Patient in rigor mortis

[tatara]

My friend is really in trouble!

Her patient was already in some degree of rigor mortis when she got in the room. For what she said, she made rounds to take routine vital signs at 4 in the morning when she discovered that the patient is dead. The watcher didn't notice anything unusual and was asleep.

She told me that patient was feeling okay at midnight; normal v/s, conscious, coherent, even asked for a glass of water, no complaints.

Patient in mid 50's with Colon CA awaiting another round chemo.

The patient slept their way to death, as there was no evident signs of resistance or struggle but they say possible foul play is still being considered. Massive MI was noted as the cause of death.

Does my friend just happened to be in the wrong place at the wrong time? She swears there was no irregularities or any significant observations she can think of that might lead to the death of her patient. Her parents was seeking legal counsel.

I don't know what to say or how I can help. I just stayed with her the whole morning.

[Sparrowhawk]

Aren't supposed to round every two hours to make sure they're okay? FOur hours is a long time...

Then again he had CA...could have been his time to go..hope it turns out okay *hugs*

[tatara]

Aren't supposed to round every two hours to make sure they're okay? FOur hours is a long time...

Then again he had CA...could have been his time to go..hope it turns out okay *hugs*

I understand that sometimes onco patients get a little ****** off when I check on them at night in the middle of their sleep- they tend to be irritable and would complain that I am disrupting their sleep, and that they need to have rest before chemo, that I'm inconsiderate, that they will just call a nurse when they need one, etc... Sigh. But you are right. Our patient, our responsibility.

Thanks a lot.

[Sparrowhawk]

You don't have to wake them up to check on them. I will admit something is fishy...whether it's your firends responsibility or not isn't my call...it's unfortunate.

[heron, ASN, RN]

Question: is the cause of death as massive MI a result of an autopsy, or just presumed?

Foul play has to be ruled out because the death was unexpected ... however, we also know that MIs tend to be more lethal the younger the patient. Sudden death is not unheard of.

The problem your friend might run into is in not making rounds or in not actually making sure the pt is breathing when she sees him. The issue of disrupted sleep is real and underappreciated. When I make walk rounds, even in hospice, I watch for chest excursions to be sure my pt is still breathing. You can monitor color, respirations, even a pulse without waking someone up.

ETA: one thing to keep in mind ... no matter how unusual an occurrence, you can bet on seeing it at least once in your practice. That's why most good nurses always ask what's the worst that could happen. You never know when you'll find a zebra in amongst all those horses. Can't hurt to keep an eye out for stripes!

[dcampbell]

heron,

OB nurse here. Why would a MI be more fatal in a younger pt.? This pt was in his 50's, was he more likely to die of a MI than a 65 year old? Or is it the fact that the MI was unexpected given that he was adm. for CA/chemo? Thanks.

[heron, ASN, RN]

The body grows new, collateral circulation in situations of chronic insufficiency.

The younger patients tend not to have developed the same collateral circulation as an older pt who has had coronary artery disease for years longer.

I have a friend whose husband is barely forty years old and probably had an MI in his teens or early twenties ... the old MI showed up on his ekg but the angiogram showed no impaired circulation ... he had literally grown new blood vessels. Lucky dude! (He had familial high cholesterol and never knew it.)

[dcampbell]

Thank you so very much.

[Laught3r]

where i work we are supposed to round q 1 hour. at nite i usually count respirations for 1 minute and use a small beam flashlight to look at skin color without flashing patient in eyes then I chart that.

[NRSKarenRN, BSN, RN]

The watcher didn't notice anything unusual and was asleep

Appears patient had an aide/companion/sitter assigned for private duty assistance that fell asleep and therefore didn't realize pt not breathing. If standard of care on that unit is q 4hr assessments and patient had a sitter, I might not have peeked my head into room if busy elsewhere on floor. Had similar situation when I was LPN charge night shift with just me and aide for 14pts. After that I rounded in dark with flashight every 2 hours unless in code/emergency then would eyeball all patients immediatley thereafter. HUGS to your friend to get through this trying time and alert to all nurses to check on patients even if they have a sitter. I've had patients stop breathing 5 minutes after assessment and conversation too... we rarely can prevent death from happening ..it is a part of cycle of life, especially in patient with advanced cancer.

[tatara]

Question: is the cause of death as massive MI a result of an autopsy, or just presumed?

Presumed. My friend told me that massive MI was noted on the incident report made by the Medical resident-on-duty, and it was how the doctors explained the incidence to the relatives along with other presumed diagnoses. An autopsy is yet to be performed.

Thanks!

:redbeathe

[chenoaspirit, ASN, RN]

The body grows new, collateral circulation in situations of chronic insufficiency.

The younger patients tend not to have developed the same collateral circulation as an older pt who has had coronary artery disease for years longer.

I have a friend whose husband is barely forty years old and probably had an MI in his teens or early twenties ... the old MI showed up on his ekg but the angiogram showed no impaired circulation ... he had literally grown new blood vessels. Lucky dude! (He had familial high cholesterol and never knew it.)

If a MI is more lethal in a younger patient, then why didnt your friend even know he had one when he was young? Im confused.

I understand how an older person can grow new vessels and such, but I dont understand how..if more lethal then how he didnt know.

I always hated cardiac!