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.?
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.
I reported to the nurse responsible about my pt's VS and general condition, she kept saying "yeah, her lungs sound bad - she's probably got pneumonia - we TOLD her she had to keep moving" Then before I left I told her nurse that she seemed very anxious and does not want to be left alone, and I didn't think I should leave her, and she said " you know what hon, she won't remember in 10 minutes don't worry about it" I did not actually tell her nurse that she said she wasn't going to make it - I don't know why I didn't tell her. I feel really stupid now for not. But the whole stinkin' night everything I did tell her - she just kinda brushed it off like i was making a big deal out of nothing. Now I understand she's a nurse that sees alot of patients, and this is not the first little old lady to develope pneumonia......Since I only have one patient at a time, I spend alot of time with them, and I guess feel my patient is the most important one on the floor. I realize now I should have told the Nurse exactly what she was saying, and I will next time. At least I did not leave until her neice was there, and I know she will be keeping a very watchful eye, and report any distress to the nurse. I was also wondering if her doctor could give her something for anxiety - guess I should have asked. Hindsite is 20/20. THIS is why I feel so FRUSTRATED. I CANNOT seem to create a big picture and KNOW what to do:uhoh21: . I hope I get better at this. At least I learn from these experiences.
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 =)
Well her surgery was on Friday and she was my patient on Monday. She was running a low grade temp, and her 02 stats were dipping a little on 3L/NC. What was so awful was all the mucous you could hear when she coughed, and I mean she would cough her little head off, but she could NOT spit up one ounce, and her family said she had been like that her entire life.
I'm just encouraged to know that she can recover from pneumonia. I just wasn't sure about someone her age. I plan to study it today before I go back tomorrow.
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.
Thanks! That's nice to know. It's weird, I've enjoyed all my other patients (well most of them) but I have never felt this emotional attachment before. I'm not sure what it is. Her husband just really made an impact also. He loves her so much, and they had both been through so much. I couldn't be a nurse if I felt this attachment to ALL my patients..... I'd be sad all the time!
It is certainly all right to cry at such a sad situation as this. When you get some more experience under your belt you may find yourself more able to detach yourself from events such as this but there is no denying that situations such as this are very sad. Just remember that your presence there, providing comfort and listening to and helping this woman reach her family are all such very important things in this world. I work in oncology and had always shied away from this area, fearing the sadness of it all, not knowing what to say. I do not cry often but there are always those few patients who touch you deeply. I have cried with families after things are over. Just remember that yours is a hard job but so much better to do something to help the suffering than to fear it so much that you cannot do it at all. I am sure you will be a fine nurse.
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
Well, I'm glad I'm not the only one who's a little emotional. I honestly don't think I would be crying for the patient (she seemed very much at peace) but for her dear little husband who worships the ground she walks on.
As I posted to someone earlier -- I reported several times to the RN about her anxiety about me leaving, and the physical findings & breathing status - which she basically just said "is nothing new". Which like I said - this is probably her 100th patient that has come down with pneumonia, so she knows what to expect. One my part - this is my 1st patient with pneumonia, and really didn't know enough about it to know what to expect and what is worrisome and what is not. You can believe when I go back on Wednesday - I will know all about pneumonia. The one thing I did NOT do was tell the RN that my lady said she was going to die. I realize now that I should have. I won't make that mistake again.
Thanks for your thoughts.
OH, one thing is I DID feel good about the way I stayed with the patient - which calmed her anxiety alot. I do realize the RN had several patients and could not spend time with my little lady to calm her, so I feel like I was a benefit in that perspective. I treated her like I would want someone to treat my grannie. I talked to her about her arts & crafts - which I knew she loved, and things I knew she had an interest in, which helped. So, At least I did some things right!!!!!!!! :)
It is certainly all right to cry at such a sad situation as this. When you get some more experience under your belt you may find yourself more able to detach yourself from events such as this but there is no denying that situations such as this are very sad. Just remember that your presence there, providing comfort and listening to and helping this woman reach her family are all such very important things in this world. I work in oncology and had always shied away from this area, fearing the sadness of it all, not knowing what to say. I do not cry often but there are always those few patients who touch you deeply. I have cried with families after things are over. Just remember that yours is a hard job but so much better to do something to help the suffering than to fear it so much that you cannot do it at all. I am sure you will be a fine nurse.
What an awsome responsibility we have as nurses (and students) that we help a person to be ready for their final moments on earth and help them to move on comfortably into the next chapter of their existance. I am a student as well and I hope I hold up as well as you did when it comes my time to care for someone who might be on their way out of this world. Thank you for posting your experience
I'll just add that nursing means "caring" a lot more that "treating", so, I think what you did was great. We sometimes think that a procedure or a medication is more necessary than our empathy but in cases like these (and you'll learn with experience when to react and when to just be there), I think reassurance and listening was the thing to do. People who feel they are dying need to be heard and understood. I think it was great that you called the husband at the demand of your patient. Because a patient who says she feels like she's dying... well, she feels like she's dying! (wheater they are or not in our professionnal view). Not a benign feeling!
As someone said before, death is an important part of life, and we tend to forget that in our super-mega-extra-stronger than God-today's medecine. Take care and good luck!
I'll just add that nursing means "caring" a lot more that "treating", so, I think what you did was great. We sometimes think that a procedure or a medication is more necessary than our empathy but in cases like these (and you'll learn with experience when to react and when to just be there), I think reassurance and listening was the thing to do. People who feel they are dying need to be heard and understood. I think it was great that you called the husband at the demand of your patient. Because a patient who says she feels like she's dying... well, she feels like she's dying! (wheater they are or not in our professionnal view). Not a benign feeling!
As someone said before, death is an important part of life, and we tend to forget that in our super-mega-extra-stronger than God-today's medecine. Take care and good luck!
Oh my Gosh, I never thought of it this way. The reason I felt so inadequate was because I couldn't come up with another "medical' intervention to do. Therefore I felt like I had failed. I never thought that what I actually did was what was best for her. That's awesome to think about.
And also - like you said - even if she really wasn't "passing" --- in HER MIND she was, and that's the important thing - instead of dismissing her as "oh she's just confused" I think I actually helped by acknowledging what she was saying - whether it was true or not - and called her husband. It gave her peace.
Thank you SO much - you helped me see things from a different perspective.
Geriatric patients can be amazingly strong. No one but God knows if this patient will live or die. Sometimes the patient can clue you in but you just never know she just may have been scared and confused once her husband left. You spent 5 quality hours with her and that's all you can do. If she does pass while you're taking care of her try to look at it as an honor. It's tough to lose a patient, especially your first. Don't worry about crying. We all do at times. There are patients who just touch us and that makes us human and makes us better nurses. Let us know.
Many nurses have big hearts and tend to wear them on their sleeve, so to speak. I have been a LPN for 17yrs. and I too have been attached to many of my patients. It is ok to cry. Sometimes I try to keep it from the patient and family, but there are those times when it can't be helped.
I have went home many nights and cried and prayed for my patients and their families. Sounds like you will make a good nurse. Keep up the good work.
Many nurses have big hearts and tend to wear them on their sleeve, so to speak. I have been a LPN for 17yrs. and I too have been attached to many of my patients. It is ok to cry. Sometimes I try to keep it from the patient and family, but there are those times when it can't be helped.
I have went home many nights and cried and prayed for my patients and their families. Sounds like you will make a good nurse. Keep up the good work.
Thank You. I'm glad we aren't expected to be emotionless!!!
RN2Bn2006
142 Posts
I reported to the nurse responsible about my pt's VS and general condition, she kept saying "yeah, her lungs sound bad - she's probably got pneumonia - we TOLD her she had to keep moving" Then before I left I told her nurse that she seemed very anxious and does not want to be left alone, and I didn't think I should leave her, and she said " you know what hon, she won't remember in 10 minutes don't worry about it" I did not actually tell her nurse that she said she wasn't going to make it - I don't know why I didn't tell her. I feel really stupid now for not. But the whole stinkin' night everything I did tell her - she just kinda brushed it off like i was making a big deal out of nothing. Now I understand she's a nurse that sees alot of patients, and this is not the first little old lady to develope pneumonia......Since I only have one patient at a time, I spend alot of time with them, and I guess feel my patient is the most important one on the floor. I realize now I should have told the Nurse exactly what she was saying, and I will next time. At least I did not leave until her neice was there, and I know she will be keeping a very watchful eye, and report any distress to the nurse. I was also wondering if her doctor could give her something for anxiety - guess I should have asked. Hindsite is 20/20. THIS is why I feel so FRUSTRATED. I CANNOT seem to create a big picture and KNOW what to do:uhoh21: . I hope I get better at this. At least I learn from these experiences.
Thanks for your thoughts.