Been an LVN for 3.5 years on a med-surg floor. I work on a busy floor that has post surgical patients. We see a lot ofdifferent surgeries. This past weekend was no different. I worked Sunday and took care of a patient who was my age (43), and who had come in through the ER with cholecystitis. He went for a lap chole last Saturday night. I came on Sunday morning. The patient was on a dilaudid PCA, and not getting any relief. He was able to get bolus every 4 hours. I called the surgeon and he changed the dose to 0.6 every 10 mins and a 2mg bolus every 2 hours instead of every 4. He just seemed to never really be able to have pain control, until later in the day. He also complained of a lot of pain and his abdomen was distended. Pretty normal stuff we see after surgery. He got up and walked the halls once and did fine. Then the next hour he got up and walked, but I was in another room. I came out of my other room to find him in a chair being pushed back to his room. He finally fell askeep, and was taking in clears with no nausea.
Yesterday morning (Monday) I had him again. I came in to find that over night his fluids had been increased to 200cc/hr, his PCA had been changed from Dilaudid ot Morphine with a basal. He was getting 15 mg of morphine an hour. Around 9AM the patient asked me to please call the Dr and have the basal removed, which we did. He got back into bed. He looked ok in the morning. Vitals stable, no more nausea, pain better, but just kept saying he was dizzy. Then he was asking for his xoepenex inhaler. He didn't sound wheezy, just diminished. Not wet. Nothing. I told him that the Pulmonologist was aware and was coming in. (This guy had called 2 Dr's on his own on Sunday) he as being very nasty with us. Anyways, I told the charge (As I have to report to the RN) I went to lunch, and when I came back the pulmonolgist was on the phone, and the charge was talking to him. I went to the patient room and he looked like crap! He was definitely having trouble breathing. He was jaundiced and scared me! The CNA had gotten vitals at 1pm and his bp was 103/60. I went in and took vitals and his BP was 60's/50's!! I stayed with the patient, the pulm. Dr wanted him transfered to the ICU. The patients wife was like...>WE NEED TO GO NOW. I told her, we don't have a bed yet, I am not leaving his side until the bed comes available and the ICU RN is here. His BP remained in the same range for 40 minute and then drop to 40/33, right before we left. His HR was in the 110-120 range. We gave him plasmanate to gravity. One Dr was calling saying decrease fluids to 100, the other called and said put them back to 200. He had gone into acute renal failure, and his bili was rising fast. He was dx'd with pancreatitis the day before. He just took a HUGE nosedive.
as of the time I left last night, he had gone for chest CT, and some other tests. This morning my friend texted me from work and said HE DIED! This morning! I am freaking out. I also found out, that when they took out his gallbladder, IT WAS FINE!
I am so scared....I keep thinking, did I do something wrong?? Did I miss something because he was being a jerk to us? I did everything I should have done. His bili level went from 5.1 to 11.8 in 5 hours time! his BUN and creat were way elevated and his amylase and lipase were elevated (2000 and 800). This poor guy, he had 2 young kids and a wife. Ugh, god. This man had to have something else going on. He had a pacemaker placed in 2005, he had COPD. was NOT a drinker or smoker. Wow. Truly one of those moments as a nurse where you did not think it was going to turnout this way.