Mouth care almost led to death of patient-input

[oxyjen]

Here is the senerio: New stroke from October/nonverbal/peg tube/little muscle tone/needs assist for all ADL's, just so you get the picture.

The husband said he found she had hard crust in the back of her throat, wanted something done right now. The nurse tried flashlight, tongue despresser and toothette and couldn't find what he meant. Then she did, way back, brown gunk had hardened and glued itself back there. She was trying to remove it when a chunk (sorry, this isn't pretty) fell back and blocked her airway. The patient turned clear blue and was unable to take a breath, fell unconscious, then finally vomited her recent tube feed. We put her head down, suctioned and swept her mouth and throat and eventually came up with a big chunk that I think was the culprit. This was probably 2minutes though it felt like longer.

Put her head back up high fowlers but when I left she wasn't breathing right and still wasn't as responsive as before, color had returned, pulse ox 94.

She was a DNR, but I don't think that should have applied in this case? She was choking, and I wonder if she should have been sent to the hospital. She'll probably have aspiration pneumonia now? I could be wrong, I need to talk about this as it did upset me.

[bellcollector]

First of all calm down you didn't do anything wrong. Secondly I do agree with you this pt should have been sent out if her condition did not return to her baseline. DNR does not mean do not treat. Aspiration pnemonia can be treated if caught early believe me I have seen it often enough. If she has not returned to baseline I would speak to the husband about sending her out for evaluation. It couldn't hurt to call the MD to update on what happened and fill him or her in on what has happened and her current status. I hope that helps.

[HappyJaxRN]

I agree with Bell. I don't think you did anything wrong. What a horrible way to die, choking. I believe with a DNR patient, you still provide comfort messures. So you did the right thing. She may have aspiration pneumonia. I would definitely call the MD. If she's stable, she may not need to go to the hospital, especially if she is a DNR. But the MD will make that determination.

You did the right thing. Especially responding as quickly as you did.

[PamUK]

I agree... you did exactly the right thing.

The term DNR applies to cardiopulmonary or respiratory arrest that is unlikely to be of any clinical benefit. Benefit is the probability of an intervention leading to a desirable outcome.

The probable benefit of suctioning under these circumstances was likely to be a desirable outcome. She had stopped breathing because her airway was blocked due to a foreign body, not because she was in the process of dying through natural causes. You were providing her with basic care in this case.

As for aspiration pneumonia, there is nothing you could have done to prevent it, but it can be treated

You did well. Congratulate yourself!

[oxyjen]

Thank you for your responces and now I feel better. I was with student nurses and this was one of their assigned patients; like I said the assigned RN did the mouth care and I was a helpful? observer. I want to be prepared for questions when we discuss this and appreciate your valuable advise! The DNR is still confusing to me at times. It was also awful because 3 family members were there at the time, and surely didn't expect the person to die that day.

Lesson learned, I'll never do deep mouth care on a semiconscious person without laying them on their side first. The semifowlers position contributed to the choking insident most likely.

I'm sure the MD was called and there will be close follow up, I'll be anxious to hear what happened when we go back.

I guess what I think DNR means is don't interfere if a "natural" dying experience is taking place. But this felt like an emergency, and really was scarey. I bet this person won't bounce back to where she was, but it really couldn't be helped.

Also, I wonder why the husband put his finger in the back of her throat in the first place and found this, but I didn't have the nerve to ask him questions. We were just glad she was better!

Hey, this board is awesome, I'll be back and hopefully able to help others. Thanks!