Lost one

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This is not my first, but this one was verry unexpected. I will give you some back ground. Male pt, 76yo, 215 lb, hx of colonresection with colostomy on right side, this admition he came in with constopation/abd pain, on a clear liquid diet, full code. I'm an lpn on the 11-7 on med-surg, in a smaller hospital (20 pt this night). At midnight I saw pt for first time, verry distended abd. on right side, c/o pain Dolodid given IV by RN covering me, with relife, VS stable. Pt asleep nest check. About 0345 c/o pain returned more Dolodid VS stable, 0430 pt resting in bed, no s/s of distress. 0510 found pt laying across bed, unresponsive, face and extremites "blue" in color, skin cool to touch. Called for help, superviser entered room and started yelling, I kinda blanked for a second.:banghead: Code called, CPR and manual ventalion started, suctioned air way, black "coffe ground" liquid retunded, MD finally got tube down throt, CPR and manual ventalion contuned. Pacer started, IV meds given. About half hour after start RN found HB in right arm, MD confermed in left arm. Moved pt ot ICU. When family came in they decided to "unplug".

This is not my first code or the first pt I have lost, but this one got to me. I use to work at nursing home so they were espected, and the ones I have lost at the hospital were also expected. I keep second gessing myself. Should I have done something different?

Any advise is welcome. And sorry about any misspellin.

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Specializes in nursing student.

Sounds like you did just fine. There were not signs at your 0430 check and that's only 40 minutes later. I do not think you did anything wrong, it's just hard because you are sitting there wondering "what if I had walked by 20 minutes ago? I could have saved him."

Don't fret, sometimes despite our best efforts, GOD wants to take the patient with him and nothing we do will stop that from happening.

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Specializes in ICU.
Sounds like you did just fine. There were not signs at your 0430 check and that's only 40 minutes later. I do not think you did anything wrong, it's just hard because you are sitting there wondering "what if I had walked by 20 minutes ago? I could have saved him."

Don't fret, sometimes despite our best efforts, GOD wants to take the patient with him and nothing we do will stop that from happening.

I concur with this...

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Specializes in MSP, Informatics.

as far as assessment and stuff... you are an LPN? what is the proc at your hosp about LPN's and assessments? was this Long term care or accute care? In our hosp, an LPN can only gather subjective data.... the RN has to do any of the other assessment criteria.

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Specializes in LTC, HH, clinic.

It appears that you were meeting the needs of your patient to the best of your ability. There are some things in life that you have no control over: this is one of those things. You checked on your patient , assessed and met the needs as appropriately as possible, and attempted to resuscitate when discovered. What else could you have done? Do not beat yourself up over it, learn from it and grow. :nurse:

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Specializes in Acute Care.

as far as assessment and stuff... you are an LPN? what is the proc at your hosp about LPN's and assessments? was this Long term care or accute care? In our hosp, an LPN can only gather subjective data.... the RN has to do any of the other assessment criteria.

In the state I live in and the state I work in (two different states, in case you're confused), LPNs cannot do ADMISSION assessments but can to f/u assessments. The LPNs can gather admission history but cannot do care plans, etc. LPNs can give any medication except IV pushes and accessin of PICC lines even for blood draws.

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I work in NY. I do a head to toe assessment with every pt I have and listen to lung, heart, and bowel sounds. The RN has to listen as well. some times they don't get to this untill well into the shift. They like to see there own pts first. I figure they are my pt and I should now what is going on, and if something changes I will now.

Thanks for all the replys.

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i'm going blank at the moment.

what is "hb in right arm"?

did you do his admitting assessment prior to giving his meds?

what were his bowel sounds like?

distention was local to colostomy site?

how did the left side of belly feel?

all his vs were wnl, despite the pain he was having?

and hb is what?

it's driving me crazy...:p

leslie

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heartbeat?

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Specializes in ICU.
heartbeat?

:heartbeat

lol hot belly?

hairy brain?

lol,, naaa,,, maybe iv?? :p

:beercuphe

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Sorry yes HB is heart beat.

"did you do his admitting assessment prior to giving his meds?"

Yes as per policey VS before and pain meds given and check pt about one hour after pain meds. And did full assessnent at start of shift.

"what were his bowel sounds like?"

Maybe I didn' tell enough for all. Due to surgerys no bowel on left side, much scare tissue. Bowell sounds on bight side diminished. Also asked RN about this after her assismet.

"distention was local to colostomy site?"

Yes. directley under and around area on right.

"how did the left side of belly feel?"

Hard, also asked RN about this she stated that was expected and she was not supperised. She didnot show any concern.

"all his vs were wnl, despite the pain he was having?"

I belive I stated VS stable. And the RN was in the room when the last set were taken, and showed no concern.

I realize I have only worked in the hospital for 8 months I do no the sings of a pt failing. This pt showed of this type of distress.

The nest day the NM took me aside and sayed the MD beleves pt asperated. Pt tryed to get OOB (out of bed) by self. And yes the call bell was within reach. NM belives pt set up at edge of bed, becouse of SOB (short of breath) fell back on to bed. Fluid filld up airway.....ect. I think every one can fill in the rest. I hope this will answer all questions.

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