

SERIOUSLY

thanks for sharing this experiences with us , your story just make me cry , you did everything you could , ok really emotional .

[Tricia76]

Thanks for sharing..your a great person!