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.?
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!
My earlier post tells about her condition on Wecnesday..... But wanted to tell you the reason for her surgery. I too thought 86 is pretty risky, her diagnosis from colonoscopy was adenocarcinoma - which was contained. I guess she just took her chances - she was (before surgery) in otherwise good health, ate very healthy, exercised, had hobbies, and many friends - traveled alot - I guess she just wasn't ready for cancer, and decided her better chance was surgery. She did say at one point - doing a painful transfer, that if she had known how bad the recovery was going to be - she wouldn't have done it. But after she got settled, she was oK again. I guess everyone has to make the decision to take the chance of dying from complications of surgery, or dying of the disease they have. I'm sure it's pretty upsetting to come out of the hospital after surgery with a whole new set of problems... guess that's life.
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!
You know this is the very reason we made some decisions about my grandmother. She is in the ??? stages of alzheimers, and knows enough to know she is slipping everyday - is ready to meet her maker, etc.... so when she was in the hospital recently for her condition they did a routine chest x-ray and said there was a possible mass in one of lungs and wanted to do more tests...... we - as a family group- declined. Even if it is cancer - we would not seek surgery, chemo, etc...... I do not believe it would help increase her quality of life. She has told us numerous times she is ready to "go" and doesn't want to lose her mind. BTW, she just turned 80. I will miss her when she's gone, but I don't want to see her drag on for years with alzheimers..... maybe another disease will take her sooner....... My hope is to keep her as comfortable as possible no matter what.!
Thank you for sharing your thoughts and feelings through this post. Thank you to all who replied for your insight and experience.
I am hoping to start an ADN program Spring Quarter and pt dying is one of the issues I have been most concerned with in my chosen 2nd career. I tend to be an emotional person...wearing it all out there on my sleeve. I am a big cry baby with tears springing at the drop of a hat. I am very worried about this when I get into the field. So far, my only real experience is volunteering at a Level 1 trauma center which provides a lot of intense situations, but not much time to develop an emotional connection. I worry that I'll get too attached or be too emotional when I am on the job. I worry that I'll appear unprofessional and that I'll loose the respect of my co-workers - I've seen that happen in the business world.
Thanks again for your post...I am sure with time I'll find a way to keep my emotions in check. This thread has helped me think about these issues and find ways that others have dealt with them.
Thank you for sharing your thoughts and feelings through this post. Thank you to all who replied for your insight and experience.
I am hoping to start an ADN program Spring Quarter and pt dying is one of the issues I have been most concerned with in my chosen 2nd career. I tend to be an emotional person...wearing it all out there on my sleeve. I am a big cry baby with tears springing at the drop of a hat. I am very worried about this when I get into the field. So far, my only real experience is volunteering at a Level 1 trauma center which provides a lot of intense situations, but not much time to develop an emotional connection. I worry that I'll get too attached or be too emotional when I am on the job. I worry that I'll appear unprofessional and that I'll loose the respect of my co-workers - I've seen that happen in the business world.
Thanks again for your post...I am sure with time I'll find a way to keep my emotions in check. This thread has helped me think about these issues and find ways that others have dealt with them.
~Tabitha
Well, I consider this to have been a definate learning experience. (even though I did not lose this particular patient) I was forced to face my fears/thoughts/emotions concerning a pt dying on my clinical shift. I am sure I have much more to learn, but feel like since I've had to search my heart on this one - I will be somewhat more prepared. I at least now know from all the post that I'm not the only one to cry. AND it's NOT a bad thing.
I believe you will be able to learn to control your emotions somewhat (until at least you are alone) and wouldn't let that hold you back. I hope NEVER to become hardened to where a pt death did not effect me in some way.
She was probably in good shape to be having major surgury at her age. A lot of it probably has to do with anxiety, being away from home and her husband, etc. Plus, she's getting the pneumonia (we think) so the breathing probs can be scary. Anyway, she'll most likely be OK.
Actually blow bottles are an aged technique, but they are still around, when you have a confused patient that cant comprehend the technique of the inhalation with a IS and what you need them to do,, using the blow bottles sometimes works with what they can comprehend. To blow up a balloon. They will take the deep breath to blow the fluid to the other bottle. It becomes a game of sorts for them. Anything you can do to get more air in the lungs is acceptable and most patients i would use a blow bottle for wouldnt be exhaling enough of their full capacity to cause a lung to collapse, their expiratory force isnt that great. The atelectasis is what is causing their respiratory problems to begin with, so if they can get air in there to open them up and help dry the secreations its not going to hurt them further.
I have had confused elderly who while recovering from surgery have had their respiratory status go bad. Seems the first thing everyone wants to do when their confused patient is becoming loud(I didnt say mean) is load them up with haldol or something to quiet them down.
Quit it,, let them yell a little,, even yelling is going to get air in those lungs. You arent ignoring it,, but if you cant get them to open those lungs up any other way you take what you can get.
with tears springing at the drop of a hat. I am very worried about this when I get into the field. So far, my only real experience is volunteering at a Level 1 trauma center which provides a lot of intense situations, but not much time to develop an emotional connection. I worry that I'll get too attached or be too emotional when I am on the job. I worry that I'll appear unprofessional and that I'll loose the respect of my co-workers - I've seen that happen in the business world.
RN2Bn2006
142 Posts
My earlier post tells about her condition on Wecnesday..... But wanted to tell you the reason for her surgery. I too thought 86 is pretty risky, her diagnosis from colonoscopy was adenocarcinoma - which was contained. I guess she just took her chances - she was (before surgery) in otherwise good health, ate very healthy, exercised, had hobbies, and many friends - traveled alot - I guess she just wasn't ready for cancer, and decided her better chance was surgery. She did say at one point - doing a painful transfer, that if she had known how bad the recovery was going to be - she wouldn't have done it. But after she got settled, she was oK again. I guess everyone has to make the decision to take the chance of dying from complications of surgery, or dying of the disease they have. I'm sure it's pretty upsetting to come out of the hospital after surgery with a whole new set of problems... guess that's life.
PB