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.?
Specializes in Med-Surg, , Home health, Education.
Well I'm hoping that all the talk about not making it was just because she was somewhat disoriented. (who knows??) But she was very adament about it, and seemed oriented at the time. But I did go ahead and call her husband because I would have never forgiven myself if I didn't and she died.
I didn't know if the pneumonia was usually fatal for someone her age. Also, as a student I feel so stupid when it comes to situations like this. I honestly DIDN'T know how to help her other than turning her, having her breathe and cough. At one point I wondered about suction since she wasn't able to actually get that stuff out herself, but didn't ever ask about it (I should have) but I had my instructer in there twice, asking her what else I could do - she said basically nothing. And I asked her primary nurse which just basically said nothing also - I just felt so dang helpless. I hate that I have such a limited knowledge - I know it will come with time..... but in the meantime -sometimes I feel like a big DUMB KLUTZ in my patients room. I guess that will get better with time too (It HAS to!! )
Thanks for your reply. Oh, and I didn't even think about asking about a DNR??????????!!!!!!!!!!!!!!! Maybe one of these days I will finally get the big picture!!!!!!!!!!!!!
My experience....if someone tells you they are going to die.....believe it. You absolutely did the right thing by calling her husband and niece. If you hadn't and she had you would have felt much worse. Good luck, you'll be a great nurse someday.
I agree that she probly felt like she would die. But,, a few things that could be done with doctors order. And i have seen so many people with colon resections etc say they were going to die, because they feel like they are. And its very very difficult for them to take deep enough breaths to prevent respiratory complications.
An order could have been written for nasotracheal suction to promote the cough reflex,, with suctioning during coughing. Would help her get it up and you could help remove it if she couldnt cough it up far enough.
When i have a patient with post op atelectsis or pneumonia, sitting them in a chair and having them deep breath, do blow bottles, incentive spirometer, whatever. Works better if they are in a upright position.
Did the doctor order some type of duo neb or percussion for her? That may have helped her get some of it broken up enough to get it out.
Believe me, if she desats enough and isnt a DNR they will vent her and they will get that stuff up then. And she wont die.
I hope for the best for this lady, there are a lot of things that can be done.
Just had one similar this last week, she's going back to the LTC this week. Ya just never know.
Do nurses out there really need MD orders to do nasotracheal suctioning? Where I work it a patient requires it a nurse can just go ahead. In addition I have not seen blow bottles in use for a number of years as trying to forcefully expire air collapses the alveoli instead of expanding them. Are they still in common use?
Do nurses out there really need MD orders to do nasotracheal suctioning? Where I work it a patient requires it a nurse can just go ahead. In addition I have not seen blow bottles in use for a number of years as trying to forcefully expire air collapses the alveoli instead of expanding them. Are they still in common use?
If blow bottles are the same as incentive spirometry? , we use them on every surgical patient.
Blow bottles are NOT the same as incentive spirometry. Using blow bottles a patient exhales to force the ball or whatever it is into the next bottle. Incentive spirometry is the exact opposite. The patient inhales as much as they can to use it. That is why blow bottles have fallen by the wayside and been replaced by the use of incentive spirometry.
Specializes in Education, Acute, Med/Surg, Tele, etc.
86 and had colon surgery! Well...the risks are clear, hopefully to the patient as well. This is a high risk surgery for a person of that age (dependant on health status), and pneumonia is certainly a very high risk in recovery!
I work in assisted living, and have seen this happen to many patients who chose surgeries. Sadly the ones that do make it out of surgery suffer some sort of consequences to their healths..and then it becomes a matter of quantity vs quality of life...but rarely is this explained to the patient!
Since Christmas I have seen surgeries and flu/cold take 9 of my residents...we have never had this high volume of death in our facility! It is weighing heavy on me and my staff...and yes I have seen many of my closest patients wither away to nothing then die slowly. It is never easy...especially at the volume I have had to deal with. But you learn that it is part of life, and you will find your own ways to cope in time. But grief is healthy...just how you deal with it is what can have you burnt out in no time, or secure in your methods and personal beliefs on death itself...
I think one of the best lessons I had in RN school was a cool hippy nurse that had us take a very hard look at our own individual thoughts on death, and then linking them to our thoughts while in clinicals. It was such a good insight to my own personal beliefs and foundations with DO find their way through to your patients at this time...it was awesome. I would suggest you suggest this as part of your curiculum if you can...it was very helpful (maybe a lecture from hospice nurses?!?!). That information about myself has helped me be strong for my patients at that time of their lives, kept me focused, and even though I am still working on how I can grieve loss better (I am never home alone, and I need that alone time to cry and let it out...especially after 9 patients!!!!! LOL!), I have the tools now to realize my own needs in dealing with death.
Good luck to you, look into yourself and really find out what death means to you. It is very helpful in learning your own way to overcome the sorrow, anger, pain, and sometimes personal suffering you will have as a constant along the way in this career.
86 and had colon surgery! Well...the risks are clear, hopefully to the patient as well. This is a high risk surgery for a person of that age (dependant on health status), and pneumonia is certainly a very high risk in recovery!
I work in assisted living, and have seen this happen to many patients who chose surgeries. Sadly the ones that do make it out of surgery suffer some sort of consequences to their healths..and then it becomes a matter of quantity vs quality of life...but rarely is this explained to the patient!
I so so so so agree with this. I see these patients all too often in the CTICU. What on earth are docs doing heart surgery on folks that old! Our oldest was a 98 (98!!) year old 4 vessel cabg!!! He was the grandfather of one of our Trauma Residents. Amazingly, he did fine, but a greater percentage of the elderly don't and end up trached and pegged and completely agitated and confused. And even then, the docs still want to go on and on and on. So sad and a large source that contributes to my burnout in nursing.
OP, I think today is the day that you returned to clinicals, right? I wonder what was the outcome of your patient? Is she still there or discharged one way or the other. At any rate, you did a very nice job!
Specializes in Education, Acute, Med/Surg, Tele, etc.
Yep...but this also opens an ethical delema...how old is too old? Can we rightfully deny treatment, including surgical, to patients in elder years? No, we can't..but there does seem to be a trend of friv surgeries for geriatrics going on in my neck of the woods lately!
I had a...oh get this 103 year old patient that had carpal tunnel surgery!!!! Okay??? Ummmmm point??? What is that doing to the old medicare? Not that I think she shouldn't have the choice..but according to her it was basically..."doc said so..I will do" (very typical of this generation of patients!). She went through surgery alright, but recovery was not well...immune system suffered a large hit, and she got very ill with pneumonia. Oh wait..there is more! After they fixed that, she was weak for months, then came down with skin cancer..what did they do then? You guessed it...radiation and surgery....she got weaker...cancer spread...then CHEMO..OMG!
She suffered so...so very much it brought tears to my eyes at the mention of her name! WHY? Because of the inital carpal tunnel surgery triggering weakness and complications. she passed in pain, a little skeleton of a person who once was a strong political woman in our community, and had the spirit of self I can only hope to achieve. Her loss has made me very skeptical of surgery in the geriatric years...seems to be a swinging pendulum...you either do too much, or nothing at all....no middle ground.
Geriatric patients must MUST be informed and family involved..they need to be quided in a real serious way! Docs won't do it...it is up to us to obtain the facts and get families and patients the info! One surgery can go so wrong...and I am sadly finding this is not the minority of cases..it is the majority!
Specializes in Geriatric, LTC, PC, home care, pediatric.
I'm am proud to say that I have been a nurse for over 15 years, and I have found that one of the greatest gifts in the world is to comfort someone as they are passing into the next world. I would NEVER assist it. I have cried at every death, as I have provided aftercare, and the only time I was ever close to being ashamed was at my first death. I was a CNA, and the other aides poked fun at me. Crying is part of grieving, not for everyone, but for alot of people. As long as it is not in excess, and doesn't interfere with your everyday life, and taking care of your other patients, don't worry about it, and don't ever let anyone tease you about it. I wish you the best of luck in school, and your career. I would be proud to work along side someone who cares.
When I got there on Wednesday - my pt was still alive, but not necessarily well. Her color looked better, and she was no longer having anxiety issues and saying she was going to die. She was actually talking, and joking around.
Her lungs were still VERY noisy, and I noticed her Heartrate was very irregular. Her RN came by, and I asked her to listen to her heart, and when we did her VS her O2 sat was in the 80's. Anyway to make a long story short - she was having major heart issues - they were giving her lasix, so her potassium had dropped to like 3.2? i think, and they ended up doing an EKG, Telementry, and was transferring her to the CCU when I was leaving, (and of course gave her potassium). She was having v-tach's - string of 7. I do not understand all of this yet, but know it wasn't good. Poor little lady.
I was impressed with how the RN on this shift immediately came when I asked her to verify what I heard w/ her heart, and jumped right on the situation. I feel like maybe I am somewhat getting the hang of things.
I did find out that my patient had a living will that said "no heroics". I am glad she has that taken care of.
She acted sad when I left yesterday, and told me that the next person to get me was going to be very lucky!!! WOW talk about making me feel good. She was a very special lady, whom I will NEVER forget. I intend to check on her Monday if she is still in the hospital.
I agree that she probly felt like she would die. But,, a few things that could be done with doctors order. And i have seen so many people with colon resections etc say they were going to die, because they feel like they are. And its very very difficult for them to take deep enough breaths to prevent respiratory complications.
An order could have been written for nasotracheal suction to promote the cough reflex,, with suctioning during coughing. Would help her get it up and you could help remove it if she couldnt cough it up far enough.
When i have a patient with post op atelectsis or pneumonia, sitting them in a chair and having them deep breath, do blow bottles, incentive spirometer, whatever. Works better if they are in a upright position.
Did the doctor order some type of duo neb or percussion for her? That may have helped her get some of it broken up enough to get it out.
Believe me, if she desats enough and isnt a DNR they will vent her and they will get that stuff up then. And she wont die.
I hope for the best for this lady, there are a lot of things that can be done.
Just had one similar this last week, she's going back to the LTC this week. Ya just never know.
I did keep her upright. She was getting some breathing treatments from RT. When I came back on Wednesday they had increased the frequency of them.
I am taking note of your suggestions for the future. It's nice to know the things that are actually available, so that I can "SUGGEST" them for the pt.
86 and had colon surgery! Well...the risks are clear, hopefully to the patient as well. This is a high risk surgery for a person of that age (dependant on health status), and pneumonia is certainly a very high risk in recovery!
I work in assisted living, and have seen this happen to many patients who chose surgeries. Sadly the ones that do make it out of surgery suffer some sort of consequences to their healths..and then it becomes a matter of quantity vs quality of life...but rarely is this explained to the patient!
Since Christmas I have seen surgeries and flu/cold take 9 of my residents...we have never had this high volume of death in our facility! It is weighing heavy on me and my staff...and yes I have seen many of my closest patients wither away to nothing then die slowly. It is never easy...especially at the volume I have had to deal with. But you learn that it is part of life, and you will find your own ways to cope in time. But grief is healthy...just how you deal with it is what can have you burnt out in no time, or secure in your methods and personal beliefs on death itself...
I think one of the best lessons I had in RN school was a cool hippy nurse that had us take a very hard look at our own individual thoughts on death, and then linking them to our thoughts while in clinicals. It was such a good insight to my own personal beliefs and foundations with DO find their way through to your patients at this time...it was awesome. I would suggest you suggest this as part of your curiculum if you can...it was very helpful (maybe a lecture from hospice nurses?!?!). That information about myself has helped me be strong for my patients at that time of their lives, kept me focused, and even though I am still working on how I can grieve loss better (I am never home alone, and I need that alone time to cry and let it out...especially after 9 patients!!!!! LOL!), I have the tools now to realize my own needs in dealing with death.
Good luck to you, look into yourself and really find out what death means to you. It is very helpful in learning your own way to overcome the sorrow, anger, pain, and sometimes personal suffering you will have as a constant along the way in this career.
Well you know what - the closest person to me that has ever died is a GREAT-grandparent, or GREAT aunt/uncle, and my father IN/LAW that I wasn't very close to. Needless to say I have not had much experience with death/grieving.
My own personal religious beliefs leaves myself NOT afraid of death, because I believe in heaven, ( I also believe in Hell) But do not want to go into religious issues.............PLEASE. Saying that I am not afraid of death itself, just the grief that follows I suppose.
I realize that my little lady had a wonderful fulfilling life - her husband told me so, and as I said she seemed at peace with her religious aspect of it, I guess I just HURT for her husband, and couldn't stand the thought of his sadness???? Does this make sense??
As I stated in a post earlier today - she did not die, but still is in serious condition.
Thanks for helping me look at it from a diffent perspective.
Dorito, ASN, RN
311 Posts
My experience....if someone tells you they are going to die.....believe it. You absolutely did the right thing by calling her husband and niece. If you hadn't and she had you would have felt much worse. Good luck, you'll be a great nurse someday.